Proper treatment and care are the primary focus of the provider. Submitting the correct claims helps to improve collection rates and increase cash flow. It’s also essential to know the rules and regulations of insurance companies, followed by proper coding and billing practices. Outsourcing dental billing is a way to reduce friction and a practical option to avoid common mistakes that get counted as abuse/fraud.
How to reduce dental denials?
- Provide correct documentation and information.
- Submit the claims within the time limit of each insurer.
- Remember to attach the necessary details, such as x-rays and claims.
- Provide the description related to the services performed as confirmed by the provider.
- Consider the limitations, exclusions, and frequencies.
- Form an office policy for the process.
Let’s take a look at the top reasons for dental denials and dental delays that make the process looks difficult.
Incomplete documentation:
- Inaccurate documentation has led to 50 percent of dental denials. A pending status or no revenue payments affect the RCM of the dental practice.
- Insurers expect complete patient details without any errors to process the claim. For instance, patient ID number, service date, provider’s name, license number, address, TIN (tax identification number), EIN or SSN of the provider, etc., details should be available in the submitted claim.
- For dental billing, many insurance companies require documents like x-rays for scaling and root planning and charting for bone loss.
- Information related to the procedure, such as periodontal charting or the last six months’ data, suffice the treatment and prevent dental denials in many cases.
Late submitting the claims:
- Deadlines are crucial in the claim filing process, and every insurance company’s deadlines are different, which leaves the provider under revenue loss if they are met.
- For RCM, meeting deadlines and submitting claims on time are mandatory and posted throughout the dental practice.
- No matter what, all the claims get filled within a year from the date of service availed by the patient to avoid late submission.
- The shorter filing period is 90 days from the rendered service.
Missing X-rays and descriptions from the claims:
- As per American Dental Association, missing x-rays and their description is one of the reasons for dental claim denials.
- The low resolution of the attached documents and the inability to refer to the attached documents need to be clarified.
- Before submitting the x-rays and the claims, the dental practice should receive an acknowledgment from the insurer to meet the claim processing requirements.
- X-ray description justifies the treatment and gets submitted to the insurer in the form of digital or printed format.
- Accurate labeling and particulars like the date on x-rays are mandatory.
Limitations, frequencies, and exclusions:
- Each insurance plan has particular limitations, frequencies, and exclusions.
- Every dental policy limits annual or lifetime maximums.
- The dental practice office has to have this information while verifying that specific procedures can only cover a few years, such as crown replacement covering only five to seven years.
- Specific procedures have limitations on the age group.
- If the provider gets a copy of the patient’s information that mentions all the details and benefits before performing the procedure, it becomes easy to handle the claim.
Upcoding
- That means billing for the services that provide more payment/cash flow than the actual service. For instance, if the dental office submitted bills for fillings on eight teeth and the services rendered were non-covered sealants, considered a fraud.
- This practice involves coding for the services the patient never receives and is still mentioned on the claim.
- As per American Dental Association (ADA), upcoding is reporting for higher-cost procedures than the actual procedure.
- Insurance companies concentrate on and scrutinize every claim not to evade the insurance rules and regulations.
- Instead, the provider should only bill for the rendered services.
Billing challenges related to payer processes or diligence on your part will always remain, but many of them can get addressed by implementing a system that utilizes automation and technology. Stay informed about the coding changes and rules updates to avoid revisions and denials.
