09 Sep A Guide to Submitting Accurate Dental Billing Claims on Time
An obstacle course stands between you and getting your dental billing claims paid. Insurance companies have imposed a series of rules that you must follow if you want your claim remitted—and it’s easy to break these rules inadvertently.
As a national leader in dental billing, we at Medusind Dental would like to share with you some of our thought leadership: how you can avoid these bureaucratic land mines so the revenue keeps flowing to your practice?
What Are the Most Prevalent Mistakes That Keep the Insurance Company’s Funds From Hitting Your Bank Account?
Don’t miss the filing deadline!
This one is non-negotiable. To ensure prompt payment, file claims right after you deliver patient services. While some plans dictate a 90-day filing period, Preferred Provider Organization (PPO) plans demand you file claim within one year of service. Many claims that could have been appealed lose the opportunity because they were filed late. Be familiar with each insurer’s rules for timely claim submission.
Don’t mess up the codes
If you make common coding errors in your dental billing, your payment can get delayed, your claim can be denied, and you can even be accused of fraud. Some tips:
- If you want to be reimbursed, you must submit claims with the latest CDT and ICD-10 codes.
- Don’t miss diagnosis codes.
- Don’t do duplicate billing by mistake—the insurance company will spot it.
- Without your realizing it, it’s also easy to upcode, downcode, and overbill—so avoid these mistakes.
- If you can, use an expert to avoid coding errors.
Basic patient information must be 100% correct
Double-check to make sure you recorded patient demographic data correctly and that the information is complete. Did you capture all the correct patient information, including their name, birthdate, sex, and Social Security number? For the provider, is its name, address, and contact information accurate? Be certain you’ve input the right insurance policy number.
Verify their dental insurance
One of the biggest mistakes a dental practice can make in dental billing is failure to verify a patient’s insurance status before you deliver treatment. In advance of every appointment, ascertain from the patient if their insurance or personal information has changed. Do they have the same home address, job, and contact number? Double-check the name of their insurance company, their member ID, and their date of birth (DOB). Be certain they’ve got active coverage, whether they need preauthorization for upcoming work, and to what extent each procedure is covered. Limit surprise bills for your patients.
Charges are bundled incorrectly
In dental billing, bundling occurs when a third-party payer (like an insurance company) combines different dental procedures so the patient gets paid less. This happens often with X-rays. You submit a series of X-rays for charges, but sometimes the insurer combines (bundles) them, recodes them as a full mouth series, and then subjects them to dental benefit plan frequency limitations. But to you, the submitting dentist, this series of X-rays doesn’t constitute a full mouth series, and as a result of this improper bundling, the patient won’t be reimbursed properly. Your dental practice will lose money too if the insurer incorrectly bundles procedures that you’ve billed separately on the claim.
Should you be filing a medical claim?
Bill the patient’s medical (not dental) insurance for oral surgery, trauma repair, and biopsies to diagnose possible oral diseases. Medical insurance may also cover aesthetic procedures. See if you can bill medical insurance first, and then bill the patient’s dental insurance if cross-coding will permit.
Include all supporting documentation
The insurance company needs to see proof of all your claim’s assertions. Be sure your dental billing claim is supported by accurate documentation. The narrative should explain complicated treatment or treatment of long duration. Include X-rays, photos, and clinical notes.
Follow up on your claims
You didn’t hear back after a couple of weeks? Check with the insurance company and see what’s holding up payment. Is there incomplete information? An irregularity? Or are they just slow? Chase after your claims, because those dental insurance checks aren’t going to cut themselves.
An Expert Can Help
You’re already asking a lot of your staff. Can they also keep up with the latest codes and chase after every single detail in the thousands of claims you submit every year? Or is it smarter and more cost-effective to outsource your medical filling to an accomplished third-party provider who does nothing but see millions of dental and medical claims through to successful payment every year?
Consider contacting Medusind and having a conversation with us. Let’s see how we can best meet your needs. We’d like to show you how you can make more money by working with us than you would on your own. When you partner with a national leader in dental billing, you enjoy a 10-15% increase in collections revenue and a 40% reduction in labor costs devoted to billing.
