Billing errors made by the dental team are a waste of time and resources, and they also lead to dental insurance rejections. This can affect the cash flow of the practice over time. Simple lapses or errors, such as the use of wrong codes, missed deadlines, or incomplete patient information, lead to a dental claims denial as well as disgruntled patients, revenue loss, or delays in reimbursements.
It has been observed that many dental claim denials are due to such errors and that such lapses can be easily prevented. A few reasons why such dental insurance rejections happen and what the dental team can do to avoid them are as below.
A very important component of dental billing is the usage of dental codes. At the time of submitting the claim, the team needs to confirm the diagnosis and procedures or services rendered with the correct codes that need to be applied. Such codes can be a CDT or an ICD-10-CM code or a combination of codes.
The codes to be applied generally belong to a set of Current Dental Terminology or of International Classification of Diseases, tenth revision, Clinical Modification.
The most common or glaring errors committed by the dental team are coding errors. Codes are updated and revised annually, and the team needs to stay aware of changes in codes as well as the regulatory environment.
The team also needs to be adept at using codes when both medical and dental codes are being used. Most dental insurance rejections happen when the billing team is not fully aware of changes in coding guidelines.
The practice needs to ensure that the billing team is periodically trained on codes and other requirements in the regulatory landscape. This can help the practice to prevent mistakes that lead to loss of revenue and time. The dental team must also browse and thoroughly understand revisions in the CDT code book and stay aware of the annual revisions.
There is a chance that insurance organisations can update their claim forms. There might be changes in the information needed to complete these forms. The dental team must ensure that the prevailing form of the insurance company is being used to make claim submissions.
Failure to use the current form will result in dental claims denial. For any doubt or query, the team can call the insurance firm and verify the form that needs to be used. Updated forms are also available on the ADA website. Verification of the form that needs to be used might take a few minutes, but it can save hours.
As simple as it might appear, this is a common reason why dental insurance claims are denied. A simple error or even the smallest omission can lead an insurance company to reject claims made by the dental practice.
The team might make errors in keying the patient’s name. There can be data entries that lead to a claim denial, such as a wrong insurance number. Patient
information might have changed, and the same has not been updated on the software. These errors and mistakes can lead to a dental claims denial. Frequent dental claim denial can lead to delayed reimbursements, and this has an impact on the cash flows.
The dental team must make sure that only precise and confirmed information is filled in on the claim form, as this is vital for the insurance company to accept the form. The team must also be able to understand how to detect error descriptions. Moving forward, the team will understand where the error is and how it can be rectified.
The team member who does billing and sends claims mustn't be saddled with additional responsibilities that could act as a distraction. There could be a dedicated time set aside during the day to handle filling claim forms with adequate time to create, rectify, and double-check that all fields and blanks have been filled completely and with precise information.
The dental team must always ask for details of the patient’s insurance plan before the day of the visit. This gives the team ample time to check for important information. Between the previous visit and the coming visit, a few critical details could have changed. This could include the address of the patient or even the insurance company that covers the patient. Even if the patient has the same policy, the benefits could be updated or changed.
As a good habit, the team must review all the benefits available to the patient. All personal information must be checked and confirmed. The amount of coverage that the policy covers can be shared with the patient. Such a verification also helps to prepare the patient for any financial outlays. The patient can be apprised of the amount covered by the plan and any out-of-pocket expenses that need to be borne by the patient. If possible, the team can also garner details of the patient’s medical insurance plans. A few medical insurance companies might cover a few dental procedures.
A lot of documentation is now online, and a lot of information is now shared electronically. There are chances that charts or X-rays are difficult to read or comprehend, and there could be additional documentation needed by the insurance company.
Some services are preventive in nature, and these could include radiographs, cleanings, and fluoride treatments. Such services do not need any attachments, but important procedures such as implants, crowns, or bridges need attachments and clinical notes outlining why the recommended treatment is needed.
Since digital documentation is more frequently used, the chances of illegible writing have been reduced. When filing handwritten notes for submission, the team needs to make sure that the writing is legible. Care needs to be taken that photos, images, and narratives are clear so that there is no rejection by the insurance company.
By providing good-quality images or X-rays, the dental team can avoid claim denials. The practice must invest in good-quality clinical equipment that delivers superior colour representation. Make sure that images are properly labelled and easy to read.
There are instances when many dental practices waive the deductible or copay amount due by the patient. While this might seem like a means to help a patient or a business tactic, it
is considered a fraud by the insurance company. Insurance companies need dental practices to collect the dues to be paid by patients. Failure to do so can lead to a false claim and penalties for the practice.
Most payer contracts require practices to collect the patient’s financial responsibility. Ignoring that can lead to penalties or accusations of false claims. It needs to collect all deductibles or co-pays as per the guidelines of the patient’s insurance plan. More importantly, it needs to adhere to the insurance company contracts and stay compliant as per regulatory guidelines.
Typical billing errors very often lead to dental insurance rejections. When claims are denied, it affects cash flows and also leads to unsatisfied patients. The dental team must ensure the usage of the correct codes, accurate patient information, and timely submission. This helps to prevent revenue loss or delays in reimbursements.
