Dental insurance billing and how it differs from medical insurance billing. The same principles apply to dental billing insurance as with medical billing. However different forms and procedure codes are used.
Similar to medical billing, dental requires a familiarity with dental terminology. Coding for dental uses the Current Dental Terminology (CDT) maintained by the American Dental Association (ADA) and updated periodically. Dental insurance claims are submitted on an ADA accepted dental claim form, the latest version of which is the J430D dated 2012. It has been revised to incorporate changes required for HIPAA for electronic dental claims. Here’s the instructions from the ADA website.
Diagnosis codes for dental insurance claims are assigned from the appropriate ICD-9 (or ICD-10) codes similar to medical claims. As with medical practices, dental practices must also comply with HIPAA privacy and security standards to protect patient protected health information.
The American Dental Coders Association offers certification – Certified Dental Coder (CDC) for dental billing and coding professionals.
Benefit Programs
Dental insurance benefits are available as either managed care or fee-for-service. The managed care may include Capitation plans or PPO plans, Capitation plans are dental health management organization (DHMO) plans. These pay the dental provider a monthly for each patient covered by the plan. The PPO plan bases reimbursement on a predetermined fee schedule.
Dental Claims
A large number of dental insurance claims are still submitted on paper – up to 60% by some accounts. One of the reasons for this is because many practices do not have an electronic means of sending the required attachments, such as radio-graphs or periodontal charting for certain dental procedures.
Some dental practice management software programs allow digital images to be sent with the electronic claim. These images have to be scanned for each attachment adding to the effort involved in submitting an electronic claim. The scanned attachments are posted to a Web site, where the third-party carrier retrieves the image for review with the dental insurance claim. A clearinghouses or attachment vendors that performs this service charges a fee in addition to claim processing.
Depending on the number of claims an office submits, the charge per transaction is less than the cost of mailing the claims. Some third-party carriers allow dentists to submit their electronic claims directly to them. This is more efficient and reduces processing costs. The benefit to electronic dental insurance claims is they can be tracked from submission through processing and reimbursement.
Just as with medical practice management systems, there are both PC or server based and online or web based practice management systems for dental insurance billing. Electronic claims that are submitted electronically must be in accordance with HIPAA standard ASC X12N 837.
Dental Billing Software
Dental practice management software is similar to medical billing software. Just like medical practice management software programs there are a variety of options available. The cost can range from several hundred dollars and up. For example AltaPoint offers Standard Dental starting at $295 for the Standard version to $995 for the Professional version.
When I first started my medical billing company, we purchased PractiSoft Dental insurance billing software. My intent was to to after dental clients as well as physicians. From my research and limited experience with PractiSoft, it certainly seems like a capable software.
I’m not endorsing the above software, just sharing my limited experience in dental insurance billing. If you are considering purchasing dental practice management software, Google them and download their demo before buying.
Dental Needs Billers Also
Due to the high number of paper claims still submitted by dental providers, and the shear number of dentists, there is an opportunity for a billing specialist to learn the specifics of dental insurance billing. For medical billing services, dental providers seem to be more reluctant to outsource their billing than medical providers. This is most likely due to the complexity of adding attachments to the claims. However for a medical billing specialist with a demonstrated knowledge and proven track record, they could be convinced given the opportunity.