How to avoid Dental billing fraud? - Capline Dental Services

How to avoid Dental billing fraud?

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Dental practices are required to be more careful than ever to avoid billing fraud. It’s been reported that an average business loses a significant percentage of revenue every year to fraud. Just like any other business, dental practices are also prone to fraud and that’s why they need to take certain steps to ensure that their practice is not exposed to any kind of billing or any other fraud. Dental practices need to be aware that beyond heavy penalties and fines, fraud can cause their exclusion from certain healthcare programs as well. 

Although outsourcing dental billing services can possibly resolve all the fraud incidents, this article will talk about what steps dental practices can take to prevent billing fraud. The article will also highlight some common reasons behind dental billing fraud. 

What constitutes Dental Billing fraud? 

It’s important for dental practices to be aware of the ways billing fraud can happen. Although Medicare, regulatory bodies, and commercial insurance companies consistently monitor practices to penalize the ones committing billing frauds, unethical work practices in order to generate more revenue are still being reported. Some of the common ways in which dental billing fraud occurs are as follows : 

  • Falsely billing patients for the services not rendered 
  • Misrepresenting services to increase claim reimbursement
  • Submitting claims for fake patients, 
  • Wrongly unbundling dental procedure, and 
  • Waiving copayments and deductibles 

Ways to avoid Dental Billing fraud

Getting involved in the business management of your practice is the first step that you can take to avoid any kind of fraud. As an owner of a dental practice, you need to know who is doing what. Let’s take a look at some of the ways you can avoid dental billing fraud.

  • Improve hiring process – You need to establish an effective hiring process or improve the existing one to avoid bringing dishonest employees and contractors on-board. To ensure that you are hiring a truthful candidate, you can conduct background checks including employment history, educational achievements, and if there is any criminal background. You can consider using a third-party background verification company to conduct proper background checks. Beyond this, you also need to check if the candidate is the right fit for the billing role. 
  • Code of conduct – Keeping a code of conduct that includes a fraud policy in place is likely to help you minimize your exposure to fraud. Educate your billing staff about the benefits of submitting honest claims and what can be the repercussions if a fraudulent claim is submitted! Make sure to have a policy in place that allows your staff to report suspicious activities. 
  • Start a daily check program – You would not be able to avoid billing fraud if you do not keep a daily check on everyday bills, insurance claims, and payments. Make sure to run a daily schedule at the end of the day to check if patient bills, claims, and payments are accurately reported. If possible, create an in-house regulatory team to sit down with you to keep a check on billing and claims accuracy. 
  • Increase patient awareness – Ask your staff to make each patient aware of the coverage they are eligible for as per their plan and fees before treatment so that they’re completely informed of their financial obligations. It would be a great idea if you provide a printed walk-out statement to your patients showing the amount and type of payment made or owed after each visit. 
  • Monitor monthly finances – you can track any kind of discrepancies if you pay close attention to your monthly profit and loss records. Make sure to take note of any inconsistency you observe. Also, checking approval of unusual discounts, debt write-offs, and adjustments would allow you to track fraud. 

The above-mentioned steps will allow you to prevent billing fraud significantly. However, if you believe that executing all the steps would be difficult, you can always choose to outsource dental billing services. 

Partnering with a professional dental billing services provider is possibly the best and the most convenient way to avoid billing fraud. We offer transparent and error-free dental billing services that help you maintain the integrity and compliance of your practice. You can solely focus on your practice and stay away from fraud troubles. 

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