Tips to prevent dental billing problems

As we all know, dental billing has some complex steps. Even the errors like outdated billing practices and submitting claims without training can lead to cash flow disruptions, and insurance companies thrive on the incidence of billing errors. Managing the billing process is time-consuming and costly when the dental practice has to correct the mistakes and resubmit the claim. 

The billing errors mentioned below help you be aware and ensure efficient claim submission. 

Patient demographic information 

Clean data can prevent losses and avoid to an extent to have a smooth billing process. The staff at the time of the service verifies the patient’s details like name, date of birth, sex, social security number, employment status, the provider’s details like name, address, contact information, and insurance provider information like policy number, address, phone number, etc. 

Even trivial errors like a spelling mistake or transpose of any data can affect the overall revenue of the dental practice. A cost-effective billing process is a huge benefit, and data entry has the power to reduce it. Double-check all the information and ask for details from the patient upfront, even if they are reoccurring patients. 

Ensure your team verifies the eligibility for all the patients before the scheduled office visit and reduces the workload later. 

Insurance Verification Process 

Every patient’s coverage is different and gets checked without failure. Not verifying insurance eligibility is a costly mistake. 

The verification process includes 

• Active coverage in the insurance plan says what procedures are covered and non-covered as per the insurance plan. On the date of service, whether the patient’s insurance plan offers the coverage or not, and what is the amount of covered procedures. 
• What benefit options the plan offers in terms of copays and coinsurance? Collecting full copays at the time of service is the best practice because, as per studies, once the patient leaves the office, 20 percent chances drop that you will collect the amount from the patient. 
• Predetermination checking even before performing a high-end procedure like crown or bridge. That helps the patient and provider to understand who is responsible for the uncovered portion. What is fully covered by the insurance even before the procedure gets completed? Many patients do not cover the cost portion. It allows the practice to pitch the payment plan and offer a solution. 
• Checking deductible amounts, insurance maximum, and balance amount left for the calendar year keeps informed the provider and the patient about the coverage. 

Staying informed about coding updation 

Dental coding changes happen constantly and can lead to denied claims, delayed payments, and low collections if the dental office is not keeping up with the changes. It is one of the complex parts of billing and contributes to errors. CDT procedure codes change every year as new materials and procedures arise. It is annually updated, and if the team gets this right, your chances of getting timely reimbursement increase. 

To stay up with the CDT codes, ensure that your team gets the training and knowledge as much as possible to create a more optimized dental practice. Correct coding is mandatory but avoids up-coding or down-coding to prevent errors. Codes often change for clarity, and experts ensure that every procedure gets billed correctly using the correct version of codes that cause denials. 

Bundling handling 

As per ADA, bundling is a process the payer combines the different dental procedures into one procedure and keeps providers into contracts to pay less. Any misunderstanding of how payers bundle procedures make it hard for the dental practice to collect the payment for the rendered service. For example, a panoramic radiograph gets combined with bitewings as a full mouth radiographic examination (FMX) for reimbursement. 

The problem arises when the payer bundles the two procedures that the dental office billed separately and loses money without an explanation. For instance, a panoramic x-ray costs $100 &  bitewings x-ray $50, and the dental office gets the reimbursement for $150. However, the payer bundles, and you get paid $125, and for the $25, you will have to write off to the payer if you are an in-network provider. 

Deadlines 

For reimbursement, the dental practice has to file the claim on time as provided by the payer.  Usually, it is 90 days after the date of service for the participating provider and 180 days after the service for the out-of-network provider. Each insurer has its rules, and timely filing expedites the payment of the submitted claim.