You are extremely conscientious in your services to patients. You are committed to providing the highest quality of care, you are obsessive about HIPAA compliance, and you regularly research the latest dental techniques. Unfortunately, if you make a mistake with your billing and insurance, you may still be subject to steep fines, lawsuits, and even a revocation of your license. That’s why it is vital to work with true dental billing experts.
At Dental Practice Enhancement, we are knowledgeable about all things insurance-related. While you pour over the latest dental research, we obsess about changes in CDT codes. We are passionate about dental administration and can train your team so that they are far less likely to make billing mistakes. Or we could take over your billing entirely with our virtual administrative services.
Whichever option you choose, with our help, you can be safe from devastating legal mistakes. Contact us today to get started.
1. Violating the Truth in Lending Act
Since you’re not a credit card company or a mortgage lender, you may not think the Truth in Lending Act (TILA) applies to your practice. But the TILA is applicable to any entity that extends credit at least 25 times a year. So if you offer in-house repayment plans, or you allow patients to pay over at least four installments, you need to pay attention to this law!
The TILA requires you to accurately disclose all financing information and give borrowers a three-day window in which to withdraw from the financing agreement.
2. Unbundling Procedures
Many multi-step procedures have specific CDT codes. Billing separately for each step of the process (for instance, billing for both anesthesia and an extraction) is considered dental fraud. This could be done intentionally in an effort to get more money from the insurance company. More often, however, it occurs because practices are not working with dental billing experts. Instead, inexperienced administrators make an honest – but costly! – coding mistake. We know coding like the back of our hands, including which treatments should be bundled.
3. Listing the Wrong Treatment Date
It might seem like an insignificant error, but listing the wrong treatment date is illegal. Even if you list the day a patient’s restoration was created, rather than the day it was set, it could set you up for a fraud accusation. Dates are very important because they affect patients’ out-of-pocket maximums. They are also connected to the fiscal cycle and when benefits start over.
4. Waiving Copayments or Deductibles
Some insurance plans may waive copayments for certain diagnostic and preventive treatments. But waiving fees as a favor or a gesture of goodwill is fraudulent and could make you liable for legal action. If you waive a claim under Medicare or Medicaid, you could be charged with violation of the False Claims Act. Waiving co-pays for patients covered by insurance is considered a breach of contract, and an insurance company can come after you with a recoupment audit.
Avoid Mistakes with Our Dental Billing Experts
Fortunately, legal mistakes are avoidable when you work with true dental billing experts. To find out how we can assist your practice, contact us online or call (833) DPE – FOR – U.
