How to avoid common dental insurance billing mistakes

Navigating the intricacies of dental insurance billing entails the meticulous submission of claims, a process that demands considerable time and effort. The frustration peaks when a meticulously prepared claim faces denial due to minor mistakes or oversights in adhering to the stringent requirements. This not only necessitates an additional commitment of valuable time but also runs counter to the overarching goal of optimizing the operational efficiency of your practice. In order to mitigate these challenges, a proactive approach to claim submission and billing by professionals that ensures precision and completeness from the outset becomes paramount—having thought that MedsDental Billing Company would take a step ahead to assist you and your organization in experiencing expertise in dental billing.

Common Dental Insurance Billing Errors And Their Prevention

Dental insurance billing encapsulates the systematic procedure of presenting/filing claims to a dental insurer seeking reimbursement for the professional services administered to patients. Despite its complexity and time-intensive nature, mastering this process is crucial for a thriving dental practice. It is imperative for dental practices to meticulously devise comprehensive protocols governing the meticulous preparation, submission, and tracking of dental claims.

Dental Insurance Billing Mistakes

Some errors in billing compromise the revenue as well as the reputation of the dental organizations and can be declared as illegal dental billing practices.

• Missing or inaccurate patient information
  One of the primary pitfalls in dental insurance billing is the omission or inaccuracy of patient information, leading to claim denials, delayed payments, and frustrated patients. Common errors might occur in the patient’s name, gender, address, phone number, birth date, insurance policy number, name of insurance company, etc. Insufficient information regarding the necessity of a procedure can result in protracted approval timelines or outright denials. Lack of communication between healthcare providers and patients, mainly due to the language barrier, is the primary reason for this lack of information.
• Overbilling
  Overbilling in dentistry involves the deceptive portrayal of a service fee as higher than the authentic costs (showing/demanding a higher fee than the actual fee) and may result from upcoding. This deceptive practice may manifest when a patient is presented with one fee, yet the corresponding insurance claim reflects a higher amount—either to exploit the patient's copayment or to unjustly escalate fees solely due to the patient's enrollment in a dental benefits plan.
  It is best to implement good practices to avoid overbilling because the American Dental Association (ADA) declares copayment waiver, a form of overbilling, to be an unethical and illegal action that can compromise the stability of the patient's dental coverage.
• Bundling & Unbundling
  ADA says that bundling occurs when two separate or multiple services combine, leading to a diminished benefit for the patient or beneficiary. Unbundling, as defined by ADA, involves billing individual components of a comprehensive service separately to maximize reimbursement. While these may seem financially advantageous, they can lead to scrutiny and potential penalties for fraudulent billing.
• Billing for procedures not covered by insurance
  This error becomes more prone when dental practitioners neglect to verify patient insurance eligibility before rendering services or fail to obtain prior authorization. It can be considered a scam, leading to penalties. This may include scenarios like the patient surpassing annual maximum coverage limits or the service being expressly excluded under the insurance plan.
• Billing for services not rendered
  Engaging in the deceptive act of dental billing for services that were not rendered constitutes a violation of the False Claims Act within dental insurance billing. This illicit practice involves submitting charges to patients or insurers for procedures and services not provided to patients. Violations of the Civil False Claims Act may result in civil penalties that encompass restitution of up to threefold the damages incurred by the Government due to the submission of false claims. Additionally, financial penalties may be imposed for each fraudulent claim filed.

Effective strategies to escape these errors

Implement technology

Leveraging electronic systems is a prudent strategy to enhance efficiency and streamline the overall billing process, ultimately contributing to the optimal functioning of the dental practice.
Dental billing software: This ingenious solution encourages the quick submission of insurance claims, processes billing efficiently, and expedites payment processing, ensuring patient privacy and protecting PMI to mitigate the risk of billing errors and increasing reimbursement.
Electronic claim submission: Electronic claim submission represents an innovative approach to seamlessly, promptly, and effortlessly process dental insurance claims. This sophisticated system leverages electronic claim forms, such as the ADA Dental Claim Form, and specialized software, such as Dental Practice Management Software, eliminating manual efforts to submit clean claims to insurance companies.
Insurance verification software: The process of verifying patients' insurance information becomes automatic and centralized using this software, reducing the chances of claim denial.

Obtain prior-authorization

A dentist must obtain preauthorization before rendering any service or treatment to know whether the service is covered by insurance. It is a must-to-do step because the claim gets denied if you submit a claim for a service that is not covered. Prior authorization is a preventative measure to ensure that the proposed dental procedures align with the patient's coverage and meet the insurer's criteria.
Below are key points that must be considered regarding preauthorization.

• Read the insurance plan and policies carefully.
• Contact the insurance company and verify authorization.
• Submit an appeal of preauthorization.
• Utilize an automatic insurance verification system.

Stay updated with CDT code changes

The implementation of new CDT codes starts on 1st January every year; hence, it is necessary to stay in touch with ADA to stay updated with these changes and use new codes according to new guidelines.
Encourage your coders and billers to earn certificates and credentials like Certified Dental Coders (CDC), Certified Professional Coder (CPC), and many more from authentic organizations such as AAPC and ADA to achieve perfection in this step. This would help you mitigate the risk of delays or denials in claims and potential legal complications.

Regular Training for Staff

Regular training and education of your staff members must be your utmost responsibility to ensure productivity, accuracy, and professionalism. This step is essential to boost their morale, motivation, skills, and productivity, hence low staff turnover.
Tips to follow:

• Train your staff with a thorough understanding and knowledge of the steps involved in preauthorization and its importance in generating revenue.
• Foster engagement by incorporating interactive workshops into monthly or quarterly training sessions to keep them updated with new changes.
• Conducting formal orientation programs, hands-on practice, and cross-functional training will help your team regain their abilities and billing and coding skills.
• Elaborate on each point using case studies and real-world scenarios to enhance understanding and retention of key concepts.
• Establish a feedback mechanism to assess the effectiveness of training initiatives.

Conduct regular coding audits

Auditing evaluates the effectiveness and reliability of coding and billing procedures with four major types:

1. Pre-bill/Prospective: It is done before the submission of a claim to 3rd party payer; hence, it helps you find out the loopholes in a claim before submission.
2. Post-bill/Retrospective: It is performed after submission of a claim to 3rd party payer, assisting you in navigating the coding trends by comparing past and present auditing outcomes.
3. Internal audit: This type of auditing is performed by your team or staff and is more prone to biasness.
4. External audit: It is performed by outside auditor(s), and there is less chance of bias in this type of auditing.

OIG makes it mandatory to conduct at least one coding audit per year to fulfill the compliance criteria; nevertheless, it can be performed monthly and quarterly for more accuracy and compliance.

Outsource dental insurance billing services

Dentistry is a profession that demands time as well as high-quality treatment; there is no time for dentists to pay keen attention to every step of dental billing. To provide effective treatment with focus and simultaneously ensure accuracy in billing, dentists should hand this department over to professional coders and billers. Two viable options exist for addressing this need:

1. Recruitment of experienced coders and billers to integrate seamlessly into your internal administrative team.
2. Outsourcing to a specialized dental billing company, where a remote biller collaborates with your in-house team to expedite the processing of insurance claims and ensure timely reimbursement, is preferred.

Advantages:
Dental practitioners, dental establishments, and insurance providers benefit significantly from the indispensable support of dental billing companies such as:

• Less administrative burden
• More professional services
• Increased revenue
• More prone to meeting HIPAA standards
• Efficiency and productivity
• Better reputation
• Good relationship with patients

Take a step ahead and partner with MedsDental Billing Company for flawless Dental Insurance Billing!

It is high time for you to uplift your dental practice to new heights by forging a strategic alliance with MedsDental Billing Company, an experienced partner renowned for its HIPAA-compliant services, cutting-edge technology such as Practice management software, EHR, cloud-based billing software, etc, and decade of experience. Stop stressing about insurance verification and other parts of billing, and delegate your dental insurance billing services to the MedsDental team to ensure that each step of your dental RCM goes flawlessly, with a commitment to the highest compliance standards. MedsDental conducts regular auditing using state-of-the-art technology to navigate the complexities of dental billing. By shaking hands with us, you empower your practice with the expertise needed to optimize revenue streams and sidestep the pitfalls of billing inaccuracies. Contact us today.