How Is AI Transforming Dental Medical Billing and Coding?

Artificial intelligence is taking over. It has revolutionized the healthcare industry, automating workflows to make processes easier and accurate. According to a recent study, a staggering 84% of healthcare organizations have embraced AI, integrating it into their workflows.

Due to that, competition has stiffened in the industry, primarily dentistry, where you can thrive only if you leverage AI to handle all your practice tasks, including dental medical billing and coding.

Improved accuracy in dental medical billing helps you recover claims faster and maximize collections sooner, driving revenue growth.

Want to know how AI achieves that? Let’s explore.

Challenges in Traditional Dental Medical Billing

Before we dive into the impact of AI on billing, let’s discuss some obstacles in traditional billing. 

Here’s how the traditional medical billing for dental offices makes processes challenging:

Manual Errors and Financial Setbacks

Humans can make mistakes in billing, which can impact the claims settlement process. Whether it’s patient information, CPT codes, or any other details in the form, manual errors can result in claim denials. As a result, payments are delayed, disrupting your revenue generation and cash flow.

Coding Issues and Audit Risks

The American Medical Association (AMA) revises the CPT codes annually, making it challenging for dental practices to stay current with the changes and implement them effectively. 

Your entire dental medical billing and coding process depends on the codes you use during claims submission, as they help insurers identify the dental procedure for which a patient is treated. Incorrect codes result in inaccurate claim submissions. These claims are immediately rejected by insurers.

Moreover, insurance policies and healthcare regulations can also change frequently. Staying current with the changes can be difficult for dental practices. Subsequently, you may not adhere to changes that can expose your practice to external audits, compliance risks, and regulatory fines.

Eventually, it can lead to reputational damage, and you may risk losing business as a result.

Underbilling or Overbilling

Billers can sometimes charge more or less than the actual amount set by an insurance company for a dental procedure. 

Underbilling results in revenue loss for your practice, while overbilling may lead to loss of trust between you and your insurers. And, your practice can also be evaluated via external audits.

Either way, this isn’t an ideal situation for your dental practice. But you may encounter it very often in traditional billing processes.

Time-Consuming Insurance Eligibility Verification

Verifying a patient’s eligibility for an insurance plan is perhaps the most crucial component in medical billing for dentists.

You’ve to check each detail of a patient to confirm if they are eligible to avail benefits in a dental treatment. These traditional processes often take time to complete verification and are also prone to errors.

And these errors ultimately result in your claims being denied by insurance companies.

Following Up with Insurers

Checking on insurance companies and inquiring with them about the status of your submitted claim is stressful. It distracts you from your practice’s main purpose of serving dental patients and providing quality care.

Dental practices that don’t outsource dental insurance billing to third-party service providers and rely on outdated billing processes are overburdened with the task of pursuing insurers and trying to get claims settled.

Staff Management Issues

In traditional billing processes, you’ve to assign staff, specifically to handle your billing processes. Due to that, it’s difficult for your staff to handle other important practice responsibilities.

It impacts staff productivity, while your staff can also get tired of the tough process. This may lead to burnout and stress, increasing the probability of mistakes.

Moreover, staff turnover is also a major issue, as staff can resign. And training new staff for billing all over takes a lot of time, which can be allocated to revenue generation, patient care, and other practice management tasks.

Lack of Real-Time Insights

In traditional dental claims billing, you’re not updated with real-time information. There are no insights or analytics to detect errors in your billing process or check if it’s accurate. Real-time data helps you improve your strategy and make better decisions. But, due to a lack of insight, you solely rely on the insurance company, waiting for them to inform you about the progress.

These are some common issues in traditional billing. You can overcome them by upgrading your workflows with AI-powered dental billing solutions.

To know more about that, let’s jump to the next section and see how AI takes your billing to the next level!

Navigating Dental Medical Billing with the Power of AI

With AI, you can automate your dental medical billing and coding tasks. It greatly impacts billing processes and outcomes.

Easy Integration with Portals

High-end AI systems can easily integrate with your payer portals and EHR systems that contain the Patient Health Information (PHI). With that, AI tools can automatically fetch patient data from the EHR systems, while also gaining access to their insurance policy details in the payer’s portals.

This process is super fast, which is not a possibility in manual processes, where collecting and tallying data can take up to several weeks.

However, when you’re subscribing to AI-powered dental medical billing services, you must make sure that the system is HIPAA-compliant. Your patient information is secure and is used only for billing purposes.

Real-Time Insurance Eligibility Verification

A dental patient’s insurance eligibility must be verified upfront, or even in real-time, because insurance policies can change instantly. And, verifying a patient’s eligibility on the spot is a better approach. AI solutions help achieve that by checking eligibility in real time, so you’re updated on a patient’s status. 

With that, you can treat a patient if the patient’s treatment is covered in the plan, and charge the patient upfront if benefits are not available or a certain procedure isn’t covered. It also helps you identify pre-authorization on certain procedures, and you can submit requests for prior authorization for timely processing.

Accurate Dental Medical Coding and Claims Submission

AI systems leverage the Natural Language Processing (NLP) technology for accuracy in dental medical coding. Dentists write CPT codes, and NLP performs Named Entity Recognition (NER) to identify key procedures, like the extraction of a wisdom tooth or amalgam restoration on a tooth. NLP uses the right codes against each procedure, 

With automation, patient details, procedure notes, and all the other important documentation, such as prescriptions, dental X-rays, and bill details, are entered with near accuracy. This ensures that your claims are processed smoothly, and you charge the right amount for a procedure. Due to that, you get fair compensation for a treatment.

Automatic Claims Tracking and Instant Reporting

AI tools automatically track claim progress, offering you transparency into the entire dental medical billing process. You can evaluate the details and see how close you’re to receiving payments.

These systems also generate real-time reports of the billing process, so you’re fully prepared for the results. 

Smooth Denial Management and Appealing

In case of claim denials, these systems instantly extract denial reasons by using NLP. AI recommends corrective actions to rectify the mistake and automate appeal requests to recover claims.

Identification of Unpaid Claims

AI tools evaluate your entire dental medical billing and coding patterns, identifying any loopholes throughout your billing history. These systems automatically detect your unpaid claims or other overdue payments you may have forgotten with the passage of time.

These robust tools automatically process your claims if the timeframe for recovering them is valid. For example, Medicare sets a time limit of filing a claim within a year after the procedure. An AI tool can easily process and recover claims if the request has been filed within the 12-month timeframe.

A/R Reminders

AI identifies your accounts receivable (AR) and prioritizes your aging A/R. It generates automatic alerts to these accounts and tries to recover maximum claims. If the amount isn’t recovered, AI can also assist in preparing, filing, and tracking appeals sent to the relevant authorities.

Enhanced Staff Productivity and Cost Reduction

A huge benefit of implementing AI into the billing process is reduced overhead costs and a lesser workload for the staff. AI handles your entire dental revenue cycle management (RCM), freeing up your staff to perform clinical tasks. Some AI tools can also manage your front office and dental practice tasks, allowing your staff to dedicate more time to patient care.

It also reduces your expenses of training and hiring staff, solely for billing purposes. You still need to hire staff to operate and supervise these AI tools, but it’s still a cost-effective option for your practice. 

You can save up even more money if you outsource dental billing and coding to a third-party company like TransDental, which offers billing services with reduced claim denials, maximum collections, and competitive prices.  With lesser costs, you can increase your profits. As a result, you earn more and your practice thrives with it.

Conversational Patient Billing

By using NLP, AI tools enable smart chatbots that communicate with you via voice or text, and respond to queries related to patient billing, such as insurance coverage, payment options, claim status, and account balances. Moreover, these AI tools can tirelessly work, unlike manual staff, and provide you with 24/7 customer support.

Your staff is also relieved of the stress of handling calls and can focus on more important tasks, such as maintaining a hygienic environment and assisting with patient care and treatment.

Conclusion

AI is the future, and a dental practice can be left behind by ignoring it. In this competitive environment, it’s important to stay ahead of evolving trends and policies. And this is possible if you adopt technology faster than other practices. AI helps automate processes for precision, speed, and financial growth, ultimately benefiting your practice and taking your claim recoveries to unimaginable heights!

Frequently Asked Questions (FAQs)