According to the reports by “The Wall Street Journal”, 30-70% of dental bills are presented with errors. Avoiding errors is not possible especially when a practice has to deal with thousands of codes. Billing errors in your dental practice not only enrages your patients but also impacts your practice negatively. A patient might end up paying unnecessary expenses when billing errors occur. To avoid such scenarios, physicians must understand how to avoid the common problems that are associated with coding and billing.

The most common billing issues that come as a hindrance in patient care are:

Missing Information
Errors are one of the common reasons owing to which claims get denied. These errors can only be prevented by verifying all fields and then submitting a claim. Incorrect information related to patient name, address, treatment date etc lead to problems. There may be times when the information is accidentally entered wrong. If the information is entered wrong in the patient’s record and submitted for further use, chances are that a claim denial will follow.

Errors in Coding
Coding mistakes also happen when the claim is submitted with the wrong diagnosis. Dental codes that are not coded to the highest level of specificity result in denials. At Capline, our dental billing specialists stay updated on the latest dental coding type that helps in speedy claim processing.

Incorrect Claim Information
Wrong patient info on a claim is one of the common billing mistakes. This mistake can be in the form of a misspelled name, incorrect date of birth or SSN entered. In this case, whenever a claim goes to the insurance company, it gets rejected due to inaccuracy.

Unbundling of Charges
Some charges on dental bills are bundles collectively under a procedural code. However, if the charges are entered separately, it results in dramatically increasing the total bill. Unbundling errors are difficult to track, however, if you see charge values that should be bundled together, you must clarify and work on them.

How Capline Helps?
We keep your cash flow consistent by delivering bills that are simple and accurate. Our IV experts offer the updated insurance benefits for your patients which minimize the chance of errors. Not only this, but you will also be saving thousands on collections. Let us handle your dental insurance billing services and allow your staff to focus only on patient care.

No dentist would ever wish that his or her practice falls victim to fraud or scams.

Dentists in the USA are routinely double-crossed. As per some studies, statistics suggests "At least 40 percent of practices suffer due to scam and embezzlement in the field of dentistry." Such practices can put the future of dental practice at risk. There are myriad ways through which dental office theft can be carried out. Sometimes they occur in predictable forms and the other times they are quite unclear. However, if you understand the fraud detection techniques in a dental practice, you can ultimately keep your practice clean and safe.

Identifying the Signs of Fraud:
Every dental office is a prospect for embezzlement. So, you need to identify the different ways that prevent such fraud from happening. The signs of fraud may include:
● Patients using a different ID to acquire benefits
● Submitting claims for covered services as a substitute for non-covered service
● Keeping other active coverage out of sight
● Misreporting service dates to avoid annual maximum or time limitation

In order to mitigate risks, the best you can do is:

A Keen Eye on Account Receivables
Patients should be made aware of their financial obligations that include coverage and other fees before the treatment starts. Make sure to send out monthly statements, unpaid balances. An explanation for each transaction in the patient management system should also be provided to prevent any kind of issues in the future.

Employ a Code of Conduct That Includes Fraud Policy
Keep your employees informed about out-of-bounds behavior that includes falsifying patient data, theft, insurance claim, expense reports and so on. You need to ensure that everyone is aware of reporting any kind of suspicious behavior.

Using The Right Hiring Practices
This should be done to minimize the recruitment of dishonest employees. The best way is to carry out background checks that include work history, educational achievement, criminal background, credit references, etc. This would give you a clear picture of their ethics and sense of responsibility. Take assistance from a third-party expert to help you gather the right information that can help you.

The growing exposure to fraud is a huge problem for dental offices. However, the good news is that any dentist can reduce their vulnerability to fraud by taking some basic measures. So, let’s just try one of these and see what wonders it brings for your dental practice.

Denials in medical billing are a constant headache that directly affects the revenue, cash flow and efficiency of a practice. The National Health Insurer Report Card (NHIEC) describes a few major reasons for denied medical claims as mentioned below.

1. Missing Information: A denial can easily be triggered if any field is left blank on a claim form.
2. Duplicate Claim/Service: This occurs when claims are submitted multiple times for the same service, beneficiary or date.
3. Service is not Covered by Payer: It is important to check details of eligibility to determine coverage requirements. If the services are not covered, the claim will be denied.
4. Limit for Filing the Claim is Expired: Medical claims need to be submitted within a certain number of days or service. The claim will automatically be denied if filed outside the time period.

It is therefore important to have a claim denial management system that functions to reduce the number of denials. The overall objective of this system is to improve the efficiency of your billing operations.

Steps to Reduce Denial Rates

Listed below is a rundown of all the important steps you can take to decrease denials with insurance companies.

Analyzing the Medical Coding Process

Errors in medical coding lead to most of the denials. The best way to prevent such errors is ensuring a smooth and streamlined communication between medical billing staff, coders and clinicians.

Also, make sure that you are not using misused modifiers and outdated CPT codes. Hire a medical billing team that is vigilant to rectify the errors before finalizing claim submission.

File Claim on Time

The claim usually gets denied if the deadline is missed. To make sure that the claims are processed on time, you must create processes and cheat sheets. Go for an automated process. Automated billing and verification of claim not only reduces errors but also maximizes the accuracy of claims, thereby allowing your practice to receive faster payments.

Tracking Denials

It is important to keep track of denied claims for further processing. One of the best ways is to hire a dental insurance billing company that makes use of proactive processes for getting the claims paid on time.

Staying up to date with the Payer’s Requirements

Medical billing rules keep changing constantly. This requires physicians to spend extra time and expenses to educate the training staff. There are some codes that are discontinued every year while there are others that are newly introduced. So, it is required to stay on top with these trends to keep your revenue stream flowing.

Claim denial is one of the toughest challenges for any dental practice. They affect your practice’s revenue, which is one major reason for why the dental offices outsource medical billing and collection services. 

Capline Dental Services works with you to submit clean claims. Our professionals work in coordination with you to go beyond fighting denials. 

Get in touch with us today to see how we can assist you in reducing claim denials and increasing profit for your practice.

Billing for Dentists is a complicated task. This happens because every two out of three patients fail to pay their hospital bills in full. Patients often step back to their responsibility thinking that their insurance provider will pay for everything. However hiring a billing service provider can solve this problem. With the expertise and guidance of billing service provider, you can speed up the payment process while reducing clutter at the same time.

Dental offices have started hiring experienced billers. These billing professionals work in coordination to make sure all your needs are being met. These professionals stay abreast with the constantly evolving dental insurance guidelines.

In addition to professional expertise, there are some other advantages you get on outsourcing billing providers. Let’s explore a few of them:

1. Boosts speed: Absolutely! It is one of the most crucial reasons why you need to outsource billing services for your dental office. Billing specialists make sure that you receive your payments on time without waiting for a prolonged time period.

2. Improved cash flow: With the assistance of a dental billing company, you will be able to refine your cash flow without fail. Timely incoming of payments from patients will keep the cash flow of your dental practice function smoothly.

3.Avoidance of payroll taxes: One of the essential points which most of the dental office owners fail to notice is the payroll taxes that results due to late payment. This increases the cash outflow of a dental practice.

4. Saves money in every way: So, you can see that how outsourcing billing work to companies specializing in billing for dentists saves you money. It is ultimately an added advantage for your dental office and dental practice.

5. Elimination in any kind of billing errors: Hiring an experienced dental biller keeps errors away that comes due to slow claim processing, incorrect coding and inappropriate follow- up.

6. Increased revenue: Owing to the periodic submission of claims, reduction in overhead cost and increased reimbursement, an increased revenue is definitely guaranteed when you outsource a billing service provider.

So, what are you waiting for? Outsource billing work now to experience increased productivity in a far less overhead cost.

If you run a dental practice, you're aware that the billing process demands a thorough knowledge of the practice management system, accountability, time sensitivity and being updated on ever-changing insurance plans.

Our highly-trained billing and collection experts have shared some tips to assist you in your billing process and make your collection ratio higher than ever. Have a look below and check if you've been practicing some of them already!

Tips for Successful Dental Billing

Common Billing Issues

Lack of Enough Time

Office managers typically manage multiple important functions such as Scheduling, Treatment Planning and Marketing. While office managers can be effective at most of them, they often aren’t able to manage all of these tasks while also handling billing & collection issues because of lack of enough time. This often means that one of the important functions suffers to make way for other functions. We have seen more often than not that billing & collection tasks such as posting credits & adjustments and appealing denied claims take away time from staff to properly take care of patients when they are physically in the office.

Fit

Billing & Collection tasks require undivided focus, attention to details, and ability to dig through the numbers. Delivering outstanding patient experience, advanced treatment planning and employee management on the other hand requires a people person who has ability to effectively communicate and connect with people. Some offices are lucky to have Office Managers who are good in both areas but we often find offices where Office Manager is strong in one area or other.

One Person in-charge of Billing & Collection

Billing and Collection is the responsibility of Office Manager or a dedicated biller. When that person is absent from the office, billing comes to a halt, compromising practice’s ability to collect the money that they are owed for services rendered.

Patient Ledger Errors Resulting in Frustrated Patients

Perhaps one of the leading reasons why patients seek out alternate treatment is due to billing errors that are often the result of disorganized billing and collection. This can lead to a loss of trust resulting in loss of patients.

Benefits of outsourcing medical billing

Medical billing requires specialized skills, and as such could prove quite challenging, especially for small practices and those in the midst of turmoil effected due to upgrading to a new system. Carrier red tape, increased regulations and reduced carrier allowances have made practicing efficiently really daunting. Physicians cannot deliver excellent patient care if they are bogged down with multiple aspects of running a practice, like medical billing and settling claims.