Dental insurance claims processing in-house vs outsourced: How does each work?

When exploring the option of outsourcing your insurance claims process, of course you’re going to compare it to your in-house team. You might be tempted to “go with what you know,” and stick with your team out of loyalty and familiarity. But the best business decision boils down to which group will get your dental insurance claims paid faster for optimal revenue and consistent cash flow.

It’s every dental professional’s least favorite task: Dental insurance claim processing. And we get it — it’s time-consuming, it’s complicated, and staying on hold with insurance companies doesn’t feel like the best use of your time. But dental insurance claims have to be submitted accurately and quickly to be reimbursed. Your revenue depends on it. 

You’re probably here because dental insurance claims processing has become such a challenge at your dental business that you’re exploring alternative solutions. 

And with what you know about insurance billing, you can’t help but wonder:

Who will get me the best results: My in-house team or these outsourced experts?

This article provides the details and essential definitions that will help you answer that question and many others. 

Key takeaways when comparing your in-house team to outsourced dental billing experts:

• In-house and outsourced are NOT mutually exclusive — outsourcing your insurance billing process doesn’t mean firing your in-house team. 
• Insurance claims processing is a big job that requires experience, up-to-date knowledge, and dedicated attention.
• Your insurance claims revenue can account for nearly half of your overall revenue. Think strategically about who handles this process.

Quick Start: What is dental billing outsourcing? 

Dental billing is any activity that collects payment for dental services performed in your dental practice. A dental billing payment comes from one or two sources: Insurance provider(s) and/or the patient. 

Your dental revenue cycle is the sequence of steps that give you the best chance of being paid accurately and promptly by both insurance and patients. We visualize the dental revenue cycle as these 7 steps: 

When you outsource the parts of your revenue cycle, you’re bringing on a third party for tasks that can be handled by someone outside your office. By doing this, you can enlist experts and automation to handle those essential tasks for your dental business. 

What does outsourced dental billing include? At DCS, our dental billing services cover: 

• Patient scheduling
• Insurance verification
• Insurance claims processing
• Patient billing

And also:

• Oral and maxillofacial surgery (OMS) billing

Insurance claims processing is one of our most popular services for all the reasons we’ve mentioned — it frees up your team’s valuable time and talents for patient care, and they don’t have to wrestle with insurance companies and their intricate, ever-changing rules.

In-house dental insurance claims processing — who is involved?

You might think that efficient claims processing starts with insurance verification, but it actually starts long before that. When you hire staff to do the work, you’re limiting your cash flow to their level of experience.

As you know, dental insurance claims work involves multiple steps, plus countless details that change annually — and they vary by insurer. It can be hard to recruit specialists who have mastered it, particularly with the nationwide healthcare staffing shortage.

Most of the dental teams we speak with don’t have a dedicated insurance coordinator. Instead, they have someone who merely gets to the insurance claims processing when they can. Payments from insurance claims can be 50% of a practice’s revenue, yet it typically takes a back seat to in-office patients and other administrative work. 

To add to those team’s task burden, insurance claims can get complicated. 

We’ve already mentioned the intricacy of insurer policies. On top of that, insurance companies update these policies every year, and CDT codes are added, updated, and retired annually. That’s a lot to keep up with among the everyday responsibilities on your plate.

And there are no small mistakes when it comes to insurance claims.

Even a tiny error made during claims processing leads to a complete claim denial, followed by research and an appeal, and then a claim resubmission — the sum of which can delay your payment for weeks.

And the longer a claim goes without being paid, the less likely it ever will be paid, particularly when you consider timely filing expirations that end in write-offs.

Related: The #1 report your dental team needs to understand: The insurance aging report

So, if you intend to fill your insurance claims processing position with someone in-house, here are the minimum requirements for the insurance experts we hire, and we recommend the same for you:

• Extensive knowledge in the following topics:
  • Insurance laws, regulations, and policies
  • CDT and CPT coding (dental claims vs medical claims)
  • Coordination of benefits rules
  • Insurance fraud and compliance rules
• Experience creating and submitting insurance claims accurately
• Experience appealing claims efficiently and accurately
• Experience communicating with insurance companies and strategically working to appeal claims
• Experience reconciling and posting insurance claim payments to practice management software
• Experience analyzing financial reports in dental practice management software

Ideally, the person you hire with this experience would be completely focused on insurance billing tasks — no additional administrative or patient-related tasks to divert attention from their revenue-generating role. Why does that matter?

When the person handling your insurance claims is constantly distracted or interrupted, they will inevitably make costly mistakes. 

How does a DCS dental billing expert process dental insurance claims?

DCS Insurance Billing was our first offer in 2012 — and now it’s our most popular offering, by the way! — so we’ve perfected and proven this process through more than 10 years of service.

Our insurance billing experts will:

• Review the insurance claims created by your team for accuracy and sufficient documentation
• Get corrections for the claim, if needed
• Submit claims to insurance companies daily
• Track every claim until it is paid
• Review your insurance aging report regularly to resolve troublesome claims ASAP
• Analyze your claim-related financial performance
• Reconcile your claims payments

And remember all the work experience we mentioned above for your hire? That’s the kind of person who will be working on your insurance claims when you work with DCS. A large part of our Account Specialists are former insurance coordinators and office managers with years of experience ensuring dental practices are promptly paid.

With DCS, your assigned insurance expert’s responsibility is to handle claims, without distractions. They’re hyper-focused on bringing in revenue. You don’t have to worry about them being interrupted or distracted. You don’t even have to worry about them being out of the office — another one of our experts will handle your claims until yours gets back. Your insurance claims will be handled daily, no matter what.

We’d be remiss if we didn’t boast about our DCS Knowledge Network. The DCS Knowledge Network is the ‘fleet’ of experts at DCS. We employ 100+ highly skilled revenue cycle management (RCM) professionals who specialize in the dental revenue cycle, bringing decades of experience to getting your dental business paid quickly and consistently. 

Read more: 5 benefits of outsourcing dental revenue cycle management: Collect more and support your team

Dental claim processing reveal: In-house staff vs outsourced dental billing expert

So, with all of this in mind: Who gets the best results, in-house staff or the outsourced dental billing expert?

Having an assigned Account Specialist plus access to a nationwide pool of experts is a huge perk to outsourcing your dental billing with DCS. You’ll have dozens of experienced dental professionals tapping into each other's knowledge as needed to solve the unavoidable problems that arise with some insurance claims.

Of course, you may have an experienced office manager handling your dental insurance claim processing in-house. But they’d be the first to tell you that dental office managers have a full (or overflowing) plate that makes it impossible to focus entirely on insurance billing.

And we’d like to remind you that every employee goes on vacation, takes sick days, might quit, and eventually retires, but your designated DCS insurance expert will simply be replaced without any rehire hassles for you. 

Also, the cost of an employee is significantly higher compared to outsourcing with DCS.

Our pricing depends on which service you choose, the size of your practice, the volume of your collections, while a salary depends on your location, their level of experience, and more.

Even the baseline of our insurance billing services is far less expensive than compensation for an experienced full-time insurance coordinator, even without the added cost of benefits: 

Read more here: The cost of revenue cycle management services vs. in-house dental billing: 5 questions answered

So, between in-house and outsourcing your dental billing, who will be in a better position to bring the winning results of maximizing your revenue and creating consistent cash flow?

It will be our insurance specialists who, as your outsourced experts, guarantee that time, top-notch talent, and today’s technology will be dedicated daily to getting your claims paid — and not stopping until they are.

Our client-partner, Steve Kuchuris at Yellowstone Family Dental, tells us what his practice was like before and after outsourcing their insurance billing to DCS: 

“Before working with DCS, we had too many old claims, and we were not able to get caught up. Once we partnered with DCS, we noticed an immediate reduction in AR due to catching up on posting, and then starting to work aging. They were very responsive, and Ana was amazing: Very knowledgeable and friendly! We continue to be impressed with the great communication and ease of onboarding with DCS. I absolutely recommend DCS!"

The choice is yours: Continue with what you’ve had, or have a team of experts committed to building up your revenue. 

Choose dental billing experts to generate revenue and redirect your team’s focus to patients

To recap: 

• It’s no one’s fault that your team doesn’t have the time or the niche expertise to handle insurance claims — but it’s your responsibility to do something about it when delayed payer reimbursements are holding back your business
• Insurance billing isn’t something that should be learned on the job — insurance claim mistakes are high stakes! They erode your overall revenue and slow your cash flow.
• When an outsourced expert takes over your insurance billing, your claims will be submitted more accurately and consistently, and your in-house team can redirect their attention to in-office patients and providing exceptional care.

With your designated DCS Account Specialist plus our DCS Knowledge Network handling your insurance claims, you’ll see more cash flow, cleaner processes, and a less burned-out in-house team. You’ll sleep easier knowing that someone with extensive dental insurance experience is managing this major portion of your revenue — and the continued success of your business.

DCS offers end-to-end revenue cycle management services and solutions, with our most popular being insurance claims processing.

Hand over this essential, complex work to experts who conduct business in the background, while your in-house team is front and center at your dental business: Book a free 30-minute consultation today.