Step-by-Step Guide to Dental Billing & Insurance
Learn the procedures, steps, risks, and requirements for dental billing and insurance.
Dental billing is a vital component of any visit to the dentist. Dental billing is the process of generating medical claims to submit to insurance companies for reimbursement for oral health services. The dental biller monitors the claim to guarantee that their employer is compensated for their work on a patient. An experienced dental biller can boost revenue performance for the dentist’s practice and heighten its overall efficiency.
As you might have guessed, dental billing is a frequent practice in dentistry. This basic skill may not sound like a thrilling prospect for new dental professionals, but it is a crucial task they should learn. Many Dental Assistants (DAs) are trained to fulfill dental billing tasks in several environments. Therefore, it’s essential to follow the proper dental billing and insurance method.
This article focuses on the details of dental billing and insurance, one of the most important dental procedures for medical staff.
(See our list of the most common Dental Assisting duties and responsibilities.)
Dental Billing and Insurance Definition
What Does It Mean to Perform Dental Billing and Insurance Tasks?
Dental billing is collecting payment for services performed. The process has two parts: patient billing and insurance claims processing. These are the primary revenue streams for most dental practices.
Below are some critical steps to follow:
- Gather patient information
- Confirm their insurance coverage
- Document each dental treatment and its code data
- Submit and track claims plus any attachments
- Resolve issues with outstanding claims
- Bill patients as needed
- Post payments
- Create key reports for collections, aging account reports, etc.
What is the Purpose of Dental Billing and Insurance?
Dental billing produces claims and submits them to insurance providers. Thanks to this process, the dental organization is reimbursed for the services they provide to its clients. If it wasn’t for this vital step, a dental practice might not be able to operate or continue serving their communities.
How Long Does it Take to Perform Dental Billing and Insurance Tasks?
It’s essential to remember that the dental billing cycle contains many steps that might take days to months to complete. Therefore, accurate billing and prompt follow-ups are of the greatest priority when it comes to this process. In most states, insurance companies must pay claims within 30 to 45 days.
Who Can Perform Dental Billing and Insurance Tasks?
While several oral-health professionals may be qualified to perform billing tasks, it’s often a job designated for Dental Billers or Dental Assistants. The DA has various tasks, such as patient care, recordkeeping, and appointment scheduling. In addition, Dental Assistants typically spend most of their day working closely with dentists, dental hygienists, and patients.
Dental Assistants may handle the insurance claims of their patients. They can process these claims by collecting insurance information from patients and sending bills to insurance companies. In some cases, DAs may even work as salespeople.
(Go here to learn how to become a Dental Assistant.)
Training Requirements for Dental Billing and Insurance
The requirements for dental billing and insurance can vary and depend on your location and profession. For instance, Dental Assistants usually need to graduate from an accredited program and pass an exam. However, some may learn through on-the-job training.
Dental Assistant programs typically take about one year or less to complete. They include both clinical and classroom instruction. The Commission on Dental Accreditation (CODA) accredits over 250 Dental Assisting programs in the United States. These programs provide knowledge and practical experience.
Dental Billing and Insurance Procedure
Like any other skill, dental billing requires time and practice to get right. So, the first step is to understand proper dental billing procedures.
Steps for Dental Billing and Insurance Tasks
Here are the general guidelines you should follow:
Front-End Medical Billing
- Registration: The first step to processing an insurance claim starts when patients contact their provider’s office to schedule an appointment.
- Eligibility Verification: Before a dental practice can receive payment for services rendered, you must verify that the patient’s insurance plan covers these services.
- Point of Service Collections: Once you know the patient’s financial responsibility, you can collect the copay, deductible, coinsurance, or total balance due when the patient approaches the front desk.
- Encounter Form: An encounter form, also known as a superbill or fee ticket, is created for each patient encounter. This form lists services, medical codes, patient demographics, and clinician notes.
- Checkout: At this point in the process, you can schedule a follow-up appointment as required and confirm that the doctor completed the encounter form.
Back-End Medical Billing
- Charge Entry: Use the encounter form to verify the procedures and why they were performed. You’ll then enter these charges into the practice management system. Enter any payments made by the patient at that time.
- Claim Generation: You can generate the claim after entering the charges and payments. This process may include compiling charges, revenue codes, and more.
- Claim Scrubbing: While you prepare the claim, you will “scrub” it to ensure that each procedure, diagnosis, and modifier code is present and accurate. Claim scrubbing confirms that the patient, provider, and visit information is complete.
- Claim Forms: As a medical biller, you will generally use one of two claim forms to receive payment from insurers. These forms are the CMS-1500 claim form and the UB-04 claim form.
- Claim Submission: The provider organization (i.e., your employer) can submit claims to payers electronically. Usually, medical billers use software that meets electronic filing requirements established by HIPAA.
- Claim Tracking: Remember that your part doesn’t end once a claim has been submitted. You must also check each claim status daily. If clearinghouses (i.e., middlemen) are used, they often have dashboards that will give you easy access to updates for submitted claims.
- Payment Posting: When a hospital or physician’s practice receives ERAs (i.e., electronic remittance advice), accompanying checks, or direct deposits, payments must also be posted. So, don’t forget about zero-dollar remittances.
- Patient Payments: Once an ERA has been posted, the patient statement should be sent. It needs to include all outstanding balances. The statements should also include the date of services rendered, the services performed, the insurance reimbursement received, the payments compiled at the time of service, and the explanation as to why the patient balance is due.
- Denial Management: Address any denial or reimbursement issues as soon as they are received. If a payer denies a claim, the ERA provides medical billers with a denial code(s) and a quick explanation for the claim’s denial.
- A/R Collections: Welcome to the final phase of medical billing! Unfortunately, when it comes to patient collections, delinquent accounts can happen. Follow up with patients who don’t pay within a set amount of time.
- Credit Balances: While several events could cause a credit balance, medical billers must detect overpayments and swiftly refund them to the correct parties. Failure to do so could lead to consequences like litigation, civil monetary fines, and more.
Necessary Equipment for Dental Billing and Insurance
Typically, the supplies for dental billing and insurance include the following items:
- A reliable computer
- Fax machine
Potential Risks or Complications of Dental Billing and Insurance
It’s essential that you accurately perform medical billing duties. This is because mistakes that arise at any stage can be costly for revenue, administrative workload, and more. This demonstrates the importance of qualified dental billers who can accurately fill their role in the dental billing cycle. Think about it like this: The financial health of a dentist’s practice depends on the effectiveness of the billing staff.
Pro Tips for Mastering the Art of Dental Billing and Insurance
Dental-billing tips include knowing the best method, understanding the process, and learning proper procedures. Here are some pro tips that may assist you in the future:
- Ensure you know the process. Understanding the billing process ensures accuracy and the ability to solve a problem should one arise quickly. In general, billing has these steps:
- Confirm insurance eligibility
- Collect the patient’s portion
- Share procedure and diagnosis codes for each patient’s visit
- Confirm the proper code selection
- Input claims into practice management software
- Obtain reimbursement
- Do your best to avoid assumptions. Although it may sound obvious, a client who doesn’t make their payment is one of the biggest obstacles to a smooth cash flow process. Don’t assume that clients always know what amount they need to pay. Some people aren’t informed or may be puzzled by their insurance plans, copays, deductibles, etc.
- Know the correct method to use. The answer is typically electronic! Using the incorrect method or too many types could hinder payment. What do we mean by that? It’s best not to bill a patient by mail, follow up over the phone, and send overdue payments to a collection agency. Consistency is key.
- Keep the big three in mind. Your best allies in dental billing are knowledge, mentorship, and practice. Once you understand your practice’s billing process, it would be best to share that information with your colleagues in dental billing. You can help them become experts, too. A lot of revenue setbacks are the direct result of needless errors. A well-trained staff can help ensure that patient insurance policies are validated correctly, copays are calculated properly, and claims are sent to insurers with accurate codes.
- Remember common errors. A detail-oriented mindset is your best defense against mistakes in the dental billing process. Below are some of the most common mistakes found on insurance claims:
- Incorrect name and date of birth of the patient
- Wrong address or contact information of the provider
- Incorrect payor ID and policy number (i.e., insurance information)
- Illegible, handwritten documentation
- Missing claim number information on appeals of denied claims
Why Should Dental Assistants Learn How to Perform Dental Billing and Insurance Tasks?
It’s valuable for Dental Assistants to learn how to perform dental billing and insurance tasks. This is because dental billing is a vital factor in maintaining the financial health of each dental practice. Thanks to DAs and other billing coders, dentists can maximize their time with each patient and better serve the public.
While dental billing isn’t always a job requirement, it is a task that Dental Assistants commonly perform. It’s also a valuable skill that could lead to more opportunities. Therefore, it would be advantageous for DAs or aspiring Dental Assistants to pursue training in this area. Once experienced, a DA would likely become more helpful to their employer and have better career prospects.
Start Your Career in Dental Assisting
Dental billing is a crucial skill and an essential practice for the survival of most dental providers.
Dental billing plays a crucial role and is a significant component of a practice’s lifecycle. Dental Assistants can help obtain important information, perform necessary coding techniques, and submit insurance claims.
If you’re inspired and want to pursue a career in medicine, Unitek College offers various healthcare programs, such as our Dental Assisting program.
Contact us today to learn more about our programs and tuition assistance options. Take the first step toward a rewarding future in healthcare!