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Complexities of Dental Billing

Dental Billing

Complexities of Dental Billing

Most dentists will tell you that dental billing is their least favorite part of running a dental health care facility. If the sole role of dentists were to take care of patients, their practice would have been a safe haven. However, dental billing is the key to practice success.

There are multiple complexities involved in dental billing. From claim submission to follow-ups with insurance companies, streamlining dental billing is challenging for many in practice. If you are planning to start your dental clinic but are not sure of some difficulties you can encounter in billing, this article outlines major complexities in dental billing and how to overcome them. 

Dental Billing Complexities 

Allowed Amounts

The complexity of allowed amounts can be a nightmare for your practice. Insurance companies only pay a particular allowed amount on a patient’s cover for contracted services. This implies that if your services exceed the allowed amount on the patient’s cover, the dental clinic may be forced to bear the rest of the cost.

While some insurance companies may cater for dental costs partially, some practices don’t check the insurance coverage prior to providing dental services. This can lead to massive confusion at the counter when the dental clerical staff run the patient’s insurance through the system only to find the insurance can’t reimburse for the entire cost. If the patient fails to pay the remaining cost, your dental clinic is susceptible to incurring losses.

Diagnostic and Evaluated Services

Dental x-rays are effective in diagnosing incipient dental problems before they become a major issue to a patient. With that in mind, x-rays machines are a common investment in dental practice.

Although there is a clear cost for dental x-rays, various types of x-rays can apply. Patients can also get more than one x-ray or choose a particular type depending on their medical issues. In addition, a patient may get an x-ray without sufficient knowledge of how the services are covered and then are surprised afterward.

If an insurance company provides a comprehensive cover for x-ray services but does not include specialized types or how often a patient has to get the services, billing for that service can become a problem. The insurance company can decline to reimburse for the added cost, leaving your facility to bear the cost. 


In dental practice, you have to determine how a dental insurance plan’s deductible relates to treatment. However, a challenge is inevitable if an insurance company does not provide clear specifications, or your agency lacks a simple and transparent billing model. A transparent system involves a model where you can plug in dental costs and understand what the insurance company can reimburse for a particular service. 

Patients can also refuse to pay high deductibles.

Rejected Claims

Experiencing rejected claims can be frustrating for dental practices and billers. Sometimes clerical staff don’t provide the necessary details as required by an insurance company. This can lead to rejected claims. In case of a rejected claim, you must provide supporting documents for the insurance to reimburse the service. For more information on how to avoid rejected claims, check out this article on Dental Claims Processing Best Practices.

Detailed Claims Processing Guidelines

In the healthcare industry in the United States, adherence to strict guidelines provided by different insurance companies and government agencies is essential for reimbursement. Various insurance companies have different strict processing guidelines.

Since dental clinics serve patients with different insurance covers, confusion in processing details can sometimes occur. This can lead to rejected claims and other punishments against your agency. 

Dental Billing

How Dental Providers Can Overcome Billing Complexities

Billing in healthcare has never been easy. A significant percentage of Americans with credit records have outstanding medical bills. This points out multiple challenges that the practice must undergo in billing. While dental billing is among practices experiencing billing complexities, there are ways to overcome these challenges.

Auto-checking Insurance Coverage

Checking a patient’s insurance coverage before providing dental health services is important. The practice administrator needs to verify the type of coverage a patient has before providing services.

Although this can add administrative tasks to your staff, taking such an important step can save your dental clinic from losing revenue and experiencing billing issues later.

Collecting Full Co-pays

Co-pays are essential in facilitating the day-to-day running of your dental clinic. 

If you don’t get co-pay in full upfront, it may become an issue to get the rest from the patient after a dental service. The chances of receiving the remaining balance reduce significantly once the patient leaves the office.

However, you can avoid such losses by requiring your front desk to implement your practice’s policy for collecting co-pay upfront in the full amount.

Staying Up to date with Changes in Coding

Everything is changing at an unprecedented rate. Failure to understand the best time to change can lead to a lot of inconveniences in practice. 

There are continuous changes in coding. As technology and materials change, so does materials used for dental procedures. These materials attract the need for new coding procedures to support the trend. In addition, coding updates are provided annually, which can keep even the most experienced coding experts on their toes. 

Due to these changes, you need to self-educate and stay informed about the latest changes in coding to ensure effective billing procedures. For helpful resources and to stay up to date on all things dental billing, check out our article on The Best Resources and Courses for Dental Admin Professionals.

Why Choose Apex EDI As Your Billing Partner?

In your effort to provide quality dental services and run a profitable dental clinic, you most likely have your hands in many agency operations. Apex EDI can relieve you of the billing burden and ensure your claims get paid within the shortest time possible. We utilize technology to minimize billing complexities. We also provide affordable services that can help your organization benefit from the dental services you provide. 

Contact us today for guidance on how to minimize billing complexities and increase your practice’s profitability.

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