Posted by eHealth Source

Dental Billing Errors

Supplying accurate care is the primary aim of every medical practice let alone the dental section. Due to the continuous footfall of patients submitting error-free claims is critical to hike up the cash flow and amend collection rates. But this can also be dependent on the enlightenment of the rules and regulations of insurers. Hence, being able to follow the proper coding and billing practices. Getting accurate dental insurance to outsource who can verify the eligibility as well as dental billing to a knowledgeable service provider is an interoperable option for dental practices to enhance their billing performances. This also helps in rectifying the common billing errors that could be counted as sham and maltreatment. Let’s take a look at 4 major dental billing errors that are considered frauds, to watch out for.


The most common dental billing errors in the USA that are considered a major fraud is Up-coding. It means billing for services with a rate or price higher than what was actually provided. For illustration, in a hypothetical case, a dental clinic submitted bills for fillings on eight teeth while the dentist only rendered the patient with non-covered sealants. Up-coding consists of submitting the bills for the services that the patients have not acquired. It also involves submitting codes for higher extensive operations than the dentist has in reality performed. Up-coding is defined as“reporting a more complex and/or higher cost procedure than was actually performed.” by The American Dental Association (ADA). Up-coding is known as one of the major dental billing errors that hedge insurance rules in order to receive more money from the payer. Of which are closely examined by insurance companies and restrictive agencies. To avoid this dental billing error dentists or dental offices should only code for the actual services and items provided.

Incomplete Billing or Dental Billing Services not provided:

The error of Dental Billing services in the United States that have not been performed as well as incomplete billing is yet another type of dental billing error that can lead to tough actions taken by authorities. Let’s have a look at one of the examples, when dental offices submit a bill for surgery when the aid is given was nonsurgical, which also includes billing for a cap at the prep time or before it is filled. Hence a treatment no provided but billed for is a dental billing error.

Deducting or releasing the Co-payment:

The government, as well as private insurance companies, forbids dental clinics or dentists to dispense patients’ co-payments. According to the law of medical billing patients are accountable for co-payments and deductibles. If dentists or the dental offices forgo co-insurance postulate, it is considered a law-breaking act. This is because the wavering of co-payments can result in false claims, violations of the federal Anti-Kickback Statute that has been set, and immoderate and unreasonable use of items and services paid for by the insurance provider.

Medical Identity Theft:

Medical Identity theft involves the abuse or leak of the patient’s unique medical characteristic information and acquires payments from Government or private insurance providers. Also to fraudulently retract medical goods or services on behalf of the patient. Medical practitioner’s identifiers can also be purloined to fill bogus prescriptions, advert patients for additional dental services or dental supplies that are not required. Also, extracting bills for services that were never performed. To prevent unaccredited usage, dental practitioner’s should take befitting
measures to defend their personal as well as patients’ identifying information.

In conclusion, we can say that false claims can lead to severe consequences such as penalization, loss of reputation, and patient wrath. The best way to avoid unintentional dental billing fraud or dental billing errors is to maintain accurate documentation of all items and services provided. Collaborating with an experienced dental billing company in the USA will guarantee correct dental billing practices and error-free dental billing claim submission.

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