The time it takes your hygienist to clean is twenty minutes. It may take two months to receive any payment on it; it may not be paid at all. The rate of dental claims of first submissive this year is almost a fifth of all, and most practices fail to submit them at all. Like that is a problem that you can solve by adding one more front desk staff. It is a systems issue and it only gets worse as soon as you introduce a chair, a new associate or even a second location. The revenue leak does not occur due to growth. It simply causes an already existing one to be irrelevant.
This is where outsourced dental billing services come in to bridge. A specialized billing department takes eligibility checks, coding, and submission plus follow-up of insurance end to end as opposed to a front desk floating between insurance calls and patients. The ten specific benefits practices will realize after that change has occurred are listed below.
What Outsourced Dental Billing Actually Covers
Dental billing on the ground is much further than most practices head in. The activity of a billing partner can be summarized as verifying the eligibility, coding (CDT and ICD-10 code), claim rubbing, electronic submissions, managing the denial, and appeals, patient statements and monthly reports; the whole revenue cycle between the moment the patient makes an appointment and the moment the payment is paid in full. This is the range that fuels the ten benefits below; nothing less than a claims-only setup.
Fewer Claim Denials and Faster Reimbursements
Denials make up the largest cost to dental income, and the vast majority are avoidable. The outsourced billing groups incorporate denial prevention into the workflow rather than as a part of damage control.
- Before submitting claims that have been uncovered, scrubbing claims are coded and then documented to eliminate the errors that lead to automatic rejection.
- New and revised CDT codes are followed and implemented on the spot, and would not be denied as the code set spikes annually.
- Denied claims are repurposed and resubmitted within minutes rather than lying unprocessed, which is what most in-house teams eliminate.
- Bills are appealed by billers, who understand requirements that are specific to payers, and have a better chance of an appeal being successfully reversed.
Access to Certified Dental Coding Specialists
Hire an experienced dental coder now and you will realize the issue: there is just not that many skilled people, it will take months to find one, and you will still lose him or her after a few weeks. By having a trained team on the account starting day one, outsourcing avoids it completely.
- AACP Certified coders employed in concentration on the CDT and dental related ICD-10 codes not general medical coding.
- Continuous education on annual changes in the CDT and payer policy changes, as well as state-specific dental billing regulations.
- Benefit that is not lost when an employee goes on vacation, falls ill or retires.
- Specialty code assistance in oral and periodontics, endodontics and orthodontics, which many general billers do not work with regularly.
Stronger, More Predictable Cash Flow
An adding provider practice or opening of a second location cannot sustain unpredictable collections. Outsourced billing streamlines the whole claim-to-payment process to ensure that revenue is received more regularly.
- Shortening the days in accounts receivable reduces the average days in accounts receivable.
- The reduction in claims in the 60-90 day AR bucket, which has a strongly reduced collection odds, is minimal.
- Ongoing recovery of accounts receivable, as opposed to a periodic clean-up.
- More predictable deposit schedules that can then facilitate the planning of payroll, order supply and expansion budgets.
Lower Overhead Than an In-House Billing Team
To construct an internal billing department, the salaries, benefits, payroll taxes, and continuous training as well as a separate practice management or clearinghouse license must be purchased, prior to one claim being submitted. The outsourcing concept constitutes a more variable cost structure as opposed to a fixed cost structure, which depends on the actual collections.
- No recruiting, onboarding or continuing-education billing staffing costs.
- None of the following to budget; no added payroll tax, health benefits or time off.
- No billing software or clearinghouse subscription to do or maintain separately.
- Costs increase with what has been collected by the practice, as opposed to remaining constant over the slack months.
Built-In Scalability as Patient Volume Grows
Practice growth usually outpaces a front desk’s ability to keep up. Outsourced dental billing services are designed to absorb higher claim volume without the hiring lag that comes with scaling an internal team.
- Hiring a new associate or hygienist will not need to hire an additional biller onboarding.
- Located multi-claims are consumed without a submission backlog.
- New employees searching to be hired receive provider credentialing and payer enrollment assistance as the practice grows.
- Billing capacity already exists during mergers, acquisitions or even the introduction of new location.
Tighter HIPAA and Payer Compliance
Claiming more and more patient information implies more exposure to compliance, and the majority of single-location practices just do not have the infrastructure needed to keep the pace on their own. It is done by an established billing partner.
- HIPAA-trained employees and coded hardware processing racial health data.
- Updated processes due to changes in CMS, AMA, AACP and ADA regulatory guidance.
- Uniform documentation standards which minimize exposure in an audit of payer.
- Audit trails on all claims; origin of the claim till the final payment posting.
Less Administrative Load on the Front Desk
The hourly time that a front desk staff spends in hold with an insurance company is also time that should not be dedicated to scheduling, check-in, or communicating with patients. The duties of the outsourced shift off the workload of the internal team.
- Reduced time of being on hold pursuing status of payer claim.
- Reduced lost time due to manual resubmissions and appeal paperwork.
- * Additional front desk bandwidth to schedule, check-in, and face the patient.
- Reduced burnout and turnover rates among staff due to billing frustration.
Accurate Insurance Verification Before Chair Time
One of the most preventable dental billing failures is when a patient discovers that their coverage has expired when they already have the procedure. Incidental verification of eligibility prior to the appointment makes that surprise a non-event.
- Checks of eligibility and benefits completed prior to each appointment.
- Transparency of frequency constraints, waits and annual maximums.
- Less ex post discussion of the uncovered services insurance.
- Better cost estimates provided from patients in advance of treatment.
Real-Time Financial Reporting and Visibility
The owners of practices wishing to expand require something higher than a monthly bank balance. Outsourced billing partners are usually in a position to offer a reporting that an organisation can see precisely where revenue is being lost or won.
- Clean claim rate, denial rate and AR Aging dashboards.
- Frequent performance reports on the comparison of the current collections with past collections.
- Visibility of trends between payers, procedures, and providers to raise flags around recurring issues early.
- Information to aid in decisions that involve capacity addition, new payer agreement, or venture into new sites.
A Better Experience for Patients
Billing friction affects patient trust just as much as clinical quality does. A confusing statement or a surprise balance can undo the goodwill built during a great appointment.
- Concise, precise statements by patients that minimize confusion and billing enquiries.
- Reduced errors to patients in the first place.
- More quickly resolved cases when a patient does have a billing question.
- More transparent estimates of out-of-pocket payment provided prior to treatment, not after treatment.
How to Choose the Right Outsourced Dental Billing Partner
Not all billing firms are established to effectively pay dental-specific claims. Seek out a partner with whom the delivery of revenue cycle management services is founded upon dental work process and not some general medical billing output.
- Dental-specific coding expertise in general, pediatric and specialty operations.
- Open, percentage based pricing and no add-on charges.
- HIPAA-450 compliant systems and an established process of data security.
- Open and periodic reporting as opposed to black-box billing.
- Supports the practice management and EHR software currently used.
- Checkable testimonies or comments of other expanding dental practices.
The Bottom Line
Growing practices avoid more administrative headaches than saved by outsourced dental billing services. They bridge the disparities between ever-growing payer needs and the real constraints of an in-house front desk, keeping collection rates at a healthy level as a practice adds providers, chairs, or locations.
Practices such as CureCloudMD provide dental practices with dedicated, certified-AAPC, billing teams, transparent reporting, and workflows that are payer-compliant and integrating dedicated to managing the dental revenue cycle, allowing more of the growing practices to outsource this role instead of compete against a shrinking national pool of in-house dental billing teams.