Endodontists lose 12 to 18 percent monthly of their revenue. Almost always, this loss is due to billing mistakes rather than clinical issues.
Endodontic billing has its own unique billing structure and documentation compared to that of general dentistry, and requires specific CDT codes (our specialty) for procedures such as root canal retreatments, apexifications, apicoectomies, and multi-canal molar cases. Further, due to high-payment-per-procedure reimbursement values for endodontic practices, even a modest denial rate creates an increasingly challenging cash flow management situation.
This guide examines the leading U.S. dental billing companies (in alphabetical order). We developed criteria for our evaluation based on some of the key issues affecting endodontic providers on a daily basis: accuracy of specialty CDT coding; management of the pre-authorization process; speed of denial follow-up; length of average accounts receivable cycle; and endodontic-specific documentation requirements for insurance claims.
Why Endodontic Billing Is a Different Animal Entirely
Understanding Endodontics Revenue Cycle Management Complexity Is Important Before Working with Billing Partners
The CDT Code Complexity That Generic Billers Get Wrong
Coding for endodontic procedures is arguably one of the most complicated in all dentistry because endodontics is filled with nuance. The distinction between a D3310 (anterior root canal), a D3320 (premolar), and a D3330 (molar) may seem fairly straightforward. However, where it becomes complicated from a billing perspective is during the coding of subsequent root canal retreatments, or when there are obstructions to the root canal during the procedure, apexification procedures, and/or when a periradicular surgical procedure is rendered.
Specifically, the D3331 code for the non-surgical management of a canal obstruction should be billed in conjunction with the code for the primary root canal procedure (D3310 in the case of an anterior root canal), rather than as a replacement. Failure to follow this billing convention may lead to an additional revenue opportunity being missed or an incorrect billing to trigger a denial from the insurance carrier. Further, codes D3346, D3347, and D3348 are for retreatments, and specific to each retreatment code is that the biller must document the date of the prior procedure and attach three periapical radiographs to the claim for reimbursement to occur.
If the billing team supporting your practice lacks a solid foundation in endodontic billing, they won’t know the above rules. Consequently, your practice will endure a greater expense than necessary as the billers learn these rules the hard way over time.
Pre-Authorization Pressure Is Higher for Specialty Procedures
Pre-authorizations for endodontic procedures—including retreatments, apicoectomies, and complex multi-canals—are required by many dental insurance carriers. The documentation required for pre-authorization and the clinical narrative format/structure change from payer to payer, as well as the number of days available to obtain pre-authorization all vary from carrier to carrier.
A dental billing/coding company with no experience with dental specialty pre-authorization processing could miss this step altogether, submit incomplete/substandard documentation, or could miss the pre-authorization window. The result is the claim is denied after the treatment, and the practice will find out that 90 days later the patient’s procedure is denied.
High Reimbursement Values Make Every Denial Expensive
The financial impact of denied claims is compounded as the reimbursement of molar root canals ($900-$1,400) and apicoectomies ($1,200-$2,000) is fairly substantial. In addition, a denied claim for a molar retreatment due to inadequate information for pre-authorization or incorrect coding will already be a significant loss of revenue for that practice. The total financial impact a dental practice will sustain across 15-25 endodontic cases per week is tremendous when billing partners do not deliver on pre-authorization processing standards!
What to Look for in a Dental Billing Company for Endodontists
Not all dental billing services provide for the specialty practice revenue cycle. Here’s what will help you differentiate the top options from those institutions not as revenue cycle-specialized.
Specialty-Specific CDT Coding Expertise
You should ask your billing partner, “How many endodontics practices are you currently billing for? What is your first-pass claim rate for endodontic-specific codes? What is your denial rate for D3330 and D3348?”
If they can’t give you specifics on other endo practices they bill for, then run (or walk) away.
Endodontic Insurance Verification and Benefits Analysis
Endodontic insurance verification is a lot more complex than a general dentistry eligibility verification check; it requires verifying lifetime benefits specific to endodontic procedures (root canals, for example, are limited to a certain number per tooth per lifetime under many plans), checking for frequency limitations on how often a retreatment can occur, determining whether or not the plan carves out endodontic benefits to a different specialty carrier, and if pre-authorization is needed.
Having a billing company verify all endodontic benefits prior to a patient arriving ensures that your practice doesn’t have billing chaos once the treatment is performed.
Aggressive Denial Management and Appeals
All billing teams face denials during their daily operations; However, they are defined by how they respond after being denied. When your endodontic claims have been denied, how you respond depends upon producing the appropriate appeal documentation to the insurance carrier. This includes providing a clinical narrative demonstrating medical necessity as determined by the individual’s plan, attaching the appropriate radiographs in the file format required by the insurance carrier, and in some cases coordinating a peer-to-peer review with their Dental Director.
If your billing company resubmits an endodontic claim that was denied without submitting a proper appeal letter, you are wasting your time and your money in the process.
Accounts Receivable Cycle Times
Industry averages for dental practices today is 45 days in accounts receivable; however, the best dental billing services will push that to less than 28 days. If your endodontic practice has a high volume of insurance claims having high dollar amounts, the potential for additional cash sales from reducing the AR cycle time by an average of 15 days is significant.
HIPAA Compliance and Data Security
Your billing partner has access to protected health information, so due to the nature of your business, they must have compliance protocols in place that are not negotiable; HIPAA compliance. Such compliance is often proven by verifying that the partner is SOC 2 certified (Service Organization Control) and, if possible, ISO 27001 (International Organization for Standardization) certified.
Examples of these certifications are operational requirements that will legally and ethically protect your practice.
The Medicators: Specialty RCM Built for Practices Like Yours
At The Medicators, we have developed an expertise in specialty dental billing. We specialize in endodontic billing and provide dedicated services to endodontic dental practices. Unlike other billing companies, we emphasize accuracy of specialty-level CDT codes and have a structured process for documenting endodontic insurance claims.
While most billing companies treat root canal claims as transactional, we treat them as clinical documents. Our billers understand that a root canal claim (D3330) for a molar is much more likely to clear on the first submission than if submitted without the appropriate supporting documentation, which may include current pre- and post-operative radiographs, the signed clinical narrative from the payer, and accurate tooth-specific coding cross-referenced against the payer’s coverage policy.
Our full suite of endodontic billing services includes verifying insurance eligibility with specialty benefits analysis, managing pre-authorization for procedures requiring pre-authorization, submitting clean claims with CDT-accurate codes, managing claim denials and filing appeals, posting payments, and billing patients. Additionally, integration with Dentrix, Open Dental, and Eaglesoft is seamless.
With transparent reporting on where your billing revenue sits during the billing cycle, The Medicators is ideal for you! Their denying rate by procedure code, DAAP), AR aging report, first-pass claim rates versus payer, collections percentage by payer will show you everything you need to know! After all, if you cannot see it, you cannot optimize it!
As an endodontist, if you are looking for a billing partner that understands what D3310 to D3348 billing codes mean, knows when a clinical narrative should be attached, and/or has the nuances on whether a clinical narrative will prevent denial versus just creating more work, The Medicators is the right partner to have that conversation with!
eAssist Dental Solutions
eAssist Dental Solutions! eAssist Dental Solutions is one of the largest and most recognized outsourcing dental billing services in the United States today. Since 2011, eAssist Dental Solutions has grown to serve more than 5,000 dentists in the United States with a national workforce of over 1,600 billers working diligently to create real-scale operational infrastructure.
The proprietary Clean Claims Engine framework provides both an operational advantage (by integrating experienced billing specialists with artificial intelligence [AI]-supported claim review), and a significant differentiator for eAssist Dental Solutions as they continue to support dental practices with the highest level of care. Through integration with the Practice Booster platform, eAssist Dental Solutions helps reduce coding errors on complex cases through professional guidance when coding CDT codes through the Practice Booster platform.
eAssist provides services on an ongoing monthly basis. For those who do not want to be locked into a long-term business relationship, this is great for no long-term commitment.
For endodontists in particular, there is the possibility that the endodontist will be matched up with a billing specialist who does not have experience in performing endodontic billing, as eAssist serves a variety of different specialties in the dental field. It is important to ask eAssist how many endodontic claims they handle per month as you evaluate them as a potential billing partner; if they cannot provide you with that information, they may delay providing you their specific performance metrics for endodontic-related claims until after they have had sufficient time to review your endodontic patient volume before responding.
Dental Claim Support
Dental Claim Support has built an excellent reputation due to their above-average diligence in following up on accounts receivable. Founded in Savannah, GA, in 2012, they have dedicated their entire practice to providing billing services to dental practices and have developed a specific emphasis on recovering AR dollars for endodontic practices that have a high amount of old claims due to a previous billing service or a change to an in-house billing approach.
The methodical manner in which Dental Claim Support follows up on their denials guarantees that if an endodontic practice is working with a backlog of unworked claims, there is an excellent chance they will recover significant amounts of revenue that would otherwise remain written off through a targeted Accounts Receivable Recovery engagement with Dental Claim Support.
Capline Dental Services
There is one limitation of Capline Dental Services worth noting: their clean claim rate benchmark is 85-88%, which is lower than what the highest QA companies reach. For an endodontic practice with a steady amount of high-volume claims, having a low FNSS means that they have to manually redo/rework many times throughout the month.
If you also have a need to recover your accounts receivable (AR), consider working with Dental Claim Support while you evaluate a high-performing partner to handle your ongoing billing operations. If your endodontic practice has a purely commercial insurance mix of patient types, Capline is able to provide competent dental billing services.
Capline’s use of artificial intelligence (AI) during the claim review process provides an additional benefit by detecting common coding errors that could result in a claim denial before the claim submission occurs. This becomes increasingly valuable for claims in the endodontic profession where a missing tooth number or an incorrect number of canals can result in instant denial.
A secod area in which endodontists should investigate Capline’s capabilities is with their experience in handling prior authorizations of specialty endodontic claims, especially where the claim involves a complex re-treatment. Request to see documented performance results on CDT codes that include specialty endodontic claims, and ask to speak with references from specialty dentistry practices and not just general dentistry practices.
Dental Support Specialties
Dental Support Specialties has been exclusive throughout its existence that began in 2006. Their focus has been entirely focused on becoming specialists in the area of dental revenue cycle management (RCM). Their years of experience and deep expertise enable them to provide good service to endodontic practices as long-time, relationship-based billing partners
They have particular strength in the area of verifying eligibility and collecting accounts receivable. If your single or small group endodontic practice needs a hands-on billing partner versus just a platform service, be sure to consider Dental Support Specialties.
Request to see their documented performance metrics on specialty dental accounts before committing to their billing services. Confirm the depth of their specialty billing capabilities related to endodontia versus general dentistry through direct inquiry, not just inferred through their general dentistry accounts.
The Biggest Endodontic Billing Mistakes Practices Make
Reviewing what has failed within the past will provide insight into whether potential billing company partners can help to avoid future problems for your practice.
Missing the Specialty Carve-Out
A majority of dental insurances will carve out endodontic benefits to a different specialty provider. There are many companies like Delta Dental, Cigna, Aetna, and United Concordia that will have benefits under both general dentistry and endodontics, but they will use separate companies to administer those two types of benefits. If a claim submitted to the general dentist is an endodontic claim, the claim will be rejected automatically as a no-match unless a specialty benefits verification has been conducted by the billing team before the patient/claimant receives treatment.
Insufficient Documentation on Complex Cases
In order to bill for root canal re-treatments (D3346, D3347, D3348), we must provide evidence of the prior treatment received along with the date of the first root canal procedure. Many insurance payers wish to see the exact date and, at minimum, the month and year. If the initial treatment was done in a different dental office, it is your and your billers’ responsibility to get this documentation. When a billing company does not understand this documentation requirement, they will submit the retreatment claim without the required documentation and will most definitely get denied
Incorrect Tooth-Specific Coding
Endodontic CDT codes are tooth specific. D3310 is for anterior teeth, D3320 is for premolars, D3330 is for molars. Submitting the wrong code for the tooth treated is one of the most frequently made and easily corrected endodontic billing errors. This results in an automatic denial along with a claims re-submission process which can take weeks out of your revenue cycle.
No Narrative for Medical Necessity
Payers require narratives for the majority of apicoectomies, retreatments, and incomplete root canals, all requiring D.3332. The purpose of the narrative is to illustrate why the procedure was performed, what was discovered, and how it was performed. Claims submitted without a narrative will not be accepted. Additionally, the narrative needs to be articulated using the same language as determined by the payer’s definition of medical necessity.
How to Switch Dental Billing Companies Without Losing Revenue
The majority of the time, one of the most significant disruptions in the revenue of endodontic practices is due to changes in billing partners. A few ways to do this without causing a huge mess.
Audit Your Current AR Before You Switch
Before you switch to a new billing partner, request an all-open Accounts Receivable (A/R) report from your current provider. Each outstanding claim should be accounted for: date of claim, procedure code, payer, amount, and current status. This forms your financial baseline. You should provide this report to your new billing partner on day one of the transition and have them begin working on claims that have been outstanding for more than 60 days.
Overlap the Transition by 30 Days
The best way to transition between billing partners is to have your new provider billing on new claims immediately and your current provider billing on existing A/R (with your internal billing department) concurrently for 30 days. A period of no billing coverage will allow significant revenue to permanently disappear.
Verify Credentialing Status on Day One
If you are switching to a new billing partner that also performs insurance credentialing, confirm immediately on day one of your transition that your practice has been fully credentialed with all current payers. There are substantial gaps in credentialing that can result in significant lost revenue. If an endodontist is treating patients under a carrier with whom they have not established credentialing, the endodontist will receive denials for every claim they submit until credentialing has been established.
The Bottom Line: Your Endodontic Practice Deserves Specialty-Level Billing
Endodontic practice requires accurate completion of some very detailed procedure codes, documentation, and insurance authorization workflow processes. A poorly executed claim, which results from an incorrect charge or an unclear breakdown by the insurance company, may result in significant losses for a specialty practice.
The best dental billing companies for endodontic practitioners are familiar with the specific CDT coding rules, are experienced with correctly documenting a retreatment claim, can pre-authorize claims before the patient arrives in the office, and follow up diligently on outstanding claims until the payment is received.
In addition to managing claims, a comprehensive practice analysis can help endodontists identify revenue cycle inefficiencies, coding inaccuracies, delayed reimbursements, and trends in claim denials that may be impacting profitability. By evaluating key performance indicators such as accounts receivable aging, collection rates, case acceptance, and insurance reimbursement patterns, practices can gain valuable insight into their financial health and operational performance.
The Medicators offer a great place for endodontists to begin their search for a specialty billing company. In addition to an analysis of your current accounts receivable performance, the Medicators will work with you to develop a structured transition plan to recoup what your clinical procedures actually generate revenue-wise. Their practice analysis approach helps identify hidden revenue opportunities, streamline billing workflows, and establish benchmarks for sustainable long-term growth.
Frequently Asked Questions
What is the difference between endodontic billing and general dental billing?
There are three main ways endodontic billing differs from general dental billing: Endodontic billing requires specialty-specific expertise of the CDT codes, requires pre-authorization management of any retreatments and surgical procedures, and requires detailed documentation of clinical procedures.
What is the average cost of outsourced dental billing for endodontic practices?
The typical pricing of dental billing companies is to charge a flat monthly fee or charge a percentage of collections ranging from 4% to 8%.
Will a dental billing company handle endodontic prior authorizations?
Yes, the best dental billing companies for endodontists are able to assist their clients with obtaining pre-authorizations for endodontic procedures by submitting radiographs and clinical notes to the insurance company in advance of the procedure to minimize denials of benefits.
What specific CDT codes should my dental billing company be knowledgeable about?
Your billing partner should be familiar with the following CDT codes: D3310 – D3353 (including retreatment codes D3346 – D3348), apexification (D3351), apicoectomy (D3410 – D3470), and D3331. A lack of familiarity with any of these codes is a cause for concern.
What is a specialty carve-out and what are some possible ramifications for endodontists?
Specialty carve-outs occur when endodontic benefits are covered by one insurer while the general dental plan is covered by a different insurer. Submitting an insurance claim to the incorrect payer will result in an automatic denial; therefore, verifying all payers before submission is necessary to avoid this issue.
