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Improving Medical Insurance Reimbursement Ratio of Your Dental Medical Billing for Sustained Profitability

December 19, 2013

Dental medicine is often seen as a highly profitable healthcare stream with guaranteed long term returns. However, what most people fail to understand is the amount of complex planning and execution that goes into acquiring and maintaining that sustained level of profitability. Dental reimbursement rates are generally poorer than medical reimbursement rates. Given that, ensuring continual claim settlement and reduced claim rejection requires a dental medical practitioner to focus on final details of dental billing. Whether your Dental Medical Billing Services is in-house or outsourced, there are certain steps that you can take to ensure improved medical insurance reimbursement ratio –

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  • Step 1 – Adopt dental cross coding – Many dental procedures can be cross coded medically and your practice can derive higher profitability in terms of claim settlement. Cross coding predominantly requires knowledge of medical codes which can be billed for dental procedures. In addition, dental cross coding also requires your billing process to adhere to regulations and documentation requirements of insurance providers. Although most dental practitioners are hesitant of adopting cross coding due to fear of errors, once ingrained in the billing system, this can translate into better reimbursement ratio as well as heightened profitability.
  • Step 2 – Billing for bundled services- Bundling of services in dental medicine is common practice as tooth and gum related disorders are usually correlated. However, bundling of services usually indicate a lot of red flags for insurance carriers and cross verification or claim denials happen quite frequently. Therefore, to ensure better medical reimbursement rate as well as avoid leaving your money stuck in the process; you must train your medical staff or hire a billing expert who can handle bundling of services efficiently. This is not only the most profitable component of your revenue stream, but also has potential of long term profitability.
  • Step 3 – Mandatory pre-authorization– Many employers offer dental benefits in addition to other health benefits to retain and acquire employees. Most patients in your payer mix would be accessing your dental services only when they are being covered by a third party payer. However, all insurance carriers or employers do not follow same documentation procedure or billing procedures. Therefore, preauthorization at the time of patient walk-in becomes a crucial step in defining your dental clinic profitability.
  • Step 4 – Monitor claim denials and reduce root cause – The reason for repeat denials is that many dental practitioners remain clueless about the reason of claim rejection and continue to make same mistakes in their dental billing processes. Monitoring and rectifying billing errors require iterative process checks. Your billing staff must be trained to generate regular audit reports which can assist you in scrutinizing and addressing billing anomalies in your existing system.

Medicalbillersandcoders.com is a dental billing service provider that offers services of dental medicine experts and billing professionals who analyze your payer mix and help you in attaining sustainable profitability by improving processes. When we handle your billing requirements and processes, you can focus on qualitative care and let the financial health of your dental clinic blossom under our careful administration.


Category : Revenue Cycle Management