In healthcare the process of billing takes central stage. When it comes to the revenue cycle in. That it helps the providers to claim their dues on time. Medical billing and dental billing are two different professions. As far as procedures, codes and insurance are similar. It is important for healthcare and dental workers. To understand what distinguishes these two fields. So, it this article we will learn about Medical billing and dental billing. We will also talk about importance and challenges. In the last we will also suggest dental billing company which is best in USA. So, keep reading our article to learn about these.
What Is Medical Billing?
Health insurance billing encompasses the process of filing insurance claims. With insurance providers for the purpose of recovering the costs of services rendered by physicians, hospitals and others. It uses standard medical coding systems, such as:
- ICD (International Classification of Diseases): For diagnoses.
- CPT (Current Procedural Terminology): For procedures and treatments.
- HCPCS (Healthcare Common Procedure Coding System): For services and supplies. That is not quoted under CPT numbers.
These codes are global, this therefore ensures that insurance claim processing is effective. As well as exchange of information between insurance companies and the health care providers.
What Is Dental Billing?
Dental billing only concentrates on oral health care services. Such as prophylactic examinations and cleanings, treatments and other services. Which may include fillings, crowning, root canal, and orthodontic services. Unlike medical billing, dental billing in Chicago often uses its own coding system:
- CDT (Current Dental Terminology) Codes: These codes were also established by the American Dental Association. And they are related only to dentistry.
- Dental billing highlights the dental health insurance. Which is a bit different from the general health care insurance in terms of ways of payments.
Medical Billing vs Dental Billing.
1. Coding Systems
- Medical Billing: Depends on ICD, CPT and HCPCS codes. Those include principal diagnoses and services from more than broad categories.
Dental Billing: Is based on CDT codes, which are under the HCFA and are only applicable to dental services. And can only be distinguish from medical codes.
2. Insurance Coverage
- Medical Billing: Works with health insurance companies that cater all sorts of illnesses. And diseases ranging from emergencies, surgeries and chronic illnesses.
- Dental Billing: Negotiates with companies offering dental insurance. That are usually characterized by lower limits than medical insurance. And an emphasis on preventive care, primary and some major restorative services.
3. Reimbursement Process
- Medical Billing: Frequent in involving patient insurance matters especially. When patient is in a position to require costly treatment or admission in hospital.
- Dental Billing: More often have more easy payment solutions. But might have co-payments or out of pocket expenses for patients. As still most dental insurances are not full covering but partial.
4. Preauthorization Requirements
- Medical Billing: Often needs a prior approval if the patient is to undergo an expensive procedure. Or begin treatment for a costly condition.
- Dental Billing: Similar to prior authorization for dental services. This process is most of the time less complicated with clear services like crowns or orthodontics.
5. Interconnection with Modalities
A few of the suggested dental procedures are related to medical procedures. For example:
- Medical Billing: May include some dental procedures occurring from accidents or other circumstances. Or oral surgeries or other diseases (diabetes affecting the gums, for instance).
- Dental Billing: Usually entails only the routine and routine preventive dental care. Although may require a cross over with med E&M for a given patient encounter.
Why Are Specialized Billing Services Important?
Specialized Billing Services are crucial since they fulfil tasks in accounts receivables. That are normally required of them but are not their main specialization.
With these differences it’s important to select proper medical billing coding services. Or dental billing specialists to submit accurate claims and to get proper reimbursements. So, specialized billing services are important. You should not ignore any compliance. The best solution is to outsource service.
Benefits of Specialized Services:
- Industry knowledge of the different code systems (ICD/CPT vs CDT).
- Every insurance policy and the coverage permits and customs.
- Less denials of claims and fewer delays in payments.
- Encapsulation of medical and dental procedures simultaneously for the cases which come under dual nano program.
Challenges in Billing for Medical and Dental Services
Overlapping Procedures:
When someone got treatment for TMJ. So, few practices confuse about it that it will be dental billing and medical billing. So, many other treatment can overlap. Though it is most common challenge which occur. There should need to choose right system for it. So that someone can get better treatment and practices can get maximum revenue.
Insurance Limitations:
Dental insurance have annual limits. So, if someone get dental treatment. Confusion can be arise that insurance plan is limited or not. Or patient is eligible for insurance or not. So, it is also another challenge to face in dental billing. If someone is not good in dental billing. Then he/she can cause of revenue loss.
Compliance Requirements:
Medical billing as well as dental billing requires complete attention to the compliance issues. Such as HIPAA rules and payer requirements. These rules and regulations should follow. Because if someone fails to adopt these rules. Then they can expect revenue loss.
Choosing the Right Billing Service
Outsourcing to professional medical billing and coding services or dental billing specialists can contribute a lot. For a healthcare or a dental practices. These services ensure:
- Accurate claim submissions.
- Few coding and documentation mistakes are observed in comparison to other cases.
- Regulatory information on industries practicing the four company types.
Outstanding number of clinics and dental offices prefers outsourcing services. Use professional billing to improve the management of a revenue cycle and patients’ satisfaction.
