Optimizing Dental Insurance Billing for Your Practice's Success

The success of modern dentistry is ingrained in more than just quality care and patient satisfaction, yet significant contributors to the practice. However, ensuring financial well-being supersedes primarily as it paves the way for quality care provided and practices to run efficiently. Dental insurance billing contributes significantly to this economic equation but can be either a smooth and efficient revenue engine or a complex web of challenges per your strategies. The Journal of Dental Research reports that 47.2% of US adults age 30 and older have some form of periodontal disease. Still, insurance benefit reimbursement for scaling and root planning claims creates frustration among care providers and their offices. One of the dentists in his study recently stated about his practice success that attention to detail and desire for meticulous clinical documentation were his approaches to attain success.
Here, we will delve into the deep of what transformative trends and methods can be used to invest in the financial health of dentistry, the intricacies of insurance claim submission, the significance of accurate coding, and why should your billing staff stay up-to-date with ever-changing trends of dental insurance.

Why is it essential to file complete and accurate claims in dental insurance billing?

Amidst the intricate process of ensuring accurate patient verification and communicating with insurance providers for successful billing, dental care providers' key challenge is to handle the patient record and documentation properly to gain the proper results in reimbursement of dental services rendered. As it is the key to prompt payment for dental care procedures, dentists must ensure fulfilling the steps correctly for the practice's success:
New HIPAA Policies for Dental Billing - providers must file the best dental billing claim, ensuring it contains complete and accurate patient information but with ample confidentiality. Attaining professional confidentiality is the right of patients receiving dental care, and providers must set specific standards to secure the privacy of their data. To keep up with HIPAA changes and compliance, providers must proceed with:

  • Taking patient records off of desks and social places
  • storing financial statements and paperwork in opaque files or folders
  • Never send sensitive patient information via text, email, or other similar means.

Required Supporting Documentation and Dental Insurance Billing - the acronym SOAP is a tried-and-true template for providers to ensure a clean claim submission process. These templates will help ensure your clinical notes support dental insurance billing. All required and supporting documentation, radiographics, and narratives particularly demonstrate the validity and need for a specific treatment or service provided.
Submitting Narratives - the policies about CDT code procedures in each dental plan requires a written narrative denoting who, what, where, when, and why to support the claim. A narrative is always necessary when the code is described in CDT as "by the report." Moreover, the narrative must explain why endodontists perform a particular procedure and its medical necessity. However, the professionals must refrain from restating the procedure as many of the standard narratives needed to be more effective in getting paid.
When subletting a successful narrative, you should ensure the following:

  • Don't use any acronyms
  • Steer clear of scribbled stories.
  • Make radiographs available in a legible manner.
  • If pre- and post-operative radiographs don't provide enough information, include previous radiographs, even ones from different dentists currently treating patients.
  • If clinical notes are in an easily readable electronic format, attach them.

Electronic Billing and Claim Submission

Leveraging innovative technology trends like dental software and electronic billing helps practitioners reduce A/R and makes a payment more accessible for patients. Patients can track their amounts and pay you anytime from anywhere simply by logging into their accounts. However, providers must offer multiple payment methods to patients as every individual may not prioritize the tech-savvy approach. However, combining traditional and online methods for preventing payment, like credit and debit cards, online payment portals, cash, and auto-payment options on a scheduled date will help avoid payment delays.
NYC New York Claim Medicaid allows dental care providers to submit claims electronically or in paper formats, except for dental clinicians, who must only submit electronic claims. Before submitting claims to NYC, the providers must submit an electronic/paper Transmitter Identification Number (ETIN). The certification statement applies to all claims until another adequately executed certification statement is replaced. Providers are informed about the annual transformation of the certification statement while they are provided with the renewal information about the certification statement expiration period.
Before submitting claims to the NYC Medicaid, providers must ensure the following:

ETIN - a submitter identifier issued by the eMedNY contractor that all providers must have with an eMedNY contractor on their file before submission. The identifier can be given to an individual or group (the direct billers) and to service bureaus or clearinghouses.
Certification statement - for each ETIN used for billing, all providers must file a joint certification statement with NYC Medicaid. However, each statement must be renewed after one year to sustain electronic billing under ETIN adequately. In case of failure to renew the certification statement for a certain ETIN will lead to claim rejection.


What is dental coding and its significance in getting reimbursed in dental insurance billing?

Maintained by the American Dental Association (ADA), medical billing codes for dental procedures rely on the CDT Code set, containing all required dental insurance billing codes. Dentists code procedures according to this code set for submitting specific dental insurance plans.
Dental codes are the root system in care practice, serving all the practitioners, including payers and providers, to ensure the services are appropriately reported, billed, and reimbursed by the insurance provider. These codes offer a universal language among the practitioners and professionals to understand the intricate system of insurance collection and ensure the proper revenue cycle management for the dental practice.

What can increase productivity in dental offices?

Implementing some of the practical tips will get your dental billing to success:
The first impression always wins - patients scheduling a first appointment with your office must not be anxious but professional. Your staff must learn the effective methods of dental billing and productive communication with patients so they can decide to select your office easily. Train the front desk staff for friendly and courteous interaction via phone calls with patients to help them resolve their queries and provide the information they are curious about the care procedure.
Streamline Patient Retention - to improve the care provided and to attain increased productivity, streamlining patient retention is utmost, however challenging. Create innovative ways for patients to sustain their presence and interaction at your office after deciding to schedule an appointment with you.
Always Encourage Patient Feedback - it works to solve half the problem when identified. Your dental practice can take the formula to improve your practice's productivity. Apart from the problems, you must be informed of the other aspects that need improvement. Encouraging and employing strategies for getting patient feedback will help to focus on those areas for successful practice.
Outsource your dental billing workflow - avoid keeping your practice with error risk but save your time and get an error-free procedure by approaching the most experienced and reputable dental billing companies. However, ensure that you conduct ample research and ask several questions when deciding on outsourcing dental insurance billing.

What is the difference between medical and dental insurance billing?

The fact and fiction with dental insurance billing companies are almost the same as medical insurance and part of the same practice management. However, there is a difference in procedure. For example, the dental biller more often contacts the dentist. Whereas medical billers must review the medical treatment for accurate coding and billing. Following are

  • Procedures are reported to medical payors using CPT (Current Procedural Terminology).
  • Hospitals are the only facilities that use ICD-10-PCS (International Classification of Diseases, 10th version, Procedure Coding System) to record inpatient procedures.
  • The upcoming iteration of the ICD physician diagnosis coding system is called ICD-11-CM (International Classification of Diseases, 11th revision, Clinical Modification).
  • The Healthcare Common Procedure Coding System, or HCPCS, registers supplies, medical services, and equipment.
  • The 10th iteration of the International Classification of Diseases, Clinical Modification, or ICD-10-CM, conveys information regarding a patient's condition and the need for the stated operation.
  • Current Dental Terminology, or CDT, is a reporting system for dental treatments.

Shape Up your Dental Insurance Billing with Medsdental's Modern Billing and Coding: Your Dedicated Partner Today!

With years of experience and providing success to many dentistry practices, Medsdental has collected adequate information on the crucial components of the practice. Discover the expert strategies and insights you need to optimize dental insurance billing for success with us. Our dental billing and coding experts will take you towards more prosperous practice and effective billing and coding services- HIPAA compliant and following the standard code set. Our innovative software for the dental billing process will simplify various methods like documentation, appointments, and scheduling while you keep focus on your practice. Moreover, EHR technology in dental practice cash flow ensures immense security and access to the concerned staff. Take the way with us to more innovation and core effective strategies to optimize dental insurance billing for your practice's success.

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