Dental Billing Course

Lesson 1 • The Dental Billing Profession

Defines the dental biller's role within a practice and the broader healthcare revenue cycle. Establishes career expectations and daily responsibilities.

Lesson 2 • Core Dental Terminology

Introduces anatomical, procedural, and administrative vocabulary essential for accurate billing. Provides the language foundation for all subsequent chapters.

Lesson 3 • Key Stakeholders in Dental Billing

Identifies patients, providers, payers, and clearinghouses and explains their interactions. Understanding stakeholder roles prevents common communication errors.

Lesson 1 • Eligibility and Benefits Verification

Covers methods for verifying active coverage and obtaining accurate benefit details before treatment. Verification reduces claim rejections and patient billing surprises.

Lesson 2 • Coordination of Benefits

Explains rules for billing patients with multiple insurance plans and determining primary vs. secondary payers. Correct sequencing maximizes reimbursement and avoids overpayment.

Lesson 3 • Government-Sponsored Dental Programs

Introduces publicly funded dental benefit programs for eligible populations and their unique billing requirements. Distinguishes government program rules from commercial insurance processes.

Lesson 4 • Types of Dental Insurance Plans

Compares indemnity, PPO, HMO, and discount plan models and their billing implications. Knowing plan types determines which billing rules apply.

Lesson 1 • Introduction to Dental Procedure Codes

Explains the structure and purpose of the standardized dental procedure code system. Establishes the coding framework used throughout the billing process.

Lesson 2 • Periodontal and Oral Surgery Codes

Covers scaling and root planing, surgical procedures, and extractions. Proper documentation of disease severity supports medical necessity for these codes.

Lesson 3 • Prosthodontic and Orthodontic Codes

Explains codes for dentures, bridges, implants, and orthodontic appliances. These high-value codes require precise documentation to avoid downcoding.

Lesson 4 • Diagnostic and Preventive Codes

Covers codes for examinations, radiographs, cleanings, and preventive treatments. These high-frequency codes appear on nearly every claim submitted.

Lesson 1 • Medical Cross-Coding for Dental Procedures

Covers billing dental procedures to medical insurance using diagnosis and procedure codes together. Cross-coding expands reimbursement opportunities for medically necessary dental care.

Lesson 2 • Common Dental Diagnosis Codes

Reviews frequently used codes for caries, periodontal disease, malocclusion, and oral pathology. Familiarity with high-frequency codes speeds claim preparation.

Lesson 3 • Diagnosis Code Structure and Navigation

Teaches the alphanumeric structure of diagnosis codes and how to use the tabular and alphabetic indexes. Accurate navigation prevents unspecified or incorrect code assignment.

Lesson 1 • Claim Auditing Before Submission

Establishes a pre-submission review checklist to catch errors before claims reach the payer. Internal auditing reduces denial rates and accelerates reimbursement.

Lesson 2 • Standard Dental Claim Form Completion

Walks through every field of the standard dental claim form used across the industry. Correct field completion is the foundation of a clean claim.

Lesson 3 • Pre-Authorization and Pre-Determination

Distinguishes pre-authorization from pre-determination and explains when each is required. Obtaining prior approval protects both the practice and the patient from unexpected costs.

Lesson 4 • Electronic Claim Submission

Explains electronic data interchange standards and the role of clearinghouses in claim transmission. Electronic submission accelerates payment and reduces manual errors.

Lesson 1 • Electronic Remittance Advice Processing

Explains how to receive and interpret electronic remittance files from payers. Automated remittance processing reduces manual posting time and errors.

Lesson 2 • Payment Posting Procedures

Covers the step-by-step process of applying insurance payments and adjustments to patient ledgers. Accurate posting maintains financial integrity of the practice.

Lesson 3 • Understanding Explanation of Benefits

Decodes every section of an explanation of benefits document from payers. Accurate interpretation is required before any payment can be posted correctly.

Lesson 1 • Escalation and External Review

Covers second-level appeals, peer-to-peer reviews, and external review processes when initial appeals fail. Knowing escalation options maximizes recovery on complex denials.

Lesson 2 • Denial Classification and Root Cause Analysis

Categorizes denials by type—eligibility, coding, medical necessity, and timely filing—and traces each to its source. Root cause analysis drives targeted corrective action.

Lesson 3 • Denial Prevention Strategies

Establishes proactive workflows—eligibility checks, documentation standards, and coder education—to reduce denial volume. Prevention is more cost-effective than appeals.

Lesson 4 • Reading and Responding to Denial Codes

Teaches how to interpret payer-specific denial reason codes and remark codes on EOBs. Correct interpretation determines the appropriate response strategy.

Lesson 1 • Patient Financial Communication

Covers how to present treatment costs, insurance estimates, and payment options before and after treatment. Clear communication reduces billing disputes and improves collections.

Lesson 2 • Patient Statement Preparation

Explains how to generate accurate, readable patient statements after insurance adjudication. Clear statements reduce patient confusion and accelerate payment.

Lesson 3 • Hardship Policies and Write-Offs

Establishes criteria for financial hardship adjustments, charity care, and uncollectable write-offs. Consistent policies protect the practice from compliance risk.

Lesson 4 • Payment Plans and Financing Options

Reviews in-house payment plan setup and third-party patient financing programs. Flexible payment options increase case acceptance and reduce bad debt.