Unlike other specialties, dental practices face many challenges, especially when it comes to insurance coverage as well as revenue cycle management. Medical billing and coding services for dental practices provided by experienced firms ensure that the practice has fewer accounts receivable and unresolved dental claims.

Dental Insurance Issues – A Major Challenge

It is a fact that while standard dental insurance covers cleanings, fillings and other routine care, major work like a crown or a bridge is often covered only at 50 percent and implants generally aren’t covered at all, resulting in out-of-pocket expenses for patients. Many other people, even with dental coverage, go without care because they cannot afford the large balances or co-pays for crowns, root canals and other major procedures.

Recent news in Kaiser Health News highlighted a seminar on how dental staff should bill medical insurers. In this seminar, the presenter recommends dental practices to first consider what medical insurance might cover and then bill the dental plan for the rest. Medical insurers should also cover oral problems attributable to an underlying medical condition, such as diabetes or dry mouth, a common side effect of many medications. This strategy will not only spare patients the pain of big bills but can also boost income for dentists.

Survey Highlights Most Common Issues

An August 2017 survey conducted by NEA has highlighted key dental practice pain points and the most pressing issues practices face with claims management.

10 most common issues reported were:

  • Claims processing delays due to many reasons – incorrect CDT codes, missing or incorrect patient details, duplicate claims or more
  • Following up on claims not paid/rejected claims; rejections causing slower turn around payments
  • Dental insurance verification – there are cases where coverage is verified prior to procedures, but then patients are told the procedure is not covered
  • Payers claiming they did not receive documents that were sent
  • Reimbursement levels – lower than originally expected
  • Rejections/requests for additional information
  • Long hold times/not getting a person on the phone/payer’s automated customer support systems
  • Coordination of benefits
  • Dental insurance downgrades
  • Dental Medical billing – challenges of CDT vs CPT coding; what gets billed medical versus dental?

Troublesome CDT Procedure Codes

The NEA survey also revealed three troublesome CDT procedure codes for practices – D4341, D2740 and D2950 that require the most supporting documentation for adjudication, and the claims most often rejected by payers after first submission.

  • D4341: Periodontal scaling and root planing, per quadrant (instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces)
  • D2740: Crown-porcelain/ceramic substrate
  • D2950: Core buildup, including any pins when required

Specifically, code D4341 is causing trouble for practices because more dentists and hygienists are using periodontal scaling and root planing as treatments to help patients control their periodontal disease. Unfortunately, according to survey respondents, many practices are also experiencing insurance-benefit issues relating to the claim number. While most indemnity carriers cover D4341, restrictions and requirements for payment are abundant.

Other key challenges include managing accounts receivable, claim denial appeals as well as high competition between dental providers, making it difficult to acquire and retain new patients. If an insurance company denies request for benefits, it is important to appeal.

Read our blog to learn the top reasons for dental claim delay or denial.

The claims appeal process provides an opportunity for providers to get back lost revenue. Busy dental practices can choose to partner with experienced medical billing and coding companies to work on claim denials.