There are three main categories of how dental practices tackle the issue of billing insurance. Each of which have their advantages as well as disadvantages.
Insurance free practices – There are a growing number of practices that are no longer accepting insurance. The obvious downside to this is that these practices are limiting their patient pool. However, most of these practices feel that this is outweighed by the reduction in frustration in dealing with the insurance companies. They actually can set their own prices and work with the patient on their treatment options as opposed to having to tailor the treatment to what the insurance will allow.
In-House Billing – These practices generally have a designated staff person who is responsible for all of the insurance billing. Typically there are very few checks and balances in the process and it is very easy for billing mistakes to slip through. According to TDIC, there are several types of transactions that frequently occur, but they are not allowed and raise red flags for insurance audit.
· Failing to collect full co-pay
· Offering to waive co-pays
· Concealing other insurance coverage
· Incorrect treatment date
· Submitting for covered service when a non-covered service is performed.
While the negatives are plentiful, this form of billing offers the dentist the greatest patient pool, and the ability to minimize their overhead.
Outsourced- Billing – This segment of dental practices employs a third party vendor. The advantage to using one of these services is that it frees up you staff to focus on your practice. Also, with an outside service involved, there is more oversight in the process (and the third party can bear some responsibility). The most obvious downside is the increase in expense. The services generally charge a percentage of the amount billed. When you have to pay around 3% on the amounts collected, the margin can start to dwindle fairly fast.
We can sit down with you and analyze your practice. Together with our team we can help you decide if a change would be beneficial to you.
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