How to Boost Payments with Dental Billing and Practice Management Integration?

In a dental practice, you don’t just fix teeth and restore smiles. A lot more is involved to run it smoothly.

You need to schedule and manage patient appointments, maintain the patient’s clinical record, submit insurance claims, and pursue these claims for reimbursements. It’s a full-time task.

It’s easier when you process practice management integration with dental billing to track your treatments and finances at the same time. With that, your claim submissions are quick, errors are less, and payments are complete.

So, let’s discuss how integrating dental billing services with practice management tasks makes your daily operations smooth.

What’s the Benefit of Dental Billing and Practice Management Integration?

It’s important to make your dental billing and practice management smooth. Here, we’ll guide you on how to integrate the two processes to improve your daily tasks and financial health

Clinical and Billing Synchronization

When clinical details are integrated into the dental billing processes, all the patient’s clinical data including procedure details are stored in an electronic health record (EHR). With EHR integration, the system matches the details and automatically generates the right CDT code for the treatment.

If the treatment plans change, updates are reflected in the EHR and billing record on the spot. With automation, there is no need to switch systems and make changes in the records. Staff can easily access all the data in one place. It also prevents duplication of data, as staff don’t need to copy or migrate data.

Smarter Insurance Claim Management

With integration, the billing system fetches all the patient details from a practice management system (PMS), and initiates dental insurance eligibility verification in real time. The system can easily pull these details when your front office staff schedule a patient appointment. 

The billing system then checks all the patient responsibilities like copays, waiting periods, deductibles, frequency limitations, and coinsurance, so you can charge patients for their costs and submit claims for what insurers cover.

After that, the claim forms are filled and required documentation is attached. But, claims aren’t just submitted instantly. The system automatically flags errors via built-in claim scrubbing, making sure that:

• Codes are correct
• Documents are complete
• All fields are filled
• Patient’s coverage plan is still in effect and doesn’t exceed limitations
• No duplicate claims are submitted

Overall, scrubbing detects errors if the claim doesn’t comply with payer policy rules. For example, if you treat a patient for a service not covered in the patient’s plan and enter it into the system, the billing software flags it. This allows your staff to make corrections and submit clean claims, which reduces claim denials and makes reimbursements faster.

After that, the system submits claims where you can expect faster reimbursements.

Improved Patient Experience and Faster Collections

As we just mentioned, real-time eligibility verification helps your staff know what insurance covers and what patients have to pay. It helps you provide accurate written estimates to patients and respond to their queries by checking data in one place instead of toggling between systems.

With dental billing and practice management integration, you can automate appointment reminders, treatment plan summaries, and invoice generations from the same system.

And the best part is the payment stage. Patients pay their bills via the payment portals and the amount reflects in the billing system, which automatically posts the payment in the right patient account in the PMS.

Patients can easily pay for the dental services. They get a positive experience and you recover payments fast, making it a win-win situation.

How Does Dental Billing and Practice Management Integration Work?

Understanding the Complete Process

Appointment Scheduling

First, a patient schedules an appointment with a practice for a dental treatment. All the patient details, including demographics, contact details, previous dental record, and insurance details, are entered into the PMS.

Insurance Eligibility Verification

The integrated dental billing software pulls patient details and verifies details by matching it with the patient’s coverage plan and other details in the payer portal.

Example: When the front-end staff enters subscriber ID or other patient’s details in the PMS, the billing system extracts the data and enters it in the payer portal. It then checks the coverage details against it.

Charge Capture

Practice staff record the procedure details and required documents in the PMS after the patient’s treatment is complete. The system generates the CDT code for the procedure, which the billing system pulls. It reviews payer policies and sees which dental services are covered by the payer, and submits claims with the appropriate CDT codes. 

Example: The staff has performed three treatments: D0150 (comprehensive oral evaluation) for check-up, D1206 (fluoride varnish application), and D1110 (adult prophylaxis). However, the insurer may count D0150 for visits and D1206 for preventive treatments and exams as part of the major treatment code D1110, and bundle the two codes into it. In this case, the system checks payer policies and automatically submits claims with D1110 code.

Claim Submission

The billing software has a built-in claim scrubbing feature to check errors in the claim form. It flags if any fields are missed, codes are incorrect, documents are incomplete, and names are misspelled. If there are errors, it highlights them for correction. And if the claim is accurate, the claim scrubbing feature marks it claim-ready.

Once details are corrected, the system forwards it to an integrated or built-in clearinghouse. The clearinghouse converts it into the electronic claim format, according to ANSI X12 837 standards, and after that, it submits the claim.

Claim Decision in EOB/ERA

Whether the payer reimburses or denies the claim, it posts the Explanation of Benefits (EOB), a statement, which features all the treatment and claim details with the claim decision and payer remarks. Key details in an EOB include the amount the insurer has paid or denied, and the treatment costs patients have to cover.

Electronic remittance advice (ERA) is the electronic version of EOB, which is automatically posted to the billing system. Unlike EOB, it’s not a complete invoice, but a summary of details like claim ID, CDT code, reimbursed amount, and remark codes.

Payment Posting and Automatic Ledger Update

The billing software automatically updates the patient accounts with the information received in EOB or ERA. If the payer has reimbursed the amount, the system posts it to the ledger, and if a claim is denied, the software updates these details in the ledger, which is stored in the PMS.

It allows the front office staff to view the details of that patient account and take further steps accordingly.

Example: Insurer has paid its share of a patient’s treatment and mentions that in the EOB statement. The statement also explains the costs which the patient has to pay. So, once the EOB details are updated in the PMS, practice staff contacts the patient or automates patient billing to recover payments.

Automated Patient Invoices

After posting the payment in the EOB, the billing system automates reminders to the patient by sending invoices at their email address or updating them in the patient portal. A practice may customize the system’s notification processes and choose alternative mediums like calls or SMS to generate these alerts.

Easy Dashboard Tracking

With dental billing and practice management integration, it’s easy to see all the administrative and billing metrics in one place to evaluate the practice’s financial performance. 

First, the PMS reviews operational efficiency by analyzing data from key metrics like:

• Case acceptance rate
• Chair time efficiency
• No-show or cancellation rate
• Patient satisfaction rate
• Staff productivity
• Treatment completion rate

These metrics are migrated to the dental billing software in real time. It merges the data with metrics like:

• A/R aging
• Claim denial rate
• Claim reimbursement rate
• Denial resolution rate
• Net collection rate
• Patient collection rate

And after that, the billing software generates a unified dashboard, which features a complete and clear picture of how efficiently the practice’s clinical and billing staff are performing their duties. 

You can easily identify the weak performance areas all in one place and make improvements in workflows.

Integration Technology

The following are the common technologies used to integrate dental billing software with PMS:

Application Programming Interface

The API technology allows practice management integration with dental billing in real-time. It connects the billing system with the PMS, so data is continuously synchronized and exchanged safely. With real-time synchronization, billing dashboards are frequently updated to show fresh performance metrics. Modern practices prefer using cloud-based API technology for smart and real-time processes.

Batch Exports

PMS exports the patient information and clinical data in batch files, available in formats like CSV, TXT, or XML. It works mostly in legacy systems.

HL7 Messages

Health Level 7, or in short, the HL7 standards define how to exchange, integrate, and share patient information across different systems. HL7 messages play a key role in dental billing and practice management integration. PMS exports billing-related patient information in the HL7 format. This exported data is known as an HL7 message, which the PMS sends to the billing software. The billing system automates charge capture, and imports all the details to submit the claim.

What are the Best Practices for a Successful Billing and PMS Integration?

Let’s have a look at some best practices through which you can leverage practice management integration with dental billing and coding.

Migrate Data Securely

Make sure that practice management integration with dental billing processes is secure and complies with the Health Insurance Portability and Accountability Act (HIPAA). Since these details contain sensitive patient health information (PHI), it’s important to synchronize data safely. And your systems should be protected from malware or viruses.

Once the data is safely synchronized, limit its access to only authorized personnel, like your front office and billing teams. They need patient data to schedule patient treatments, record treatment details and submit insurance claims.

And to maintain HIPAA compliance, set up policies where staff can access and use only the required data.

Centralize Processes in an All-in-One System

Data integration has its fair share of challenges. Just imagine the software is corrupted and outdated, or you don’t have IT experts who can initiate and handle the integration process.

The best solution is to invest in an all-in-one software, which manages and performs all the clinical, administrative, and financial tasks easily. Whether it’s taking digital images, recording treatment details, or managing insurance claims, investing in a billing or practice management system, which centralizes tasks, is the ideal approach.

Today, most advanced billing systems centralize these processes, preparing your complete documentation, and managing all the aspects of your revenue cycle. These systems provide a complete solution for dental practices, taking dentistry to a whole new level.

Partner with a Dental Billing Company

A professional dental billing company, like TransDental, is your most reliable partner to assist with dental billing and practice management integration.

These companies make integration easier for dental practices. You don’t have to invest in purchasing a new system or shifting software solutions. The companies can easily integrate the dental billing process with your existing practice management software. 

You continue to manage practice operations and clinical care, while these partners manage the administrative and financial tasks for you. And they also offer transparency, as you can monitor the billing performance every time. 

Regular reports and combined dashboards display metrics, which provide real-time visibility into the financial health and staff performance, so you can identify room for improvement and make data-driven decisions to optimize your processes.

Set Clear Key Performance Indicators

Setting key performance indicators (KPIs) is important to monitor your revenue performance and see how close you’re to achieving that goal and what steps you can take to improve metrics. You can also set expectations for your staff in the system, so they can view if they’re meeting their individual goals.

For example, your practice has an average monthly clean claim rate of 75%. While it indicates that most of your claims are good, these are still less than the industry standards of 85%. You can set a KPI to achieve 85-90% clean claim rate during the next month. And then you customize your system, so it displays your performance level in the dashboard. You can check it and see if you’re close to meeting your set goals.

It’s also helpful for your staff, so they check the dashboards and reports and evaluate their performance. If the metrics are below expectations, it’s time for your staff to put in their best efforts and meet the targets.

Reconcile and Audit Data

An automated dental billing and practice management integration might give you real-time visibility into the financial performance, but the work doesn’t end here.

It’s important to check the accuracy of the data generated by the system. Reconcile claims, payments, and adjustments, to see if you’re getting fairly paid for the dental services rendered and the fee schedules finalized with the payer.

Schedule regular or frequent billing audits to see if the CDT codes, documentation, and other procedure details are accurate and your processes are error-free. These audits help catch discrepancies, so you can identify underpayments, denials, or other issues with your payments and claims, and correct them.

Conclusion

Whether you integrate your PMS with dental billing software or use an all-in-one system to centralize tasks, make sure that the services are reliable, secure, and efficient to optimize processes and improve revenue performance. Choose to work with a software vendor or service provider, who offers solutions tailored to your practice needs and provides complete integration support from deployment to updates.

Frequently Asked Questions (FAQs)