Increase profits without raising fees: Learn proper dental billing and coding


This article originally appeared on DentistryIQ and can be found here.

Who to Contact

Billing, Chart, and Code reviews and more please visit Dental Evolutions

Medical Billing books and courses please visit Successful Medical Billing

Billing is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a provider at your dental practice. That definition may seem obvious, but your dental office may be losing revenue daily due to lax billing practices. The problem? Haphazard and imprecise dental and medical diagnostic coding for your services.

The impact of billing and coding problems on your practice
Dental billing and coding problems can cost you thousands in lost revenue. But it’s lost revenue that you can easily recapture with a better understanding of the latest billing and coding methods. That’s what my company is about. We teach the latest coding practices, including cross-coding to dental and/or medical insurance for applicable procedures. The difference between a profitable, growing dental practice and one that barely breaks even is expertise in dental billing and coding.

Your disadvantage: dealing with insurance company experts

One thing is certain, insurance companies train their teams to be experts in dental diagnostic codes and treatment codes so that they don’t pay you any more than absolutely necessary. If your office has fallen behind on the latest dental coding and billing best practices and is using the same codes constantly because they’re all you know, you’re leaving money on the table.

Due to lack of billing and coding skill:

  • You’re using inadequate diagnostic codes, not coding and billing for the complexity or extent of the examination. You may not be using the most up-to-date codes from ICD9, and ICD10 is coming soon.
  • You’re getting paid slowly because when documentation isn’t in order and properly coded, claims are denied.
  • You’re wasting staff resources. Your office must resubmit documents, which uses valuable staff time and slows down your receivables.
  • You’re not collecting proper co-pays and deductibles.
  • You’re getting paid less than you should for procedures you perform. 
  • You may be missing out on payments for certain billing codes entirely in some cases.
  • You’re missing out on payments for medically necessary dental work.

Solutions 

Get expert training and consulting services
Optimize your billing practices with proper training. Get your billing paid more quickly with properly submitted documentation. Save staff time by eliminating resubmissions. Get paid your full fee for every procedure. Clean up your billing. Use the funds you’ve been missing to grow your business! Don’t be at the mercy of insurance companies. Make sure all your procedures are billed optimally so that no code is left to chance.

Get a professional chart audit 
Why should you have a professional chart audit? Have you been underbilling patients insurance at your dental practice? That’s what an audit will tell you. Without proper training in insurance billing and coding, chances are you have been missing out on fees that you’re entitled to receive. You can mine your recent billing for missing revenue: You can hire an expert to find missing or incorrect codes and identify recurring error patternsSchedule a professional audit to find out about under-billed procedures to help you recover lost revenue. Your audit should more than pay for itself.

The advantages of a professional dental chart audit are:

  • Ensure that the CDT codes your practice reports are reflected in the services documented
  • Verify that your practice is following CDT guidelines along with Medicaid (if applicable), state, and federal rules and regulations
  • Ensure that your practice is receiving proper reimbursement for services provided
  • Determine whether your dentists and staff are applying the principles of documentation for compliance
  • Evaluate documentation for risk management exposure not specific to the documentation guidelines. (Insurance companies conduct their own audits and reviews of your billing to their insured. When they find incorrect documentation or overpayments, they will seek to collect from you.)
  • Identify any missed or absent documentation and possible unbilled charges

Dental office staff: Request an expert coding class
According to the BLS (Bureau of Labor Statistics), health care is the largest US industry, making it a sound career choice. Dental support staff can make their job easier, and obtain valuable skills to advance your career, with up-to-date knowledge of codes, both dental and medical (cross-billing for medically necessary dental procedures). Large dental practices may pay for staff to take classes to be at the cutting edge of coding knowledge. But if your practice won’t, I highly recommend taking a class anyway for your own professional development.