Dental billing refers to specialized support for dentists who need assistance in claim submission and billing. With complex procedures, rules, and detailed claim submission process, ensuring comprehensive dental billing services can be challenging for a conventional in-house billing staff. It can be really confusing to manage the RCM process because there are multiple stages that are involved in billing for dental healthcare. Errors in billing are common, along with further delays in claims reimbursement. We at SunKnowledge ensure that all your denials are reduced and you experience a streamlined reimbursement process.
What causes claim denials in Dental Billing?
Before handling denials, it is first important to identify the reasons behind them. The major claim denial reasons include:
1) Inadequate information
In dental billing services, inadequate information is the most common reason for a denied or delayed claim. Every dental claim must have accurate patient information along with details of their insurance. Additionally, there should be information about the dentist such as name, address, license number, and tax identification number in the claim form. If you see a claim being denied due to the reason that beneficiary identification is incorrect, it is suggesting an incorrect name or enrollee’s ID number on the claim.
2) Missing documentation
Claims are often denied due to insufficient supporting documentation. Dental claims need accompanying documentation that includes clinical chart notes, x-rays, intraoral photos, operative reports, exam forms, specialty referral forms, dental health history, and anesthesia records.
We at SunKnowledge ensure that all the submitted documentation is legible in the billing process. We provide complete information about the treatment process when filing a dental claim.
3) Missing X-Ray reports:
A major issue with third-party payment methods is lost claims and lost X-rays. Dental clinics often issue claims or conducts X-rays multiple times before the payer acknowledges the receipt. The dentist will receive an explanation of benefits (EOB) requesting X-rays, even though they are submitted with the claims. The insufficient standardization for attachments from carriers is the main reason for this confusion. The American Dental Association recommends that each office contacts each carrier individually to determine the claim processing requirements.
4) Coding errors
The significant codes in dental billing include ICD-10, CDT, and CPT. The use of incorrect, outdated or discontinued codes results in claim denials. ICD-10-CM codes help to identify the medical necessity of a dental procedure. An increasing number of payers require diagnostic codes on claims. CDT codes must be applied for reporting all dental procedures performed by a dentist. CPT codes are applicable for certain procedures to bill the patient’s medical insurance.
Some of the frequent dental coding errors include incorrect use of periodontal codes and overlooking discrepancies in documenting. It is advisable to choose the codes that accurately represent the treatment provided. It is also necessary to stay informed on the types of attachments that are required by each CDT procedure. SunKnowlegde’s CPC-certified coders help to maintain high accuracy in coding and minimize errors.
5) Delayed claim submission
Even if there are no errors in documentation or coding, your dental claims might still be denied if they are not submitted within the specified time limit. Every insurance company has its own deadlines for claim filing, also known as TFL (Timely Filing Limit). Any claim that is submitted outside this timeframe is automatically rejected. It is important to file claims soon after dental services are provided. Payers may deny claims stating that they were not submitted on time. The time limit varies among payers, ranging from 180 days to one year. In some cases, resubmitted claims may also be denied if not submitted within the specified time.
6) Missing patient eligibility confirmation
The other reasons behind claim denials include insurance coverage issues like lapsed policies, limitations, services not covered under a patient’s plan, etc. It is vital to review a patient’s benefits prior to their office visit, to avoid claim denials. SunKnowlege prioritizes verification of dental insurance since it is an essential step to confirm that patient information is updated, their benefits are still active, and the planned procedures are covered under their insurance policy.
How SunKnowledge helps in reducing denials and improving revenue
Just like any other specialty, dental billing has its own complexities. Dentists can maintain their financial stability and reduce errors in reimbursement by availing dental billing services provided by an expert RCM organization, such as SunKnowledge. Our CPC-certified coders, trained staff, and 17+ years of experience refine your entire reimbursement process. We offer 30 days’ free trial, and have a service charge of just $7 an hour. Along with this, we also have no binding contracts.
If your dental revenue is struggling with claim denials, we have got you covered with our end-to-end billing and coding services that include both pre-billing and post-billing activities. Our specialized virtual assistant services like appointment scheduling, setting up appointment reminders, responding to patient enquiries and voicemails, managing prior authorization – fulfill every requirement of virtual support in your dental clinic. Our billing personnel are experienced in working on software platforms like Pearly, Curve Dental, and Dentrix Pay.
As a healthcare practitioner, your primary objective is to provide improved patient care and maintain your revenue generation too. If you are spending time on reworking claims and managing denials, you are losing valuable time as well as revenue. To address this, partner with us and let our experts take care of your dental billing requirements.
Contact us for a free consultation today.