The success and sustainability of dental practice rely comprehensively on the seamless management of financial transactions. More significantly, as the dynamic prospect of dentistry, and the industry’s continuous evolution demand higher-level capabilities of dentists to handle the process, so does the digital advancement reshaping every aspect of dental billing services like never before. The continual evolution of the industry and digitalization integration for the last decades have considerably lightened the dentistry administrative burden and streamlined every step of the process. However, navigating efficiently the nuanced steps involved in the process, the latest trends and dental billing updates and understanding the novel methods of efficient implementation of digital technologies in the process requires substantial knowledge, productive skills, and education and training to boost the efficiency and accuracy of dental billing workflow, as a determining factor of revenue cycle management within the dentistry. This comprehensive guide aims to illuminate the path to understanding in detail the step-by-step process of dental billing, addressing the professionals’ challenges, the latest trends, facts and figures shaping the financial backbone of dental practice. Join us in the information realm of dental payment procedures.
According to experts’ views, dental billing solutions have evolved in the last ten years. There have
been changes in insurance claims payments and billing processes, caused by advancements in technology,
evolving healthcare regulations, and an increased focus on patient-centric care. According to
industry reports, the dental billing services market is projected
to grow steadily, fueled by the rising
demand for streamlined administrative processes within the dental practice. Some of the key innovations
Integration of Technology and Automation - Dental billing services are increasingly integrating advanced technologies including artificial intelligence and automation, enhancing the accuracy of coding and billing and contributing to the efficiency of claim processing and submission. Some of the significant changes reported for the last decade in dental billing processing are:
Telehealth Impact - Dental practices are also influenced by the global shift toward
telehealth in healthcare services. Dentists are adapting to support remote consultations and virtual
care, necessitating adjustments to billing practices in alignment with telehealth regulations
Patient-Centric Billing - Dental billing efforts are placing a greater emphasis on transparent billing practices, user-friendly interfaces, and accessible financial information for patients.
Dental EHRs have integrated various billing tools to manage billing cycles and ensure proper payments. After the application of a specific treatment or procedure, it benefits dentists in ways:
In order to make the claim considerable for payment, your practice staff must be required to send
additional information. According to a 2018 DentistryIQ article covering claim denial information, at
least 50% of dental claims for both basic and major services will be placed on pending status and sent
back to the dental office.
Many effective methods can be used to avoid denials, claim rejections or late payments. However, digging deep into the reasons for claim issues prove to be the most effective way of making progress in the revenue. One of the surveys conducted on the reasons for claim denials are reported as follows:
Staffing shortages in dental billing workflow have been a significant challenge since the 2020 COVID-19
Pandemic due to economic decline. In the 2021 ADA Poll, more than 70% of dentists reported that
recruitment of administrative staff was extremely challenging, and more than 50% of the practice owners
highlighted the same issue in recruiting dental associates. However, hiring expert dentists having
specific skills and expertise to handle the process may be profitable in terms of fewer claim denials
and improving dental billing efficiency.
Furthermore, investing in automation for error-free billing will improve efficiency in case your practice has a lower rate or sufficient staff to work on dental billing effectively. Moreover, automating billing will provide you with a speedy process and claim adjudications without having to add extra staff.
Effective dental billing requires a crucial skill set and collaborative effort so that each and every step of the process is performed accurately and completely. Starting from the patient visiting your office to the claim submission and reimbursement, the dental billing cycle requires a straightforward approach and the process can be categorized into two phases: the dental patient’s life cycle and the dental claim’s lifecycle. To help you understand the complex process, here is an overview of the typical steps involved in dental billing services:
To support transparency, reduce claim denials, minimizing errors in billing and promote high-quality
care, proper documentation is the fundamental aspect of dental billing. Whereas, accuracy is the need of
practices such as proper coding, claim submission, compliance, continuity of care, and effective
communication with insurance payers.
Accurate documentation is essential to support the reimbursement process as it ensures:
Complying your dental practice with various laws, regulations, and guidelines set by the Health Insurance Portability and Accountability Act (HIPAA), and the American Dental Association (ADA) is the utmost and accurate documentation ensures compliance with these regulations to ensure practice is safe from certain legal penalties, regulatory issues, or audits.
Even if there is the risk of malpractice claims or legal issues, accurate documentation can defend that the dentists performed the service following the rules and standards of care, obtained informed consent, and recorded correct treatment to prevent dentists from any legal or financial liability.
Accurate documentation also helps dental offices to justify services performed, charges that are billed, or demonstrate compliance with coding and billing in the event of audits or reviews conducted by insurance companies, government agencies, or regulatory bodies.
Pre-authorization, A Crucial Step of the Process - Obtain pre-authorization
in case of uncertainty about the insurance reimbursement for a procedure. It will protect both you and
the patient from unexpected costs, facilitate a clear payment plan, and is best practice for maintaining
patient trust, specifically for extensive treatments or new CDT codes.
Gather Complete Patient Information - Collecting detailed patient information is crucial for effective billing and occurs at the initial patient contact when they schedule dental appointments. The information must be collected for example:
Dental Procedures and Insurance Information Documentation - A designated dental care team member documents patient procedures and assigns codes during appointments. Administrative staff ensure thorough documentation, review, and electronic signing by the provider within dental software. Daily sign-off on the day sheet is recommended to ensure accurate representation of treatment in the software and on the patient's ledger for billing.
Filing and Monitoring Claims within the Associated Documents - You can use the data stored in the software to generate, consolidate, and file insurance claims. The claims will include procedure codes executed, complete patient and insurance details, and any required supplementary materials including clinical notes, X-rays, periodontal charts, primary EOBs, narratives, intraoral photos and more.
Simplify Payment Receiving process - Considering the diversity of patient demographics, their proficiency levels of online or phone-based payments or preferences for tech savviness, you can accommodate patients with various options for timely payments.
Cease the over-expenses you will pay in acquiring a complex dental billing service. Outsourcing your dental billing to seasoned dental billing companies will yield profit as a cost-effective strategy and other benefits. The external service providers are trained and specialize in understanding the intricacies of insurance processes. MedsDental Billing has been striving for years to deliver value in billing and help top-notch dental care companies improve their revenue rates and release their staff from taking additional administrative workloads, facilitating them to turn their focus to delivering proper patient care. Our services comply with the rules and dental billing guidelines set by the healthcare regulatory bodies, specifically in the dental field. We strategize our claim management and submission swiftly and efficiently, utilizing the latest technologies and dental billing software, industry trends, and regulatory changes to optimize reimbursement for the services delivered.