Overcoming Challenges to Dental Claims and Billing

Patients come to you for a variety of reasons. From preventative to urgent care, they look to you to help keep them healthy and relieve aches and pains. Much like you, their focus, when they walk through your door, is on their oral health–not insurance, not claims, and not billing. And, when in an exam room, you don't want your staff worrying about those issues either.

Yet, the reality is, that the business side of running a dental practice and managing your revenue cycle can seem far more challenging and time consuming than the mission of patient care. What if you could spend more of your time focusing on patient care and less time worrying about revenue cycles (while still ensuring your cash flow)? The truth is, you don’t need to sacrifice your staff’s valuable time to dental claims and billing processes. In fact, with the right tools and support, the process can be simplified and streamlined.

Quick Links

• The Importance of Dental Claims and Billing
• The Dental Claims and Billing Process
• Top Challenges to Dental Claims and Billing
• How to Overcome Dental Claims and Billing Challenges

The Importance of Dental Claims and Billing

While running the business aspects may not always be a practice owner’s favorite priority, no business runs without revenue, and a dental practice is still a business.

Unfortunately, many dental practices leave accounts receivable on the back burner and attempt to make collections well after the patient’s visit, which can create problems. As you can imagine, creating a streamlined and efficient dental claims and billing process is the key to keeping cash flowing at your practice. Thankfully, the tools and support to do just that are available.

The Dental Claims and Billing Process

The dental claims and billing process starts with insurance verification. Once you’ve verified a patient’s insurance, you’ll have a better understanding of what procedures and treatments are covered by a patient’s insurance provider. You’ll also know how much of the cost insurance will cover and how much your patient will be expected to pay out of pocket.

Typically, at that time, you can provide an estimate to your patient, so there are no surprise bills later, and discuss payment options for out-of-pocket costs, as many practices prefer to receive payment at the time of treatment.

Once the procedure is completed, you’ll submit a dental claim to the patient’s insurance. They can then process it, provided all the information you have presented, including the patient information and coding, is correct. Once it is processed, they’ll provide payment to you.

Both claims and billing are an essential part of ensuring you receive payment. Many providers offer 100% coverage for preventative care and annual checkups or cleanings; however, restorative or cosmetic procedures typically involve far more out-of-pocket expense. So, staying on top of claims and accounts receivable, including the billing side, is important. Unfortunately, for many practices, the entire process often takes quite a bit of labor as well. 

Top Challenges to Dental Claims and Billing

Ahh, if time were the only challenge to dental claims and billing. While it’s one of the biggest, there are some significant challenges to what should be (and could be) a simpler and more streamlined process.

1. Labor and time

We’ll start here because it is, for many practices, the biggest challenge. While the tasks associated with dental claims and billing seem straightforward, short-staffed offices, or even issues with insurance verification or coding, can make an already daunting task seem insurmountable. For example, errors on insurance or claims forms can mean multiple corrective call backs, tying up your administrative staff for hours. And–even if you’re not short-staffed–that’s time your staff could be spending on patient care.

2. Human error and intervention

Another of the biggest challenges, especially when it comes to completing forms for submission, is human error. And that’s not just errors by your staff. Patients may put incorrect information on paper forms, or simply have illegible handwriting. When that data is transferred to an electronic form or database, errors occur. Those errors can result in claim denials and more time spent on call backs.

Further, some estimates suggest that nearly 2/3rds of dental practices may be victims of fraud or embezzlement. Often, the vulnerable spot in a practice is dental claims and billing.

3. Coding Updates and Issues

Dental coding and medical cross-coding for dental isn’t easy. On top of it not being easy, the codes involved are updated yearly which means there may be new procedures, new treatments, new techniques, and new tools which can all change coding requirements. Those changes can make an already complicated task even more complex and, again, time consuming.

4. Insurance provider claims requirements

Insurance companies set forth pretty specific guidelines when it comes to completing claim forms. While you may be working with a variety of insurers, insurers are working with even more practices, making insurer guidelines increasingly detailed. That doesn’t make your job any easier.

5. A/R calls and collections

Whether it’s a defaulting payment plan, a patient leaving prior to paying or even confusion caused by multiple insurance providers, sometimes your team will be called upon to track down payments. Co-pays and out-of-pocket costs are still a good portion of your practice’s revenue, but A/R and collections often take a backseat which means payments languish, get delayed or forgotten, and then take even more time to track down and collect.

Further, when your team is trying to nurture the kind of relationships that help build successful practices, having them act as the collections team, on top of their other responsibilities, can create friction you’d probably rather avoid.

How to Overcome Dental Claims and Billing Challenges

There are, thankfully, a few options to help resolve the issues most dental practices face when it comes to dental claims and billing.

One option is to attack the problem from its root and work towards reducing human error. While you can’t eliminate it, automated tools, like iCoreConnect’s iCoreVerify, can run automated insurance verifications for your entire week’s patient schedule in one shot, reducing the time your team spends on calls with insurers.

Additionally, this tool alerts you to errors so you can correct them before the patient ever walks in the door. And because it connects to over 2,100 insurers, your team can stay on top of insurance changes, ensuring your patients get the treatments they need and are entitled to.

But, that’s just one part of the problem. What about those coding issues? That’s where iCoreConnect can introduce you to your latest team member, the coding wiz, iCoreCodeGenius. Help your team accurately and correctly code, in significantly less time, for faster claims service. With this tool, your team gets a helpful assist for medical cross-coding, ensuring all aspects of complex ICD-10 codes are considered.

These two tools are amazing time savers that can help reduce errors, but they don’t help alleviate all your dental claims and billing challenges. But, don’t worry–we’ve got a solution for that too. iCoreClaims is the ultimate solution. We’ll leverage our tools on your behalf to help you manage the revenue cycle quickly and efficiently.

iCoreClaims handles the insurance revenue cycle from the insurance verification process to managing both insurance and patient billing, providing a consistent, reliable, and accurate revenue cycle. Additionally, your staff can get off the phone and go back to providing the service and care that helps you stand apart.

Ready to alleviate your revenue cycle pains and challenges? We’re ready to help. It just takes one more call to let your staff hang up the phone and focus on patients. Reach out to our team today and let’s get started on saving your time and effort while keeping revenue flowing.