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In 2025, several changes were made that will affect endodontic insurance billing. Here's what you need to know:
Medicare Coverage Updates:
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As noted in our last blog about contract conflicts, many aspects of dental insurance contracts heavily benefit the insurance carrier at the expense of the doctor. If an insurance carrier’s low reimbursement rates fail to cover the cost of operation, dentists can reasonably refuse to contract with that specific carrier. The ADA provides information on understanding and weighing the value of insurance contracts in a guide called What Every Dentist Should Know Before Signing a Dental Provider Contract.
Unfortunately, opting out of major insurance networks can affect patients’ access to care, and potentially reduce a dentist’s overall patient load. On the other hand, when dentists decline exploitive insurance contracts, it puts pressure on insurance companies to provide mutually beneficial contracts. Carriers cannot sustain unprofitable contracts if no dentists accept them. That’s why dental practices must carefully consider the terms of each contract before agreeing to them. Where We Come In We can make addressing insurance policies and profitability simple by:
With this service in place, our clients naturally comply with their contracts, avoiding fraud through ignorance or intention. Additionally, we help our clients understand their contracts and weigh the benefits and drawbacks associated with each plan, so they can make informed decisions about which plans to accept. By teaming up with us, our clients gain insight into the complicated and ever-changing world of dental billing, take the burden of dental billing off of the staff’s shoulders, and confidently comply with dental billing contract law. Give us a call to learn more about navigating insurance contracts. At SB Dental Solutions, we help our clients understand and accomplish all aspects of the dental billing process. Perhaps the most complicated piece of the dental billing puzzle comes from dental insurance contracts. These contracts are legally binding documents that often differ from plan to plan and usually contain complex jargon and legalese. Dental practices must comply with the contract to the letter, but unfortunately, many don’t fully understand the requirements of their provider contract. Take these three common contract conflicts, for example:
Billing Patients Your Standard Fees, Not Contracted Fees One of the fundamental terms of most insurance contracts stipulates that the provider must accept the insurance company’s fees. Discounted fees constitute a major portion of the insured patient’s benefit. The dentist may only charge for the allowed copay or percentage. Any difference between the dentist’s standard fee and the allowable amount must be written off, as stipulated by the insurance agreement. Skipping the Insurance Altogether A contracted provider must, by law, bill the patient’s insurance. Patients generally benefit from this, even for noncovered services, because (as detailed above) insurance plans provide discounted fees. Furthermore, a carrier’s contract with the insured entitles patients to specific benefits and obligates the insurance company to provide those benefits. Failure to submit correct claims prevents the carrier from upholding their legal responsibility to your patient. And finally, practices need to code thoroughly to ensure that the patient’s records (both the ones kept by their dental provider and by their insurance carrier) accurately reflect treatment rendered. If providers fail to bill for services, they have committed fraud and can be prosecuted. Charging Patients for Down-Coded Procedures Down-coding (or remapping) occurs when the insurance plan covers a lower-cost alternative procedure, rather than the procedure the provider billed. If their contract includes a LEAT (or Least Expensive Alternative Treatment) clause, then they are within their rights to down code. For example, many insurance companies cover white (composite) fillings at the rate of cheaper metallic (amalgam) fillings. Simply put, they do this because they can, and it saves money. Some (but not all) insurance plans have clauses that specifically prohibit billing patients the difference for down-coded procedures. We help our clients navigate these concerns and more with our comprehensive billing solution. Give us a call to learn more. At SB Dental Solutions, our expert staff consistently helps clients reach new levels of productivity and success. We take pride in delivering a range of dental billing benefits, including the following:
1. More Accurate Billing Dental billing can be complex and time-consuming, often reducing practice efficiency when staff members have to spend valuable time correcting errors. Navigating the intricacies of various insurance companies and hundreds of dental codes can overwhelm even the most experienced professionals. Plus, dental billing regulations continue to grow more complicated every year. From submitting claims to estimating patient portions, our specialized dental billing professionals bring precision and efficiency to every step, ensuring a more accurate process. 2. Preventing Burnout Burnout is a significant challenge for thriving dental practices. When overwhelmed by billing tasks, team members are more prone to mistakes, which can result in lost revenue and high staff turnover. At SB Dental Solutions, we alleviate the burden of dental billing, allowing your team to focus on what matters most: patient care. By improving billing accuracy and reducing administrative strain, we help protect your practice from the costly effects of burnout. 3. Streamlined Cashflow Inefficient billing practices can lead to cashflow bottlenecks that strain a business. Our team at SB Dental Solutions employs robust billing administration strategies, leading to faster, more efficient processes than in-house billing can often provide. With increased claim accuracy, timely denial escalations, improved patient portion estimates, and a smoother reimbursement process, outsourcing your billing gives your practice greater control over its financial success. 4. Simplifying Insurance Billing Many dental professionals assume that medical insurance rarely covers dental procedures. However, health insurance plans increasingly cover dental, surgical, and endodontic treatments. With medical insurance now encompassing more dental services than ever, there’s never been a better time to explore this profitable, patient-friendly option. At SB Dental Solutions, we simplify the process of integrating medical insurance billing into your practice with minimal effort required from your staff. Ready to optimize your dental billing process? Contact us today to learn how we can help. Dental insurance verification can pose a problem for many dental offices. One practice reported that their receptionists regularly spent well over half of the day simply checking eligibility for their patients. Those hours could be spent much more lucratively by scheduling appointments and catering to the needs of patients. Instead, the staff would tie up the phone lines by waiting on hold to confirm benefits for patients one at a time.
Meanwhile, another practice chose to forgo verifications and simply take patient’s insurance cards and ID numbers. This practice saw a huge increase in denied claims and unexpected patient bills. Patients hated getting high bills months after treatment and accused the office of cheating them. Sometimes patients took weeks or months to get back in contact about the balance and report their new, more accurate insurance information, further delaying payment while the office resubmitted claims. Often, the upset patients never responded to collection attempts, which cost the office a good deal in uncollectible revenue. Yes, checking insurance makes a big difference financially. Verifying insurance helps dental practices ensure proper reimbursement and avoid unpaid patient balances. Seeing patients without verifying benefits runs the risk that insurance will deny claims due to an expired or ineligible plan. This frustrates patients and delays payment for completed dental work. On the other hand, verifying insurance for every patient takes time and effort. Practices that accept a wide variety of dental insurance plans will find that each insurer requires extensive information to set up an online account, and that online verification systems experience frequent bugs. If online systems aren’t an option, dental staff might spend hours of precious time on hold while trying to reach an insurer and verify benefits. Many practice management software options claim to offer automatic verifications, but they usually fail to deliver, either because they do not provide sufficient benefit details or because the system cannot communicate with the dental insurance companies at all. With all of these obstacles facing dental practices, how can dentists get the benefit information they need without wasting their staff’s time and resources? SB Dental Solutions Dental Billing Company has the answer. With our comprehensive dental billing solution, we verify active insurance coverage for your patients and provide a breakdown of benefits as often as necessary. We can save your staff many hours of work by taking on the tedious task of interfacing with dental insurance companies. Give us a call to find out more, or sign up! When patients have treatment planned during their consultations but don’t get their treatment done, it causes many problems in a dental practice, from worsening treatment results to limiting production opportunities for the dentist. Increasing patient acceptance ratios (the percentage of total treatments prescribed compared to the number completed) not only improves patient outcomes but also makes it easier to maintain a full schedule — and a profitable dental practice.
Three Major Reasons Why Patients Don’t Follow-Through
Improving Patient Follow-Through Provide Comprehensive Treatment Explanations Choose effective language when counseling patients. Use terms patients can relate to, and emphasize the risks associated with postponing treatment. Encourage the dental staff to take their time when discussing patient concerns. Talk nervous patients through the entire treatment process, and always give openings for patients to ask their own questions. Follow Up with Patients Proactively contacting patients helps them understand the importance of the treatment and shows that the dentist really cares. Additionally, reaching out to unscheduled patients demonstrates reliability and professionalism, increasing their confidence in the care they’ll receive. Additionally, following-up on unscheduled treatment can help fill gaps in the dentist’s schedule, improving efficiency and revenue. Offer Financing Options Endodontic treatment can cost a pretty penny, which can cause financial difficulty. But with managing dental insurance companies, dental claims, patient statements, and offering in-house financing can feel like too much work for a dental practice. But they don't have to figure out financing options alone! SB Dental Solutions will bill patient portions, manage patient payment installments, and offer additional repayment options. These options often enable patients to complete otherwise cost-prohibitive procedures, which benefits both the patient and the dentist. The American Dental Association gives specific definitions for various procedures, which dentists must follow when billing dental procedures. One of the most narrowly defined procedures is a core buildup. The circumstances in which dentists are allowed to report core buildups are laid out in great detail here but can be summarized into three major categories.
Red Light Non-negotiable billing errors that could trigger an audit or nullify your contract with an insurer in addition to non-payment include:
Yellow Light Practices which insurance companies may not cover or may require additional justification such as:
Green Light Dental Billing Best Practices to Ensure Reimbursement:
If the above guidelines seem confusing, our specialized endodontic dental billing professionals can help. Give SB Dental Billing Solutions a call to find out more. Making dentistry more environmentally friendly can be as easy as choosing one brand of disposable cups over another. Patients appreciate efforts to protect the environment, and less waste often results in saving money. In fact, eco-friendly practices can even increase overall profit for a dental office. At SB Dental Solutions Dental Billing Company, we would like to assist our clients in running efficient, effective, and ethical practices, and as such, the following sustainable choices could offer a great start:
Give Out Bamboo Brushes Americans discard about one billion plastic toothbrushes worldwide per year. While plastic toothbrushes offer an inexpensive, waterproof, antimicrobial tool for home dental hygiene, plastic pollution also poses a serious threat to the environment. Once discarded, plastic doesn’t biodegrade over time but continues to clog up our landfills, cities, and waterways. A low-cost alternative to plastic, bamboo toothbrushes are tooth-healthy and eco-friendly. Bamboo offers a sturdy, affordable, sustainable material that’s already found in green products from toilet tissue to t-shirts – and now biodegradable toothbrushes. Reduce Single-Use Plastics Purchase reusable, stainless-steel prophy heads, which can be sterilized and reused, instead of disposable ones. Paying more upfront for high-quality reusable supplies instead of regularly replacing cheap single-use attachments, eventually pays for itself. Similarly, always use stainless-steel surgical and endodontic suction tips rather than plastic. Dentists may also switch to recycled and/or recyclable paper products including patient bibs, surgical masks, and disposable cups. Prevent Pollution Install secondary filters within your pump and drainage systems to stop heavy metal particles from entering wastewater. These filters reduce about 68% of toxic runoff and can even be used to recover and recycle dental amalgam. In addition to reducing waste and pollution, using recaptured material also decreases the costs, saving dental offices a good deal of money over time. For additional cost-effective dental billing and practice tips, call SB Dental Solutions Dental Billing Company today. Successful Practices Empower their Employees
From hygienists to receptionists, a dental practice only works when every staff member feels empowered to succeed. Sadly, when it comes to dental billing, many otherwise effective dental teams fall behind. Companies that manage dental billing the old-fashioned way, with in-house employees juggling everything from credentialing to accounts receivable, quickly suffer from inefficiency and staff burnout. When team members feel overwhelmed, errors start showing up, and dentists lose revenue due to avoidable dental claims denials, lapsed filing periods, and missing or incorrect information. Dental Billing Burnout Burnout is a state of chronic emotional and physical exhaustion due to work-related stressors. Studies indicate that dental professionals and auxiliaries suffer from astronomically high rates of burnout compared to similar workplaces. According to one study from the Oral and Dental Research Institute, some of the main contributors to burnout in the dental industry are: 1. A heavy workload 2. A lack of support 3. A lack of resources By nature, dentistry requires a fast-paced, heavy workload. Moreover, most dental practices rely on revenue from many different dental insurance companies and patient payers. Because of the complexity of dental billing, each new dental patient exponentially increases the staff's total workload. That leaves booming dental offices only two options: fall behind and risk burnout or take some of the extra work off the team's shoulders. Set Your Staff Free Fortunately, SB Dental Solution Dental Billing can free teams from the burden of dental billing while improving their accuracy and efficiency. Our clients spend less time and energy fighting dental insurance companies, so they can spend more time on what really matters: caring for their patients. Empower your staff to serve more patients with less stress. After all, a thriving dental practice depends on a thriving team. As dedicated endodontic billing specialists, we at SB Dental Solutions Dental Billing Company are devoted to improving the success of our endodontist clients. In endodontic practices, wasted chair time means a lot of lost income. That’s why it’s so important to do some cost-benefit analysis before planning endodontic procedures. Endodontists can use chair time more efficiently if they avoid starting a procedure that won’t ultimately work. Moreover, risk assessment helps endodontists avoid putting patients through potentially painful, costly, and time-intensive treatments, only to end up extracting the tooth. Planning and completing effective endodontic work turns a profit and protects patient wellbeing, whereas retreating or referring a patient after failed endodontic intervention just wastes everyone’s time. Even lucrative cases sometimes end up losing profit due to inefficiently budgeted chair time. Before planning time-intensive endodontic procedures, determine if the patient would be better off with a simpler intervention. To start out, endodontists should consider the following variables to evaluate the risks vs rewards of a given endodontic procedure:
When endodontists optimize their chair time, the profitability of their practice skyrockets. Additionally, SB Dental Solutions can help our clients discover other potential revenue improvements through our business consultation services. Click here to learn more about increasing profitability with Better Endodontic Dental Billing. |
AuthorSB Dental Solution Archives
November 2024
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