Dental Office Fees and Billing: Getting It Right

Setting Your Dental Office Fees

Establishing the right fee schedule is foundational for a successful dental practice. Dental office fees should reflect the true value of your services, regional cost benchmarks, and your practice’s unique expertise. Begin by analyzing your overhead costs, including staff salaries, supplies, lab fees, and facility expenses. Next, research local and regional fee surveys—many state dental associations provide annual reports—to ensure your fees are competitive yet sustainable. Consider the complexity of procedures, time required, and the expertise involved when assigning fees to each CDT (Current Dental Terminology) code.

It’s also important to regularly review and update your fee schedule to account for inflation, increased supply costs, and changes in the dental market. Transparent communication with patients about your fees, including providing written estimates and explaining what is and isn’t covered by insurance, builds trust and reduces billing disputes.

Insurance Participation vs. Fee-for-Service

One of the most critical decisions for dental practices is whether to participate with dental insurance networks or operate as a fee-for-service (FFS) provider. Participating providers (in-network) agree to accept contracted fees from insurance companies, which can mean lower reimbursement rates but increased patient volume. In contrast, FFS practices set their own fees and patients pay directly, often submitting claims for out-of-network benefits themselves.

When evaluating insurance participation, assess the impact on your revenue cycle management (RCM). In-network practices must be diligent in verifying patient eligibility, understanding plan limitations, and submitting clean claims using accurate CDT codes. FFS practices, while enjoying more control over fees, should provide clear financial policies and educate patients on their payment responsibilities. Both models benefit from robust billing workflows and transparent communication about costs and coverage.

Handling Patient Bills and Outstanding Balances

Efficient patient billing is essential for healthy cash flow. Start by verifying insurance benefits and eligibility before the appointment, so you can provide accurate treatment estimates. At the time of service, collect copays and any known patient portions. After insurance processes the claim and issues an Explanation of Benefits (EOB), promptly bill patients for any remaining balance.

For outstanding balances, establish a consistent follow-up process. Send clear, itemized statements and use friendly reminders via phone, email, or text. Offer flexible payment plans when appropriate, and train your team to handle billing questions with empathy and professionalism. For accounts that become seriously delinquent, consider a formal collections process, but always prioritize patient relationships and compliance with federal and state regulations.

Working with Dental Billing Services (Outsourcing vs In-house)

Deciding between in-house billing and outsourcing to a dental billing service is a significant operational choice. In-house billing gives you direct control over claims, AR (accounts receivable), and patient communications, but requires ongoing training and investment in dental billing software. Outsourcing can free up staff time and leverage specialized expertise, especially for complex insurance claim appeals or high-volume practices.

When outsourcing, choose a reputable dental billing service with experience in your state and with your practice management software. Set clear expectations for claim submission timelines, AR follow-up, and reporting. Whether in-house or outsourced, best practices include daily claim submission, timely follow-up on unpaid claims, and regular reconciliation of patient accounts. Accurate documentation and use of correct CDT codes are crucial to minimize denials and maximize collections.

Regularly Reviewing and Updating Fee Structures

Fee schedules should never be static. At least annually, review your dental office fees in light of changing costs, insurance reimbursement trends, and local market dynamics. Analyze your AR reports to identify underperforming codes or frequent write-offs, which may signal the need for fee adjustments or improved billing processes.

Engage your team in fee review discussions, as front office staff often have valuable insights into patient concerns and billing challenges. Update your written financial policies and ensure all staff are trained on new fees and billing protocols. Communicate any changes to patients in advance, emphasizing your commitment to transparency and quality care. Regular fee reviews not only protect your practice’s financial health but also support long-term patient trust and satisfaction.