Revolutionalize the practice from dental billing services to timely claims This blog presents nine powerful tips guaranteed to kickstart dental billing claims. Capline offers dental billing services for a steady and reliable stream of revenue.
Dental insurance claims often create barriers to receiving accurate and timely insurance reimbursement. For success and longevity, dental practices must implement an efficient billing system by outsourcing dental billing services to Capline Services. The American Dental Association (ADA) highlights a significant issue. Inaccuracy in dental billing can result in rejections by 10-15%. It disrupts cash flow and impacts overall revenue.
In this article, we will explore how to submit accurate dental billing claims to keep the revenue flowing to the practice.
Timely claim submissions are definite and cannot be adjusted. The study says there is an increased reimbursement of 20% if the practice files a claim right after rendering services. Delays result in human errors and missed opportunities.
The filing period varies for insurance plans. For instance, some insurance plans allow 90 days to file a claim, whereas the PPO plan permits one year. Late submission can lead to a missed chance to appeal. Each insurer offers a timeframe that can expedite the collection process.
This one stands out to avoid denials, fraud accusations, and delays. As per AAPC audits, the accuracy rate for CDT codes is 79%. Alarmingly, 14% of claims exhibited incorrect coding, while 7% highlighted significant missed opportunities for additional services.
The wrong CDT codes are due to incomplete documentation, unbundling practices, and instances of over-coding.
Coding errors in dental billing is a costly outcome.
What steps will you take to liberate yourself from this situation?
• Using the newest CDT and ICD-10 codeset to submit claims,
• Include diagnosis codes,
• No upcoding,
• No overbilling,
• No duplicate billing, and
• Outsourcing to Capline Dental Services.
Streamlining the dental billing process can result in a smoother patient experience, new recommendations, and loyalty.
Dental insurance billing requires the patient demographic data to be correct and accurate. Typo and minor errors can put the practice under scrutiny.
You are thinking how difficult it could be to write details such as names, dates of birth, social security numbers, policy numbers, etc. Capturing the correct data for the provider, such as contact information, name, and address, is crucial to increasing reimbursement.
Taking professional help in handling reimbursement and billing processes can result in higher revenue as they are well-versed in billing regulations and insurance claim processing.
It is a costly mistake, and this step starts before the patient sits in the office. Patient insurance coverage validates the active coverage on the date of service, covered and non-covered procedures, copays, coinsurance, maximums, deductibles, and predetermination required or not. That is a crucial step and requires verification on each patient visit to update the changes related to personal details such as contact number, job details, home address, member ID, insurance company, etc.
The American Dental Association (ADA) firmly recommends that patients secure pre-approval for complex and costly procedures, such as bridges and crowns, as close to their appointment dates. It guarantees clarity and ensures financial readiness for the patient and the provider. Dental practice messing up with insurance verification can increase the chances of fines, penalties, and legal complications.
According to the ADA (American Dental Association), bundling is the strategic integration of diverse dental procedures by third-party payers that directly reduces the benefits available to beneficiaries.
For instance, in dental billing, bundling is a common practice in which third-party payers, such as insurance companies, combine different dental procedures, often resulting in reduced reimbursement for beneficiaries like X-rays.
When the practice submits a series of X-rays for charges, insurers may improperly bundle them, recoding them as a thorough mouth series and applying frequency limitations from dental benefit plans. However, it doesn't reflect a full-mouth series.
Misleading bundling leads to unjust reimbursement and financial losses for the dental practice due to billing exploitation on claims.
Providers must understand the instances in which to file a medical claim rather than a dental claim and how to use dental insurance as secondary coverage.
Medical insurance is essential for oral surgeries, trauma cases, and biopsies. It diagnoses diseases related to gums, teeth, and the mouth. It also covers anesthetic procedures.
Typically, medical insurance takes precedence in payment, with dental insurance potentially serving as secondary coverage. Exception for cross-coding is applicable.
Understanding these helps minimize rebuttals and ensure reimbursement for all services rendered.
Clean claim through complete documentation
The insurers want proof for all aspects of the claim, such as X-rays, photos, and clinical notes for medical necessity. It ensures that the dental billing claim gets backed by comprehensive documentation that effectively articulates complex treatments.
Insurance companies hold back the payment, and typically, the dental practice hears from them about the reason, but in case of irregularities, the practice has to chase them for the claim.
Working with the experts has some advantages, such as the dental staff not having to keep up with the latest codes or chase each minute of patient details. Lastly, do not worry about reimbursement. The practice can enjoy a 10-15% increase in collection revenue.
