In theory, dental billing should be simple: A patient comes in, gets a procedure, pays for the procedure, and goes home. However, most practices find that keeping up with payment options, health insurance codes, and late payments can feel overwhelming.
Ultimately, the health of your billing and collections system will play a large part in the overall success of your practice, so it’s worthwhile spending some time developing a streamlined system to generate a clear and understandable dental billing statement.
The Dental Billing Process
As billing becomes increasingly complex, having an established process is essential to keeping track of various accounts and their unique quirks. One way to streamline the process is to have a clear system of steps whenever a new patient steps through your door.
These steps will remain broadly the same regardless of whether you have a manual process or are using a dental payments solution from Dental Intelligence. They include:
- Collecting patient information, including their name, contact details, date of birth, insurance carrier, insurance plan, and insurance ID number.
- Verifying the patient’s insurance coverage by contacting their provider. This verification will usually also give you a full breakdown of the patient’s dental benefits.
- Recording the patient’s treatment as it occurs and including the necessary dental code for each procedure. Dental practices can become incredibly busy, so using a daily sign-off sheet is the best practice to verify what happened to each patient during the day.
- Submitting claims to the patient’s insurance carrier often involves providing the procedure code, patient information, and supporting documentation.
- Following up on claims denied by insurance or ignored for more than 30 days.
- Billing patients for the outstanding balance. Practices may choose between a fee-for-service or reimbursement billing type, depending on which one best meets your practice and patient needs. While the fee-for-service model will get you more money upfront, you may find that fewer patients have the available funds to pay for the entire procedure upfront. Similarly, a reimbursement model may get more patients through the door, but you’ll need to spend more time dealing with health insurance providers to get your payment.
- Recording payments to properly document and complete the life cycle of a particular claim.
Understanding Dental Coding on Your Dental Billing Statement
Dental codes are often the most confusing part of a dental billing statement for patients. To comply with HIPAA guidelines, practices must use official procedure codes to report conditions and treatments. Failing to assign the proper code to a procedure may result in fraud charges and fines, so it’s worth the time to learn and keep up with changes in the various dental coding standards.
The two most common dental billing codes are the Current Dental Terminology (CDT) and Internal Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Both code sets will have a specific code for a procedure, which you will need to document correctly. Both codes change annually to keep up with developments in dentistry, and you must use the latest codes to remain compliant with HIPAA guidelines.
Components of an Explanation of Benefits Statement
Insurance companies will send out an EOB statement with every claim they pay out. To ensure that you receive the correct payment and that your patients receive clear communication about their benefits, the EOB statement must contain:
- The plan allowance for a specific dental procedure
- The percentage of the maximum plan benefit that the insurer will pay
- The patient’s deductible
- The dollar amount paid by the provider
- The outstanding balance that the patient must pay, either outright or through a payment plan
Working with an Expert
Many dental practices rely on front-desk staff to take care of their dental billing needs, but the truth is that accurate billing requires expert knowledge and a dedicated individual or team. Even if you have a streamlined system, your billing administrator must know:
- Medicare rules
- Coordination of benefits rules
- The procedure for accurately calculating a patient’s payment responsibility
- The practice’s various payment options
- The appeals process for denied claims
- Documentation requirements for various claims
- How to run reports
- The latest coding updates
- How to calculate write-offs
- How to post payments promptly and accurately to meet accounting regulations
The expense and time required to train a billing expert for handling each dental billing statement have led to many dental practices opting for a third-party solution. These solutions will help you implement a payment system that will generate clear billing statements for your patients, regardless of how many payment options or insurers you have to work with. For more information about Dental Intelligence payments and billing solutions, request a free demo on our website today!