Medical Billing: A Quick Rundown and Best Practices

By Crystal Stanton

Between overcoming staffing challenges and staying on top of technology trends, working in the healthcare industry comes with many obstacles. The most challenging of those obstacles can often be medicine-specific responsibilities, such as medical billing.

While billing is something almost all businesses do, the process is more complex for healthcare organizations. Let’s break down medical billing and what you can do to make the process easier at your dental practice.

What is Medical Billing?

Medical billing is the process of generating, submitting, and tracking claims to insurance companies to obtain payment for services provided to patients. It falls under medical practice management tasks and is crucial to revenue cycle management (RCM).

Generally, the medical billing process follows these steps:

1. Collect patient information. This includes demographic information such as full name, date of birth, address, and gender. It also includes emergency contacts and insurance information. Accurate data collection here is essential—with inaccurate or incomplete information, the billing process becomes much more difficult.
2. Verify insurance information. Contact the patient’s insurance company to verify coverage and double-check the policy’s effective dates, type, and covered services. You also want to clarify any preauthorization requirements.
3. Document patient encounter. During the patient’s visit, document any services, tests, or procedures provided and assign the right dental code, as required by the American Dental Association (ADA). Not only does accurate documentation minimize your chances of claim denial, but it also helps you protect patients by providing an accurate medical history.
4. Complete charge entry. Add all the charges the patient incurred during their visit, combining all billable items. For example, a patient receiving a cleaning might incur a $75 cleaning charge and a $20 fluoride treatment charge for a total of $95.
5. Submit insurance claims. Submit error-free claims on time to maximize your chances of approval. The insurance companies will adjudicate your submitted claim to determine coverage eligibility and the amount they’ll pay based on medical necessity and compliance with their guidelines. During this step, you’re in charge of following up with insurers and appealing any denied claims.
6. Bill patient for remaining charges. Any charges that the insurer won’t cover, such as co-pays, you must bill to the patient. Present statements that outline the balance due, due date, and payment methods accepted. This boosts transparency with patients and makes it easier for them to pay on time.
7. Payment posting. After collecting payment from the patient, post it to the patient’s account and update their outstanding balance. Failure to do so can result in lowered customer satisfaction and billing inaccuracies—no one wants to pay the same bill twice!

While dental billing follows the same general process as medical billing, there are a few key differences. Namely, dental practices must use Current Dental Terminology (CDT) from the ADA instead of Current Procedural Terminology (CPT) codes or the Healthcare Common Procedure Coding System (HCPCS).

Dentists must also fill out different insurance claim forms that list information other healthcare providers don’t need, such as information on missing teeth, the perimeter of the oral cavity, and the number or letter of any teeth treated.

To assess the current status of your medical billing processes, examine your practice’s data using dedicated analytics tools. For example, Arcadia recommends using a healthcare data platform to assess claims data. Track key metrics such as claim denial rate, claim rejection rate, collection rate, and number of overdue claims to pinpoint inefficient areas of your medical billing process.

Best Practices for Medical Billing

Now that you know the basics of medical billing, here are a few best practices you can implement to improve efficiency:

1. Implement a clear payment policy. Create a transparent policy that communicates how you handle payments and outlines how you’ll handle overdue payments, such as by assessing additional fees.
2. Regularly review coding and billing rules. Governing bodies like the ADA may periodically adjust their codes for new procedures and medical advancements. Avoid denials by regularly reviewing coding and billing regulations, and ensure you’re using the most up-to-date codes and processes.
3. Provide robust training for staff members. Training is more important than ever, especially with new initiatives to utilize pre-dental students to solve workforce challenges. Properly onboard and train all new staff members on your medical billing processes so they’re on the same page, and keep them updated on any changes you make.
4. Monitor and follow up on insurance claims. Denials and rejections are significant sources of lost revenue for medical practices. Continuously monitor the status of submitted insurance claims so you can promptly follow up on any unpaid, rejected, or denied claims.
5. Purchase medical billing tools. A robust solution will boost billing efficiency by speeding up reimbursement and reducing claim errors. Plus, some providers (such as PracticeSuite) may provide medical billing features as part of a more comprehensive solution, helping you streamline other aspects of your dental practice.

It’s perfectly understandable if you can’t implement all these strategies now—perhaps your dental practice is new or still needs to gain its footing. Start with the top of the list and work your way down so you’re constantly making progress toward a better medical billing system as you’re able to.

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The medical billing process can get complicated, especially if you’re submitting a claim for complex procedures like maxillofacial reconstruction. What’s important is setting up sustainable systems and tools that empower you to get your payments promptly and efficiently.

Bio: Crystal Stanton is a creative marketing professional with a wealth of varied experience and education. She has been successfully educating consumers in the Health Information Technology industry since early 2015. She is currently a digital marketing specialist at MicroMD.