How Dental Providers Can Overcome Billing Challenges

Robert Patrick


As drastic electronic overhauls revolutionize dental practices, improving the way that dentists record and track patient health remains a primary challenge for managing their billing processes. Getting paid is another.   

Bill collecting has never been easy. According to the United States Consumer Financial Protection Bureau, 52% of collection services originate from unpaid medical bills. About 43 million people have outstanding medical bills, indicating the challenge that a practice faces when trying to collect from its patients. Medical and dental billing can be a complicated process, but these challenges can be overcome.  

Collecting Full Copays

Copays are down payment for services provided by caregivers. If providers don’t get the full amount up front, they may struggle to get the rest of the patient’s portion. Studies show that the chance of collecting from a patient drops almost 20% as soon as the patient leaves the office. 

Losses can be avoided by requiring front desk staff to be clear about the practice’s policy for collection upfront and asking for a credit card to cover patient copays at check-in before the appointment. Amounts not covered by insurance may require an additional down payment on top of the deductible, too. 

Collecting payments and copays at the time of service is best for the patients and the practice. A large bill after a procedure can be overwhelming and usually is more difficult to pay. In physicians’ offices and dental practices alike, collecting copays before providing services is the way a thriving business continues to grow.

Writing off uncollected copays is not a viable solution because most dental practices can’t afford to do so. In a typical office with two doctors and one assistant, assuming an average copay is $25, if each clinician sees 12 patients, that’s $900 in copays requiring collection per day. The practice in this example open 200 days a year, meaning a total possible copay collection of $180,000 for the year. 

Auto-Checking Insurance Coverage

Every patient’s coverage should be checked before they walk in the door. Practice administrators must make an effort to verify coverage before services are provided. While this can add to administrative tasks for the team, taking such steps can substantially prevent revenue loss and billing issues later on.

Approving Procedures That Aren’t Covered or That Require Pre-Authorization

Prior to performing a high-cost procedure, the provider should know what the patient’s plan covers to determine if there is something that patient must cover out of pocket. Many patients are unable to cover the cost of their portion of the procedure.

Likewise, some patients may think a procedure is fully covered by insurance, but instead they are responsible for the uncovered portion. Knowing this gives you the opportunity to prepare patients and offer a payment plan for procedures.

According to the Medical Group Management Association, 94% of medical practices offer payment plans to their patients, but only 25% offer the plan at the time of service. About 45% of practices offer payment plans as a last effort before a bill goes to collection. Most dental practices operate similarly. Payment plans can ensure treatment gets done and the patient can manage affordable payment terms. 

Staying Informed About Coding Changes 

Dental coding expert Teresa Duncan, founder of Odyssey Management, frequently speaks to audiences about dental coding changes. One of the things she points out is that materials and technology used in dentistry for procedures and implants are constantly changing.

As new materials and procedures arise, so does the need for the coding to support them. Additionally, annual coding updates issued every year can keep even the most experienced practice managers on their toes. Codes often are changed for clarity or to define newly added areas of treatment coverage, such as conditions like sleep apnea. 

Each practice must review and note the changes for codes most often used and evaluate how its billing will be affected. And because of the copious number of regular changes, billing managers must self-educate to ensure they are billing procedures appropriately.  

Other Billing Challenges 

Billing challenges loom large. We’ve only covered a few here. There are other cumbersome hurdles to jump too:

  • Time Constraints: A bustling practice with limited administrative support creates a potential problem, especially where manual processes support billing. Automation will serve the practice well, and services like electronic attachments can improve claim adjudication times without the need for additional support staff. 
  • Detailed Claims Processing Guidelines: Adherence to strict processing guidelines established by insurance companies and government agencies is required. Failure to comply means rejected claims, among other possible punishments. Managing processing guidelines can improve a practice’s billing cycle.
  • Lack of Support Solutions: Kicked back claims most likely require supporting documentation. If this is the case, there’s no reason to print and ship materials to the payer. As previously discussed, automate this with a secure electronic claim attachment solution. Documents can be submitted electronically with a tracked delivery number for payers to retrieve as they work to process the claim. Less paperwork and fewer phone calls trying to track down claims mean quicker reimbursement and fewer headaches.

Billing challenges will always remain, but many of them can be overcome. For billing challenges related to payer processes, diligence on your part is required, as much of that is out of your hands. However, you can address shortcomings in your administrative processes by implementing systems that utilize technology and automation.

And, as Duncan says, stay informed about code changes. If you need more information about the coding changes and updates, you can view Duncan’s free webinar “The 2019 Coding Update” courtesy of NEA Powered by Vyne here. The session covers coding 15 additions, five revisions, and four deletions, all of which went into effect on January 1, 2019. You may also register for Duncan’s upcoming 2020 Dental Coding Update webinar slated for January 7, 2020, here.

Mr. Patrick is Vyne’s president of dental. He has served the dental industry for more than 20 years and has authored numerous pieces for most of the sector’s leading publications on a number of its most pressing current practice administration topics.

Related Articles

Beef Up Your Practice’s Email Security

10 Common Mistakes Dental Practices Make and How to Fix Them

Making Room for Traditional Practices Among DSOs