Dental Billing involves sending everything from the complete treatment procedure as a claim to the insurance carrier for reimbursements. The physician, specialist, or healthcare provider gets reimbursed based on the patient’s insurance coverage/plan and eligibility. Dental billing and coding both involve billing insurance claims to receive reimbursements for the services performed. However, along with some similarities, there is a significant difference between medical billing and dental billing services.
Dental Billing Vs. Medical Billing:
For dental billing and medical billing, information like patient’s insurance info, demographics, and other details are similar for both. However, there are various differences between the two, for instance:
The difference in coding:
Medical billing and coding involve the use of primary and most commonly used code sets; the ICD-10, CPT, and HCPCS coding systems. On the contrary, dental billing companies use a diverse code set, also known as CDT (Code on Dental Procedures and Nomenclature). CDT codes are maintained and published by the American Dental Association (ADA).
The difference in claim form:
Dental insurance claim billing also uses claim forms like medical claims. A dental claim form is significantly different from a medical claim form. These forms comprise information like:
- Patient demographics and information
- Date of service
- Dental procedure codes
- Dental Insurance information of the patient
Along with extra information including:
- Tooth surface
- Tooth system
- Missing teeth information
- Area of the oral cavity
- Description of the procedure performed
- Tooth number or letter
Dental Insurance Vs. Medical Insurance:
There are basically three kinds of insurance coverage:
First and foremost, the absence of the correct coverage means the procedures performed will not be paid/covered. Meaning the patient will have to cover or pay for the entire procedure on their own. A dental or medical insurance claim is the bill made by the dental/healthcare provider for getting reimbursed for the service they performed. These insurance claims are approved by the insurance payers/providers. On the approval of the claim by the payer, funds or reimbursements for the service provided are issued to the healthcare practice or physician.
Now that is just the simple way of how to define an insurance claim; however, the real thing is actually quite complex. Insurance claims can get rejected or denied in case of an error in the claim. Moreover, the entire process of preparing the claim comprises challenges, complexities, and time that eventually affects the revenues. This is exactly what the dental billing company is for, to make sure your billing process goes smoothly.
In several ways, dental insurance claims and medical insurance claims are quite similar. However, there are some differences between the two;
1. Medical health insurance:
Medical health insurance doesn’t cover dental claims.
2. Yearly benefits:
Generally, medical insurance maximum yearly benefits are much higher than dental insurance benefits.
3. Insurance claim approvals:
With little regulation or oversight of what services the insurance provider must cover, insurance claims can sometimes be approved.
However, with differences, there also exist some similarities between dental and medical insurance claims, for instance:
- Deductibles must be met by the patient
- Patients must have a co-insurance payment or co-pay
The frequency of the updates between dental coding and medical coding systems is significantly similar as well. Meaning both code sets are updated annually now.
What are CDT codes?
Code on Dental Procedures and Nomenclature, The CDT Codes. It is a reference manual published by the American Dental Association (ADA). The ADA is also the copyright owner of CDT codes. CDT Code set is maintained by the ADA Council on Dental Benefit Programs’ Code Maintenance Committee. Similar to medical billing code sets (ICD 10, CPT & HCPCS), dental billing codes are also revised annually. CDT codes are categorised based on the type of service:
- Removable prosthodontics
- Maxillofacial prosthetics
- Implant services
- Fixed prosthodontics
- Oral and maxillofacial surgery
- Adjunctive general services
This code set begins with a “D” – the procedure code and is followed by four digits, also referred to as the nomenclature. For instance: D2930 for Prefabricated stainless steel crown – primary tooth. CDT codes are used by the dentists for insurance claims and help them achieve:
- Treatment accuracy in the electronic health records
However, there are some dental procedures that are covered under medical insurance. For instance:
- Oral or dental procedures that are a result of any traumatic injury to the mouth
- Oral inflammation or infection’s emergency treatment
- Radiographs for certain diagnostic purposes or screening purposes
- Excisions and biopsies
- Any interim and final prostheses associated with surgery related to any medical condition or traumatic injury.
CDT Codes for Dental Billing Specialist 2022:
Diagnostic. Evaluations and Exams
Periodic oral evaluation – established patient
Limited oral evaluation – problem-focused
Comprehensive oral evaluation – new or established patient
Intraoral – complete series of radiographic images
Intraoral – periapical first radiographic image
Intraoral – periapical each additional film
Preventive. Dental Prophylaxis for Adults and Children
Prophylaxis – adult D1120 Prophylaxis – child
Preventive. Topical Flouride Treatment
Topical application of fluoride varnish
Topical application of fluoride, excluding varnish
Other Preventive Services. Oral Hygiene Instructions
Oral hygiene instructions
Other Preventive Services. Sealants
Sealant – per tooth
Interim caries arresting medicament application
Resin infiltration of incipient smooth surface lesions
Restorative. Resin Restorations
Preventive resin restoration
Restorative. Anterior Resin-Based Composite Restorations
Resin-based composite – one surface; anterior
Resin-based composite – two surfaces; anterior
Resin-based composite – three surfaces; anterior
Restorative. Stainless Steel Crowns
Prefabricated stainless steel crown – primary tooth
Endodontics. Retreatment of Previous Root Canal Therapy
Retreatment of previous root canal therapy – anterior
Retreatment of previous root canal therapy – bicuspid
Retreatment of previous root canal therapy – molar
Periodontics. Full Mouth Debridement
Full mouth debridement to enable comprehensive evaluation and diagnosis
Prosthodontics. Complete Dentures
Complete denture – maxillary
Complete denture – mandibular
Being up-to-date with the changes in CDT coding is crucial for proper dental Billing. According to the American Dental Association (ADA), CDT coding for 2022 comprises the following changes:
- 16 new codes
- 14 revisions
- Six deletions
This update comprises the new codes for the following:
- Pre-visit patient screenings
- Fabricating, adjusting, and repairing sleep apnea appliances
- Intra-coronal and extra-coronal splints
- Immediate partial dentures
- Rebasing hybrid prostheses
- Removal of temporary anchorage devices
- Medicament application for the prevention of caries
Outsource Dental Billing Process:
When it comes to dental services, the entire process can be divided into two phases.
- Starts from when a dental appointment for a patient is created
- Data entry
- Insurance verification
- Ends with the completion of the appointment
- Preparing the dental insurance claim starts after the completion of the appointment.
- By using the information, a dental claim is created, submitted, and then processed by the insurance provider.
- Followed by this, the claim is either approved, denied, or rejected.
- On approval, the insurance provider pays the claim, or the payment is posted via dental billing software.
- In case of a claim denial, the insurance claim must be refiled. However, if the claims are not reimbursed in a specific time period, the claims are forwarded to the patient.
In simple words, the outsource dental billing process comprises:
Step 1: Collecting insurance information of the patient
Step 2: Preparing, submitting the claim, and notifying the patient
Step 3: If necessary, refile the insurance claim
Step 4: Claim approval, denied or rejected.
Best practices for Outsource Dental Billing:
Revenue cycle and financial management play a vital role in keeping the healthcare practice afloat and profitable. Dental Billing comes with several challenges, requiring accuracy and proper insurance claim. Following are some of the best practices for proper dental Billing and financial accountability.
Getting a pre-authorization for the procedures or services being performed can save you and the patient from any challenges leading to claim denials. It also ensures whether the procedure(s) is covered or not.
Collecting co-pays of the date of service:
Remind the patients regarding their co-pay or initial payment portion beforehand. This helps the patient know their estimated payment as well as builds trust between your healthcare practice and the patient.
Accurate and organized:
Keeping the documentation organized during the insurance claim process is necessary. It helps save your time and money as well as reduces the claim denials or rejections.
Insurance payer’s requirements & rules:
There are several insurance providers out there, and every single one with its own set of requirements and rules. They require a specific type of documentation or clinical notes. In case their rules and requirements aren’t met, insurance claims can be denied or rejected. This is the reason why the insurance claim must meet those requirements.
In order to prepare and submit an accurate claim, knowing where to use the cross codes is necessary. For some dental procedures, various insurance payers have started incorporating relevant medical codes as a requirement. This is why it is crucial for a healthcare practice to know when, how and what cross codes to use.
Updates and changes in the coding:
Dental Billing comprises complex codes for billing the insurance claim. Using incorrect or outdated code can lead to the claims being denied or rejected. If your practice is having trouble keeping up with the coding changes and requirements, outsource your billing process to a dental billing company in USA.
Outsourcing dental billing services:
Dental Billing is the process of getting reimbursed for the procedures rendered by the dental practice. Handling, preparing, and submitting an insurance claim is crucial for any dental practice. Now the critical step is to decide whether to keep the billing process in-house or outsource it to the dental billing experts/company. Outsourcing dental billing services can result in several benefits for the practice. Some of the benefits of outsourcing include:
Benefits of outsourcing dental Billing:
- Dental practices can cut administrative costs like labor, benefits, training, software (purchase & maintenance), and computer equipment. For instance, with UControl Billing, you get affordable pricing, plus we only get paid when you get paid.
- Streamlines the billing process
- The dental practice can focus more on patient care.
- The outsourced team of dental billing experts is up-to-date with all codes, updates, guidelines, and insurance payers’ requirements changes.
Why UControl Billing?
UControl Billing is a result-oriented and well-reputed medical billing outsourced services company. With UControl Billing, you get:
- Competitive Pricing
- Reduced overall expenses
- Maximized reimbursements
- Uninterrupted service & stability
- Faster turnarounds
- Streamlined workflow
- Increased cash flows
Our Medical Billing Services include:
- Fee schedule review and analysis
- Eligibility verification.
- Referral, Authorization alert, Claim tracking, reduced rejections, and denials
- Patient statement processing, Mailing, Customized Monthly financial reports
- Rules-based claim review, scrubbing, Insurance follow-up.
- Helping the collection agency to recover patient balances & Always remain HIPAA Compliant
Frequently Asked Questions (FAQs)
1. What is dental billing in medical billing?
Dental Billing involves sending everything from the complete treatment procedure as a claim to the insurance carrier for reimbursements. Medical billing and dental billing both involve billing insurance claims to receive reimbursements for the services performed. However, along with some similarities, there is a significant difference between medical billing and dental billing.
2. What are common aquatic therapy CPT code errors?
Submitting a clean claim is crucial for getting reimbursed for the services or procedures performed. However, errors in medical claims can lead to claims being denied or rejected, meaning late payments or lost revenues. Common errors include:
- Use of incorrect code
- Use of incorrect modifiers
- Inaccurate or incomplete documentation
- Late submissions
3. How do you prevent aquatic therapy CPT code errors?
When you outsource dental billing services to a well-reputed outsourced medical billing services company can lead to:
- Lesser errors
- Higher reimbursement rate
- Lesser expenses
- A team of highly professional medical billing
- More focus on patient care
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.