Coding is vital in revenue cycle management as it comprises adapting to dental services, procedures, and equipment into codes for the submission of claims. The dental regulatory environment is dynamic and codes keep evolving hence accurate and compliant coding is an absolute must. This is needed so that claim denials are minimized and the dental practice gets timely reimbursement.
Due to coding and payer guidelines, compliance encourages precise and ethical coding, and thus claims can be successfully submitted. practices.
Vital to the claims process and getting reimbursed, a dental practice must ensure accurate and compliant coding to receive pending sues.
Coding involves appropriating terminology that corresponds to a specific diagnosis code. It must match the treatment, surgery, or procedure that was rendered to a patient. Coders can assign a code based on the documentation and treatment notes maintained by the dental team. Codes cannot be assigned based on inference or interpretation.
Here are a few reasons why accurate and compliant coding helps.
Codes for dental services and procedures are based on the Current Dental Terminology and it outlines all the dental procedure codes for all dental procedures that need to be submitted to the insurance company.
The dental team needs to stringently observe such norms and guidelines and thereby ensure accurate code assignment and documentation.
Coding and billing guidelines are governed by numerous regulations, such as HIPAA, the False Claims Act, the No Surprises Act, and the Anti-kickback ruling among others.
The practice needs to comply with these regulations so that all claims are correctly coded, billed, and reimbursed by the insurance company as per the rules of the insurance company.
The dental team needs to be always updated as coding rules keep evolving. Sending submissions with wrong codes can result in claim denials or a loss in revenue besides a potential compliance risk.
When coding is accurate, fraud within the system is prevented. Fraudulent coding can arise when the team has indulged in upcoding or incorporating higher-value codes than needed.
Unbundling is also a case of fraud if components of service or procedures are billed separately and not together. Such actions can warrant fines or legal consequences.
Quite a sizable volume of claim denials happens due to incomplete documentation. Precise coding is possible when documentation presented by a dental practice is complete and detailed.
Proper documentation also aids in the right assignment of codes. It helps in billing services accurately and as per the treatment rendered. Compliance with documentation requirements also avoids coding errors and claim denials.
Building a rapport with insurance companies is critical for sorting issues and avoiding claim denials. This helps to quickly handle inquiries or additional requests for information. A great connection with insurance companies also enables problem resolution and streamlines claim settlements.
The practice needs to undertake periodic claims scrubbing and audits. This aids in identifying probable errors even before submitting any claims. Claims scrubbing can be done with automated software. It can spot claims for errors, missing data, or even inconsistencies within the data.
Internal audits can point out possible trends in denials and areas for improvement while lowering the chances of claim denials.
A reduction or keeping claim denials to the minimum is a must for optimizing revenue cycle management. Incorporating a few steps as mentioned above can lower claim denials and boost overall operational efficiency. Staying on top of coding regulations and rigorous documentation practices is vital for ensuring effective communication with insurance companies. All these measures can augment the financial performance of the practice while also delivering enhanced patient care.
