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Day: November 6, 2022

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Billing for dental services and billing for medical services are two different things that have different steps, codes, and rules.

There are some similarities between dentistry and medicine, but there are also significant differences that dentists and doctors must be aware of.

The types of procedures covered are among the most significant differences between dental and medical billing.

Billing for dental services usually includes cleanings, fillings, extractions, and orthodontic work. On the other hand, billing for medical services can include things like surgeries, lab tests, and prescription medications.

This means that you can’t switch between dental billing and medical billing codes, and you have to use them correctly for claims to be processed correctly.

The way insurance is handled is another big difference between dental and medical billing.

Dental insurance is usually separate from medical insurance, and the coverage and benefits can differ.

For example, dental insurance may not cover procedures like cosmetic dentistry, and medical insurance may not cover alternative treatments like acupuncture.

Dentists and doctors need to know how their patients’ insurance works to ensure they are billing them correctly.

One important thing to remember is that different agencies control dental and medical billing.

Most of the time, state dental boards are in charge of dental billing, while federal agencies are in charge of medical billing.

This means dental offices and medical facilities need to know the rules that apply to their fields to ensure they follow them.

Systems for dental billing and systems for medical billing are also very different regarding technology use.

Dental billing software is made to handle the unique procedures and codes used in dental offices.

In contrast, medical billing software is made to handle a broader range of procedures and codes used in medical facilities.

This means that dental offices and medical facilities need to use special software to ensure that their billing processes are as quick and accurate as possible.

Conclusion

Billing for dental services and billing for medical services are two different things that have different steps, codes, and rules.

Even though they are similar in some ways, dental practices and medical facilities need to be aware of the differences to ensure that their billing processes are as quick and accurate as possible.

To do this, you need to know the rules, codes, and insurance coverage for dental and medical billing and how to use the right software for each field.

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Dropping network participation is often considered an overwhelming task by many dentists due to the fear of losing customers or money. In 2019, around 80% of Americans had a dental plan. In 1994, the figure was a meager 43%. The growth of dental benefits drastically changed the landscape of the practice, bringing in a massive inflow of providers into dental networks to attract and retain insured patients.

On average, providers are part of 8+ dental networks, and nearly half are affiliated with 11+ networks. Simply put, it is no longer a new thing to be a participating provider since participation only improves the playing field.

How to Drop Network Participation in Dentistry?

Dentists drop dental participation to increase revenue. However, transitioning away from heavy insurance participation may seem daunting. The following 4 factors will help you gather the relevant data and speed up the process.

Collect Contract information for all your in-network plans

This step is crucial and will involve scrutinizing each plan, its updated fee schedule, and the possibility of renegotiating the fees. It is also essential to know when the contract will be renewed and the notice period required (some require a six-month notice) before the network can be left.  

Know your Active Patient Count

Before knowing how the transition will affect your practice, it is critical to know the active patient count. This includes all the patients who have visited your office in the last one and a half years. Once you have calculated your active patient count, determine how many participate with each insurance plan. This will help you understand the potential attrition you could lose with a network change.

Know your Cancellation Rate

Sometimes, dentists drop one or more insurance contracts because their schedules seem “overbooked.” Keep in mind that many offices experience high cancellation rates, which can disguise an underlying schedule issue by filling it with appointments that might get canceled. The ideal hygiene cancellation rate is 8% or lower, translating to less than one patient per column per day. Moreover, doctor cancellations should lie below 1%. For example, if your cancellation rate is 11%, take appropriate measures to reduce or make room for extra patients to compensate for the canceled appointments.

Assessing cancellation rates is integral as it will help you see if you are overbooked with many patients or if you have a masked cancellation issue that will probably worsen if you drop networks.

Meet Patient Expectations

Irrespective of your fees, patients inherently see you as an expensive option when you are out of fees for service or network. Some patients will be willing to pay more, but it typically comes with the expectation that your service will be exceptional compared to the dentist down the block who is in-network.

If your existing service is already top-tier, or if you are willing to go the extra mile to improve the level of provided care, then dropping networks may be a good solution.

Conclusion

Dropping network participation in dentistry is viable, provided that it is done for the right reasons, such as those mentioned above.

Additional Sources:

https://www.actdental.com/blog/the-5-things-to-know-before-you-drop-a-dental-insurance-ppo

https://www.dentistryiq.com/practice-management/insurance/article/14181287/how-dentists-can-successfully-drop-ppos

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Plan to switch to a different dental billing service?

Before making a choice, one must know the 20 most common mistakes people make when picking a dental billing service.

In the long run, you can save time, money, and stress by researching and avoiding these common mistakes.

Please continue reading to learn about these errors and how to avoid them.

  1. Not Doing Your Research

Check the company’s history and past clients before hiring them. Read reviews and ask in forums about dental billing. Think about price, quality assurance, and customer service.

See what services are available by comparing them. Do they specialize in billing on your practice management software? Is  there a long contract? How fast can they begin? Next, ask other dentists who have used a service what they thought about it. 

  1. Not Knowing What You Need

When choosing a dental billing service, knowing what you need is essential. Assistance with claims? Patient billing? Insurance verifications? Which services are right for your organization will depend on your practice size and office staff capabilities. Compare service providers to find the best match.

  1. Not Looking For A Company That Is HIPAA Compliant

Ask the dental billing service if they follow HIPAA and for proof that they are certified. HIPAA-compliant services must use the most up-to-date security methods to protect patient information, set up procedures for dealing with data breaches, and educate their staff every year.

  1. Not Getting Quotes From Multiple Companies

Get quotes from companies to find your business’s best prices and services. Check the services and prices of each quote. This will help you choose a billing service. Finally, when comparing estimates for dental billing services, you should look at the expertise and customer service.

  1. Not Asking For Referrals

Referrals could help you choose the right dental billing solution for your business. Ask other dentists who have used the services you’re considering if they’d recommend them. They can tell you what they liked and didn’t like about a company and how well it did in accuracy, customer service, and other vital areas.

  1. Not Reading The Reviews

Customer reviews could show what a company sells. In addition, customer service, job quality, and experience should be reviewed. Both good and bad reviews help you decide on a company. Reviews from Google, Yelp, and the BBB can be trusted. Look into the company you’re considering to make a good choice.

  1. Not Understanding The Contract

Misreading the contract is a typical error when picking a dental billing service. Before signing any document, please read it carefully since certain billing services may have hidden fees or other stipulations. Not having a backup plan could leave you without the support you really need for an extended period of time. 

Some billing companies have long term contracts, hefty sign on fees, or require you to purchase expensive equipment. 

  1. Not Staying Current With Dental Billing News

Follow dental billing news to know what’s going on in the field. When you read news and industry magazines, you learn about changes in the law, new technologies, and industry trends. You can also learn if the billing company in question was recently acquired which may not be a good sign as transitions for service-based businesses can be turbulent. 

  1. Not Being Organized

Organize your information before you choose a dental billing company. Prepare questions to ask potential billing companies before you meet with them. Ask about the tools they have for keeping track of payments and denials, best form of communication, their guarantees, reporting, etc. If you have stacks of EOBs in your office that have not been handled…or you’re not sure if they’ve been handled…scan them into a PDF file. Let the billing company know how many pages needs to be sorted through.

  1. Not Taking Advantage Of Technology

Find a billing service for dentists that uses electronic billing and integrates data. This will make it easier to manage accounts and speed up operations.

  1. Not Monitoring Your Statements

Make sure your monthly statements are correct. You should contact your billing managers immediately if the figures seem incorrect. Your reporting should show the lengths your billing company took for the day/week/month/year to collect all outstanding balances for your practice as well as the status of your accounts receivable. 

  1. Not Knowing Your Insurance Contracts

Know the basics of your insurance contracts if you are participating as an in-network provider. For example, you may have to ensure that your billing service will be following up on outstanding claims in a timely manner so you do not surpass the timely filing limitations of the plan. Some insurances require claim submission within 90 days, others require one year from date of service. The insurance carrier may also disallow payment for certain procedures done together. 

  1. Not Knowing When To Outsource

Find someone who knows about billing and can navigate through your software. Billing companies may offer a free discovery session to show you the pain points and how much money is really being left on the table. If turnover in your practice is holding your collections back, it’s time to outsource. They should be able to  give up-to-date advice and provide solutions.

You might save time and money by outsourcing dental billing, but you must make the right choice for your business. If your front office rockstar is overwhelmed with keeping the schedule full, answering phone calls, checking patients in and out, verifying insurance, and keeping the office running smoothly, there may be little time & energy left for the tedious task of billing. It’s time to outsource. 

So before you hire a billing company, think about what you need.

  1. Not Considering All Your Options

Compare the features and prices of companies. You should also think about training, customer support, and software connections. Check out each choice to see which one works best for your practice.

  1. Not Budgeting For Dental Billing Services

Dental offices often need help making ends meet if they require the help of a billing service. Count the costs and determine if the benefits of collecting outstanding balances and taking a load off your front office team outweighs the cost of the service. Billing services for dentists take care of insurance claims, follow up on claims that were denied or unpaid, and bill and collect from patients. 

  1.  Not Being Proactive

Your practice could have profitability problems if in-house billing takes a large amount of time. If not done correctly, claims could be denied unnecessarily because of missing information. Begin the process of finding a billing company sooner rather than later.

  1.  Not Following Up

By staying on top of billing problems and quickly and correctly processing claims, your practice may reduce the chance that claims will be rejected or those reimbursements will be late, improving its financial health. Your billing company can solve most issues, but you will likely need to respond to follow up requests for larger issues.

  1. Not Being Patient

When dealing with billing issues, not being patient can lead to frustration and make it hard to solve problems systematically. In addition, the billing process can be complicated and take a lot of time, and it may take a while to fix or overturn denials.

  1. Not Having A Backup Plan

If your leading billing service does not meet your expectations, you can still run your practice with a backup plan. A backup vendor may help. A backup plan can also give you peace of mind that your accounts receivable will remain healthy and your collections will still come on time..

  1. Not Having A Good Relationship With Your Dental Billing Service

Hiring a dental billing company means real people are working on your accounts. Having a level of respect and trust for your dedicated billing team will encourage them to do everything possible to keep you satisfied with their services. It’s important to keep the lines of communication open with your billing company.

Questions on how Versa Solutions can help your individual dental practice or DSO? Contact us today for a demo on our services.

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When selecting a dentist, there are many considerations, such as what school did the dentist attend? Have they had a solid reputation? How far is the office from my house? And most importantly, do they accept my dental insurance?

Insurance corporations have conditioned us to think that we can only see doctors who accept our insurance, also known as “in-network providers.” What does that imply, though? The distinction between in-network and out-of-network dental providers will be briefly explained in this article in plain terms that everyone can comprehend.

A network is a collection of healthcare organizations. A provider accepts a negotiated cost for services rendered to the member when an insurance company partners with that provider. A provider who is in-network is one like this. On the other hand, when a service provider doesn’t work with your insurance carrier, your insurer is forced to pay the total cost of their services, increasing both your costs and theirs. An out-of-network provider is one like this.

In-Network VS Out-of-Network Dentistry: Which is Better?

Most customers think that going to an in-network dentist gives them free visits. Said this is untrue! Every insurance policy has specific guidelines or restrictions that apply to its coverage. For instance, some people operate on a charge schedule, meaning they will only pay a portion of a service. Others offer yearly benefits, which means they give you a predetermined cap on how much they will contribute to your dental treatment in a calendar year.

Some have deductibles that must be fulfilled before the insurance provider would pay, and the majority only cover preventative visits. Before enrolling in dental insurance, always read the fine print and ask questions to know what will be covered.

Additionally, by employing scare tactics, insurance providers terrify customers into believing that out-of-network providers are “bad” and more expensive. On their websites, they employ phrases like “avoid paying large out-of-pocket expenditures” and “beware of out-of-network providers.” They fail to mention that even with insurance, out-of-pocket expenses will still apply and that your treatment may be denied or reduced by your insurance provider.

Does this imply that the cost of using an out-of-network service will be higher? This depends, as everything relies on your insurance policy, the care you require, and the conditions established by the insurance provider regarding which treatments they will cover and when. When visiting an out-of-network provider, there may often be an out-of-pocket cost for preventative checkups like cleanings and exams. Contrary to what insurance companies claim, it is typically not a significant sum, and the cost is justified by the long wait times and higher-quality service received.

What is the final verdict, then? As usual, you must put your health and well-being first. However, it is always good to know that you are NOT compelled to see only those inside your insurance company’s network and that you can choose any dental professional. Whether a practice is in-network or out-of-network, you can only go right if you pick one where you feel safe and well-cared for.

Conclusion

The debate about whether in-network dentistry is better or out-of-network, however, totally depends on one’s preferences and how one wishes to be treated. Additionally, each insurance company offers a different set of facilities and benefits, so based on the benefits one provides, their choice can also vary.

Sources:

https://www.metlife.com/stories/benefits/in-network-vs-out-of-network/

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Some new insurance updates that affect claims submission, EOB management, and payment reconciliation have come to light. To help you navigate this new dimension, we bring you key updates you should know about. This will help you make informed decisions with your claims and act quickly where necessary. 

We’ve highlighted some important information for you below. 

Catch Up on Insurance Updates

As of January 1, 2023, Avesis stopped being the administrator of dental benefits for Molina Healthcare of Illinois Medicaid plan and Molina Dual Options Medicare-Medicaid plan in Illinois. However, Avesis will still process all eligible claims with dates of service on or before December 31, 2022. 

You must note the important filing dates and their deadline to ensure you stay compliant. 

Molina Healthcare of Illinois Medicaid plan Deadlines

  • File and correct an initial claim 180 days from date of service
  • Correct a claim 90 days from the last EOB date after the timely filing limit has expired
  • Appeal a claim 90 days from last EOB date
  • Submit a claim with primary EOB 90 days from date of primary payer’s remittance advice

Molina Dual Options Medicare-Medicaid plan in Illinois

  • File and correct an initial claim 365 days from date of service
  • Correct a claim 90 days from the last EOB date after the timely filing limit has expired
  • Appeal a claim 30 days from last EOB date
  • Submit a claim with primary EOB 90 days from date of primary payer’s remittance advice

When billing Avesis for claims with a DOS before December 31, 2022, you can file claims through the following three formats.

  • The first format is going through Avesis secure web portal. Proceed to the portal and follow the prompts to bill Avesis. 
  • Clearinghouses: Avesis has three clearinghouses through which you can file your claim. These include Change Healthcare (Payer ID: 86098) (1-888-255-7293), DentalXChange (Payer ID: 86098) (1-800-576-6412), Tesia (Payer ID: 86098) (1-800-724-7240)
  • The final option is sending a completed paper ADA claim to:

Avesis Third Party Administrators, Inc. 

ATTN: Dental Claims

PO Box 38300

Phoenix, AZ 85069-8300

2023 Changes Avesis Billing

Starting in January 2023, you will need to use Payer ID AVS02 (dental) to avoid claim rejections and payment delays. Your billing team at Versa Solutions will make the necessary changes in your software for clean claims submission.

Speak With Our Professionals

With new updates concerning insurance and billing, we understand you may have concerns and questions you need answers to. At Versa Solutions, we’re always available to take your questions and provide you with practical answers that help solve your dental billing needs. 

Our goal remains to help you create a predictable cash flow so that you can focus on offering premium dental care without worrying about your A/R. We’ll help you navigate your billing systems to ensure you don’t miss out on cash flow. 

You can always reach out to us for any billing questions you have. We’re always happy to help!

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