Billing is a complex process for any dental practice. Errors and lapses in billing can tarnish a practice’s reputation and lead to legal repercussions if the mistakes made are unlawful. Regulations are constantly changing, and billing codes are frequently updated. There are numerous details and rules to adhere to, and errors can lead to claim denials. Therefore, a practice must be well-versed in billing processes, capable of identifying these errors promptly, and proactive in taking corrective measures to prevent them. It may benefit from the services of a dental billing and collection company to enhance productivity and cash flow.
Billing mistakes that can significantly harm a practice and several critical errors to be aware of include:
1] Inaccurate or Incomplete Patient Data
The information entered on any insurance claim must be accurate. Errors during this process are common in many dental practices, leading to possible claim denials and the resultant loss of time and expenses incurred in rectifying these issues. A denied claim delays payments, impacting the practice’s cash flow significantly. Since insurance payments constitute more than 50% of a practice’s revenue, ensuring error-free billing is imperative. Collecting and verifying clean data at the outset and during every visit is crucial. This includes verifying personal information and all relevant insurance details, such as the insurance provider, member ID number, and employer.
2] Errors in Billing and Coding
Employing correct coding practices can reduce risks. Inexperienced staff might use incorrect codes for procedures or rely on outdated codes. Upcoding, or assigning a more severe code to a procedure by mistake, is considered fraudulent. An experienced biller, who can more easily interpret notes and procedure recommendations, will assign appropriate codes. Outsourcing billing to specialists can also be beneficial, as accurate billing and coding enhance cash flow.
3] Waiver of Co-payments/Deductibles
Waiving co-payments and deductibles, which are standard in most plans, is illegal. These are payments made by the patient to the insurance company for specific dental services. Waiving these fees can encourage unnecessary services, depriving insurance companies of due payments and giving the dental practice an unfair advantage over competitors. Penalties for waiving these fees include fines, license suspension, or even criminal charges.
4] Delay in Submission of Claims
Submitting all claims promptly ensures efficient and productive receivables management. Missed or delayed submissions can make the process chaotic and time-consuming to rectify. Claims are generally denied if submitted late.
5] Altering Claim Forms
Insurance companies rely on claim forms to process payments and verify services. Alterations to claim forms may be perceived as attempts to modify information or inflate service costs, which is illegal and leads to errors in system input or service verification, resulting in claim denials or incorrect processing.
6] Forgetting Attachments to Claims
Proper billing and coding are ineffective if relevant supporting documentation is not attached as evidence to the claim form. Attachments, such as x-rays, intraoral photos, and clinical notes, substantiate the necessity for services and act as proof of execution, ensuring quicker reimbursement. It is essential to recognize that different services and procedures require specific types of documentation.
