In-House Insurance Coordinator vs. Third Party Billing: What is Best for Your Practice?
There are many factors to consider when choosing to do insurance billing in-house vs. outsourcing it to a billing company.
These include:
- the practice size
- the team’s knowledge
- the cost
- the time
- the familiarity with practice-specific procedures
Our practice has dedicated time and effort to training our team to become knowledgeable about insurance so our patients have a better understanding of their benefits and can comfortably move toward accepting treatment.
An insurance coordinator’s primary responsibility is to verify coverage for all incoming patients’ insurance plans.
The insurance coordinator must be familiar with insurance policies and requirements. The insurance coordinator must process all claims on behalf of the practice with all necessary information and follow up on these claims regularly. The insurance coordinator should enter all insurance payments into the practice management software so that any incorrect claim payment can be evaluated and reprocessed if necessary.
Why In-House?
- Insurance coordinators have control over the claims and the billing process. They have direct oversight of the claims and can monitor them. They have access to the software and can easily include all information needed for claim processing or reprocessing.
- Insurance coordinators can communicate with the team about coverage and answer patients’ questions about their specific plans. They can also inform the team of regulation changes when processing claims.
- An in-house team member may be more cost-effective for processing claims, especially for smaller practices.
- The Insurance coordinator is more familiar with the patients and will have a better understanding of the treatment being done. Incorrect information can be recognized before claims are submitted, minimizing the need to reprocess claims.
Why Third-Party Billing?
- Third-party billers are insurance experts. They are specialized and knowledgeable about regulations and policies.
- Processing claims outside the practice allows the office team to concentrate on other duties. The team can focus on patient care vs. administrative tasks.
- Third-party billers are equipped to handle many claims.
- Third-party billing agencies understand the constantly changing regulations and stay compliant.
Things to Consider When Deciding
In our practice, we have decided to go the “in-house” route. Here is a recent example of why we made this decision.
We pre-authorized a bridge that would be a replacement for a partial. It would be a six-unit bridge replacing laterals. We also pre-authorized four single crowns if the partial stayed, and single crowns would be placed.
The authorization for the single crowns was approved. However, the bridge was denied due to the missing tooth exclusion rule. We notified the insurance company because this was a replacement of teeth, not an initial placement. They had us resubmit the claim.
Another denial came through, reusing the missing tooth exclusion rule. I contacted the insurance again, and they said the claim was submitted as “initial placement,” which was inaccurate since we had a copy of what was submitted. I explained this was a replacement and gave them the necessary dates of prior placement. The claim was finally approved at 50% coverage.
I’m sure many offices have experienced incorrect claims processing. Still, this example shows how it could have easily been processed incorrectly in-house and by third-party billers.
My knowledge of the patient’s history allowed me to recognize the insurance companies’ errors and correct them in a way the third-party biller would likely have missed.
Had our office not been knowledgeable about claim processing, we might have accepted the denial as “insurance knows best.” Had third-party billers processed the claim, they would not have been familiar with the patient, aware of the history, and may not have questioned the claim.
Doing What’s Best for Your Practice
Our insurance coordinator has been with our practice for 21 years and has spent many of those years in billing. That, along with my 38 years with the practice, we knew that something with this claim was incorrect.
Many offices may not have the luxury of having long-term employees. It isn’t easy to take the time to learn insurance billing if you are dealing with employee turnover.
The good news is that third-party billing agencies are out there to help maneuver your practice through the claims process. It is still essential to have employees in place to evaluate that the information going to the third-party billing company is accurate.
Sound claims processing, in-house or third party, is only as good as the information in the software. Every practice needs to have systems in place to ensure the accuracy of the documentation.
In-house and third-party billing have advantages and disadvantages. The specific needs and resources available to the dental practice must determine whether to choose either of these options.
About the Author
Tracy Gryger, MAADOM
Tracy entered the dental world in 1986 and is proud to have worked for the same dental office for 38 years. She started her career as a dental assistant and assisted for five years; however, her passion was administration.
Tracy was drawn to the daily administrative tasks and, before long, was offered an Office Manager position. She has experienced many changes in the dental world over the years and has helped her office grow. Eventually, she merged with another office to become a very successful dental practice.
Tracy has been a member of AADOM since 2015 and received her Mastership in 2021.
She currently lives in Dannemora, NY. Tracy has a beautiful grown daughter, Emily, and many “grandpets.” When she is not busy in the dental world, you can usually find her in the wood shop with my best friend and partner, Tom, and our Cavachon, Bullock. Her newest hobbies have been wood-turning, beekeeping, and gardening.
