Billing for dental practice makes sure you get reimbursed fairly and in a timely manner after the services you have provided. Professional outsourced dental billing solutions efficiently eradicate fraudulent practices. Outsourcing your billing services to experts or companies that specialize in dental billing can help avoid these instances.
What Is Dental Billing?
Dental billing services include support for submitting and tracking claims with insurance companies for payment made. It is complicated and involves collaboration with patients and insurance companies, along with several forms of coding. Regardless, it is important for a dental practice to bill correctly to avoid delayed reimbursement, denied claims, or legal issues.
Illegal Dental Billing: What Are the Signs?
Practices need to be careful of fraudulent or unethical billing practices. It can lead fines or penalties, or loss of license altogether.
1. Upcoding
Upcoding occurs when a dentist bills for a more complex service than the one performed, often to attract insurance companies into paying a greater reimbursement.
2. Unbundling
Unbundling occurs when services are separated that would normally be billed as a bundle, in turn resulting in higher reimbursements.
3. Billing for Services Not Provided
Billing for services not provided means a dentist bills for services that do not exist or have not been rendered.
4. Falsification of Patient Information
Falsification of patient record details, such as the date of service or patient diagnosis to get a higher reimbursement is considered insurance fraud.
5. Double Billing
Double billing is defined as sending a claim for the same procedure to two different insurers or submitting the same claim multiple times.
What are the Risks of Illegal Billing?
- Legal Costs: Illegal billing leads to fines and penalties which providers have to pay.
- Financial Loss: Insurance companies deny payment due to fraudulent billing which results in revenue loss.
- Reputation Damage: Providers may experience harm to their reputation, or lose their patients’ confidence in their care.
Solutions for Compliant Dental Billing
Ensuring compliant billing practices is critical in order to avoid unlawful billing and to receive timely payments for services through a proper dental billing solution. These five critical elements ensure compliant dental billing:
1. Accurate Coding Practices
Billing staff should use latest coding guidelines including ICD-10 codes, CDT codes, and CPT codes. It is essential to avoid mistakes which can arise due to improper use of codes.
2. Automated Claims Process
Use software that simplifies the claim submission process and assigns a tracking status to the general claims review progress. Automation increases efficiency, and speeds up reimbursement by reducing human errors.
3. Staying Current with the Regulation Change
Dental billing regulations and insurance policies in the US are always changing. It is important to stay on top of all changes in coding or billing in order to follow federal and state regulation.
4. Documentation
Monitoring service delivery is essential in order to receive adequate reimbursement and be consistent with the regulatory body. You should document every service performed, including documenting patient’s informed consent, the documentation of the care and treatment you provide. Additionally, documenting the processes by which you describe care and treatment provided to patients is essential.
5. Denial and Appeal Process
Continue monitoring for claims that have been denied and evaluate the issues to deal with denied claims. These include the re-submission of claims with changes or additional information.
Dental Billing Outsourcing: The Benefits
For many dental offices, outsourcing dental billing can be a very appealing option that provides practice owners with a wide variety of benefits. These are reduced overhead costs with painless maintenance. Here are a few of the advantages:
1. Expertise and Specialization
Outsourcing services to a dental billing company is useful to the practices as the specialists are current with billing codes, regulations and the guidelines to proper application of these dental codes. This alone will cut down on errors that usually lead to a claim denial.
2. Save Time and Money
When the dental office is managing in-house billing, they are often taking on an administrative burden. Outsourcing can save time for the dental staff to focus on taking care of the patients. Moreover, these third-party billing pros significantly reduce labor costs.
3. Accelerated Cash Flow
Dental billing companies are professionals at securing payments for the practice in a timely manner.
4. Compliance
A dental billing company that has been in business for a long time is aware of all local, state, and federal regulations and laws, including HIPAA Act, healthcare regulations and fraud prevention laws. They assist in avoiding costly legal situations while maintaining a great practice.
5. Lower Risk of Fraud
With an established billing company to manage dental billing can reduce the possibility of internal fraud or unintentional mistakes made by the internal billing teams.
What Should You Consider When Choosing an Outsourced Dental Billing Company?
Choosing a respectable dental billing company is one of the most important factors to ensure successful claims. There are some things to consider when choosing a third-party dental billing company:
1. Experience and Dental Industry Knowledge
The first thing to consider when choosing a billing company is experience. You need to consider the company’s experience and knowledge of the industry and the policies regarding billing and coding.
2. Transparency and Reporting
The second thing to think about is the type of reports and transparency. You will know the denial rates, trends, and analysis of your accounts receivable.
3. Customer Service
Customer service team must be responsive to address any concerns. It can be questions that arise during the billing process or related to a denied claim.
4. Technology and Tools
The dental billing company should leverage the use of high-tech billing software that will enable the smooth operation of billing functions, reduce weaknesses, and ensure timely submission.
Dental billing is a vital part of any practice. The objective for completing the billing accurately and ethically is of utmost importance to the financial and the legal side of your practice.
