Completing the encounter form and prior-approval form (if necessary) are the only two billing functions normally delegated to clinical staff. The remaining functions take place in the front office, back office, or billing department. If you are part of a comprehensive primary care program, billing and collections from this point forward may be handled by a central billing department. This department will determine the best way to submit bills to third-party payers (batching hard copy printouts or electronic submission). However, input from oral health professionals is critical in setting up the billing department's dental component.
Input from the dental department is needed for the following:
Most general billing personnel without dental knowledge are not aware of the intricacies of dental billing (progress vs. completed procedures, need for tooth numbers, quadrant identifiers), or of the different fees to be charged for procedures (single surface vs. multi-surface restoration). Without professional input, billing errors such as under-billing or over-billing for services, or fraud for billing for incomplete services (such as incomplete dentures or RCTs) may occur that can jeopardize dental clinic viability. Once professional dental input is complete, billing department staff should be able to run the billing and collections functions and produce various reports that are both administratively and clinically useful. They will also establish guidelines for aging accounts receivable and writing off bad debt, as well as collections policies for various situations.
Since all good operations look at cost centers (e.g., dental cost center) for the contribution each component makes toward overall program solvency and viability, the outcome of dental charge generation, and subsequent billing and collections, must be regularly evaluated, not only for billing efficiency and rate of collection but also for the bigger picture comparison of the critical financial aspects of revenue vs. expenditures discussed in Unit 3.