Every dental practice is committed to provide proper treatment and care, but submission of correct claims is also paramount to increase cash flow and improve collection. It highly depends on knowledge of the rules and regulations of insurers and proper coding and billing practices. Outsourcing eligibility verification and dental billing to an experienced service provider is a perfect option for practices to avoid common billing mistakes which are counted as fraud and abuse.
Here are 7 top dental billing mistakes:
Upcoding is considered a major fraud. Upcoding involves using codes for services the patient did not receive, or codes for more intensive and expensive procedures then the dentist actually performed. For example, the dental office submitted bills for fillings on six teeth while the dentist only provided non-covered sealants. Upcoding to get more money from the payer is closely scrutinized by insurance companies and regulatory agencies. Dentists should only bill for the actual services or for the items actually furnished.
Unbundling of procedures defined by the American Dental Association (ADA) as “the separating of a 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.” When actually one CDT code is sufficient to get payment for the service provided, unbundling is used by several CDT codes to report a service on a claim. For example, crown has numerous components as anesthesia, preparations, impressions, temporary crown, etc. and each of these do not require a different code. Unbundling practiced deliberately to gain practice reimbursement. Practices should be aware with applicable payer rules for the services are bundled or billed together.
Billing for Services not provided or not completed:
Billing for services not performed or not completed is also considered as fraud. For example, billing for a crown at the prep time or before it is cemented, billing for surgery when the treatment provided was nonsurgical.
But, if a crown is prepped and not cemented, the dentist can claim partial payment from the payer.
Waiver of Copayment/ Deductible:
Government as well as private insurance companies not allow dentists to waive patients’ co-payments or deductibles. If dentist waive co-insurance requirements, it is considered fraud because it results in violations of the federal Anti-Kickback Statutes and false claims.
Misrepresenting or Altering Dates of Service:
This malpraxis involves reporting a service for the patient was provided on two separate days instead of on the same day. The office visit is regarded as a separate billable service and falsification in the date of service is done to take advantage.
Medical Identity Theft:
It is the misuse of the patient’s unique medical identification information to obtain or to bill insurance carriers to fraudulently obtain medical goods or services. Similarly, physician identification information also be stolen for fake prescriptions, to refer patients for additional services or supplies that are not needed, or to bill for services that were never performed. To prevent such unauthorized use, dental practices should take measures to protect identification information of patients nd dentists.
Non-Verification of Patients' Insurance Eligibility:
Front desk staff often assume that the patient’s insurance coverage is not changed. But if such assumption is wrong and dental eligibility is not checked, the dentist may suffer trouble. Terminated coverage, unauthorized services, plan not covering services, or maximum benefits availed and additional or primary coverage etc., should be verified to prevent errors in claims.
False claims result into severe penalties and loss of reputation. To avoid unintentional fraud, maintain accurate documentation of all services provided. Outsourcing to dental billing company can ensure error-free claim submission for dental practices.
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