How do dental practices manage insurance billing and patient copays?
Dental billing starts before any treatment happens. The front desk verifies patient insurance to confirm what procedures are covered, what percentage the plan pays, and how much remains on the annual maximum. This step prevents surprises and helps estimate the patient’s portion upfront.
After treatment, the practice submits a claim using CDT codes for each procedure performed. Claims typically go through a clearinghouse that checks for errors before sending them to the insurance company. Clean claims with accurate coding get processed faster and have fewer denials.
When the insurance company processes the claim, they send an Explanation of Benefits showing what they’ll pay and what the patient owes. The practice posts this payment to the patient account, applies any contractual adjustments, and updates the remaining balance. Posting errors here create problems that compound over time if nobody catches them.
Patient copays should be collected at the time of service whenever possible. Most practices estimate the patient portion based on verification data and ask for payment before the patient leaves. Collecting upfront drastically reduces the time spent chasing balances later. Patients who leave without paying are harder to collect from, and that money often becomes a write-off.
Tracking receivables separately matters for cash flow. Insurance receivables typically pay within 30 to 45 days if claims are clean. Patient receivables take longer and have lower collection rates. Knowing which bucket your outstanding balances fall into helps prioritize follow-up and forecast what’s actually coming in.
Write-offs and adjustments are unavoidable in dental billing. Contractual adjustments cover the difference between your billed rate and what the insurance allows. Write-offs happen when collection efforts on patient balances have been exhausted. Both need to be recorded accurately or your revenue numbers will mislead you.
Monthly reconciliation connects your practice management software to your full-service bookkeeping. Insurance deposits in the bank should match payments posted in your billing system. Patient payments should reconcile the same way. Discrepancies mean something got missed or posted incorrectly.
Many dental practices underestimate how much time billing consumes. Between verification, claim submission, denial follow-up, payment posting, and patient collections, it can take hours every day. Practices that don’t have dedicated billing staff often fall behind, leading to aging receivables and cash flow problems. Outsourcing the billing function lets staff focus on patient care while professionals handle the revenue cycle.
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More Questions
What should I look for when hiring a medical billing service?
Look for specialty-specific experience, HIPAA compliance, transparent reporting, and a clear denial management process. The right billing service should communicate regularly about your revenue cycle and integrate smoothly with your practice management system.
Read answerHow long should a medical practice keep financial records?
Medical practices should keep most financial records for at least 7 years. Patient billing records may require longer retention due to HIPAA and state medical record laws that overlap with financial documentation.
Read answerHow do I reduce claim denials at my medical practice?
Most claim denials are preventable with proper front-end processes. Focus on eligibility verification, prior authorization, accurate coding, and complete documentation to get claims paid the first time.
Read answerHow do I track patient payments and insurance reimbursements?
Track patient payments and insurance reimbursements by posting each payment to specific charges in your practice management system. Reconcile posted payments to bank deposits weekly and monitor patient balances separately from insurance AR.
Read answerWhat is prior authorization and why does it cause claim denials?
Prior authorization is pre-approval from an insurance company confirming that a service is medically necessary before it's performed. Claims get denied when authorization isn't obtained, expires before the service date, or doesn't match the procedure actually performed.
Read answerWhy are my insurance claims getting denied?
Insurance claims get denied for reasons including missing prior authorization, eligibility verification failures, coding errors, and incomplete patient information. Most denials are preventable with proper front-end processes.
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