50 Dental Billing Tips to Make Your Life Simple(r)

1. Always get important patient information upfront:

   This includes not only a copy of their insurance card, but also their name, address, date of birth, phone number, the subscriber ID shown on the insurance card, and employer.

2. Always make copies of claims you’re submitting:

     If there is ever a discrepancy between parties, you always have proof.

3. Don’t ignore errors:

   Always correct errors, whether it be spelling error or coding error, and then re-submit the denied claim.

4. Keep up with changing trends:

   More and more insurance companies are using email and online filing instead of paper and fax filing, but you must inquire with each insurance company as they do not tell you when they make such changes.

5. Always document:

   When you call insurance companies, never forget to jot down the phone number, name of the representative you spoke to, what they are going to do and when, and a reference number.

6. Watch your tracks:

   When entering data into your software of choice, click the back button in the software rather than the browser back button, or you will tend to lose all the information you entered into the page and have to do it all over again.

7. Verify patient benefits:

   Check for and collect prior to acceptance any remaining deductibles, co-payments, and co-insurance responsibilities, and verify any prior authorization for planned procedures.

8. Handle changes as they come:

   Oftentimes a patient’s information will change if they have a new policy or they have lapsed on their insurance policy and have no insurance, and it’s up to you to contact them and either get payment or refile a claim with the new policy.

9. Know Medicare’s dental limits:

   Medicare doesn’t pay for most dental services, but it can pay when dental services are inextricably linked to certain Medicare-covered medical services, and some Medicare Advantage plans cover dental services as an added benefit. See the Centers for Medicare & Medicaid Services page on Medicare dental coverage.

10. Organize your files properly:

    You must have a system in place that promptly notifies you of receivables and allows you to easily access information about claims when necessary.

11. Don’t be afraid to ask for help:

    If you’re unclear about something while on the phone with an insurance company, do not hesitate to ask them for assistance–they are more likely to give you an answer if you just ask.

12. When in doubt, check the code set:

    Look up procedure codes in the current CDT code set from the American Dental Association rather than relying on memory or an outdated list.

13. Have an ongoing system in place:

    Some insurance companies don’t have just one address per department, or may choose to suddenly assign another company to handle its dental billing services, and increases the chances of sending a claim to the wrong recipient and having the claim be denied.

14. Get digital:

    Understand the different electronic transactions used in dental billing: the 837D submits a dental claim, electronic funds transfer (EFT) delivers the payment, and the 835 electronic remittance advice explains the payment. Ask your practice management software vendor or clearinghouse which transactions your system supports and what enrollment is needed. The ADA’s electronic transaction resources can help you review these workflows.

15. Track how long payers take:

    Payment timeframes differ by payer and plan, so record the date each claim was received and follow up when a claim is still unpaid after that payer’s usual turnaround.

16. Protect your email:

    The HIPAA Security Rule does not expressly prohibit email, but electronic patient information must be adequately protected when it is sent. Review how your practice email account protects that information, such as encryption, choose a solution, and document the decision.

17. Make deadline:

    Timely filing deadlines differ by insurance company and plan, so it’s up to you to know each deadline and submit your claims on time, or else they will most likely be denied.

18. Get it done quickly:

    Clinical documentation should be reviewed promptly and checked for thoroughness, and claims should be submitted as soon as the documentation is complete.

19. Sometimes old school is better:

    When applying a quick fix to a denied claim, try faxing it over to the insurance company for the fastest results.

20. Compare submission routes:

    Ask your clearinghouse about its per-claim fees and any claim limits, and check whether a payer accepts claims directly through its own portal.

21. Age well:

    In order to create an Aging Report, you must be consistently posting your paid claims in your software and keeping a list of unpaid claims at the same time.

22. Don’t forget support:

    You only get reimbursed once you provide supporting documents with the bill, but understand that each insurance company needs different kinds of supporting documents.

23. Manage your time wisely:

    In addition to your clinical duties, you must ensure claims get to the insurance company and perform proper follow-up procedures while also appealing claims that haven’t been paid–have an organized system in place.

24. Don’t bill patients for balances if you’re in-network:

    You must accept the rate that insurance companies give you if you are in-network and not try to collect the difference if your cash-rate is larger than what the insurance company quotes you at–you can only collect said remainder if you’re out-of-network.

25. Be real:

    Don’t submit implied codes, codes that are not documented by medical necessity, unbundle codes for the sake of additional reimbursement, or select a procedural code that is similar to the actual service provided.

26. Don’t be taken advantage of:

    Insurance companies make money by investing premiums that can be debited monthly, and the longer it takes for you to get paid, the more insurance companies earn from its investments.

27. Handle back-end issues gracefully:

    Oftentimes claims will be rejected at the clearinghouse, insurance companies will be updating their systems, or your billing software will malfunction for you, but it’s important that you express these problems to the companies that provide these services with courtesy and compassion–you’re on the same team!

28. Check frequency limits:

    Dental plans can limit how often they pay for a procedure, so confirm the plan’s frequency limitations when you verify benefits.

29. Never accept a denial:

    Always call and ask what information needs to be corrected or entered in.

30. Go in order:

    You can only bill to a secondary insurance after the primary insurance claim is handled.

31. Get what you deserve:

    When you have a contract in place, there is no reason for you to be underpaid, so always follow up and appeal when necessary.

32. Not all pre-authorizations were created equal:

    While most insurance companies don’t require pre-authorization, some always do and others only during specific circumstances–you must know the regulations for every insurance company.

33. Protected communication:

    Apply reasonable safeguards whenever you email patient information: check the address before sending, limit the information you include, and use a more secure method when a patient asks for one.

34. Have it handy:

    Keep a list of phone numbers, websites, and username/passwords of not only insurance companies, but also clearinghouses.

35. Know your forms:

    For reporting dental services to a patient’s dental benefit plan, consult the ADA Dental Claim Form guidance. The ADA promotes use of the most current version of its dental claim form.

36. It’s up to you:

    If and when a claim is rejected, you must take care of fixing the rejection immediately, for you will never be informed about these claims from the insurance company in the future.

37. Be certain:

    Always check whether planned procedures need prior authorization.

38. Don’t sleep on your AR:

    You should be monitoring your accounts receivable daily, making sure claims have been received while monitoring aging reports and taking action on any outstanding accounts–or source out your dental billing to someone who will stay on it.

39. Utilize tech support:

    If you have a diagnostic code question, make sure to contact your software vendor for the answer.

40. Protect:

    All patient information must be protected, including demographic, insurance, and billing information, as well as treatment notes.

41. Be “in” the know:

    Reimbursement can differ depending on whether you are in-network or out-of-network with a plan, so confirm your network status and how the plan pays in each case before treatment.

42. Keep an eye out on the COBRA:

    COBRA coverage can end early if premiums are not paid in full on time, so verify that a patient’s COBRA coverage is active before treatment.

43. Be persistent on the phone:

    You should call insurance companies that have claims over 60 days old, and always verify important information like the claim number, amount of payment, date of payment, etc.

44. Ask about a second plan:

    Ask every patient whether they are covered by more than one dental plan, and record which plan is primary so benefits can be coordinated.

45. Use auto posting:

    Ask your practice management software vendor or clearinghouse whether it can receive electronic remittance advice (ERA) files and post them automatically.

46. Have a deep knowledge of insurance contracts:

    When you know the contracts you have with insurance companies inside and out, you will be able to handle claims faster and deal with any changes or updates that may be made to said contracts.

47. Know where to look:

    For CDT coding resources and code-maintenance updates, consult the American Dental Association’s CDT resources.

48. Monitor annual maximums:

    Many dental plans set an annual maximum, so track how much of it a patient has used and discuss expected out-of-pocket costs before treatment.

49. Batch process:

    If you have multiple outstanding claims in your Aging Report, inquire about all of them in one single call.

50. Don’t assume coverage:

    The existence of a CDT code does not mean a patient’s plan covers or reimburses the procedure, so check the plan’s limitations and exclusions before treatment.

For walkthroughs of billing workflows, see our billing tutorial videos, review how the dental billing process works, learn how to help prevent dental claim denials, check 10 reasons dental insurance claims may be denied, read 6 dental insurance recoupment dilemmas, or compare providers with our guide to choosing a dental billing company. 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. Contact eDental Billing to discuss your practice’s billing needs.