Dental Billing and Coding Course

Lesson 1 • The Dental Revenue Cycle Overview

Maps every stage from patient scheduling through final payment posting. Provides the end-to-end framework that all subsequent billing skills plug into.

Lesson 2 • Regulatory and Ethical Framework

Introduces patient privacy regulations, anti-fraud standards, and professional ethics in billing. Compliance awareness is embedded from the course's first chapter.

Lesson 3 • Essential Billing Terminology

Defines deductibles, maximums, co-pays, co-insurance, and co-ordination of benefits. Precise terminology prevents claim errors and patient miscommunication.

Lesson 4 • Types of Dental Insurance Plans

Distinguishes indemnity, PPO, HMO, and discount plan structures. Students match plan type to billing rules before coding any claim.

Lesson 1 • Prosthodontic and Orthodontic Codes

Introduces codes for dentures, bridges, implants, and orthodontic appliances. Students apply coverage limitation rules specific to these high-cost procedures.

Lesson 2 • Restorative and Endodontic Codes

Addresses amalgam, composite, crown, and root canal procedure codes. Students learn surface-specific coding rules that directly affect reimbursement.

Lesson 3 • Diagnostic and Preventive Codes

Covers codes for exams, radiographs, cleanings, fluoride, and sealants. These high-frequency codes appear on nearly every patient claim.

Lesson 4 • Periodontic and Oral Surgery Codes

Covers scaling and root planing, osseous surgery, and extraction codes. Correct site and quadrant documentation is emphasised throughout.

Lesson 1 • Medical Cross-Coding for Dental Procedures

Covers scenarios where dental procedures are billed to medical plans using procedure and diagnosis code pairs. Students identify qualifying conditions and correct code combinations.

Lesson 2 • Linking Codes to Clinical Documentation

Demonstrates how chart notes, periodontal charts, and radiograph findings translate into defensible code pairs. Documentation quality directly determines claim success.

Lesson 3 • Navigating the Diagnosis Code Set

Introduces the hierarchical structure, tabular list, and alphabetic index of the standard diagnosis code set. Students practise efficient lookup strategies.

Lesson 4 • Why Diagnosis Codes Matter in Dentistry

Explains payer mandates for diagnosis codes on dental and medical cross-coding claims. Establishes medical necessity as the bridge between clinical documentation and reimbursement.

Lesson 1 • Calculating Patient Financial Responsibility

Applies benefit data to calculate accurate patient portions before treatment. Accurate estimates build trust and reduce collection problems after service.

Lesson 2 • Reading and Interpreting Benefit Summaries

Teaches students to extract deductibles, maximums, frequencies, and waiting periods from explanation of benefits and benefit summary documents.

Lesson 3 • Co-ordination of Benefits in Practice

Covers primary and secondary payer sequencing, birthday rule, and non-duplication clauses. Students correctly sequence dual-coverage claims to maximise reimbursement.

Lesson 4 • Managing Eligibility Discrepancies

Addresses steps when verification data conflicts with payer records or coverage lapses mid-treatment. Students protect the practice from uncompensated care.

Lesson 1 • Clean Claim Checklist and Quality Review

Applies a systematic pre-submission review process to catch errors before claims leave the practice. Students internalise a repeatable quality-control habit.

Lesson 2 • Pre-Authorisation and Predetermination

Explains when and how to request prior authorisation and predetermination of benefits before treatment. Proactive authorisation prevents post-treatment denials on high-cost procedures.

Lesson 3 • Claim Attachments and Supporting Documents

Identifies which procedures require radiographs, periodontal charts, or narratives as attachments. Proper attachments are the most common missing element in denied claims.

Lesson 4 • Electronic versus Paper Claim Submission

Compares electronic data interchange and paper claim workflows, including clearinghouse roles. Students select the appropriate submission method for each payer scenario.

Lesson 1 • Accounts Receivable Monitoring

Introduces aging report analysis and key performance indicators for receivables management. Students set follow-up priorities based on claim age and dollar value.

Lesson 2 • How Payers Adjudicate Claims

Describes the automated and manual review steps payers use to approve, reduce, or deny claims. Understanding adjudication logic helps billers anticipate and prevent denials.

Lesson 3 • Payment Posting Procedures

Covers manual and electronic remittance posting into practice management software. Accurate posting keeps accounts receivable data reliable for management decisions.

Lesson 4 • Reading Explanation of Benefits Documents

Trains students to interpret every field of an explanation of benefits, including allowed amounts, adjustments, and remark codes. Accurate reading is prerequisite to correct posting.

Lesson 1 • Peer-to-Peer Review and External Appeals

Covers escalation options including peer-to-peer clinician review and external independent review. Students know when and how to escalate beyond standard appeal channels.

Lesson 2 • Correcting and Resubmitting Claims

Walks through the process of correcting errors and resubmitting claims within payer timely filing windows. Speed and accuracy in resubmission protect revenue recovery.

Lesson 3 • Writing Effective Appeal Letters

Teaches the structure, tone, and evidence requirements of a persuasive appeal letter. A well-constructed appeal with supporting documentation significantly increases overturn rates.

Lesson 4 • Denial Classification and Root Cause Analysis

Categorises denials by type—administrative, clinical, and contractual—and traces each to its root cause. Accurate classification determines the correct resolution path.

Lesson 1 • Billing Across Multiple Providers and Locations

Manages billing for group practices, specialists, and referral scenarios with shared patients. Students correctly assign provider identifiers and split billing responsibilities.

Lesson 2 • Paediatric and Orthodontic Billing Nuances

Covers age-specific coverage rules, primary dentition codes, and orthodontic contract billing. Paediatric and orthodontic claims have unique frequency and eligibility constraints.

Lesson 3 • Building a Compliance Programme

Outlines the components of a practice-level compliance programme including policies, training, and auditing. A formal programme reduces regulatory risk and demonstrates good-faith effort.

Lesson 4 • Billing for Implants and Complex Prosthetics

Addresses multi-code sequencing, bone grafting, and staged implant billing over multiple dates of service. These high-value cases require precise documentation and code co-ordination.