Top 6 Dental Billing Mistakes

Highlights

In the complex landscape of dental billing, avoiding common mistakes is crucial to maintaining a successful and compliant practice. Here are the top 6 dental billing mistakes that practitioners should be vigilant about to ensure ethical billing practices and financial stability.

Upcoding

• Billing for services that are more expensive than actually provided.Upcoding is closely monitored by insurance companies and regulatory agencies.
• "Upcoding" means reporting a higher-level service or procedure or a more complex diagnosis, than is supported by medical necessity, medical facts, or the provider's documentation.
• For example, reporting a diagnosis of chronic bronchitis if the patient has acute bronchitis qualifies as upcoding, as would billing a level 5 evaluation and management (E&M) service when the lesion actually measured 1 cm.

Unbundling

• When two procedures should be bundled in a single CPT code, coders who bill the two procedures separately using two CPT codes are unbundling the procedures.
• Unbundling also occurs when a coder charges for two services when the code for the major service assumes that the minor service is also provided.
• Since two charges will result in a larger bill than a single comprehensive charge, unbundling results in overbilling.

Billing for Services Not Provided or Not Completed

• Providers knowingly submitting claims to the insurance provider for medical services not provided or for a higher level of medical services than actually provided.

Waiver of Copayment or Deductible

• Healthcare service providers sometimes waive patient financial responsibility, i.e., copays and deductibles, as an accommodation to the patient, professional courtesy, and employee benefits.
• However, waiving copays and deductibles may violate fraud and abuse laws and payer contracts.

Misrepresenting or Altering Dates of Service

• Healthcare fraud occurs when an individual, a group of people, or a company knowingly misrepresents or misstates something about the type, scope, or nature of the medical treatment or service provided, in a manner that could result in unauthorized payments being made.

Not Verifying a Patient’s Insurance Before DOS

• Not verifying insurance benefits prior to rendering service can result in nonpayment, which affects your bottom line. Because this is a costly mistake that can be avoided, make it routine to verify eligibility prior to every patient visit.
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