Dental billing mistakes can impact claim denials and delays and decrease the revenue cycle for dental practices. Stay updated with advanced techniques and coding; it will increase our revenue cycle.
1. Incorrect use of the CDT code: Using outdated or incorrect CDT codes can result in claim denials and payment delays. The American Dental Association (ADA) updates CDT codes annually, so it’s essential to ensure that your billing team is using the most recent codes for procedures. ADA coding updates should be reviewed and trained on a regular basis by your billing staff.
2. Inaccurate or incomplete patient data Errors in patient demographics, insurance details, or provider information can lead to claim rejections. Names that are misspelled, policy numbers that are incorrect, and dates of birth that are missing are all common errors.
Tip: Implement a verification process to cross-check patient information before submitting claims.
3. Insufficient Prior Authorisation For some procedures, pre-authorisation is required by many insurance plans. Patients and practices alike can suffer financial losses and claim denials if prior authorization is not obtained.
Tip: Set up a system to keep track of and manage the different insurance providers’ pre-authorization requirements.
4. Lack of Proper Documentation
During audits, claim denials may result from inadequate clinical documentation. When proving the need for a procedure, insurance companies frequently ask for periodontal charts, X-rays, and detailed notes.
Tip: Ensure that providers document all procedures thoroughly and attach required supporting documentation when submitting claims.
5. Issues with Insurance Verification and Incorrect Fee Schedules Charging incorrect fees due to outdated fee schedules or misunderstanding insurance coverage can lead to disputes and non-payment.Before providing treatments, update fee schedules frequently and verify insurance benefits.
Most Commonly Asked Questions
1. How can I ensure my dental practice is using the correct CDT codes?
Stay updated with the latest CDT code changes by subscribing to ADA newsletters, attending coding webinars, and using dental billing software with automatic updates.
2. What steps can I take to prevent claim rejections due to patient information errors?
Implement a double-check system where front-office staff verify patient details at check-in and before submitting claims.
3. Why is prior authorisation necessary, and how can I manage it effectively?
Prior authorisation ensures that an insurance company agrees to cover a procedure before it’s performed. Use tracking software or a spreadsheet to monitor prior authorisation requests and approvals.
4. To avoid having my claim denied, what documentation should I include? Include clinical notes, radiographs, intra-oral images, periodontal charting (if applicable), and any supporting medical history that justifies the treatment.
5. How often should I update my practice’s fee schedule?
Review and update your fee schedule at least annually or whenever insurance providers make reimbursement changes.
By avoiding these common dental billing mistakes, your practice can streamline operations, reduce claim denials, and maximise revenue in 2025.
