Tag - Dental Billing

Dental Insurance Denials

How To Properly Appeal Dental Insurance Denials?

Dental Insurance denials are very common in the medical billing process. For the health service provider, it becomes so frustrating and they try their best to avoid denial rate as much as possible. 

Similarly, the dental service provider faces equivalent kinds of issues. In some cases, the insurance company decided to deny the coverage to the patient.

At that point, the dental care handled this situation in a different manner by submitting an appeal. But first, we need to have a quick look at the reasons behind the dental denial rates.

Top Reasons Behind the Dental Insurance Denials

Getting a full reimbursement for the services you rendered is sometimes very frustrating but if we know the exact reason behind the lower reimbursement rate then we can better manage our revenue cycle management. 

There might be many reasons behind the insurance denial rates but if we closely observe in the perspective of dental denial then there are various other reasons behind it.

In this article, we will try to explain some of the main reasons behind the denials in dental insurance.

Eligibility Issue

For any dental service provider, the verification eligibility of the patient for the insurance should be the topmost priority. In many cases, patients are not aware of the insurance coverage of their plans and they might take the services and treatment that might not be part of their insurance coverage.

On the other hand, the insurance regulation plans are not constant throughout the year. So when a patient came for the services you need to take the essential documentation on the first interaction. 

Your front desk staff can note the following information carefully the patient’s name a brief detail of his primary insurance, social security number, insurance carrier details, identification number, etc. It will help you to verify all the necessary details first hand and it will also minimize the chances of error later.

Root Planning or Periodontal Scaling Coverage

In Dental Practices, Root Planning and Periodontal scaling are supposed to get higher denial rates compared to any other treatments. For insurance purposes, they required a special documentation list that includes some clinical indicators and evidence.

The periodontal chart required a pocket depth and full mouth radiographs and digital images.

This documentation should be embedded with the patient record first hand.

On the other side, the correct use of CPT and CDT codes is also essential in this stage. Many a time Insurance companies fail to present guidelines for the relevant purpose and codes.

In SRP claims you can make your case even stronger by giving them additional documentation of periodontal charting description of the procedures that are used during the treatment and some radiographic evidence of bone loss.

Core Build-up Procedure

The core build-up procedure is applied to maintain the crown retention in the internal anatomy of the tooth. The purpose of this procedure is to completely replace the missing tooth structure and make a proper symmetry to protect the integrity of the tooth. Usually, this procedure is denied with the statement of no benefits or low benefits.

There are multiple complexities in this procedure like when the dentist conducts this treatment then they have to further remove the irregularity and all the existing filling from the tooth and use the material to fill these irregularities. 

This procedure is pretty much similar to the D2950 build-up. It is the same procedure but for different purposes so it might create some mess.

Let it be very clear with your patient about the lack of benefit in doing this procedure. Use radiographic evidence to get reimbursement from the insurance company while performing this kind of treatment.

How To Deal With Dental Insurance Denials?

Dental insurance denials can be managed in various ways. Here are some of the ways in which you can minimize your insurance denials. 

Prepare an Appeal Letter

An appeal letter is an essential step for getting reimbursement for your dental services from the insurance payer. In this letter you need to fulfill all the essential details required by the insurance provider this information consists of;

  • Complete details of the patient like his name, policy number, contact information, and information about the policyholder.
  • In this letter, you should also mention the complete details about the denial rate.
  • Like you have to mention that what was the reason behind the denials, the date of the denial and also specified some main reason which leads to this.
  • Lastly, mention the details of the dentist who performed the whole treatment for the patient.

The purpose of this detailed appeal letter is to tell the insurance company to have a look at the case as soon as possible and your practice is strongly eligible for reimbursement.

Make a Template of Appeal Letter

For your convenience, you can also prepare a template appeal letter in case you are filling multiple appeal letters. In this template, you can add a similar process and treatment and you just need to switch the name and claim number and relevant information associated with each patient.

This template will eventually not only save you time but also increase the efficiency and productivity of your practice.

Proper Coding 

To get a maximum reimbursement the proper coding is an essential part to be done.

Make sure that your practice has a team of professional coding experts who are aware of the proper CPT coding or dental terminologies coding CDT by the American dental association.

Now you are pretty much aware of how you can effectively make an appeal for your dental insurance claims and what is the real reason behind the increasing denial rates and how you can manage it by following steps like appropriate coding practices, understanding the agreement of different insurance companies creating awareness about lack of benefits among the patient and preparing proper documentation of all the required procedures. To avoid hassles you can also take assistance from a medical billing service provider.

Med-Miles is one of the most prominent names in medical billing services. We have been serving our clients for more than 8 years and our professional team is pretty much aware of the challenges dental health service providers face. We have the best billing solution for your practice call us at 8885 989 181 for the services.

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Dental Surgeries

How to Bill Dental Surgeries to Medical Insurance?

Oral health plays a key role in the overall well-being of a human. Good oral health leads to a healthy lifestyle. So dental hygiene plays an important role in our life.

Dental billing Is more complicated compared to other medical billing activities. One of the most difficult tasks a dental surgeon faces is to guide their patient about how they are paying for the services. 

The majority of the time patients are clueless about the consequences of their dental health which if not treated earlier can lead to serious health conditions. Dental surgeries are relatively more expensive and it has a very low benefit cap.

Meanwhile, medical billing for dental surgery is more suitable for patients who can’t afford the expenses of dental treatment. Not only for the patient but a dental practice can get maximum reimbursement from the insurance company.

Tips to Get Medical Insurance For Dental Surgeries

To get medical insurance for dental surgeries you need to make a very strong case that the patient’s dental health is associated with his overall health condition. For this purpose, you will require proper documentation like;

  • The initial condition of the patient represents the complications.
  • A secondary note with supportive diagnosis 
  • An appropriate diagnostic code as these codes are used to get reimbursement so the appropriate diagnostic code is essential for the treatment you plan for the patient.
  • A surgical preauthorization is also essential for the treatment.
  • A letter termed as a medical necessity this letter recognizes that the surgery is necessary to treat the patient for his underlying health condition.
  • A support letter from the patient’s primary care physician has also required. A support letter to make sure that the patient needs dental surgery to avoid a serious health condition.
  • Lastly, the documentation of the procedure that is performed at each surgery location should be given as this documentation is critical for the coding purpose which eventually gives your dental practice reimbursement from the insurance company.

This will give a clear picture to the insurance service provider that the dental treatment or surgery is performed to treat a medical condition.

Dental Procedures That Are Covered By Medical Insurance Payers

Below are some of the dental treatments and procedures that will be covered by the health insurance provider. This coverage is according to the plan of the patient and the coverage of the procedure and treatment by the insurance payer. Let’s have a look!

  • Any accidental injury which required dental restorations.
  • Any kind of oral infection can impact the body function of the patient.
  • The treatment that is related to cancer complications.
  • The cone-beam computed tomography (CBCT) is used to get the data by using a cone shape X-ray that is used to create a 3D image of the teeth.
  • Frenectomy, a procedure that is used to remove the connective tissue from the upper and the lower side of the mouth or specifically under the tongue and it is usually recommended for newborns suffering from speech eating or other oral disorders.
  • Treating sleep apnea which is a serious sleep disorder in which a patient suffers from interrupted breathing during sleep, dental appliances are used to treat sleep apnea for patients who suffers from moderate to obstructive sleep apnea these instruments will prevent the tongue to block the throat and lower jaw region and that eventually leads to help in passing the air during the sleep.
  • Gentle biopsies are usually used to get tissue from the patient’s oral cavity.
  • The treatment that is used to treat congenital malformation.

These were some of the treatments that are covered by the insurance service provider.

Step By Step Guide To Get The Reimbursement

There are some steps that you need to consider to get reimbursement from the medical insurance payer for the dental surgery.

A pre-authorization Process:

A pre-authorization is an initial step to getting a reimbursement. As you are providing dental services to the patient or treating any other underlying health complication. When a patient visits to get treatment the first step you do is to verify the insurance eligibility and insurance coverage.

Many times patients are not familiar with their insurance coverage. Complete information related to copays and deductibles helps you to guide the patient to pay their liability so a pre-authorization can save your practice revenues.

Medical Necessity:

The letter for medical necessity is a type of statement which is written by a doctor that clarifies the services or instruments which are used to treat the patient from a medical condition. 

Through the letter of medical necessity, a dental service provider can get reimbursement from the insurance company by highlighting the case for surgery.

You can get the reimbursement by giving appropriate reasoning for the surgery. In that case, you need to use the proper ICD-10 coding procedure; an insurance company only approves those claims that are properly managed under ICD-10 coding.

For the claim approval, list down the most essential part of the procedure to the least essential part.   

The appropriate cording is the key to getting reimbursement your dental practice has to explain to the insurance provider about the need to have the dental surgery like if a patient loses his tooth and has other medical complications like cancer or diabetes then it becomes essential to get a tooth surgery to prevent the further complication.

Filling and submitting the claim:

The last step is to properly check, fill and submit the claim. In the earlier section, we have discussed that we should list the procedure and treatment for the surgery from the most appropriate or most expensive to the least appropriate or the least expensive procedure.

Before submitting the claim make sure that your claim is appropriate, all the essential information is embedded and there is no coding error in your claim.

To make your case stronger always include some supporting documentation with your claim like you can add Lab reports for dog diagnostic imaging.

If you are facing any denied claim due to some kind of error in your claim then your practice should find out those errors and resubmit the claim and consistently follow up with the insurance companies to get reimbursement.

Need Help?

Get desired results and maximize your revenues with Med miles. Med-Miles LLC provides the best solutions to get maximum reimbursement. Call us at (888) 598-9181 for more information. 

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Medical Billing

How Do I Choose The Right Dental Medical Billing Service Provider?

There is never a moment inside healthcare facilities where the staff can truly take a deep breath and relax, it’s always busy. Not only do the staff deal with the patients but they also have to face the families and comfort them. Staff also have the responsibility to verify insurance and review medical records. 

One of the main tasks to look after is the process of medical billing by handling audits, checking fee schedules, and providing an overview on coding and charges to ensure the financial health of their practice.

Dental medical billing is a very tough and confusing task as the rules and regulations change frequently. The medical biller you choose to work with should be updated with the latest codes of dental medical billing to increase revenue over time.

Professional billers make sure you receive payments on time instead of waiting months for them. They are well revised and experienced in dealing with insurance providers to expedite your medical payments. 

With many options available, how can you pick the right dental medical billing company?

Let’s find out below!

Types Of Billing Services

Finding a dental medical billing company for outsourcing billing can be complicated. Three types of dental medical billing companies should be known to understand choosing the right one for you.

Small-scale Medical Billing

If your practice is on a limited budget and you have a low volume of data, home-based dental medical billing can be of good help for you regarding coding/billing tasks without breaking your budget. The only criteria are ensuring that the dental medical billing company possesses enough experience in the healthcare market.

The best approach, in this case, is to outsource a few tasks because they charge per job basis which saves you money in the long term. Also, providers need to keep in mind that not all companies offer coding and billing services. So, ask first, what billing processes will be included.

Professional Medical Billing Business

Have a bigger budget? Then professional medical billing service providers are a great option for you. The services on offer include more features than smaller dental medical billing services. So get into details about the specifics of the services they provide.

Physician Practice Management Company

Most companies that fall in this category are large enterprises that have teams of over 200 staff and advanced infrastructure. They need premium services for coding and billing that run thousands of dollars encouraging clients to relax while the dental medical billing companies carry out administrative tasks entirely.

Tips To Choose Dental Medical Billing Services

Working with a reliable dental medical billing provider can improve your cash flow. Medical billing companies are professional at what they do so you can stay up-to-date with compliances. 

Here are some of the best tips when selecting a good medical billing company. 

Experience

This is one of the best points before hiring a medical billing company. How long are they in this business? What’s their reputation? The best practice is to look for companies that are in quite a bit of time. This indicates that they have found success in client satisfaction.

Reputation

While looking for a dental medical billing company it is a good practice to search for its reviews. Markets are flooded with these companies, some good and some bad, which can be the reason for the company to lose valuable time and money. To avoid this scenario, evaluate the billing partner thoroughly looking for reviews from medical professionals.

Staff Size

The staff size matters when firms undertake large-sized projects of various specialties. With more workers and experts in a variety of dental medical billing tasks, and sufficient knowledge it is easier to deal with a sudden increase in billing.

Responsible

The best dental medical billing companies take measures to keep clients returning for repeat business. The speed of their and the company’s availability are the main factors that most healthcare providers care about.

Making revenue is important but the convenience given to the patients is equally as important. The billing partner should have a quick response to any concerns during and after the service.

Cost

Outsourcing dental medical billing boils down to the cost the company charges for its service. It is convenient to ask several questions before outsourcing your medical billing tasks.

How do they charge? Any hidden charges? Can discounts be availed for outsourcing large volumes of billing requirements? These can help you choose a billing company that offers the best and reliable that also fits the budget. 

Payment Methods

Outsourcing your dental medical billing to a service provider who gives you timely reminders and offers a variety of payment options is important. You should deal with payment matters with caution to avoid any misunderstanding.

HIPAA Compliance

Working with an ISO-certified company ensures the safety of your interest, one of which is the Health Insurance Portability and Accountability Act (HIPAA) compliance. This compliance keeps you at ease knowing that the dental medical billing company’s practices are compliant with the HIPAA specifications. 

Compare Promised And Actual Benefits

Checking with the dental medical billing company the actual benefits they are offering and what portion of it gets profitable results concerning your billing requirement is something you should do. If you feel that the numbers are convincing and offer better value than having your team, then it’s better to outsource your medical billing.

Following Deadlines

Meeting deadlines is important for any practice, as it ensures continuous client support and prevents unpleasant experiences. The billing company must deliver to the deadlines and deliver results within the given time despite the challenges involved.

Check The Software Used

Technology plays a key role to accomplish results quickly. However, the best software may not be available with every dental medical billing company.

If you are specific about the way your bills are handled, and through what software, then it is important to communicate your needs in advance and get confirmation from the billing company. 

Also Read Practice Management Software- 8 Features Healthcare Provider Should Consider

Outsource Your Dental Medical Billing Now!

If you are on the lookout for a dental medical billing company you’ll notice that not all companies fulfill the points listed above, you will realize that most medical billing companies lack in one department at least. However, Med-Miles is an exception to the rule, as we don’t only fulfill those factors, but tend to go beyond expectations. Contact our team of experts at +1 888-598-9181

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Dental Billing

Top 6 Deadly Dental Billing Mistakes

It is nothing as bad as someone coming into your life and telling you that you are doing everything wrong.

In most cases, such a statement is nothing less than fact. It doesn’t mean that you always do wrong things. Dental billing can be considered as one of every dental practices’ nightmare.

As electronic technology has revolutionized dental practice by improving dental records. It has become a primary challenge for dental practitioners to manage their billing process with maximum reimbursements. 

Dental billing has never been easy. It has been reported by the United States Consumer Financial Protection Bureau that 52 % of collection services come from unpaid medical bills. It has also been estimated that 30-70% of dental billing includes some kind of error in it. As a dental practitioner, you have to manage a lot. 

It might be possible that you have to do coding twice in order to correct the mistake that was made the first time. However, it is not possible to avoid errors particularly when you have to deal with thousands of codes.

If there are billing errors in your dental practice then it not only makes your patient angry but can also ruin your practice’s bottom line and create a headache for your customers. 

Want to get freedom from Dental billing errors? Then read this article and know about deadly mistakes that dental insurance billing has.

If you want to receive maximum profit and pleasure from patients or maximum utilization of their dental insurance, be sure to avoid the following “Deadly Dental Billing Mistakes.” In this article, we will identify some of the common problems and how you can solve them.

  • Missing Information

One of the most common billing mistakes is missing information that often leads to claims denials. Unfortunately, errors occur in your billing sheet. When you’re filling the billing sheet you may forget to enter some important information that may be necessary for your dental insurance claim. 

There are many times when you accidentally entered the wrong information and if the information is entered wrong in the patient’s record and submitted then chances are that claims denial will follow. 

If you want to avoid these errors then it can only be possible by verifying all fields before you’re going to submitting a claim. 

  • Dental Coding Errors

When you submitted the claim with the wrong diagnosis code, it will result in claim denial. Dental codes that are not coded to the highest level of specificity result in denials. Each practice must review and note the changes for codes most often used and evaluate how they are affected. 

  • Incorrect Information

Wrong patient information is also one of the most common billing mistakes. Incorrect information includes patient name, address and treatment date, etc. that are the main cause of problems. When you submitted a claim, insurance companies may reject a claim due to inaccuracy. 

  • Bundling Errors

There are some procedures that can be collectively bundled under one procedural code. For this reason, if you unbundle services that can be bundled in a cost-effective way then there are chances that dental claims may be denied. 

It is difficult to track unbundling errors. However, to prevent this kind of error you must clarify and work on them.

  • Not Enough Time 

Billing has become a burdensome task for many healthcare providers when there only is only one person to handle tasks; Patient Care in the office, treatment plans, insurance claims, appeals to denied claims, manage accounts receivables, calls, and post-credits, etc. 

 As these time-consuming tasks divert their time from their core business. And deprives you and your staff to focus more on revenue-generating tasks instead of life-saving tasks. But, how you can manage these both tasks side by side. Simply, by outsourcing your dental medical billing to a medical billing company like Med-Miles LLC. 

If dental insurance claims frustrate you and have a negative impact on your bottom line this is time to outsource. 

When you outsource your dental billing to Med-Miles LLC, you’ll have fewer rejected claims and a quicker turnaround time that will maximize the productivity of your dental practice while you can focus more on patient care. 

  • Not Confirming Eligibility

If your staff routinely files claims for benefits without confirming eligibility, overpayments will occur. Overpayments have become an unnecessary and costly reality for many healthcare providers. If you haven’t confirmed the eligibility then you are responsible for the replacement of any overpayments that are made on the part of the payer. 

With an improved billing system, you can claim without any difficulty. You can better build relations with your patients also improve your practice cash flow. If you have read the most common dental billing mistakes above then it can help you to begin your errorless Dental practice journey.

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