Importance of Outsourcing Dental Billing

Considering outsourcing dental billing? This guide covers billing tasks, staffing considerations and payment details to review before choosing a provider. For eDental Billing’s service information, visit our dental insurance billing services page. For the wider revenue picture, read how to improve dental practice revenue.

What is outsourced dental billing?

Outsourced dental billing means a practice hires an outside company to handle some or all of its insurance and patient billing work instead of assigning it to in-office staff. The billing company often works remotely in the practice’s own practice management software, so the practice keeps its patient records, its fee schedule and its relationships with dental plans.

Claims still go out under the practice’s and the treating dentist’s names. The clinical record decides which procedures are reported, and the practice should be able to see at any time what was submitted, what was paid and what is still open.

When is outsourcing dental billing worth considering?

No single rule fits every practice. These are signs that the current setup deserves a closer look:

• Claims regularly go out several days after the date of service.
• The insurance aging report shows a growing share of balances older than 90 days.
• Denied claims are filed away rather than corrected or appealed.
• Payments are posted late, so patient balances are unclear.
• Billing stops when one person is out sick, on leave or has left the practice.
• Front desk staff handle billing between phone calls and patient check-ins.

If none of these apply and your in-house biller has capacity, keeping billing in the office may be the better choice. If several apply, compare the cost of fixing them in-house (hiring, training and supervision) with written quotes from billing companies, using the cost questions below.

What tasks does outsourced dental billing involve?

Providers differ in what they take on, so ask each one for a written task list. The work commonly offered includes:

• Insurance verification. Confirming a patient’s eligibility and benefits with the dental plan before the appointment.
• Claim submission. Preparing claims from the practice’s clinical notes and ledger, attaching the documentation the plan asks for, and sending them to the plan or clearinghouse.
• Claim follow-up. Checking the status of unpaid claims and answering plan requests for more information.
• Denials and appeals. Reading the plan’s reason for a denial, then correcting and resubmitting the claim where that is appropriate or preparing an appeal.
• Payment posting. Recording plan payments and adjustments from the EOB or ERA against the right patient and procedure.
• Accounts receivable review. Working the insurance aging report by payer and by age.
• Patient billing. Sending statements for balances that remain after the plan has paid.

eDental Billing’s dental insurance billing services cover primary and secondary claims, appeals of denied claims, insurance payment posting, follow-up on overdue insurance balances and daily and monthly reports.

Once the work starts, review aging by payer and reason, agree on follow-up priorities, and track unresolved balances without assuming every balance can be collected. For a denied claim, review the plan’s appeal instructions and agree who will prepare the appeal, obtain supporting records and track its deadline. The ADA’s 2020 appeal guide advises following the particular plan’s required form, destination and time frame.

Also Read: What are Dental Claim Denials and how to avoid them?

Full or partial outsourcing: what stays with the practice?

A practice does not have to hand over everything. Some outsource one part, such as insurance verification or follow-up on older claims, and keep the rest in the office. Others outsource the insurance billing cycle from claim submission through payment posting.

Whichever scope you choose, some work stays in the office:

• Collecting accurate patient and subscriber details at check-in.
• Writing complete clinical notes and taking the radiographs and charting a claim may need.
• Collecting payments from patients at the front desk.
• Answering the billing team’s questions promptly, because a claim cannot be corrected without the practice’s records.

Put the split in writing so that both sides know who does each task.

Staffing considerations when comparing billing options

Ask who will perform the work, who is accountable for the account, how coverage is provided during absences, and how staff are trained. Evaluate costs against the actual responsibilities the practice retains.

A dedicated billing team usually spends its working day on claims, follow-up and payment posting, while in-office staff often split billing with phones, scheduling and patient check-in. When comparing providers, ask how billers are assigned to your account, how their work is reviewed, and what experience they have with dental claims specifically. See medical billing vs dental billing for where the two workflows diverge.

Outsourcing can also move the hiring, training and supervision of billing staff from your practice to the provider. Ask each company who supervises the billers on your account, how questions and escalations are handled, and how its processes are documented so work continues if a team member leaves. The eDental Billing team can walk you through how this works for your practice.

Understanding dental plan payments and EOBs

An explanation of benefits (EOB) statement or electronic remittance advice (ERA) helps a practice understand how a dental plan processed a claim. The American Dental Association’s guide to reading an EOB statement identifies details to review: the allowed amount, the portion covered by the plan, the deductible applied, the amount paid, patient responsibility and remark codes. The labels can differ between plans.

Remark codes explain adjudication and payment decisions and may identify requests for additional documentation. Reviewing these details gives the practice and its billing team a more specific basis for discussing a payment than looking at the payment total alone.

What does outsourcing dental billing cost?

Outsourced dental billing fees are usually quoted in one of three ways: a percentage of collections, a flat monthly fee, or a fee per claim. Some providers combine a percentage with a monthly minimum. The headline number alone does not show your total cost, so ask each provider to answer these questions in writing:

• What is the percentage calculated on, such as insurance collections only or patient payments as well?
• Is there a monthly minimum, and at what level of collections does the minimum, rather than the percentage, set your bill?
• Which tasks are included (insurance verification, claims submission, denial follow-up and appeals, payment posting, accounts receivable follow-up, patient billing) and which are charged separately, such as setup, patient statements or work on older balances?
• What are the trial, notice and cancellation terms?

To compare quotes on the same basis, divide each provider’s expected monthly fee by your average monthly collections. For example, a $1,500 monthly fee on $60,000 of monthly collections works out to 2.5%. Then weigh that figure against the in-house cost of the same work, including wages, payroll taxes, benefits, training, software and coverage when billing staff are absent.

eDental Billing’s terms are a 2.75% rate with a $250 monthly minimum and a 30-day free trial. Contact eDental Billing to confirm how the rate applies to your practice’s collections before you compare it with other quotes.

Download our dental billing outsourcing quote comparison worksheet to record written fee, scope, trial, cancellation and reporting answers from each provider you compare.

How does a practice transition to outsourced dental billing?

A clear handover reduces the risk of claims slipping between your team and the billing provider during the switch. Before the start date, agree on these points in writing:

• A business associate agreement. A billing company that handles your patients’ protected health information on your behalf is a HIPAA business associate, and the U.S. Department of Health and Human Services notes that the HIPAA Rules generally require a contract with business associates to ensure they safeguard that information.
• System access. How the provider will reach your practice management software, clearinghouse and dental plan portals, with individual user logins for the billing team rather than shared passwords.
• Starting data. A current accounts receivable aging report, a list of open and unpaid claims, recent denials, your fee schedule and the dental plans your practice participates with.
• Who owns each task on day one. Claims for new appointments, follow-up on older claims, payment posting and patient statements, so no work is duplicated or missed.
• Reporting. Which reports you will receive, how often, and who to contact with questions.

Ask each provider how long setup usually takes for a practice of your size and what it will need from your team in the first weeks. eDental Billing offers a 30-day free trial; contact eDental Billing to discuss what the handover would involve for your practice.

Related guides: compare providers with our dental billing company checklist, review the benefits of outsourcing dental billing, or read how the dental billing process works. Explore our dental insurance billing services (2.75% rate, $250 monthly minimum, 30-day free trial) for claims follow-up, payment posting and accounts receivable support, or contact eDental Billing to discuss your practice’s billing needs.