Whether inadvertently or deliberately, flawed dental billing can result in unsatisfied patients, claims rejections, or legal liability. Besides, inaccurate billing practices can lead to significant financial consequences for your practice and may not receive the total amount it is entitled to from the patient or the insurance company. Therefore, higher accuracy of medical claims saves revenue and certifies that you stay within the ethical guidelines for dental billing.

Although dental insurance billing missteps can be devastating, here are five simple ways to remain above board:

1. Study the Processing Manuals

While it may be tempting to want to jump in and start dental billing feet first, it’s not the wisest way to approach administrative tasks. Doing your homework and taking time to read the manual, provider agreements, and processing policies in your network before processing can pay off and may lead to less frustration in the long run.

Each insurance company has its specific requirements. From knowing the difference between service year and calendar year, policy frequency limitations, and even missing tooth clauses, the opportunity for disparity from company to company is infinite. Generally, processing manuals change annually, and staying informed is well worth the time it takes to read them.

2. Submit Claims Using the Most Current ADA Format

As of May 2022, the 2019 ADA Dental Claim form is the most current claim form. Using the most up-to-date ADA format cuts down on insurance denials due to missing information on the claim form. Although differences between forms may be subtle, the differences between forms are critical when it comes to receiving prompt payment from insurance companies.

Additionally, it pays to be meticulous (literally). Ensuring that all of the boxes are checked, and information is filled out correctly can ensure that your payment goes through the first time. Double-check if your dental practice management software uses the most updated claim form.

3. Gain Familiarity with Your Provider Support Services

Thanks to the ADA, dentists, and other dental entities, dental billing laws are changing in many states. Provider support representatives exist to mentor and talk you through the correct way to get your services covered at fair and reasonable fees that you and your patients can be content with while maintaining compliance. As you grow comfortable, your patients will appreciate your confidence in billing and ability to maximize their benefits.

4. Understand Your Contractual Obligations

Contractual obligations protect both parties involved by spelling out clear expectations, and not following through with contractual obligations with fidelity is extremely risky behavior. If an audit determines fraudulent billing practices, doctors and office managers are ultimately responsible. Ignorance does not hold up in the eyes of the law, so fully understanding billing practices and contracts is one of the wisest ways to avoid insurance fraud.

5. Outsource a Virtual Administrator with Dental Practice Enhancement

Dental billing is one of the most challenging yet necessary aspects of dental office administration. Production carries no weight if you cannot successfully and ethically collect reimbursement for services. So, consider hiring a virtual administrator that can handle your billing claims with fidelity.

At Dental Practice Enhancement, our detail-oriented virtual administrators are trained to handle:

  • Submitting clean claims daily
  • Reviewing all denied and rejected claims
  • Posting all insurance payments
  • Verifying insurance and benefits
  • And so much more!

Learn how to improve your practice with our virtual administration services by calling (833) DPE-FOR-U or messaging us online.

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