In Dental Billing

Dental offices often wonder if posting dental insurance claim payments by procedure is important. You may be a dental office already posting by procedure, but don’t really know why. Maybe you post total claims payments as a single payment, applying to the entire claim rather than by line item. Dental offices do things differently.

Why does posting by procedure really matter though? Well, if you like correct patient ledgers, presenting accurate treatment plans, and paying your providers correctly, it does matter!

Outsourced dental billing companies, such as Dental ClaimSupport, often receive the question, “Do you post our insurance payments by procedure?” The answer is always, absolutely! However, whether or not you choose to utilize a dental billing company, it is always advisable to post payments by procedure.

Correctly posting dental claim payments by procedure can be more time consuming on the front end, sure. However, this article will help you realize why taking a little extra time for accuracy and correct allocation of payments will save you time and headache moving forward. There’s much more to payment posting than just applying a credit to an account ledger.

 

What does posting by procedure mean in dentistry?

Posting payments by procedure means allocating exactly what was paid for each procedure/line item to the correct procedure and line item in your dental software. Let’s simplify that a little. Take a look at the sample explanation of benefits (EOB) below. These procedures were completed. A dental claim was sent to the insurance company, and the claim was paid.

 

Submitted amount on claim:

Evaluation  $   70

Bitewings   $   60

Prophy       $ 100

Total Fee   $230

 

Allowed and approved amount on explanation of benefits (EOB):

Evaluation  $ 50

Bitewings  $ 45

Prophy $ 75

Total Allowable $170

Insurance paid a total of: $170 

It is a bad practice to post:

$170 in your dental software to the entire claim without regard for the line item procedures. This is often referred to as posting as a “total” payment. Yes, this closes out the claim. However, anyone in your office viewing the claim and ledger doesn’t know how much was paid for each procedure.

It is a good practice to post:

$50, by line item, to the evaluation 

$45, by line item, to the bitewings

$75, by line item, to the prophy

It may not seem like too big of a deal, but there are many benefits to posting by procedure that help your dental practice. From compensating your providers correctly to accurately calculating a patient’s out of pocket expense for procedures performed, posting by procedure is the way to go.

 

 What are the main benefits of posting by procedure?

Accurately and efficiently compensate your providers

Many dentists and hygienists (dental providers) are paid based on a percentage of collections for dentistry produced. If payments aren’t posted by procedure and only posted as a “total” payment, collections may be allocated to the wrong provider. This means the provider that actually performed the services will not be paid correctly. 

Let’s look back at the simple hygiene appointment from above. Most dental offices would have the doctor perform the evaluation and the hygienist perform the prophy and bitewings. Typically, the doctor should get credit for the eval, and the hygienist for the prophy and bitewings. 

But what if the insurance paid for this procedure, and your dental biller posted the entire payment as a “total payment” and not by procedure? Your dental software will only post this payment under one provider. This means that either the hygienist or the doctor would get credit for the whole date of service. If the entire payment is posted under the doctor, then the hygienist being paid off of collections would lose out on pay.

Taking the time to post payments correctly by procedure ensures that reports are accurate, and that the correct dental provider gets credit for the work performed. This is much less time consuming than trying to correct inaccurate payroll. 

 

Know exactly what was paid for each procedure

By posting an insurance payment by procedure, you know how much of the total payment was allocated by the plan for each procedure. Therefore, if there wasn’t a procedure paid for any reason, it can be documented on the ledger. Any team member can easily read the notes and documentation to explain to the patient where a balance is coming from. 

This shows the savviness of your dental team and builds trust with your patients. Your patients are then more inclined to pay their balances because of the accurate explanation of where it came from.

This posting protocol applies to all dental benefits payments, whether in or out-of-network. Posting an out-of-network insurance payment by procedure allows you to develop a history of how much will be paid on the same services should the patient or a different patient insured by the same group plan present for treatment.

This enables your dental practice to more accurately estimate expected patient portions and can increase treatment acceptance.

It is not easy for patients to clearly understand their benefits. That task typically falls on your dental team. The more your dental team knows about the patient’s benefits and can educate the patient, the more likely the patient is to accept treatment. Higher treatment acceptance leads to full dental chairs and more revenue for your practice.

 

Maintain a current Preferred Provider Organization (PPO) fee schedule

Posting payments by procedure for a PPO plan will allow you to know exactly what the write-off should be for any procedure when the full fee, not the contracted fee, is entered on the ledger. You will also be able to easily determine when contracted fee schedules need to be updated by knowing exactly what was paid for each procedure and comparing them to the fees you have entered in your software system. 

It is important to maintain an accurate fee schedule when in network. Simply put, you wouldn’t want to collect a wrong copay when a patient leaves your practice after an appointment. An example would be collecting $55 from a patient when you should have collected $60. If you don’t maintain accurate fee schedules, you’ll do just that.

The primary benefit of maintaining an accurate fee schedule, in your dental software system, is to communicate with the patient the estimated out-of-pocket expense when presenting treatment plans and making financial arrangements.

 

Accurately calculate the patient’s portion and PPO provider write-off for dual insurance

If you post by procedure accurately, you know exactly how much was paid for each procedure by primary and secondary plans. By doing this, your PPO write-off can also be precisely calculated for each procedure.

Ledgers can get messy when the patient has more than one plan, and the provider of service is in-network with one or more of those plans. Do yourself a favor and post by procedure. You will be glad you did when an account analysis is needed. Since posting was done accurately, the account audit and analysis is completed quickly.

Less time is also spent explaining to a patient what was paid for each procedure or why a patient may owe your office. Lastly, your dental team can correctly calculate write-offs by understanding the in network fees for each insurance carrier and knowing exactly what both insurances paid for all procedures. 

What if your office only enters contracted fees on the ledger rather than the full fee or standard fee you would charge a cash patient? 

Great question! Contracted fees entered on the ledger may create a false credit when there is more than one plan. A false credit occurs when the total amount collected from all plans is more than the amount charged in the ledger. It can also occur if an incorrect write-off was taken making the dollar amount of credits higher than the dollar amount of debits (charges) for the date of service.

An example would be $105 in credits (payments and write-offs) but only $100 charged for the date of service. This would be a “false credit” of $5, and is incorrect.

Applying the contracted fee and write-off to the ledger creates the false credit. So, once all payments post from primary and secondary insurance claims, and the PPO write-off is taken in error, the false credit is created. Many times this “credit” is refunded to the patient, and the practice essentially loses money. In the example above, the office would lose $5. Posting payments by procedure allows for efficient research of credit balances, and helps your practice avoid losing money that was already earned.

 

Clean dental ledgers are GOOD for your office

Clean dental ledgers are a product of your dental office running smoothly. Accurate fees for the various insurance companies are entered correctly into your dental software. Detailed insurance verification is completed by the admin team and data entry into the dental software is error-free. All of these duties lead to precise estimates of patient out of pocket expenses, and your dental team knows what the insurance should pay for all procedures done. 

What does that mean…? Essentially, once patients pay their copays before leaving the dental office and insurance pay claims, this should leave the patient with a $0 balance for that date of service. If insurance didn’t pay exactly what the estimate was, but we posted accurately and by procedure, you still know exactly where the leftover balance is coming from. This is what we mean by a “clean ledger”. 

This will decrease your overall accounts receivable. You will have to call less insurances and patients to collect on unpaid claims and balances. This increases your overall collections and collection percentage, and saves your dental team more time allowing your team to be more patient focused.

This article was written to give you a clear understanding of why it is important to post dental insurance payments by procedure. Review with your team to ensure proper written protocols are in place so that all team members are posting accurately and in the same manner. 

Posting payments can be tricky. Your dental team needs to understand how to read EOBs and correctly transfer this information to patient ledgers. You may wonder what else your dental team can do for your office and patients if they aren’t having to focus on posting payments and other billing duties.

Outsourcing may be able to help. If you want to learn more about outsourcing your insurance receivables to a dental billing company but aren’t quite sure how it works, take some time to review the benefits of outsourced dental billing.

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