It might be difficult and time-consuming to bill for dental services. Some frequently performed dental treatments have poor reimbursement values. Dental clinics may experience financial losses if error-free claims are not filed on time. Dental billing mistakes still happen despite the market’s abundance of dental billing technologies. Some mistakes are simply the result of human error, while others are brought on by ignorance. Not only can these typical dental billing mistakes lower customer satisfaction levels, but they also severely affect the money generated by dental clinics.
Clinicians may face income loss, fraud investigations, financial sanctions, disciplinary action, and exclusion from government programs if they submit false billing. (Diane L Adams 1, Helen Norman, Valentine J Burroughs, 2002) Therefore, it is crucial for dental professionals to keep an eye on the billing process. They must be able to spot billing mistakes that impact revenue and raise alarms for insurance audits. In this article, will discuss deadly dental billing mistakes that cost your practice.
One of the trickiest aspects of dental billing is coding. CDT procedure codes are updated each year, and it may be pretty challenging to adapt to the latest changes. Research shows that “coding errors that occurred in the hospitals were more likely related to profit loss than profit gain.” (S. A. Zafirah, Amrizal Muhammad Nur,and Syed Mohamed Aljunid, 2018)
So, whenever a claim is filed with the incorrect diagnostic code, it will result in denial of that claim. Denials also occur when dental codes are not coded with the utmost precision. Each practice must study, note, and assess how the changes to the most frequently used codes will affect them. Inaccurate coding has a detrimental effect on your revenue. A study in 2018 recorded a total potential loss equivalent to 39.1% of the possible hospital income. (S. A. Zafirah, Amrizal Muhammad Nur,and Syed Mohamed Aljunid, 2018)
Putting incorrect information about your patients on their insurance claims is a widespread mistake made in dental billing. It raises your likelihood of having a denied claim and generates extra fees from having to reconfigure things. According to a recent BlackBook Research report, 33% of all denied claims result from incorrect patient identification or information, costing the average hospital $1.5 million in 2017 and the US health care system more than $6 billion yearly.(Lisa A. Eramo, MA, 2020)
According to statistics, a significant portion of dental invoices contains either incorrect or missing patient information, such as the patient’s name, address, or date of birth. Furthermore, if your claim is rejected, the insurance companies will take longer to submit the payment, and you will have more effort to investigate, correct, and appeal the claim.
You must know that insurance payment is essential to your practice and may contribute up to 50% of total revenue. Therefore, efficient insurance billing is very advantageous to your clinic.
Overpayments will arise if your staff consistently submits benefit claims without first validating eligibility. Numerous healthcare professionals now have to deal with the unneeded and expensive reality of overpayments. To avoid claim mistakes, extra or primary coverage, terminated coverage, services that were not authorized, services that were not covered by the plan, or the maximum benefits achieved, must be confirmed. If you have not verified your eligibility, you are liable for the repayment of any overpayments made by the payer.
Another serious error that frequently happens in dental billing is missing preauthorization. It is advised to get preapproval for some treatments before beginning them in order to communicate with the patient and collect their copayment properly.
The bitter rule followed in billing is that if it is not recorded or documented, it did not happen. Inadequate paperwork will directly result in diminished reimbursement. The claim may be rejected or downsized if the supporting paperwork is not attached to it to verify the services provided. In addition to raising risk, this causes insurance company audits and may result in jail time.
An article in the Indian Journal of Urology stated, “With the increased usage of medical insurance for treatment, insurance companies require good record keeping demonstrating the patient’s desire for medical costs. Improper record keeping can lead to medical claims being denied.”(Thomas, 2009)
You must file your claims on time in addition to making sure they have the correct information in order to prevent denials. Late claim filing significantly impacts your ability to bill for dental services. Your possibility of receiving a smaller reimbursement increases as you spend longer to make your claim.
It entails a significant load for practices when just one person is handling all these:
This prohibits you and your team from concentrating on the parts of the practice that make profits. Failure by the clinician to adequately capture the relevant components in the medical record may result in incorrect coding and billing. (Kristie Burks, Jessie Shields, and Susan Flesher, 2022)
Employees are vital assets to any organization. Training and development are frequently utilized to bridge the gap between present and predicted future performance. (Nassazi, 2013)
Dental practices must stay updated with the changes implemented in CDT regulations to get rid of coding mistakes. The billing staff will also be able to precisely code dental operations, services, and treatments, leading to error-free claim submission and, finally, more money in the bank.
Outsourcing dental billing services are the most cost-effective and straightforward option to prevent all forms of billing mistakes.
In addition to cost savings, outsourcing critical tasks transfers risk to the service provider, assuring and raising the quality level of completed tasks. (Gabriel Giertl,Marek Potkány,Miloš Gejdoš, 2015)
The whole billing procedure is likely to be error-free when handled by a group of dental billing professionals, hence dental offices should think about contracting with a reputable partner to handle their billing needs.
Outsourcing your dental billing process with a reputable company is the best choice in today’s era. So in this situation, MedsDental Dental Billing Company is the right option because of several reasons, such as
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