Mastery of dental billing comes from mistakes, but some are costly for both practitioners and patients. The approach safeguards the money and reputation of the dental practice from potential exploitation. Illegal dental billing practices seem innocent errors but can be detrimental to the practice, particularly in the context of insurance companies or federal agencies.
After the treatment, the patient receives a bill from the practice with the associated charges. However, some participate in illegal practices to expect instant results for maximum reimbursement from the insurance companies.
Here's how the top 5 illegal dental billing practices can play a part in the downfall of the practice journey.
Upcoding is a serious offense where a dental practitioner overcharges for the procedure's average cost than necessary, aiming to extract higher fees from patients or insurers. This practice constitutes fraud under both state and federal laws.
The ADA has assigned a specific code for each dental procedure for the insurance companies to validate costs. Through the procedure codes that report treatment with a higher-priced code, dental practices can increase their income than it rightfully deserves.
If condemned, the upcoding hurts the provider's career. Severe penalties, revocation of their professional license, hefty fines, and serious criminal charges are a few examples of repercussions depending upon the severity.
For instance, a dentist should always accurately report the service by the patient's actual condition, not just defaulting to the highest code. Meeting the patient for 15 minutes for regular check-ups and billed for 30- or 60-minute sessions can cause serious legal consequences and the integrity of the dental profession.
Unbundling is the submission of different claims for services and procedures that should get billed as a single service. It is a serious violation of the ADA's legal and ethical standards. The procedure is broken down into smaller ones to inflate the claimed cost. For instance, the practitioner performs an extraction and is billed for curetting out the tissue, elevating the flap drainage, incision, and suturing. The all-along procedures are a part of extraction.
The practice increases the revenue but is a form of fraud. Unbundling represents overcharging. Bundled services cost more when billed as separate individual claims. Therefore, it is illegal and has repercussions. Dental billing and collection services like Capline offer solutions to optimize the dental billing process.
Co-payments and deductibles are key components that patients must manage before dental care. Co-payment is a specific amount set by the insurer. It is due upon receiving services. A deductible is a patient’s financial responsibility before the insurance begins to help with treatment expenses Removing co-payments and deductibles is treated as suspicious. It seems this practice tempts patients to risk policy into unnecessary treatments and undermines the insurance system. The providers collects the legitimate fees owed by the patient. That creates an unfair competitive edge over their competitors by quoting lower prices and playing unevenly by waiving their fees.
It is serious and, depending on local regulations, can result in losing their licenses and hefty penalties. It is also considered a criminal offense, such as abuse or fraud. While not paying co-pays
and deductibles sound appealing for a dental practice, it is against the law and creates an unethical environment.
Such practices disadvantage ethical practices and can pressure patients into treatments that they do not need. Instead of providing payment plans, refrain from waiving these payments.
Insurers rely on service dates on claims to process payments. This situation indicates that the dental provider is attempting to falsify information, such as invoicing for a dental crown on the preparation date instead of the actual cementation date.
This alteration seems minor but is significant in coverage before the insurance plan's effective date or waiting period. This inaccuracy can hinder claim processing or result in payers refusing to pay. To maintain quality standards, it is imperative that the staff verify the claims or that the practice collaborates with Capline Services. The professionals verify and accurately enter information into the system to minimize potential financial or legal repercussions
Documenting every treatment is the key to a successful practice. Accurate billing holds legal integrity in case of discrepancies. Occasionally, while offering discounts to family or friends, the practice does not itemize invoices. Instead, outline the discount as a courtesy allowance or write-off to keep things transparent.
This practice maintains a complete record of earnings, even of discounts. However, making it a regular practice is not the aim of the practice. Charging a fee different from what is on the claim form is a breach of ethics. Uniformity in the fee structure is essential, making things under compliance and getting applied to all patients.
The dental practitioner faces repercussions of illegal dental billing practices other than civil and criminal penalties. They face a loss of patient trust, license revocation, and exclusions from sanctions. Intentional or unintentional human errors contribute to mistakes, and the practice has to find a solution by collaborating with dental billing and collection services to ensure accuracy an
compliance.
