Dental Billing has its own challenges and any lags in Dental billing can affect the claim reimbursement. However being accurate and billing only for the exact services rendered is also primary requirement as otherwise these errors may invite unwanted legal issues to the practice, physicians, patients or all parties involved. Dental billing rules and regulations have now become more concrete and upholding high standards of integrity to avoid fraudulent billing is crucial. Listed below are few illegal or fraudulent billing errors mostly prevalent across the industry which needs to be curbed to protect the physicians and billing practices.
Upcoding or Overbilling
This occurs when a dental procedure is billed at a higher code or level of complexity than was actually performed. It’s important to accurately code procedures to reflect the services provided.
Unbundling
Unbundling involves billing separately for components of a procedure that should be billed together as a single code. This can lead to higher reimbursement rates but is considered fraudulent if not done correctly.
Misrepresentation of Procedures
Billing for services that were not performed or misrepresenting the nature of a procedure can lead to fraudulent billing.
Duplicate Billing
Submitting multiple claims for the same procedure on the same day for the same patient is considered inappropriate and can result in overpayment.
Balance Billing
Balance billing occurs when a patient is billed for the difference between the dentist’s charge and the amount covered by the insurance company, even though the dentist is contracted to accept the insurance’s negotiated fee.
Misuse of Modifiers
Modifiers are codes used to provide additional information about a procedure. Misusing modifiers to increase reimbursement rates or to get around insurance limitations is improper.
Falsifying Patient Information
Providing false information about a patient’s diagnosis or condition to justify a procedure for insurance coverage is unethical and illegal.
Billing for Non-Covered Services
Billing for services that are not covered by the patient’s insurance plan without proper disclosure and consent can lead to billing disputes and potential legal issues.
Inadequate Documentation
Insufficient documentation of the procedures performed, diagnosis, and treatment plans can lead to claims being denied or flagged for review.
Failure to Verify Insurance Eligibility
Failing to verify a patient’s insurance eligibility or benefits before providing treatment can lead to billing errors and unexpected costs for the patient.
It’s essential for dental professionals to stay up-to-date with billing and coding guidelines, follow ethical practices, and maintain accurate records. If you have questions about proper billing practices or need guidance on any legitimate dental billing concerns, Ecare can help.
About Ecare
E-care is one of the leading Medical Billing Companies in India. Dental Billing is one of the top services handled by e-care with huge clientele of Dental Practices and Groups who have been with us for more than 23 years. With our expertise on Dental Billing, we can handle complete Dental Billing requirements with minimal transition period. Our team of Dental Billing expertise can guarantee increased billing collections. To know more about ecare and its services call 1-813-666-0028 or log on to Top Dental Verification Company | Outsource Dental Billing & Coding (ecareindia.com)