Services we offerDental Excellence: Where Every Smile Tells a Story of Care
Dental Insurance Verification
We specialize in patient coverage and eligibility verification, saving you valuable time and streamlining the process, allowing you to prioritize patient well-being with peace of mind..
LEARN MORE >>Dental Insurance Billing Service
We work diligently to ensure that insurance companies pay you the rightful reimbursements you deserve, handling the collection process on your behalf..
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Who We Are
About
Our
Company
After gaining extensive experience in the dental billing and insurance verification industry, our team noticed a significant gap in the quality of services provided by the companies they worked for. Recognizing the need for dental providers to have peace of mind while running their practices, our team made the decision to establish their own company, Elite Dental Billing Consultants. The primary goal of Elite Dental Billing Consultants is to deliver the highest quality dental billing and insurance verification services.
With a growing number of satisfied clients who have experienced the exceptional quality promised by Elite Dental, we invite you and your practice to join us on this journey. By partnering with us, you can enjoy the peace of mind necessary to provide the best possible treatment to your patients.
Efficient Solutions, Competitive RatesOur Pricing
- Feel free to call for a customize solution. For multi-location dental practices contact us for a perfect solution.
Streamlined Dental Billing & InsuranceClear. Flexible. Stress-Free. Your Path to a Healthier Smile.
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Billing FAQ CornerFrequently Asked Questions
What is the process of dental billing?
Dental billing is the administrative process of managing and submitting insurance claims for dental services provided to patients. It involves preparing and submitting claims to insurance companies, as well as following up to ensure timely reimbursement. Dental billing ensures that dental practices receive proper reimbursement for the services they provide, helping maintain financial stability and support the delivery of quality dental care.
How is dental billing conducted?
- Patient Registration and Insurance Verification: Dental billing begins with registering patients and verifying their insurance information, ensuring accurate coverage and benefits assessment.
- Treatment Planning and Coding: After dental treatment, procedures are coded using the American Dental Association's Current Dental Terminology (CDT) codes, accurately documenting the services rendered.
- Claim Preparation: A dental claim form is prepared, including patient demographics, procedure codes, fees, and necessary attachments like X-rays, to provide comprehensive information for claim processing.
- Claim Submission: Claims are submitted electronically or by mail to insurance companies, expediting the process and ensuring all required details are included.
- Claim Adjudication: Insurance companies review claims to evaluate coverage eligibility, considering plan guidelines, limitations, deductibles, and maximums.
- Explanation of Benefits (EOB): Insurance companies send EOB statements to dental offices and patients, outlining covered amounts, adjustments, patient responsibilities (e.g., co-payments, deductibles), and reimbursement details.
- Patient Billing and Payment Collection: Dental offices review EOB statements, generate patient statements, and collect payments, including deductibles, co-payments, and uncovered services.
- Follow-up and Appeals: Dental offices follow up with insurance companies to address claim denials or underpayments, filing appeals when necessary.
- Account Reconciliation and Reporting: Dental offices reconcile insurance payments, generate reports on claims, payments, outstanding balances, and financial performance.
What is the difference between dental and medical billing?
The difference between dental and medical billing lies in the coding systems, coverage, reimbursement rates, claim submission processes, and provider networks. Dental billing involves the use of the American Dental Association's Current Dental Terminology (CDT) codes to describe dental procedures, while medical billing uses the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.
Dental insurance plans typically cover preventive and diagnostic dental services, while medical insurance plans cover a broader range of medical treatments and services.
Dental insurance plans often have lower reimbursement rates compared to medical insurance plans. Claim submission processes may differ, with medical claims commonly submitted electronically and dental claims allowing for both electronic and paper submissions.
Additionally, medical insurance plans typically have larger provider networks compared to dental insurance plans.
How many dental codes are there?
The American Dental Association's Current Dental Terminology (CDT) encompasses a wide range of dental codes used to describe specific dental procedures and services. The CDT is regularly updated to reflect advancements in dental treatments and technology, resulting in a comprehensive and evolving set of codes. While the precise number of dental codes may vary over time, the CDT consists of numerous codes designed to accurately represent the diverse dental procedures performed by dental professionals. For the most up-to-date and detailed information on the number of dental codes, it is recommended to refer to the latest edition of the CDT published by the American Dental Association (ADA).
Why get dental billing services?
Dental billing services offer numerous advantages to dental practices. By outsourcing their billing tasks to professionals, dental practices can benefit from the expertise and knowledge of billing specialists who are well-versed in dental coding, claim submission, and insurance reimbursement processes. This can result in accurate coding, timely claim submissions, and optimized reimbursement. Moreover, dental billing services can be cost-effective, as they eliminate the need for hiring and training in-house billing staff. By operating on a percentage-based fee structure, dental billing services align their costs with the revenue generated, making it a financially advantageous option. In addition to cost savings, outsourcing dental billing improves efficiency by streamlining the billing process. Dental billing services have established workflows and systems in place to handle claim submissions, follow-ups, and issue resolution. This allows dental practices to focus on providing quality patient care and managing their practice, rather than investing time and resources in complex billing tasks. Another significant benefit is the potential for increased revenue. Dental billing services are well-versed in insurance plans, fee schedules, and reimbursement rates. They can optimize coding and documentation to ensure proper reimbursement for services rendered. By reducing claim denials, improving claim accuracy, and diligently following up on unpaid claims, dental billing services help maximize revenue for dental practices. Furthermore, dental billing services stay updated with regulatory changes and insurance requirements, ensuring compliance and minimizing the risk of audits, penalties, or legal issues related to billing practices. Ultimately, outsourcing dental billing allows dental practices to focus on what they do best—providing exceptional dental care—while leaving the complexities of billing to experienced professionals.
What to look for in a dental billing service?
- Expertise and Experience: Look for a dental billing service with extensive experience and expertise in dental billing, coding, and insurance claim submission processes.
- Knowledge of Dental Insurance: Ensure that the billing service has a deep understanding of dental insurance plans, including coverage limitations, fee schedules, and reimbursement rates.
- Compliance and Security: Verify that the service is compliant with healthcare regulations, such as HIPAA, and has strong security measures to protect patient data.
- Transparent Reporting and Communication: Choose a billing service that provides clear and transparent reporting on claims, payments, and outstanding balances, and maintains effective communication channels.
- Technology and Software: Assess the service's technology infrastructure and software capabilities for efficient claim submission, follow-up, and tracking.
- Customization and Flexibility: Consider if the billing service can adapt to your practice's specific needs and workflows.
- Cost Structure and ROI: Evaluate the service's pricing model and compare it with potential revenue increases and cost savings for your practice.
- References and Reviews: Request references and check online reviews to gauge the service's reputation and client satisfaction.
How much do dental billing companies charge?
The pricing of dental billing companies can vary depending on factors such as the size of the dental practice, location, scope of services, and the fee structure of the company. Typically, dental billing companies charge fees based on a percentage of the practice's revenue, which can range from 3% to 10%. Alternatively, they may charge a flat fee per claim or per month, with the amount varying based on the services provided and claim volume.
It's important to note that additional charges may apply for services like credentialing, electronic claim submission, patient statement generation, or follow-up on denied claims. These fees may be bundled into the overall pricing or offered as separate add-ons.
When considering dental billing companies, it's essential to understand their pricing structure and any potential extra costs. Comparing fees among different companies and assessing the value and quality of services provided is recommended.
Ultimately, the cost of dental billing services should be evaluated in relation to the potential benefits for the dental practice, such as increased revenue, improved efficiency, and reduced administrative workload.
Is the dental office responsible for inputting the plan into the software or is this included in the verification process?
- Verification Process: Elite Dental Billing Consultants verifies the complete breakdown form by accessing the insurance portal, sending fax requests, or making phone calls to the insurance company.
- Documentation: Once the insurance breakdown is obtained, Elite Dental Billing Consultants upload it into the patient's document center in PDF format. This ensures that the information is easily accessible and organized.
- Updating Insurance Plan: Elite Dental Billing Consultants updates the insurance plan information in the practice management software. This ensures that the dental office has the most up-to-date information when dealing with insurance claims.
- Notification: Elite Dental Billing Consultants leaves a note in the comment box of the insurance plan or appointment to inform the dental office that the insurance has been verified.
- Work Log and Reports: Elite Dental Billing Consultants maintains a work log and generates reports on a shared live spreadsheet. This enables easy tracking and transparency of the billing process.
Regarding insurance payments and adjustments:
- Posting Insurance Payments: Posting insurance payments is included as part of the billing service provided by Elite Dental Billing Consultants.
- PPO Plan Payments and Network Fees: Elite Dental Billing Consultants handles PPO plan payments that require adjustments for network fees. Before making any adjustments in the software, they communicate with the dental office via email, explaining the reasons for the adjustments. The adjustments are made according to the clinic's instructions.
Regarding narratives:
- Narrative Handling: Elite Dental Billing Consultants recommends that narratives are maintained in the software for each patient. This helps ensure that billing procedures are submitted with the correct tooth numbers and surfaces. However, narrative templates can be used for billing attachments as needed.