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 Even the errors like outdated billing practices and submitting claims without training can lead to cash flow disruptions, and insurance companies thrive on the incidence of billing errors.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
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.
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.
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.