How to Improve Dental Practice Revenue: Unlocking the Power of Dental Billing Services

A dental practice can lose revenue on work it has already done. A procedure is completed but never billed, a claim goes out with a missing detail and is denied, or an unpaid insurance balance sits for months with no follow-up. This guide covers the billing side of practice revenue: where money gets held up, seven steps that help you collect it, the numbers worth tracking, and when it makes sense to bring in outside dental billing help.

Where dental practice revenue gets held up

These are the usual places to look first:

• Procedures not attached to a claim. The treatment is in the patient record, but no claim was created for it.
• Claims sent with missing or wrong information. The plan returns or denies the claim, and payment waits until someone corrects it.
• Denied claims that are not appealed. A denial that nobody reviews stays unpaid.
• Overdue insurance balances. Claims that have had no response from the plan and no follow-up from the practice.
• Insurance payments not posted. Until a payment is posted to the patient ledger, the practice cannot tell what the patient still owes.

Seven billing steps that help a dental practice collect what it has earned

1. Verify insurance coverage before the visit. Confirm that the patient is eligible on the date of service and what the plan covers, so the patient and the practice both know what to expect. The American Dental Association (ADA) publishes an eligibility and benefits verification letter among its tools for dental practice administration.
2. Bill every completed procedure. At the end of each day, compare the procedures completed with the claims created, and create a claim for anything that was missed.
3. Check each claim before it goes out. Review the patient and subscriber details, the procedure codes and the tooth or area information the claim form asks for. The ADA Dental Claim Form and its completion instructions show what each field needs.
4. Keep procedure codes current. Dental procedures are reported with the ADA’s Code on Dental Procedures and Nomenclature (the CDT Code). The ADA’s Code Maintenance Committee meets each year to agree on changes for the next edition, so check the current edition before you code. Source: ADA on the CDT Code.
5. Send claims and receive payments electronically where you can. A claim sent to a health plan is one of the electronic transactions that have standards adopted under HIPAA. Source: CMS overview of HIPAA transactions. Electronic claims and electronic funds transfer cut down on paper handling, and the ADA tools linked in step 1 include an electronic funds transfer checklist.
6. Post insurance payments promptly. The plan reports its decision on an explanation of benefits (EOB) statement, which shows what the plan paid and what the patient owes. Post the payment and any contract adjustment to the patient ledger, then bill the patient for the remaining balance. Source: ADA guide to explanation of benefits statements.
7. Work denials and overdue claims on a schedule. Review each denial, correct or appeal it, and follow up on unpaid claims from your insurance aging report every week instead of when time allows.

Billing numbers to track

A few numbers show whether the steps above are working. Track them every month and compare your practice with its own earlier months:

• Unbilled procedures: how many completed procedures have no claim.
• Time from visit to claim: how many days pass between the date of service and the date the claim is sent.
• Insurance aging: the total of unpaid insurance claims that are 30, 60 and 90 or more days old.
• Denials by reason: how many claims were denied and why, so the same error can be fixed at its source.
• Unposted payments: how many EOBs are waiting to be posted.

When to consider outsourcing dental billing

Many practices handle these steps in-house. Outside help is worth considering when the billing work is regularly behind: claims go out late, denials are not appealed, or the insurance aging report keeps growing because the front desk is busy with patients. Outsourcing dental billing services gives that work to a team that does it every day, and your staff get that time back for patients.

Review the provider’s privacy and security safeguards, contracts and responsibilities for electronic protected health information rather than assuming every billing service meets the same standard.

Also Read: Importance of Outsourcing Dental Billing

Questions to ask about billing software or a billing service

• Claim status: ask which claim-status updates the specific software and clearinghouse actually provide, how often they refresh, and who is responsible for acting on them.
• Automation: automated submission can reduce repetitive entry, but validation, exceptions and payer rules still require review. Ask which steps remain manual and how exceptions are handled.
• Patient-facing features: ask which are included in the proposed service, who hosts them, and how they are configured for the practice.
• Reports: ask which reports are included, how metrics are defined, and whether the practice can export the underlying data.

For a step-by-step evaluation checklist, read how to choose a dental billing company, review the benefits of outsourcing dental billing, or check common reasons dental insurance claims may be denied. Explore our dental insurance billing services (2.75% rate, $250 monthly minimum, 30-day free trial) or contact eDental Billing to discuss your practice’s workflow.