4 ways to ensure successful and ethical dental insurance billing
When it comes to dental insurance billing, mistakes can be catastrophic. Luckily, there are some straightforward ways to stay above board.
Dental billing is one of the most difficult yet crucial aspects of dental office administration. Production doesn’t matter if you can’t successfully collect reimbursement for services. I started in dental billing 30 years ago, and as a dental office manager, the ability to code and bill insurance properly to maximize reimbursement is one of the most fundamental requirements of my job. There’s so much to know, and the answers aren’t always transparent.
A few things I’ve discovered over the years that make dental billing more successful and less frustrating have come from good training and communication not only with the clinical team, but also with the insurance companies.
Read the processing manuals.
The first step toward successful dental billing is to read the contracts and processing policies. The frustration with dental billing does not begin nor end with the administrative team; the doctor(s) and other team members are equally frustrated. There are specific requirements that vary from insurance company to insurance company. Some examples are the type of x-rays required for different periodontal and restorative services, policy frequency limitations, service year vs. calendar year, missing tooth clause, etc. The list is endless. It’s crucial that you read the processing manuals, because knowing the limitations of your contract in advance will greatly improve the ease of billing for you and your team. After all, to be forewarned is to be forearmed. I’d be willing to bet that most practice owners and their insurance coordinators have never read their provider agreements or processing policies for the insurance companies with whom they are in network. How can you know what you need to process a claim if you’ve never read the manual? These manuals change on a yearly basis, and the information they provide is well worth the time it takes to read them.
Know what questions to ask and where to find reliable information.
It’s essential that you provide your business administration team with quality reference material. If they have the information needed to do the job right, they’re less likely to go down the rabbit hole of social media to find answers, which will likely give bad information and also perpetuate bad billing practices in your dental office.
Know your contracts.
As I network with other offices, one of the most common things I notice is that they don’t follow the contractual obligations outlined in their contracts. This risky behavior is not only detrimental to the doctors who are ultimately responsible, but also for office managers who also have culpability if an audit determines fraudulent billing practices.
“Insurance fraud” is a term that incites fear and defensiveness in many dental professionals. They don’t understand that the billing practices they themselves follow fit in the category of fraud. Unfortunately, ignorance is no excuse in the eyes of the law. For example, it’s not uncommon to hear that people are billing insurance and writing off the patient portion. This seems innocent enough, as it could be argued that the insurance company should pay regardless, as they are collecting patient premiums; however, their policy manual states that if the patient is given a discount, the insurance company is also entitled to an equal discount. Another frequent insurance billing practice is to simply not bill the insurance company if the contracted rate is too low. This practice is born out of frustration with low reimbursement rates, but if the patient should call and complain to the insurance company, there will be an investigation that will likely end in your office being forced to reimburse the patient in full, and then there’s the possibility of an audit.
Reach out to your provider services representative.
Laws surrounding dental billing are changing in many states due to legislation changes around these very subjects thanks to the American Dental Association and other dentists and dental entities. Provider support representatives can talk you through the correct way to get your services covered at fair and reasonable fees that you and your patients can live with, all while staying compliant. Your patients will appreciate your confidence in billing and your ability to maximize their benefits while collecting maximum reimbursement for your practice.