Avoiding Common Dental Billing Mistakes

Hello, this is Amber Darst, Solutions Manager here at Managed Outsourced Solutions and today, I’ll be discussing some common billing mistakes and how having an experienced insurance verification specialist handling your insurance tasks can help you avoid these issues.

Billing for dental procedures sounds easy enough, but there are some common mistakes that can easily happen. Knowing the rules and regulations of insurers and following the proper coding guidelines is crucial when submitting dental claims.

So let’s take a look at the top 7 dental billing mistakes to watch out for.

00:43 Upcoding

First, we have upcoding. Upcoding means billing for services that are more expensive than that which were actually provided. Upcoding to evade insurance rules and get more money from the payer is closely scrutinized by insurance companies and regulatory agencies. Dentists should only bill for the level of services or items actually furnished.

01:08 Unbundling

Next, we have unbundling. The ADA defines unbundling of procedures as “the separating of the dental procedure into component parts with each part having a charge so that the cumulative charge of the components is greater than the total charge to patients who are not beneficiaries of a dental benefit plan for the same procedure.” This can be an inadvertent error or done deliberately to increase practice reimbursement. Practices should be familiar with the applicable payer rules on which services are bundled or billed together.

01:47 Billing for services not provided or not completed

Then we have billing for services not provided or not completed. And billing for these is another type of dental billing fraud. Examples include billing for surgery when the treatment provided was nonsurgical, billing for a crown at the prep time or before it was cemented. Now, there is an exception if a crown is prepped and not submitted, the dentist can claim partial payment from the insurance company.

02:16 Waiver of copayment or deductible

Both government and private insurance companies do not allow dentists to waive a patient’s deductible or copayment. If providers waive these payments, it is considered fraud because it then results in false claims.

02:37 Misrepresenting or altering dates of service

This involves reporting that a service for a particular patient was provided on 2 separate days instead of on the same day. The date on the patient’s medical file documentation should match the date of service listed on the claim form.

02:56 Not verifying a patient’s insurance before their date of service

And last but certainly not least, not verifying a patient’s insurance before their date of service. Oftentimes, front desk staff may assume that an established patient’s insurance coverage has not changed. But if it has and dental eligibility is not checked, the provider can run into several issues such as term policies or different coverage percentages that do not pay towards the procedures that have been completed. Oftentimes, this will cause a lot of frustration with the patients over high unexpected bills.

So, the bottom line is, false or inaccurate claims can lead to severe penalties and loss of a good reputation. The best way to avoid unintentional fraud is to ensure that you have an experienced verification specialist handling your insurance related tasks. They will know the proper questions to ask when calling each insurance company for the full benefit information.

And that’s all. Thanks for listening in.