4 ways to ensure successful and ethical dental insurance billing

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Dental billing is one of the most difficult yet crucial aspects of running a dental practice. The production does not matter if you are unable to get reimbursement for the services. I started in dental billing 13 years ago, and as a dental practice manager, the ability to code and bill insurance correctly to maximize reimbursement is one of the most basic requirements of my job. . There is so much to know and the answers are not always transparent.

Some things that I have discovered over the years that make dental billing more efficient and less frustrating are the result of good training and communication not only with the clinical team, but also with the dental companies. assurance.

Read treatment manuals.

The first step to successful dental billing is to read the contracts and treatment policies. The frustration associated with billing dental care does not start or end with the administrative team; the doctor (s) and other team members are also frustrated. There are specific requirements which vary from one insurance company to another. Some examples are the type of x-rays required for different periodontal and restorative services, policy frequency limitations, year of service versus calendar year, missing tooth clause, etc. The list is endless. It is crucial that you read the processing manuals, as knowing your contract limits ahead of time will greatly improve billing ease for you and your team. After all, to be warned is to be warned. I would bet that most practice owners and their insurance coordinators have never read their provider agreements or the handling policies of the insurance companies they network with. How do you know what you need to deal with a complaint if you’ve never read the manual? These manuals change every year and the information they provide is well worth the time it takes to read them.

Know what questions to ask and where to find reliable information.

It is essential that you provide your business administration team with quality reference material. An example is the Charles Blair Training Booster website that includes Insurance Solutions publications. It also offers Coding books with confidence. With these books, insurance billing professionals have the answers for correct coding right at their fingertips. If they have the information they need to do the job properly, they are less likely to go down the social media hole to find answers, which will likely give bad information and also perpetuate bad billing practices in your dental office.

Know your contracts.

As I network with other offices one of the most common things I notice is that they fail to meet the contractual obligations outlined in their contracts. This risky behavior is not only detrimental to the physicians who are ultimately responsible for it, but also to the chiefs of staff who are also at fault if an audit finds fraudulent billing practices.

“Insurance fraud” is a fearful and defensive term among many dental professionals. They don’t understand that the billing practices they themselves follow fall into the category of fraud. Unfortunately, ignorance is no excuse in the eyes of the law. For example, it’s not uncommon to hear that people charge for insurance and cancel the patient portion. Sounds innocent enough, as one could argue that the insurance company would have to pay anyway, because it collects premiums from patients; However, their policy manual states that if the patient receives a discount, the insurance company is also entitled to an equal discount. Another common practice of billing insurance is to simply not bill the insurance company if the contracted rate is too low. This practice grew out of frustration with low reimbursement rates, but if the patient calls and complains to the insurance company, there will be an investigation which will likely result in your practice being forced to reimburse the patient in full. , and then there is the possibility of an audit.

Contact your service provider representative.

The laws surrounding dental billing are changing in many states due to legislative changes regarding these same topics thanks to the American Dental Association and other dentists and dental entities. Provider Support Representatives can walk you through the right way to get coverage for your services at fair and reasonable rates that you and your patients can live with, while staying compliant. Your patients will appreciate your confidence in billing and your ability to maximize their benefits while receiving maximum reimbursement for your practice.


Before moving on to the dental field, Tammy Gemmer, MAADOM, worked for several years as a medical transcriptionist. For over a decade, Tammy worked as a dental practice manager. Tammy always takes her career forward with passion through AADOM. She currently holds masters status and is working towards obtaining her diplomat distinction.

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