3.5 Billing and Collections Responsibility
Completing the superbill is a billing function normally performed by clinical staff. The remaining functions are completed by front office, back office, or billing department staff. If your clinic is part of a primary care program, billing and collections should be handled by the billing department. The billing department will determine the best way to submit bills to third-party carriers (batching paper or electronic claim submission). However, input from clinical staff is critical in setting up the billing department’s dental component.
For clinics that are part of a primary care program, it is essential that the billing department is familiar with billing for dental services, which is different from billing for medical services. Stand-alone dental clinics need to designate a staff member to coordinate the credentialing process for clinic dentists as providers with Medicaid, Medicaid managed care plans, and insurance companies. Most clinics choose to establish the clinic as a group provider and the dentists as individual providers.
The credentialing process may take months, so it is important to start the process as early as possible. Private insurance companies allow clinics to bill as out-of-network providers, but clinics still must set up an account with a tax identification number before they can be paid for a claim.
It is inefficient to submit paper claims, but, for cash flow purposes, it may be necessary to do so at first. Clinics can pay a clearinghouse to electronically submit their claims. In addition, some large dental benefit plan companies (such as Delta Dental) bill other payers for a fee.
Once reimbursements begin arriving, the designated staff member needs to compare them to the claims that were submitted. Rejected claims must be researched and resubmitted. Staff should also check on claims that have not been paid after 90 days.
Many clinics have a “pay at time of service” policy for private-pay patients, which cuts down on the costs involved in billing.