Numerous complex steps are involved in dental billing and claim submission processes. A simple error can interrupt consistent cash flow and lead to repercussions for a dental practice. On the other hand, dental billing accuracy saves time and money. The intricacies of dental billing play a crucial role. Working with an experienced dental billing company can facilitate accurate reimbursements from insurance companies.
Here are common dental billing errors – identify, correct, and avoid them in the future to optimize claim submission.
Inaccurate Patient Information:
Incorrect patient information is a common dental billing mistake and can affect the likelihood of claim denials. A trivial error can delay payment from insurance companies and increase workload due to rework to get it paid.
Incorrect details include the patient’s name, date of birth, sex, social security number, wrong policy number, and incorrect provider’s address, name, and contact details. Insurance revenue greatly benefits dental practice. The best way to avoid these errors and receive timely reimbursement is by double-checking and keeping all documents hygienically.
Not Verifying the Patient’s Eligibility Hits the Dental Billing Accuracy:
Verify the existing and new patients’ eligibility before the scheduled appointment. Failure in eligibility verification is an expensive mistake, and this part of the dental billing process is often least favored as it seems repetitive.
However, getting it right creates a framework for the claim’s lifecycle. Correct insurance verification includes active patient coverage, procedures covered, covered procedure costs, copays, coinsurance, and predetermination.
Checking the patient’s deductibles and maximums for the calendar year helps calculate out-of-pocket expenses. It saves time, and the dental office can provide payment options. It enhances the patient’s experience and dental billing accuracy.
Ensuring Dental Billing Accuracy Through Dental Coding:
Incorrect coding results in denied claims, delayed payments, and allegations of fraud. Correct CDT and ICD-10 codes result in no payment discrepancies. Partnering with a third party like Capline Dental Services is one way to prevent coding errors like upcoding, downcoding, and billing for services not provided.
Companies providing dental billing services ensure coding accuracy and stay updated with coding guidelines. They also support the assigned codes with proper documentation.
Maintain Dental Billing Accuracy with Bundling:
As per the ADA, third-party payers use an approach to combine different dental procedures into a single billing code. This leads to reduced benefits for the patients. This practice limits access to necessary dental care and impacts the patient’s out-of-pocket costs.
The payers do not consider each component service as a separate payment on the claim. For instance, a panoramic radiograph combined with bitewings for payment, and the insurance company will reimburse the lower amount. Dental practices lose money, and patient benefits get reduced if inappropriately bundled.
Practices can get correct reimbursements by partnering with a dental billing company. At Capline Dental Services, experts provide comprehensive support to optimize claim submissions. The dental billing company contacts the payers directly to clarify concerns.
An early start is key to prompt payment. The sooner, the better, after services are provided. Begin the process as some insurance plans’ filing period is 90 days, while PPO plans have a period within one year from the treatment date. Late filing is a common reason for claim denials, and sometimes, requests for appeal also get rejected.
The main challenge is meeting insurance company requirements and navigating the submission portals. Therefore, an early start can give ample time to ensure accurate claims and avoid dental billing errors.
Missing Supporting Documents:
Supporting documents such as clinical notes, photos, and x-rays, attached along with the claim form, provide sufficient information as evidence that the procedure performed is a medical necessity. The ideal way to avoid dental billing errors and maintain a financially healthy practice is through outsourcing the billing services to a reputable partner.