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As a manager of a dental practice knows, quality patient care does not always translate into quality revenue, and problems with claims submissions and payments can arise even as the business grows steadily. However, dental billing seems to be one of those amorphous processes that seem to take up all time and effort without producing concrete results. This is where a Dental insurance billing company can help. The right billing partner can save a practice hundreds of hours a year on chasing payments.
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WhyBilling Claims Are Not Simple Matters
Unlike with medical claims, all types of dental insurance seem to have a few peculiarities, for example, the percentage of a given procedure that is covered. Some insurers pay 50 percent of the crown cost, while others cover 80 percent, and some do not cover crowns at all. The same applies to benefits’ annual maximums, copayments, waiting periods, and the formulas by which insurers determine the reimbursements – per the fee schedules or otherwise.
Also, for patients with more than one insurer, a billing company should be able to identify the primary and secondary carriers and understand their rules about such cases. Finally, the proper application of CDT codes is also essential if the practice wants the maximum reimbursement for the services rendered. The final roadblock on the way to getting paid by an insurer is the timely claim submission by the practice, which is also programmed differently by various carriers.
The problems start when the front desk personnel do not have the resources to verify every submission, especially when they must also manage day-to-day operations, such as booking, or calling patients in for checkups.
What a Billing Company Can Do for a Dental Practice
To understand what can a dental insurance billing company offer to a practice, one must first examine the main functions performed by such organizations. In reality, most billing companies do not differ significantly from providers of other outsourced services: their primary purpose is to help the practice receive payments, or rather, to remove obstacles from the way of reimbursement.
Therefore, the list of activities a billing agent handles normally includes preauthorization of benefits, electronic claim submission and follow-up on them until approval, appeal of denied claims, and processing and applying payments and adjustments when they come. Moreover, such partners often assist the practice in analyzing treatment plans before the start of any procedures and examining the patient’s ability to pay.
Indeed, if a dental insurance billing company has insight into available benefits, it can analyze this information in advance and prepare the practice for further explanations to the patient. The main advantage of such assistance is reducing complaints about unexpected costs and, hence, balances due.
The Benefits of Outsourcing in General
The biggest boon of outsourcing, and in particular dental claims billing, is usually faster payments. First of all, billing partners typically handle a larger volume of claims, so they quickly learn the peculiarities of different insurers’ requirements, thus, minimizing the number of rejected submissions.
Finally, billing companies are a source of expert knowledge for a practice, and working with these specialists can significantly improve the financial performance of the dental office, since they bring in innovative ideas and best practices. Moreover, in-house billers are not immune to absences, whether planned or not, and during this time, claim submissions are at a standstill.
However, a company with multiple billing specialists who handle various practices can quickly cover all responsibilities without overloading any one specialist. While the idea of a third party being involved in practice management decisions may be unwelcome, it must be recognized that a billing partner is an integral part of a practice that reduces its overhead costs. It is worth comparing the overall cost of an in-house biller (including wages, benefits, required software subscriptions, vacancies, etc.) with the value of the services of an outsourcing company.
Finally, the cash flow becomes more predictable as billing partners are highly motivated to collect as much as possible by working with the practice and the insurance companies. Additionally, reputable full-service billing companies provide extensive and reliable billing reports that can help the practice notice and correct issues that the practice owner may not have known about.
Keeping the Billing Department ‘In House’ Versus Outsourced
The bottom line is that both options for the billing department ‘in house’ or its outsourcing have advantages and disadvantages that must be carefully considered.
Overall, the in-house billing department offers more convenience, faster communication and decision-making, closer attention to each account, and reduced administrative burden on the practice. At the same time, an in-house billing department makes most sense when considering all the practice’s needs.
An in-house option can be attractive when a practice already has qualified billing personnel in its ranks and is satisfied with the current situation. Having already invested in people and training, continuing to use these resources makes more sense than using external ones without the need. Such a decision is also beneficial if the billing supervisor who may already be in the employ of the practice is highly motivated and meets the staff’s expectations.
However, a large part of practices choose to outsource their billing needs for several key reasons. First of all, this is done when a practice is experiencing issues with billing departments such as rising denial rates or high turnover of in-house billing specialists. In addition, reasons to choose an outsourcing company can be a rapid practice expansion or a need to free up the time of practice owners to deal with more pressing issues.
It is worth remembering that many organizations that provide outsourced services also offer hybrid billing options, when, for example, the reception and verification of claims is handled in-house and only their actual submission is handed over to external partners. Thus, it is possible to customize the set of services based on the unique needs and pain points of the practice.
What to Look for in a Billing Company
When searching for the best fit insurance billing company, the most critical considerations include the company’s industry specialization, its knowledge of claim denial rules and how to overcome them, as well as the expected timeline for dispute resolution. It is also necessary to understand what the company needs to operate correctly: the scope and depth of information exchange (claims-level detail or summary-level reporting), the method of payment (percentage of collections and/or fixed subscription), whether additional documentation or requirements need to be established.
Since billing involves processing personal data, it is also essential to ensure that the company has the appropriate security measures in place and that a practice’s accounting data will remain confidential.
Additionally, verifying information about the compatibility of the billing organization’s software with the practice’s practice management system and clearinghouse is also of particular importance.
Moreover, it is always helpful to arrange a reference call with one of the company’s current clients to determine the nature of collaboration and how the insurance billing company reacts to practice concerns.
Getting Started
For many practices, the decision to select a billing partner is an important step towards obtaining consistent revenue through faster reimbursements and reduced overhead costs. Therefore, to choose the best billing company for a practice, it is important to weigh the advantages and disadvantages of both options, plan, and carefully select a potential partner. For example, for a growing practice, this move may mean expanding the team without overloading it with additional responsibilities. Moreover, it is worthwhile to familiarize oneself with the capabilities of outsourced dental billing services to increase the scope of the practice’s capabilities. Today, many dental practices benefit significantly from insurance billing companies and use their services to maintain positive cash flow and smooth daily operations.
