Dental billing is the process of generating medical claims to submit to insurance companies for reimbursement for oral health services. The dental biller monitors the claim to guarantee that their employer is compensated for their work on a patient.

Direct Billing. Direct Billing is an arrangement whereby guest charges are transferred to an Accounts Receivable account for payment. Typically, when a guest uses direct billing, an invoice is sent directly to the guest’s company or other sponsoring organization.

 The dental invoice is a record of care and a formal request for payment. It should include descriptions of all services provided and their costs. In addition, the invoice should include:

·        A date of issue.

·        Complete contact information for the patient.

 Top 8 Steps of Dental Billing :

The dental billing process refers to all the steps involved to receive payment from insurance companies and patients for services your practice provides. The dental billing process may be broken down into patient billing and insurance claims processing – the two main revenue streams for practice. 

Like any process, there are clear steps can be followed to move through the dental billing process with ease.

Here is a brief Dental checklist of steps in the dental billing process:

1.  Collecting patient information – This is done during the initial phone call with the patient when they call to schedule their dental appointment. This information will include their name, phone number, address, email address, contract preferences, date of birth, name of the subscriber’s employer or insurance plan, insurance carrier, carrier’s provider phone number, insurance ID number.

2.  Verifying patient insurance coverage 

Once patient’s personal insurance information collected it can easily verified y by either calling the insurance company or logging into company’s insurance portal. This will give a full breakdown of their benefits that will let us know the state of their coverage.

3.  Recording dental treatment and code data 

As the patient receives treatment the day of their appointment, someone on the care team records the necessary details on clinical notes and codes the procedures performed. Usually, an admin team member ensures this is documented, reviewed, and electronically signed by the provider in dental software. A daily sign-off on the day sheet is a best practice to always verify that what happened in the dental chair is what is recorded into company’s software and on patient’s ledger to be billed.

4.  Submitting and tracking claims and any attachments 

With the recorded information in software, it is easy to create, batch, and submit insurance claims. The claim will include the code or codes of the procedure performed, all of the patient’s personal and insurance information, and any attachments needed. Attachment notes are as following:

·        clinical notes,

·        x-rays,  

·        periodontal charts,

·         narratives,

·        primary EOB’s, 

·         Intraoral photos, etc.

 5. Resolving problems on outstanding claims 

 If a claim has been denied, or 30 days have passed and the claim has not been reimbursed, you will need to follow up on it. This is called working the insurance aging report. Your biller gets a list of outstanding claims, contacts the insurance company and figures out where the claim went wrong, and then works to appeal it for reimbursement. This is a crucial stage where the biller’s expertise and efficiency determine whether you see a high collection rate or a low rate and high overhead.

6. Billing patients – Depending on the revenue model you’ve chosen, you either bill the patient for the entire amount of the procedure up-front (fee for service) or you bill patients the balance after subtracting what their insurance benefits should cover (reimbursement model). Patient billing allows you to collect the patient’s portion before they leave the dental office, or request payment later by mail or email. You then file the claim to be reimbursed by their insurance. Either way, fully collecting on patient accounts receivable is crucial because it can bring in about half your revenue.

7. Posting payments – Once your insurance claim has been paid and deposited into your bank account, you’ll need to post the payment to your practice management software. Doing so keeps all of your information properly documented and reported. It also completes the life-cycle of a claim and you will be able to close it out. Patient payments also need to be posted promptly so that your patient bills and cash flow numbers are accurate.

8. Running key reports such as collections and account aging reports – Once the payments are posted and the claim is closed out, you’re able to really take a look at how your billing activities are performing to gauge how well they are collecting payment for what your practice produces. Through your dental software you are able to run both net production and net collection reports as well as outstanding account and insurance aging reports will show you a list of outstanding claims and patient balances that need attention.

Now you have an overview that gives you an idea of what the dental billing process looks like. You can see the lifecycle of a claim from start to finish. Understanding this can help you stay on track with how you collect your patient and insurance information, and how you work to get your practice paid via insurance claims and patient payments.

Medical billing refers to the process of billing medical insurance for care provided in your dental practice.

Sometimes the dentist performs treatments that fall under the category of medical care. For example, a dentist may treat damaged teeth, gums, and jaw due to accidents or trauma, which is considered medical care. A biopsy is another common medical treatment dentists can perform. 

Insurance claims should go to the medical insurance carrier as primary instead of dental insurance, and that’s something dental billers need to know.

Out Source Your Dental Billing |US Global Medical Billing Services @ 2.49%

Out Source your dental Billing Services to US Global  at the lowest rate @2.49% to remove your headache. Our main moto is you take care of your patients and we take care of your billing.
If you’re a growing dental practice that is frustrated with being at the mercy of the insurance companies and spending precious hours trying to configure proper and accurate dental codes to prevent claim denials, halt the rat race in its tracks!
we provider following services:
1. Dental Billing
2. Dental Coding
3.Dental Credentialing
4. Dental Practice Audit
5. Free Dental EDI & Re-Credentialing Services.


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Dental Provider choose US Global Medical Billing Services due to following reasons.
1. Dental Billing Services @ 2.49%
2. Dental Credentialing Services @ 150 Dollar each payer 
3. Free Dental Credentialing Services, if provider have more than 10 payers for above 10 payers credentialing is free.
4. Free re-credentialing services.
5. Free dental EHR. Services.
6. Free Dental Coding services.
7. Free Dental Practice Audit services.


Get paid faster, enhance patient experience, and improve your dental practice profitability through dental billing outsourcing! Get free Audit service of your practice if you like our services then :

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Medical Billing is one of the most complicated aspect to run a medical practice with thousands of codes and multiple payers/insurances .These is not a one solutions for all aspects of problems when it comes to the medical billing as Staff of a clinic or health department are responsible for all aspects of revenue cycle management. They submit claims to a clearinghouse, directly to Medicaid, or to the insurance company for reimbursement. They also set charges, collect patient fees (copays and deductibles), and manage the accounts receivable.

TOP 6 benefits of In-House Billing Services.

• Retaining Control billing functions.

 If existing employees have the capacity to execute medical coding and billing, your administrators and providers will appreciate having hands-on control of financial operations through in-house billing, and receive all the profits.

• Accessibility.

 Should issues arise, the accessibility of your in-house billing department will be a major advantage, since all it takes to observe the billing process and address any problems is a walk to the billing office.

• Maintain patient confidentiality.

 Maintaining patient confidentiality is one of the most important issues for STD clinics.

• Return on Investment:

Once a practice has invested in training medical billers and purchasing a billing technology, moving to an outsourced solution means losing lots of time and money spent. When there is a valid infrastructure in place, it’s worthwhile to just refine existing procedures to generate the best return on investment.

• Close proximity:

Having your billing department under the single roof as your practice allows you to connect with billing staff and can communicate about any issues with them at a moment’s notice. In fact, by walking across to RCM team can be operational and resolving all billing -related problems without delaying.

• Complexity:

 Upfront expenses include labor, costs for technology, hardware, billing software and training, and ongoing expenses for maintaining the billing system. Also, updates or changes to billing software can be complicated and costly.

Top 5 disadvantages of In-House Medical Billing.

• High cost:

 Determining your expected revenues, managing partial payment and denials, and collecting co-pays and deductibles after the time of the visit are time-consuming processes that take time to master.

• Liabilities:

 If training of your staff and billing capacity (including coding, billing execution, and billing technology) are not kept up-to-date, there may be higher rates of denials, un-appealed claims, and lower reimbursement rates.

• increased dependency on limited staff:

 If your billing department consists of only one or two staff members, the operations—and cash flow—may be disrupted when even just one employee gets sick, goes on vacation, takes a leave of absence, or resigns altogether.

• More scope for errors:

With comparison to any organization that specializes in outsource RCM, the chances of errors in billing procedures is much higher when managed by individual staffers. It can increase the risk of general employee neglect which may go unnoticed in absence of an employee performance tracking system.

• Time consuming:

While increased direct control on billing operations may get in the knowhow of RCM, it will cost your precious time for actual patient care. It will harm your reputation and make you lose business in the long run. So, it’s wise to outsource processes that do not demand your expertise, time and energy. It will enable you to focus on your patient care and consequently it will flourish your business. 

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Why is dental billing important?

The role of dental billing is significant for various reasons.

1. It ensures the payment of dental practices which is critical to their financial stability and profitability.
2. Accurate billing enables to maintain patient and insurance company trust.
3. Accurate dental billing can minimize the risk of insurance company audits and financial penalties

Dental billing is important for several reasons:

1. Reimbursement:

 Dental insurance billing is necessary in order to receive reimbursement for the services provided to patients. Proper billing is crucial in order to receive payment for the full value of the services provided, which is essential for the financial stability and success of a dental practice.

2. Compliance:                                                                                                               Accurate and compliant insurance billing is important in order to avoid denied claims, audits, and legal action. Dental practices must understand and comply with the rules and regulations of the insurance companies they work with, as well as federal and state laws and regulations related to healthcare billing.
3. Record Keeping:                                                                                                                   Billing is an important component of a practice’s record-keeping system. Accurate and complete records of billing and payment activities help practices monitor their financial performance and ensure that they receive payment for all services provided.
4. Patient Satisfaction:                                                                                                             Dental billing is also important for patient satisfaction. Patients want to know that their insurance coverage is being utilized to its fullest and that their out-of-pocket costs are being accurately calculated. Accurate and transparent billing helps to build trust between a practice and its patients.

7 Steps of Dental Billing

Following are various steps typically involved in the Dental Billing

1. Pre-authorization
2. Documentation for data collection
3. Coding
4. Claims preparation/Submission
5. Account follow-up
6. Payment posting          
7. Account management for receiving
8. Pre-authorization:                                                                                                                      Obtaining pre-authorization from insurance companies or government programs for certain procedures.
9. Documentation for data collection:                                                                                  Accurately documenting the services provided, including patient information, diagnosis codes, and procedures performed.
10. Coding:                                                                                                                                Assigning the appropriate codes to the services provided using the Current Dental Terminology (CDT) codes.
11. Claims preparation:                                                                                                                      Preparing and submitting claims to insurance companies, government programs, or patients. This may involve entering claims into an electronic billing system, printing and mailing paper claims, or submitting claims through an online portal.
12. Account Follow-up:                                                                                                           Following up on the status of claims to ensure payment is received. This may involve checking for payment status in an electronic billing system, calling insurance companies or government programs to inquire about the status of a claim, or appealing denied claims.
13. Payment posting:                                                                                                             Recording payments received from insurance companies, government programs, or patients. This may involve updating an electronic billing system, recording payments in a ledger, or depositing checks.
14. Accounts Receivable Management:                                                                                Monitoring accounts receivable and pursuing payment from insurance companies, government programs, or patients as needed.
    
    

Dental insurance and its types:   

Dental insurance enables people and families pay for dental procedures and treatments.

Following are various types of dental insurance with its feature and benefits:

1. Preferred provider organization plans (PPO)
2. Plans offered be dental Health Organizations (DHMOS)
3. Indemnity plans
4. Discount dental plans

1. Preferred Provider Organization plans:

PPOs are more flexible than DHMOS, covered broader range of procedures, including major dental work like crowns, bridges, and implants. Individual with PPOs can see any licensed dentist, but they may receive better benefits if they choose a provider from the plan’s network.

• Plans offered by Dental Health Maintenance Organizations:

These plans cover a limited number of preventive and primary dentist procedures such as cleanings, X-rays, and fillings. It typically requisite of individuals to select a primary dentist from network of providers and consequently minimize the coverage for operations performance by providers outside the network.

• Indemnity plans:

These plans provide the most flexibility in terms of selecting a dentist and the procedures covered. It enables the individuals to see any licensed dentist and receive benefits for various procedures.

• Discount Dental Plans:

Discounts dental plans provide members with discounts on dental procedures and treatments. Individuals join the plan for a fee and receive discounts on dental services performed by participating providers.

Common insurance terms for dental insurance coverage and billing:

Individual must be intimate with several common insurance terms to comprehend their dental insurance coverage and billing.

1. Deductible:

The amount paid out of pocket by an individual before their insurance coverage kicks in.

• Coinsurance:

The individual is responsible for paying a portion of amount of the cost of a dental procedure after meeting the deductible.

• Co-payment:

An individual pays a set amount of money for a dental procedure, regardless of its cost.

• Maximum benefits:

The most money the insurance company will pay for dental procedures in a given year

• Pre-existing conditions:

Dental conditions or treatments that existed prior to enrollment in the insurance policy. The policy may not cover these conditions.

• Waiting period:

 A stated period of time that a person must be enrolled in an insurance benefit plan before being eligible for benefits or for a specific category of benefits.

• Coordination of Benefits (COB):

 A process that insurance carriers use to determine the order of payment and amount each insurance carrier will pay when a person receives dental services that are covered by more than one insurance benefit plan

What are some best practices for dental billing?    

Following are best practices for dental billing:

1. Staying up-to-date with time and insurance policies
   1. Using specialized software and billing service
   1. Maintaining of accurate records
2. Stay up-to-date on changes in regulations and insurance policies:                                           Dental billing industry and its rules sand regulations are changing rapidly. Consequently, it’s essential to stay informed and up-to-date. This can be possible by updating skills, education courses, reading industry publications or consulting specialists   
3. Use specialized software or a billing service:

To streamline the Billing procedure, it’s necessary to use specialized software to minimize the risk of errors. It also automate many routine tasks in billing process.

• Maintaining accurate and through records: Accuracy and complete documentation is key to the success of dental billing.                       

This includes

• Keeping up-to-date patient information,                                                                   
• Documenting all services provided, and                                                                   
• Following up on the status of claims in a timely manner.

Having a robust system for maintaining data enables to ensure the efficiency and smoothness of claims processed. It also reduces the claim denials and other issues as well.

What is illegal dental billing?

According to American Dental Association Dental insurance fraud is “any crime where an individual receives insurance money for filing a false claim, inflating a claim or billing for service not rendered”

Common fraudulent practices:

There are various billing claims habits that are fraudulent. The most common types of billing fraud are as following:

1. Billing for incomplete and unperformed services
   1. Altering date of service
   1. Waiving deductibles
   1. Submitting a claim for treatment using a different member’s information
   1. Inappropriate usage of additional codes

Fraud harms everyone in the dental industry. It not only drives up the cost of coverage for patients and employers, but it can also directly affect your practice. Being found guilty of perpetrating fraud can result in fines, loss of network participation and professional licenses and even jail time.

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US Global Medical Billing Services Offer Services :
1. Dental Audit of Practice

2. Dental Medical Coding & Billing ( CPS,CCS Certified coder services )

3. Expert Credentialing Services.
4. Free Credentialing & EDI services.


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The post DENTAL BILLING! A COMPREHENSIVE STEP BY STEP GUIDELINES 2023 first appeared on US Global Medical Billing Services.

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Criminal HIPAA penalties are much rarer than civil penalties. Most violations are organizational and not the result of individual criminality, and these fall under the definition of a civil offense.

Additionally, many of the issues that would fall under a criminal penalty (committing digital or identity fraud, hacking, etc.) are governed by other laws and aren’t specific to HIPAA or the healthcare industry.

However, individuals directly involved in healthcare can purposely violate HIPAA for personal gain, thus necessitating criminal penalties. These penalties are also broken into tiers:

• Tier 1: If an individual or organization knowingly obtains unauthorized PHI, they can face a fine of $50,000 and 1 year in jail.
• Tier 2: If the offender knowingly obtains PHI and uses false pretenses (fraud) to do so, they can face fines up to $100,000 and up to 5 years in jail.
• Tier 3: If the offender fraudulently obtains PHI with the intent to sell, transfer, or use that information, they can face fines up to $250,000 and up to 10 years in jail.

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