Editor’s note: This is part one of a three-part series

Dental practices constantly educate patients about the importance of preventive dental care. We explain how a proactive approach to maintaining oral health by stopping dental issues like cavities, gingivitis, and enamel wear can save them from complex, painful, and expensive treatment down the line. We emphasize that at-home care, combined with regular professional checkups, is an integral part of lowering overall oral health risks and reducing systemic health conditions.

But what if we applied that same philosophy to the business side of the practice?

As dental and medical insurance becomes even more complex and nuanced, it is crucial to establish a standardized approach to your revenue cycle. If we apply the same level of importance to our billing practices that we place on preventive clinical care, we can stop financial headaches before they begin. 

Dental insurance billing is more challenging than ever, and we will continue to see hurdles with payer changes, leased networks, and claim denials. To save your practice substantial time and salary dollars, consider adopting a “preventive dental billing” mindset.

The first line of defense

In preventive clinical care, the toothbrush is the first line of defense. In preventive billing, it is the telephone. 

Billing is not a process that magically begins after the patient leaves the operatory; it starts with the initial new-patient phone call. These calls set the tone for your entire patient experience, and the good news is that your practice has total control over how they are handled. 

Phone calls from prospective patients often start with one simple, loaded question: “Do you take my insurance?”

How your front office team answers this question determines the trajectory of the patient’s financial relationship with your practice. 

Step 1: Provide standardized verbiage

The first step in preventive billing is equipping your team with the right verbiage to answer this question. This ensures the response matches the patient experience that you intend to provide, while simultaneously setting clear financial boundaries.

Depending on your practice model, your script might sound like one of the following: 

• For out-of-network: “Yes, we bill all insurances. We help our patients maximize their benefits and will provide you with cost estimates for your treatment. Although we are out-of-network, we have many patients with the same insurance as you, and we work with any insurance company that will work with us.”
• For fee-for-service: “We will gladly submit your insurance claim for you. Our patients pay for their treatment at the time of service, and the insurance company reimburses them directly. If that works for you, I’d love to get some more information from you before we get you scheduled.”
• For in-network: “Yes, we are in-network with almost all insurance companies. We work hard to provide you with an accurate cost estimate so you know what your out-of-pocket will be prior to any treatment. In order for us to know what your insurance will pay here at our office, I need a bit more information from you before getting you an appointment.”

No matter what your approach is, it must be intentional and consistent to prevent billing confusion down the road. 

Step 2: Capture complete plan information

To properly protect your revenue cycle, save your team time, and avoid unexpected patient balances, you must capture complete medical and dental plan information (including secondary or tertiary plans) prior to scheduling the appointment. 

Require the following details from the patient: 

• Insurance company: name, address, phone number and payer ID
• Member information: name, date of birth, ID number, and group number
• Subscriber information: name, date of birth (if different from the patient)

Because much of this information is found on the patient’s insurance card, it is highly recommended that the office receives a copy of the front and back of the card before proceeding with scheduling.

As frustrating as it sounds, some carriers still do not provide physical dental insurance cards. Most of us know who these carriers are in our local areas. Keep a master list in your office detailing these specific employers and their plan details.

Handling patient pushback

Inevitably, your team will encounter patients who are hesitant to share detailed insurance or personal information before they have even scheduled an appointment or walked through your doors. This is a normal reaction in an era of data privacy concerns. 

When pushback occurs, your team should be trained to respond with empathy while maintaining the boundary. A great response shifts the focus back to the patient’s benefit: 

Suggested script: “I completely understand your hesitation. The reason we collect this information prior to your visit is to ensure we can secure a full breakdown of your benefits from your insurance provider. This allows us to give you a more accurate estimate of any out-of-pocket costs so there are no surprises on the day of your appointment. It also allows us to focus entirely on you and your clinical care when you arrive, rather than paperwork.”

By framing the request as a customer service enhancement rather than a purely administrative hurdle, patients are far more likely to comply. 

Step 3: Obtain a detailed benefit breakdown

Employers who purchase dental insurance as a tiny fraction of an overall benefits package rarely share adequate plan details with their employees. While many dental professionals argue that it is the patient’s responsibility to know their insurance, day-to-day reality tells a different story.

Ultimately, the practice usually ends up educating the patient about their dental benefits during treatment planning. Offices that excel at patient benefit education are the ones with the most successful billing practices. To provide this high level of service, your team must obtain: 

• The insurance policy effective date
• Coordination of benefits (if applicable) 
• A full breakdown of benefits, paying close attention to waiting periods

With this data, the team has the necessary information to give the patient a clear understanding of their financial commitment at their very first appointment.

Step 4: Communicate financial expectations proactively

The final step is for the new-patient coordinator to reach out to the patient to schedule their visit. During this touchpoint, the coordinator should review the patient’s benefits, explain the anticipated services, and clarify that any copayment, cost-sharing, or noncovered balances are due at the time of the appointment. 

It is vital to ask the patient for verbal acceptance and inquire how they plan to pay for their services that day. Handling this step professionally and transparently will save your team substantial time and prevent major headaches throughout the rest of the revenue cycle management process.

Conclusion 

Just as preventive dentistry saves patients from painful and expensive clinical interventions, preventive billing saves your practice from the pain of claim denials, delayed payments, and patient dissatisfaction. By taking a proactive approach from the very first phone call, you protect your bottom line and build a lasting foundation of trust with your patients. 

Next up: In part two of this three-part series, we will move from the front desk to the operatory to discuss the second pillar of preventive billing: clinical documentation. 

Additional reading: How dental hygienists can tap into the power of medical billing