When you think of dental billing, as a dentist or office manager, you might think “oh, that’s our system to collect money!” You’re right, and it’s more than that. The health of your billing system will make or break your dental practice, and understanding the dental billing process is how you improve and maintain that health.
Simply trusting billing is going okay is to risk your future. No dentist should have to suffer low collections because they didn’t understand how their dental billing system should work. Here’s what to know about dental billing, with special help to understand dental insurance billing.
If you want a healthy practice, It’s important for dental professionals to clearly understand how dental billing works.
Dental ClaimSupport has been working since 2012 to understand, streamline, and optimize the dental billing process for dental offices. Through this experience as a dental billing company, we see that many dental teams don’t understand the simple question of how this process works.
In this article, we will walk you through a clear picture of how dental billing works. It seems simple, but understanding how this process works and what it entails will help your dental team optimize it in a way that will bring in more revenue from both patients and dental insurance claims. We will answer the following questions:
What is dental billing?
What is the dental billing process?
What is dental billing coding?
What is dental medical billing?
Is dental billing difficult?
We will also give you a few dental billing tips to stick in your back pocket. These are commonly asked questions that will help your team bill and collect confidently at your dental practice.
What is dental billing?
Dental billing is any activity that collects payment for dental services performed in your dental practice.
What is the dental billing process?
The dental billing process refers to all the steps involved to receive payment from insurance companies and patients for services your practice provides. The dental billing process may be broken down into patient billing and insurance claims processing - the two main revenue streams for your practice.
Like any process, there are clear steps you can follow to move through the dental billing process with ease.
Here is a brief checklist of steps in the dental billing process:
1. Collecting patient information - This is done during the initial phone call with the patient when they call to schedule their dental appointment. This information will include their name, phone number, address, email address, contract preferences, date of birth, name of the subscriber’s employer or insurance plan, insurance carrier, carrier’s provider phone number, insurance ID number.
2. Verifying patient insurance coverage - Once you’ve collected the patient’s personal and insurance information, you’ll verify it by either calling the insurance company or logging into your insurance portal. This will give you a full breakdown of their benefits that will let you know the state of their coverage.
3. Recording dental treatment and code data - As the patient receives treatment the day of their appointment, someone on the care team records the necessary details in your clinical notes, and codes the procedures performed. Usually, an admin team member ensures this is documented, reviewed, and electronically signed by the provider in your dental software. A daily sign-off on the day sheet is a best practice to always verify that what happened in the dental chair is what is recorded into your software and on your patient’s ledger to be billed.
4. Submitting and tracking claims & any attachments - With the information you’ve recorded in your software, you will now create, batch, and submit your insurance claims. The claim will include the code or codes of the procedure performed, all of the patient’s personal and insurance information, and any attachments needed. Attachments include clinical notes, x-rays, periodontal charts, narratives, primary EOB’s, intraoral photos, etc.
5. Resolving problems on outstanding claims - If a claim has been denied, or 30 days have passed and the claim has not been reimbursed, you will need to follow up on it. This is called working the insurance aging report. Your biller gets a list of outstanding claims, contacts the insurance company and figures out where the claim went wrong, then works to appeal it for reimbursement. This is a crucial stage where the biller’s expertise and efficiency determine whether you see a high collection rate or a low rate and high overhead.
6. Billing patients - Depending on the revenue model you’ve chosen, you either bill the patient for the entire amount of the procedure up-front (fee for service) or you bill patients the balance after subtracting what their insurance benefits should cover (reimbursement model). Patient billing allows you to collect the patient’s portion before they leave the dental office, or request payment later by mail or email. You then file the claim to be reimbursed by their insurance. Either way, fully collecting on patient accounts receivable is crucial because it can bring in about half your revenue.
7. Posting payments - Once your insurance claim has been paid and deposited into your bank account, you’ll need to post the payment to your practice management software. Doing so keeps all of your information properly documented and reported. It also completes the life-cycle of a claim and you will be able to close it out. Patient payments also need to be posted promptly so that your patient bills and cash flow numbers are accurate.
8. Running key reports such as collections and account aging reports - Once the payments are posted and the claim is closed out, you’re able to really take a look at how your billing activities are performing to gauge how well they are collecting payment for what your practice produces. Through your dental software you are able to run both net production and net collection reports as well as outstanding account & insurance aging reports will show you a list of outstanding claims and/or patient balances that need attention.
Now you have an overview that gives you an idea of what the dental billing process looks like. You can see the lifecycle of a claim from start to finish. Understanding this can help you stay on track with how you collect your patient and insurance information, and how you work to get your practice paid via insurance claims and patient payments.
Now that you understand how the billing process works, let’s get a bit more specific about dental insurance billing.
What is dental coding?
Dental coding is the practice of using official CDT and/or ICD-10-CM procedure codes to report conditions and treatments your care team performs. These codes are required for claim reimbursement in order to remain HIPAA compliant. What you don’t know can hurt you: When you improperly or inaccurately code a procedure, you could unintentionally commit fraud.
Two code sets most often used in dental billing are: CDT and ICD-10-CM.
CDT: Current Dental Terminology
CDT codes are used when reporting and documenting dental treatment for a patient. In other words, for any procedure performed on a patient, there is a specific CDT code that corresponds to that procedure. The current year’s CDT code set is the official reference for terms that must be used in claims to third-party payers like insurance companies.
These codes begin with the letter “D” followed by 4 numbers.
Direct placement of a restorative material to protect tooth and/or tissue form. This procedure may be used to relieve pain, promote healing, or prevent further deterioration. Not to be used for endodontic access closure, or as a base or liner under a restoration.
CDT codes are reviewed and updated annually. Therefore, it is imperative that you and your team stay up to date on all changes to ensure the proper utilization not only for compliance but to ensure you are receiving proper reimbursement.
If you submit dental claims as either an in-network or out-of-network dental care provider, or your work falls under HIPAA, you have to use these codes. They may already be present in your dental practice software, but you still need to know how to choose and use them correctly.
ICD-10-CM: Internal Classification of Diseases, Tenth Revision, Clinical Modification
Similar to CDT codes, ICD-10-CM are codes used to document and report procedures that are performed by dentists, yet medical in nature. The difference is that the CMS (Centers for Medicare and Medicaid Services) is responsible for updating the ICD-10-CM annually. So, in the case of a dental office, it is used when you are filing a medical insurance claim.
ICD-10-CM is also updated annually, but instead of every year beginning on January 1st as CDT is updated, ICD-10-CM diagnoses codes become effective beginning with dates of service on October 1 of each calendar year.
Here are some examples of how you would document ICD-10-CM codes as it relates to sleep apnea or snoring:
ICD-10-CM communicates to the dental and medical payer information about a patient’s dental or medical condition(s) requiring the treatment listed on the claim form. Medical payers require at least one diagnosis code on the medical claim form, which is where this code list comes into play.
Dental coding is important in the billing process because these codes are used to file claims. Insurance companies use the CDT and medical codes as a basis to reimburse you for services through your insurance claims. And it’s important to understand codes correctly because accepting payment while using incorrect codes can be considered fraud, even if it happens by mistake.
What is dental medical billing?
Dental medical billing refers to the process of billing medical insurance for care provided in your dental practice.
Sometimes the dentist performs treatments that fall under the category of medical care. For example, a dentist may treat damaged teeth, gums, and jaw due to accidents or trauma, which is considered medical care. A biopsy is another common medical treatment dentists can perform.
Insurance claims should go to the medical insurance carrier as primary instead of dental insurance, and that’s something dental billers need to know.
As we mentioned above, you are likely to use ICD-10-CM codes when dealing with procedures that are medical in nature.
How do you bill medical insurance for dental treatment?
The process for filing a dental claim and a medical claim has a few differences.
A medical claim is completed on CMS 1500 form while a dental claim is completed on an ADA 2019 form. A medical claim uses CPT codes while a dental claim uses CDT codes. You can cross-code these claims if you’re filing both, but that’s a rabbit hole we won’t go down in this article.
Pathology (when the dentist performs biopsies needed to check for diseases inside of teeth, gums, and around the mouth)
Obstructive Sleep Apnea
Knowing whether to file medical or dental claims can be very confusing, but here’s the good news: you can always call and ask.
This is a common source of confusion, so when in doubt just call the medical and dental insurance companies to confirm which to send to. If you don't make a call and you just submit dental when it should be medical, you will receive an explanation of benefits back that will clarify: “Medical is primary, please submit to medical and start the process over.”
Medical insurance oftentimes has a timely filing limit of 3-6 months, instead of the year-long timely filing limits in many dental plans. So you will want to track medical claims especially carefully to avoid denials due to time limits.
Is dental billing difficult to learn?
Dental billing is definitely complicated. To do a good job, it’s important to understand the whole process and create a smooth workflow. The responsibilities involved are not skills that can be learned in a few days.
The process starts with collecting the necessary patient information and entering it correctly. You also need to understand coding and what attachments you must include with your claim in order to be paid. Every part of the process depends on the previous step.
Many dental practice owners want one person to run the front desk, and take care of all the dental billing. This is usually a recipe for low collections. Insurance billing in particular requires a dedicated resource - either a person, team, or service focused on collecting payments efficiently, especially from insurance companies.
This is because dental billing requires expert-level knowledge of:
If this feels like a lot, it’s because it is! We don’t say that to overwhelm you, just to emphasize the importance of having an expert in place that can make sure you are collecting all you are owed that can help the billing process run smoothly and compliantly.
Here are 3 tips for mastering your dental billing:
You might be reading this thinking, “Wow, there’s way more to this than I thought! Where do I begin?”
Here are a few tips:
1. Keep the dental billing process efficient - When it comes to your process, efficiency is key. We mentioned a lot of moving parts that need to be done not only accurately, but also in a timely manner. Be systematic to cover every billing-related task, from scheduling patients to posting payments. A smooth dental billing process is key to making a dental practice financially healthy and paying everyone well. By keeping the cost of collecting payments as low as possible, everyone gets the best return on investment for their work.
2. Control costs - Explore how to offload the most expensive part of dental billing: insurance claims processing. Unfortunately, insurance billing is often a big factor in driving up operating costs. Every unpaid claim needs follow-up. Unfortunately, this is hard to do. Most busy teams can’t keep up with insurance company stall tactics that keep you on hold for hours. Not to mention, there are constant industry changes that are out of your control:
CDT coding changes
Insurance policy changes
Insurance tactics to deny, delay or downgrade payments
You have a choice: Constantly monitor claims, denials, codes and regulations, policy updates, and limitations, or have a service keep you on top of this while you supervise.
3. Keep learning - Because medicine, insurance policies, no-pay tactics, and regulations always change, dental billers must always be learning. Constantly evolving your knowledge and best practices are crucial for being a successful dental practice. Investing in your dental team’s education and training is a good place to start.
Utilize outsourced dental billing to take control of your dental billing and revenue
We just threw a lot of information at you. What now?
No one is saying you have to do it on your own. Now that you understand how dental billing works, what the process looks like, and how complicated it can get - you’re ready to attack it and optimize it in order to bring in more money.
Dental ClaimSupport is a resource to get the attention dentists need on their insurance billing. Our expert billers can help your team through those complicated COB rules or medical billing. We can also help your team streamline their process in order to collect more. A good process is the key to high collections, low costs, and confidence in your cash flow.