Dental & Medical Insurance Billing Services

Your accounts receivable problems will be solved with the nation’s leading dental and Medical insurance billing system from AmeriDenti Billing. You will gross and net more revenue.
We offer two services that focuses on accounts receivables; Dental & Medical Insurance Billing Service and the Patient Accounts Receivable Management add-on Service. Our primary goal is to assist your office in collecting all insurance money that is rightfully owed to you. This requires us to be involved in aspects of your insurance claims processing. Our achievable goal is to ensure that your over ninety (90) days insurance account balances are minimal.

We can bill Medi-Cal, Medicaid, PPO Dental for Dental Billing. As Medical Billing relate to Dental surgeries, we are expert with Medicare and PPO, PCP Health Insurances.

We also offer Medi-Cal & Medicaid NPI enrollment and Medicare Payer Provider ID to get payment reimbursement from Health Insurances.

OUR DENTAL & MEDICAL INSURANCE BILLING SERVICE FEES

The amount of work to send claims, post EOBs, appeal denied claims, and keep your over ninety days insurance accounts receivables at a minimum is variable depending on how many patients you service monthly. The fees for this insurance accounts receivables service “as described in the above bullet points” are variable depending on what is collected from insurance. The following payment schedule applies for all offices:

8.0% / Month
Small sized Dental Office
  • If the office’s insurance collections are under $35k/month or less
  • The fee for this service described above is 8.0% of the total insurance collections
7.0% / Month
Medium sized Dental Office
  • If the office’s insurance collections are between $35k to $80k/month
  • The fee for this service is 7.0% of the total insurance collections
6.0% / Month
Large sized Dental Office
  • If the office’s insurance collections are between $85k to $120k/month
  • The fee for this service is 6.0% of the total insurance collections
5.0% / Month
Enterprise sized Dental Office
  • If the office’s insurance collections are greater than $130k/month
  • The fee for this service is 5.0% of the total insurance collections
15%
Small sized Medical Claims
  • If the office’s Medical insurance Claim submittion are under 25 claims/month
  • The fee for this service described above is 15% of Insurance Collection
13%
Medium sized Medical Claims
  • If the office’s Medical insurance Claim submittion are 25-50 claims/month
  • The fee for this service described above is 13% of Insurance Collection
10%
Large sized Medical Claims
  • If the office’s Medical insurance Claim submittion are more than 50 claims/month
  • The fee for this service is 10% of the total Insurance Collection
Government Programs
  • Medicare Part B
    Individual - Service Fee $550
    Organization - Service Fee $500
  • Medicare Part B-DME
    Sleep Apnea, TMJ/TMD & Ortho
    Organization - Service Fee $550
    Medicare Contractor - Service Fee $600
  • Medicare Supplement
    Service Fee for 5 Insurances $1500
    Service Fee for 10 Insurances $2500
  • Tricare(Active Duty Military Health Plan) Service Fee $550
  • CHAMPVA(Retired Military Health Plan) Service Fee $550
Commercial Health Plan
  • In-Network Provider
    PPO, POS
    Anthem (BC, BS, BCBS), HealthNet, Aetna, Cigna, United Health Care, Scan & Physical Health Care - Service Fee $2000
  • Out-of-Network Provider
    PPO, POS
    Anthem (BC, BS, BCBS), HealthNet, Aetna, Cigna, United Health Care, Scan & Physical Health Care - Service Fee $2000
EDI/ERA and/or EFT
No charge for existing provider's
Workshop
  • Medicare Part B
    Provider Enrollment Workshop
    (Individual & Organization)
    Fee - $550 2 Days Workshop (3 Hrs/Day)
  • Medicare Part B-DME
    Provider Enrollment Workshop
    Fee - $350 1 Day Workshop (3 Hrs)
Training
  • Basic Medical Billing
    Includes Billing support for 10 Hrs/Year
    Fee - $1500 3 Days Workshop (4 Hrs/Day)
  • Advanced Medical Billing
    Includes Billing support for 20 Hrs/Year
    Includes Online support for 6 Months
    Fee - $3500 6 Days Workshop (4 Hrs/Day)
  • Private Medical Billing
    Includes Commercial Health Plan - Provider Enrollment (Out-of-Network)
    Includes EDI/ERA and/or EFT
    Fee - $5000 8 Days Workshop (6 Hrs/Day)
Coding Support
  • Dental Coding Support
    Fee - $199/Year
  • Medical Coding Support
    Fee - $399/Year
  • Medical & Dental Coding Support
    Fee - $499/Year

EOBs Posted Daily

All insurance payments and insurance contract adjustments are posted to the patient ledgers accurately and timely–within 24 business hours after the EOB is scanned by your office. We recommend depositing the checks the next day, ensuring that our daily deposits balance with what is posted daily. Your team of AmeriDenti billing specialists will communicate daily with your office manager via email to ensure smooth end-of-day balancing.

Review All Denied Claims

All claims are closed out at the appropriate time. If a claim is denied, we will immediately investigate the cause and appeal the claim if it is appealable. This attention to detail ensures that we collect as quickly as possible the outstanding balances that are rightfully yours.

Verify Procedures That Are Not Sent To Insurance

Often we find that insurance claims are not created timely. We help ensure that this oversight is remedied.

Primary & Secondary Claims Submitted Daily

All dental insurance billing claims for primary and secondary claims are sent electronically, daily. Preauthorizations will be sent to insurance companies when requested. We utilize your current electronic claims system. If you are currently sending paper claims, we will assist you in setting up electronic claims at no additional cost to you. Every claim is reviewed before it is sent to an insurance company to ensure that the claim will not be denied over a clerical error, which typically occurs 3-4 times per week in most dental offices.

Electronic Attachments Used When Available

Electronic attachments will be sent for all claims when available. If an insurance company will not accept electronic attachments, we will process a paper attachment through the mail. But we will ask you to reimburse us for the cost of the stamps used. If you are currently not using electronic attachments, we will assist you in setting up the ability to send electronic attachments with your electronic claims at no additional cost to you.

Missing Information Is Gathered By Us

Often patient’s family files are incomplete. This will cause a claim to be denied after thirty (30) days, if not caught before the claim is sent. A typical office will usually have two or three issues like this weekly. The eAssist dental insurance billing specialists will proactively contact your patients and ask for any missing information–to complete the patient file–to ensure the most prompt payment possible. We will report these errors in your daily email summary to help you better understand how we are solving your insurance collection issues.

Insurance Aging Report Focus

The Insurance Aging Report is analyzed each month and diligently “worked”. You will receive daily summaries that track how many overdue claims were appealed, how much money was collected, and what your current accounts receivable balances are between 30-60 days overdue, 60-90 days overdue, and past 90 days overdue. If there are any outstanding balances that you prefer we do not pursue, please communicate that to us via email to ensure that all patient communication guidelines meet your expectations

Detailed Accounts Receivables Work Log

All overdue insurance balances that are thirty (30) days old or older are followed up on weekly. Your daily report will include a summary of any accounts receivable followup from that day. A detailed list of who we’ve been working with at the various insurance companies is available upon request. Every two to three weeks, detailed notes gathered by your AmeriDenti billing specialists are recorded in the claim status or patient guarantor notes in your dental management software.

Monthly Accountability Reports

Monthly reports are emailed to your management staff, with a summary of our insurance collection efforts and any issues we have discovered that will slow down our collection efficiency. Examples of these reports can be sent to you upon request.

Patient Ledger Audits

By request, we can audit a patient ledger for accuracy. Often we find that errors have occurred in previous EOB posting, which cause inaccuracies in your patient balances. There is a cost for this service. Patient ledgers are reviewed for origin of balance and we research transactions up to two years prior.

Custom Letters Requesting Payment

Patients that have outstanding balances–that you have deemed to be accurate–will receive three customized letters from us demanding payment. The purpose is to prompt the patient to call your office for clarification and make payment arrangements for their patient accounts receivable balances with you. All patient correspondence is available for client review.

Patient Phone Calls

Patients with outstanding balances that have ignored statements will receive a series of three phone calls along with the customized letters. The goal is to motivate the patient to pay what they owe.

Clean Bad Debt From Aging Report

When an account is deemed noncollectable, the office is advised, and the patient accounts receivable balance is then transferred to a collection agency–if desired by the office. We either write off the account or facilitate the collection agency transfer based on your office’s desires. Regardless of the outcome, we actively manage all of your collectible receivables to ensure accurate accounts receivable reporting.

Electronic Statements

Statements are sent electronically through your management software on a weekly or monthly basis, according to your preference.

Daily & Weekly Accountability Reports

Daily emails and weekly summaries are sent to the doctor that describe who we have contacted, how many letters have been sent, how many phone calls were made, how much money has been collected, current patient accounts receivable balances, and who left the office without paying any of their portion. This information will help your office manager better manage the front desk staff, thus improving patient portion collections at the time of service.

Summary of Dental & Medical Insurance Billing Service Features

  • All insurance payments & insurance contract adjustments are posted to the patient ledgers accurately & timely
  • All paid claims are closed and denied claims immediately investigated
  • Detailed clinical notes wil be referenced to formulate appeals
  • All procedures not attached to insurance claims will be reviewed
  • All primary & secondary claims are sent daily electronically
  • Electronic attachments are sent for all insurance companies that receive them
  • Correction of missing information in patient family files that can deny a claim
  • The insurance aging report is analyzed and worked
  • Daily (if desired), weekly, and monthly reports are emailed with summaries of all of our collection efforts
  • Our achievable goal is to ensure that your over 90 days insurance account balances are zero

DENTAL CLAIMS MANAGEMENT IS ESSENTIAL TO
ELIMINATE ACCOUNTS RECEIVABLE ISSUES

What is an EOB?

An EOB stands for: Explanation of Benefits. EOBs are NOT dental claims. EOBs are sent to your office as a receipt of services rendered. Every EOB is different and unlike that same standardization that is required to submit claims, insurance companies do not standardize their EOBs. It is important to pay careful attention to the columns, verbiage, line itemizations and in general read it thoroughly and carefully.

Why should I get a breakdown of dental insurance benefits before a patient is treated?

Dental insurance benefit breakdowns do not help your dental claims processing, but rather they allow you to properly give an estimate to a patient BEFORE the treatment is started. With all the variables that come with insurance and in order to serve your patients needs best, it is vital to know their insurance coverage in detail. It is perhaps most important for the financial health of your dental practice to get insurance breakdowns. When your staff is armed with this knowledge they are able to collect more accurately at the time of service. At one time this task required many hours on the phone, but now with convenient, easy to use websites and dental software tools, this task requires less staff time. Dental insurance breakdowns continue to be one of THE most important tools in your office.

What is the importance of having the right films, charting, and photos?

Not only are films important for diagnosing treatments but they are vital in making sure that your patient’s insurance pays to the maximum benefit that it should when dental claims are processed. Depending on the type of service if films, charting or photos are not available it is possible that no payment will be issued. Films and perio charting should not be more than 1 year old, need to be readable (no cone cuts) and should be mounted properly.

What is a prosthetic replacement clause and why is it important for the office to know?

The term prosthetic means serving as or relating to a prosthesis, which dentally would refer to crowns, bridges, dentures, and partials. The prosthetic replacement specifies how often the prosthesis service can be done. A prosthetic replacement clause is generally between 5-7 years but can be as much as 12 years. It is important to know what this clause is exactly for your patient’s insurance because dental claims are denied for this. It is then equally important for your office to find out how old the prosthesis is. If a patient cannot recall an estimated range is acceptable ( example approx. 7-8 years old).

What should my patient aging report numbers be?

​This number should be lower than 15% of total AR, 10% is ideal.

What should my insurance aging reports numbers be?

​Over 90 should be $0, this is what we strive for.

What if the wrong tooth was billed to insurance?

​It is really important to have a system of checks and balances in place so errors occur less frequently, but nothing is perfect and mistakes happen. When the wrong tooth is billed, rest at ease as this is a relatively simple fix. A letter drafted to the insurance stating the error on the dental claim and the correction will rectify the situation. It is always helpful to attach a copy of the EOB with the letter.

What do you do if the wrong code was submitted to insurance?

​Similarly to the “wrong tooth billed” issue, it requires a letter to the insurance. In this letter it is really important to include what the scenario was that created the incorrect submission, as it will help avoid the suspicion of fraud. Also in the letter include the wrong code, the correct code, a narrative (if required) and any attachments (ie films, charting, photos also if required).

I thought cleanings were free?

Getting a thorough breakdown of a patients benefits is important. Included in that breakdown it is equally important to find out about frequencies and limitations. Prophies are generally covered at 100% but when your office receives an EOB back with a denial or a reduced benefit it is important to understand why and how your office could have been aware prior to the receiving the EOB. There are several reason a prophy could have been denied or reduced here are the most common reasons:

  • Frequency limitation- the service was done too soon. Depending on the plan prophies can be covered;
    • 2 times in a 12 month period (but be careful to understand that this does not mean 2 times in a calendar year. If a plan pays 2/12 months make sure there are NOT 3 prophies during a 12 month period otherwise INS will deny for frequency.
    • 1 time every 6 months TO THE DAY!! Prophies cannot be even 1 day closer than 6 months apart otherwise insurance will deny coverage
    • 2 times in a single benefit or calendar year. (know the difference between calendar year and benefit year)
  • Patient Reached Yearly Max- in most cases if the maximum has been reached even preventative services will be denied, as they are part of the yearly maximum benefit.

Please explain the dental deductible?

​There can be different types of deductibles (preventative, basic and major) most insurance companies have a deductible that is waived on preventive care, HOWEVER, there are always some that don’t. Deductibles vary ranging from (usually) 25-100. A deductible is to be paid by the patient before any services are considered for payment. Knowing what your patient’s deductible is will help you to collect the right amount of money at the time services are rendered. This is a key to ensure that your accounts receivables are low. Once dental claims are processed, it is very difficult to collect “extra” money owed by the patient because of a miscalculation of the deductible at the time of service.

What is the formula for calculating a deductible and patient portion?

​Total charge- deductible * % of patient cost + deductible= total amount payable by the patient. Example: $175 filling with a deductible of $50.00 and patient pays 20% of basic services would look like this
$175.00-$50.00= $125.00 *.20=$25.00+$50.00= $75.00 total patient cost.

Why did insurance pay less than the % quoted on the benefit breakdown?

​In most cases this has occurred because your office is not a participating provider for the insurance billed and they have paid off of what they (the insurance company) considers UCR fee. The patient is responsible for the difference. Improper dental claims management can create upset patients that leave your practice. It is imperative that you get these initial treatment estimates correct before the treatment is completed.

What does UCR mean?

​UCR stands for Usual, Customary and Reasonable. ​