Dental offices are built around helping patients with all their dental health issues. However, taking care of their own financial health can be a bit more complicated than that. This is because, unlike a perfect smile, the financial health of a dentistry practice is dependent on less visible components.
These components include the nature of the claim, codes used for explaining the details of the claim, insurance regulations, documentation accuracy, patient balances and follow-ups. All of these things can quietly decide whether a practice gets their due seamlessly or spends months chasing it.
However, the solution to this dilemma might just be hiring a professional dental billing company. A professional dental biller does not just process claims and waits for reimbursement. What they truly do is that they can help providers like you bring order and structure to your revenue cycle management.
Follow along to learn what a dental billing firm does and whether they are relevant in the current RCM landscape.
What Is a Dental Billing Company?
For a provider to effectively understand if they need billing support or not, they need to understand the fundamentals of it. In the simplest terms, a dental billing company is a specialized service provider that takes care of the billing and other administrative side of running a dental clinic. These tasks include insurance verification, claim creation, CDT coding support, claim submission, payment posting, etc.
Therefore, the overall scope of work for a dental billing company can be broad and complex. But at the core of everything, the role of a dental biller is to extend every kind of support that a practice needs in order to receive reimbursement in the easiest way possible. This is very important since one billing mistake can certainly create a lot of confusion, which can affect the proper working of a practice.
What Does a Billing Partner Actually Do?
As we have already stated, the role of a good billing partner is to do more than just sending out claims. The overall revenue cycle management in dental practices is comprised of small but significant steps that create a whole chain of tasks. The biggest challenge that practices face is to ace all these steps without any error and in the exact order that the regulations demand. This might sound easy on paper but can be quite challenging. Therefore, paving the way for professionals who can take care of this aspect with the least amount of attrition.
1) Eligibility Verification
One of the biggest and most important things that a billing company does is take care of insurance verification. Insurance verification is one of the most important pillars of the front-end processes.
In this stage, the dental billing company in charge is supposed to check a bunch of details regarding the patient’s medical insurance policy. The team checks whether the patient’s policy is active. The procedures that might be covered by the policy, the limitations of the policy, and a bunch of other crucial details.
Practices that have skipped this part of the process have historically faced more denials and underpayments than the ones that have taken cognizance of the same. Therefore, this is where a dental billing team becomes more than a clerical set of professionals.
2) Dental Coding
The second most important thing that a dental billing company does is take care of the coding side of things. Dental procedures are generally reported using the appropriate CDT codes, with code selection based on the service documented in the patient’s record and the applicable reporting requirements. Because the CDT code set is reviewed and updated annually, billing teams need processes for keeping code selection aligned with the current code set and applicable payer requirements.
Therefore, the right billing team must have proper professionals who can take care of the coding side of things. They check whether all the used codes are supported by documentation or not, so that payers can have a better clarity of the procedure.
This not only enhances the chance of the claims getting processed in one go, but it also allays mental hassle that providers experience due to regulatory back-and-forth between payer and providers. Hence, becoming more than just an administrative requirement.
3) Claim Submission and Tracking
Once the coding and documentation side of things are taken care of, it is time for the team to submit and track the claims. Now, many new providers might be under the impression that a job is done when the claim is submitted. To be honest, this is a major misconception.
Submission is only the second phase of the revenue cycle management. After submission, claims must be monitored through payer adjudication, payment, denial, or other resolution. In this phase, dental RCM professionals track submitted claims till they get a response with reimbursement or otherwise.
Many practices tend to lose money because the claims were not effectively tracked after submission. As a result, providers failed to keep a tab on the changing status of the claim. Therefore, not having all the bits of information that are important.
4) Denial Management and Appeals
It is common for dental payers to deny claims. This can happen due to a plethora of different reasons like missing information, late filing, coding mismatches, payer limitations, eligibility problems, etc. Therefore, denials are something that providers must be prepared for.
This is why established billing firms come up with their own set of professionals who are trained to manage and recover denied claims. The logic behind the team is not just working on claims. In fact, the real objective is to create a system for denial management that identifies the cause of denial, the payer’s logic behind the denial, and other important details.
The reason this is important because it helps providers to use this knowledge to work on future denials more seamlessly. Analyzing denial patterns can help practice identifying recurring problems and reduce avoidable denials over time. Therefore, improving the collections.
5) Reconciliation and Payment Posting
Is a biller’s job done when the payment is cleared? The answer to this question is a resounding no. Even after a payment is cleared, the job does not end there. The next phase of the cycle is all about seeing if the received payment is accurate or not.
To do this, the dental billing company professionals compare the payment received with the expected reimbursement based on the applicable fee schedule, payer contract, benefit information, or other reimbursement terms. The biller usually compares details like explanation of benefits, contractual adjustment, and looks at individual service lines for underpayment.
This is not a routine administrative step. This is a highly important financial checkpoint that keeps track of the silent profit killer: underpayments. The reason is that unlike denials, underpayments in dental practices can tend to get unnoticed for weeks. All the while affecting the accounts.
6) Accounts Receivable Follow-Up
Accounts receivable (A/R) represents outstanding amounts owed to the practice, including unpaid payer balances and, depending on the practice’s accounting structure, patient balances. A/R can gradually keep building up due to unpaid, denied or long ignored claims. Therefore, this aspect needs structure.
An established dental billing company can certainly help providers to combat aging A/R with the help of a disciplined approach where professionals closely monitor different accounts and keep them from aging A/R with the help of timely following up.
Such a structured approach can help providers in two ways. First, it creates operational discipline which can gradually spread to other parts of the billing operations. Subsequently, helping providers understand patterns of payment of different payers. Therefore, allowing the practice to recalibrate itself effectively.
Why Dental Billing Is More Complex Than It Looks
The most deceptive thing about dental billing is that everything about the process looks quite straightforward on paper. Perform the procedures, record the details, send out the claim, and then receive the payment. But in reality, the process of full of rigid rules and non-forgiving exceptions that can make or break a claim.
Then comes the coding requirements for dental claims. Dental procedures primarily rely on CDT codes. On the other hand, medical billing relies on ICD-10 and CPT codes. This sounds simple, but, there are cases where procedures might overlap. Therefore, only a professional dental billing company with trained coders can understand this dichotomy. Hence, furthering the discussion as to why providers need billers for functioning.
In-House Billing vs. Outsourced Billing
Whenever a provider is at the precipice of getting billing help, they will often face the option between in-house teams and outsourced billing firms. To be honest, there is no ‘right’ choice when it comes to finding the right billing support. The entire thing is dependent on several different aspects. Here is a brisk rundown of what an in-house billing offers compared to a professional dental billing company.
In-House Billing
One of the foremost benefits of in-house billing is that it gives practices direct control of their RCM processes. The person in charge of billing usually sits inside the very clinic and can effectively communicate with the clinical team without any hassle.
One major downside of having an in-house team is that only one or two people are given responsibility. As a result, if these individuals do not show up for a day or two, the whole billing operation can cascade into chaos.
Then there is the question of training and paying salaries. Practices must have extra financial resources, along with benefit bandwidth in order to sustain the individual. Therefore, the price of having an in-house team can be quite higher than outsourcing.
Outsourced Billing
Outsourcing on the other hand can introduce greater structure to the billing process and help identify sources of revenue leakage. The reason is that professional teams tend to bring structure to a complicated process. This structure helps providers to process claims in a seamless manner and with the least amount of friction.
Another major benefit of outsourcing dental billing is that it can help scaling providers with the right support to scale in the future without extending their operational bandwidth and training. The provider in question does not have to worry about training or employing more billers.
Then again, there are issues with connectivity. Most remote billing operations work from off-site settings. Therefore, connectivity needs to be seamless. Without a proper connection, the billing team might face rejection or operational deadlocks.
What Usually Stays Inside the Practice
A common misconception that providers have is that outsourcing removes all the billing responsibility from the provider’s hands. This is farthest from the truth. For a billing team to work effectively, every vertical needs to communicate seamlessly and without any form of inhibitions.
Therefore, even if the billing operations are outsourced, the provider would not lose control. Hence, outsourcing does not take control away, but it certainly improve claim turnaround times of claims.
Signs a Practice May Need Help
Even though the benefits of hiring a dental billing company are quite significant, and most providers should actively consider bringing them in, not all the practices need them. Here are some of the most prominent signs that providers need to bring outsourced help.
If billing knowledge sits with one person and that person leaves, the practice may face sudden cash flow stress. Similarly, a growing practice may outpace its old billing process. What worked for one dentist may not work for three providers or several locations.
A dental billing company can make sense when the practice is clinically busy but financially disorganized. It may also be useful when the dentist feels revenue is being produced, yet the bank account does not reflect the work being done.
Should a Practice Need One?
In all honesty, hiring a dental billing company is not just another administrative decision. This decides the future of the firm and the overall sustainability of its operation. The right biller can impact a lot of things like billing accuracy, reimbursement rates, etc. Therefore, hiring just another biller is not the right way to proceed.
Providers must always go for billers that offer substantial experience in dental specialty and KPIs that can back this up. This is where we, SunKnowledge, come into the picture. Our billers at SunKnowledge understand the importance of accurate billing and other requirements that help providers create clean claims and boost profitability in the right or compliant way.