Important Considerations for Billing Dental Surgeries

Important Considerations for Billing Dental Surgeries

For more than 17 years, Outsource Strategies International (OSI) have been providing dental billing services for small as well as large practices. Our team provides dedicated dental insurance verification and authorization services for individual dentists, endodontists, orthodontists, or periodontists.

In today’s podcast, Loralee Kapp, one of our Solutions Managers discusses some important considerations for billing dental surgeries.

Podcast Highlights

00:10 Why are dental surgeries performed?

00:47 Factors to consider when billing for dental surgeries

00:52 Insurance verification

01:55 Established medical necessity

03:19 Obtain a pre authorization

03:45 Understand the importance of coding

04:48 Filling out and submitting claims

05:16 Outsourcing your verification authorization and billing needs

Read Transcript

This is Loralee Kapp, a Solutions Manager with Managed Outsourced Solutions. I’m gonna discuss with you some important considerations for billing dental surgeries.

00:10 Types of dental surgeries

Dental surgeries are performed to treat a variety of conditions that affect the teeth, jaw and gums such as temporal mandibular joint also known as TMJ disorder, wisdom teeth removal, facial trauma, corrective jaw surgery and periodontal surgeries to treat gum conditions like gingivitis and periodontitis. Billing the patient’s medical insurance for medically necessary dental surgeries can help patients maximize their health benefits. Utilizing a professional billing company can help ease this task as well as help increase reimbursement rates.

00:47 Factors to consider when billing for dental surgeries

The following are important considerations to make when billing for dental surgeries:

00:52 Insurance verification – Verifying dental eligibility by collecting the patient’s demographics and insurance information allows you to check their coverage and if their insurance will pay for the surgery. Collecting the following information will aid in this process. It is important to gather:

  • The patient’s name and date of birth
  • The name of the primary insured
  • Social security number of the primary insured
  • Insurance carrier
  • ID and group numbers, and
  • Contact information for the insurance company such as – phone number, website and claim submission address

With this information on hand, you can contact the insurance company to verify coverage, effective dates, in and or out of network coverage, if prior authorization is required for surgery, the patient’s portion such as deductible, co-pay and coinsurance. This will also help your patients plan for their out-of-pocket payments. Relying on a verification specialist and the billing company can simplify these tasks for your practice.

01:55 Establishing medical necessity – Medical insurance plans will reimburse for surgeries performed by a dentist if they can prove it is medically necessary and is properly coded as a medical procedure. You must provide documentation proving medical necessity. This is done to prove that the patient is medically compromised by a problem that the dentist treats. For example, tooth removal for impacted teeth, removal of teeth before radiation therapy or organ transplant. Medical plans may also cover tissue biopsies and extractions for surgical replacement of dental implants. Use the correct ICD 10 codes and CPT codes to document all aspects of care provided. This documentation should include

  • the chief presenting problem
  • any secondary or supporting diagnoses
  • diagnostic code for planned treatment
  • prior authorization for the surgery
  • letter outlining the medical necessity
  • a supporting letter of medical necessity for the primary care provider
  • procedures performed at the surgery location

This documentation should inform the payer that the patient’s concern is a medical one, not only a dental concern. All contributing factors for the patient’s medical history maybe stated in the letter to prove it is medically necessary.

03:19 Obtain a preauthorization– All dental surgery claims require a preauthorization from a medical plan. Dentist’s office must obtain this authorization before performing the surgery. Preauthorization involves contacting the insurance plan by phone or website in explaining the procedure and the day of the procedure. Failing to obtain a preauthorization may result in claim rejection.

03:45 Accurate coding –Know the proper ICD 10 codes and their uses. It is crucial for the insurer to note necessary information about the requested procedure. The first or primary diagnosis listed must relate to the most important aspect of the procedure being performed, followed subsequently by the secondary codes that pertain to the condition listed in order of lesser importance. The CPT codes on the claim must be listed in order, from the most expensive down to the least expensive procedure, not in the order that they were performed. This is done because payers reimburse for the first surgical procedure listed at the highest benefit level in each subsequent procedure at a lower or reduced rate. For example, the first procedure listed maybe paid out 100 percent, the second at 75 percent and any other additional services listed to be paid at 50 percent.

04:48 Filling out and submitting claims – After the dental surgery has been performed, the claim should be completed and submitted timely and correctly. The form should be checked thoroughly for typos and other errors that may lead to claims rejection or the delay of payment. The claims should be submitted to the insurance with all pertinent information provided including any supporting documentation such as lab or diagnostic imaging reports.

05:16 Outsourcing your verification authorization and billing needs – This is a great option to maximize your dental billing efficiency. Relying on experience companies that have experts dedicated to your practice and are up to date on all billing procedures such as – rules, claim submission processes, pricing coverage and the individual plans in each state, can enable you to focus more on your patient’s care, while resting assured that your billing needs are being handled by knowledgeable teams dedicated to ensuring that your back office needs are covered.

6 Strategies to Increase Dental Practice Revenue

6 Strategies to Increase Dental Practice Revenue

One of the leading dental billing companies in the U.S., Outsource Strategies International (OSI) is a reliable provider of comprehensive dental eligibility verifications and other services.

In today’s podcast, Loralee Kapp, one of our Solutions Managers discusses some strategies that can boost dental practice revenue.

Podcast Highlights

00:33 Perform patient benefit verifications

01:06 Review the contracted fee schedules

01:47 Establish clear payment policies

02:21 Assign the correct codes

02:39 Ensure an efficient claim submission process

02:57 Track claims

Read Transcript

Hi all, this is Loralee Kapp, the Solutions Manager with Managed Outsourced Solutions. Today, I want to discuss with you strategies to help boost your dental practice’s revenue.

The financial success of a dental practice depends greatly on proper communication between the practice and insurance companies. This proper communication will help maximize your reimbursement. Outsourcing your back office needs to a reputable billing company can make this process much easier. Here are 6 strategies to boost your practice’s revenue.

00:33 Perform patient benefit verifications – The success to billing depends on performing comprehensive dental insurance verifications before services are rendered. Comprehensive verifications should include checking the patient’s eligibility, coverage as well as active benefits with the insurance companies as well as verifying the demographic information. An important step is to ask if there has been a change to the employment status of your patients. Such a change may affect the coverage of their benefits.

01:06 Review the contracted fee schedules – The fee schedules are constantly changing. It is important to review them annually to help ensure the long term financial success of your practice. In order to review and readjust fee schedules, you will need to individually negotiate fee increases with third party payers. The ADA news reports say that dentist may need it to provide payers with the information such as – the desired fees for procedures, the costs associated with operating the business, and the date when the fees were last revised. It is also very important to review your contracts with them very carefully.

01:47 Establish clear payment policies – Establish clear payment policies for patients such as – collecting a patient’s copays or fees not covered by their insurance at the point of service can help reduce the outstanding claim, having a written financial policy outlining the patient’s obligations and what happens if they are not meant as a proactive strategy. In order to ensure that you are collecting payments, it is important to implement a process of sending out statements on a weekly, bi-weekly or monthly basis.

02:21 Assign the correct codes – As ICD 10 and CDT codes are constantly changing, it is vital to ensure that you are signing the correct codes for procedures and services rendered. This is very important as assigning incorrect codes and modifiers can lead to allegations of fraud.

02:39 Ensure an efficient claim submission process – Having a proper system in place to timely submit insurance claims is crucial to ensure reimbursement. Submitting claims the daily and implementing a system of reviewing claims for accuracy before sending them out can help improve the turnaround time.

02:57 Track claims – This is one of the most important services provided by dental billing companies. We regularly monitor claims to ensure the timely correction of any issues. Tracking the claims process ensures timely follow up in payment posting. If a claim is rejected the claim can quickly be appealed with the necessary adjustments made. Many providers have chosen to rely on experienced dental billing companies as a cost-effective option that can help increase their practice’s revenue as well as ensure efficient claim submission and maximize your reimbursement.

For more information on how Managed Outsource Solutions can help you with your back office needs, please contact us.

Avoiding Common Dental Billing Mistakes

Avoiding Common Dental Billing Mistakes

Outsource Strategies International has extensive expertise in providing dental insurance verification services. We verify patient coverage details days ahead of the patient office visit. Our teams are very thorough and makes sure to obtain all the necessary information when calling insurance companies to verify patient benefits.

In today’s podcast, Amber Darst, one of our Solutions Managers, discusses common billing mistakes and how having an experienced insurance verification specialist handling your insurance tasks can help you avoid these issues.

Podcast Highlights

00:43 Upcoding

01:08 Unbundling

01:47 Billing for services not provided or not completed

02:16 Waiver of copayment or deductible

02:37 Misrepresenting or altering dates of service

02:56 Not verifying a patient’s insurance before their date of service

Read Transcript

Hello, this is Amber Darst, Solutions Manager here at Managed Outsourced Solutions and today, I’ll be discussing some common billing mistakes and how having an experienced insurance verification specialist handling your insurance tasks can help you avoid these issues.

Billing for dental procedures sounds easy enough, but there are some common mistakes that can easily happen. Knowing the rules and regulations of insurers and following the proper coding guidelines is crucial when submitting dental claims.

So let’s take a look at the top 7 dental billing mistakes to watch out for.

00:43 Upcoding

First, we have upcoding. Upcoding means billing for services that are more expensive than that which were actually provided. Upcoding to evade insurance rules and get more money from the payer is closely scrutinized by insurance companies and regulatory agencies. Dentists should only bill for the level of services or items actually furnished.

01:08 Unbundling

Next, we have unbundling. The ADA defines unbundling of procedures as “the separating of the dental procedure into component parts with each part having a charge so that the cumulative charge of the components is greater than the total charge to patients who are not beneficiaries of a dental benefit plan for the same procedure.” This can be an inadvertent error or done deliberately to increase practice reimbursement. Practices should be familiar with the applicable payer rules on which services are bundled or billed together.

01:47 Billing for services not provided or not completed

Then we have billing for services not provided or not completed. And billing for these is another type of dental billing fraud. Examples include billing for surgery when the treatment provided was nonsurgical, billing for a crown at the prep time or before it was cemented. Now, there is an exception if a crown is prepped and not submitted, the dentist can claim partial payment from the insurance company.

02:16 Waiver of copayment or deductible

Both government and private insurance companies do not allow dentists to waive a patient’s deductible or copayment. If providers waive these payments, it is considered fraud because it then results in false claims.

02:37 Misrepresenting or altering dates of service

This involves reporting that a service for a particular patient was provided on 2 separate days instead of on the same day. The date on the patient’s medical file documentation should match the date of service listed on the claim form.

02:56 Not verifying a patient’s insurance before their date of service

And last but certainly not least, not verifying a patient’s insurance before their date of service. Oftentimes, front desk staff may assume that an established patient’s insurance coverage has not changed. But if it has and dental eligibility is not checked, the provider can run into several issues such as term policies or different coverage percentages that do not pay towards the procedures that have been completed. Oftentimes, this will cause a lot of frustration with the patients over high unexpected bills.

So, the bottom line is, false or inaccurate claims can lead to severe penalties and loss of a good reputation. The best way to avoid unintentional fraud is to ensure that you have an experienced verification specialist handling your insurance related tasks. They will know the proper questions to ask when calling each insurance company for the full benefit information.

And that’s all. Thanks for listening in.

Reasons Why Your Dental Claims Are Denied

Reasons Why Your Dental Claims Are Denied

At Outsource Strategies International (OSI), our comprehensive suite of dental billing services include comprehensive dental insurance verifications, prior authorizations, dental coding and more to help you run your practice efficiently. We can complete comprehensive verifications getting you the coverage information for all procedures and tests.

In today’s podcast, Amber Darst, our Solutions Manager, discusses the top reasons for dental claim denials and importance of proper insurance verification.

Podcast highlights

00:19 Lack of complete documentation

01:12 Late claims submission

01:42 Lost claims and loss X-rays

02:33 Limitations, exclusions and frequencies

03:10 Invalid or inaccurate CDT codes

Read Transcript

Hi this is Amber Darst, Solutions Manager here at Managed Outsource Solutions and today I’ll be talking about the top reasons for dental claim denials and how proper insurance verification ahead of the patient’s appointments can prevent these denials.

00:19 Lack of complete documentation

So I’m gonna jump right in with the first point, which is the lack of complete information and documentation. Lack of sufficient information is the most common reason for a delayed or denied claim.In addition to complete and accurate patient and insurance information, various dental carriers also require specific documentation for procedures. For instance, in the case of scaling and root planing plans typically require perio charting as well as X-rays showing the bone loss. It’s always advisable to provide more information (rather than less) about what was done in regard to the treatment when filing a dental claim. A reliable dental billing company will call up the insurance carrier and enquire what documentation they require for a procedure before sending out the claim.

01:12 Late claims submission

Next, we have late claims submission. Claims should be filed as soon as possible after the dental services are provided. Insurance companies may deny a claim on the grounds that it was not submitted in a timely manner. For PPO plans, the general rule is that the claim should be filed within one year from the date of service. Other plans however may have a shorter filing period time of just 90 days.

01:42 Lost claims and loss X-rays

Next, we have lost claims and loss X-rays. The ADA states that one of the biggest complaints with regards to third party claim payment is loss claims and/or lost X-rays. Dental offices often send claims are X-rays several times before the payer will acknowledge receipt. Though X-rays are submitted with the claim, the dentist will receive an explanation of benefits (EOB) still requesting the X-rays. The lack of standardization for attachments from carriers and the inability to reference attachment requirements for multiple carriers in a central location is the main reason for this confusion. The ADA recommends that each office contact each carrier individually to determine the claim processing requirements.

02:33 Limitations, exclusions and frequencies

Next, we have limitations exclusions and frequencies. These vary high among insurance plans and can really impact the claim reimbursement. How much a dental policy will pay depends on the limitations such as annual or lifetime maximums and then was frequencies patients can be covered only for certain procedures a few times a year or every few years. Checking on these factors before the patient’s date of service can help determine whether the patient is eligible for and how much out of pocket they will have before the procedures are performed.

03:10 Invalid or inaccurate CDT codes

And last, we have invalid or inaccurate CDT codes. There have been frequent changes to perio, endo and oral surgery procedure codes in recent years. Claims for dental procedures should be billed correctly using the latest CDT procedure codes. Using discontinued codes will result in denials.

So,with such complexities involved, billing dental procedures would be much easier with help from an expert. Experienced insurance verification specialist will provide accurate benefit break downs and can even handle your dental billing, ensuring accurate and timely submission of the claims filed electronically.

And that’s all! Thanks for listening in.

CDT Codes for Dental Restorative Procedures

CDT Codes for Dental Restorative Procedures

Dentists and orthodontists performing dental restorative procedures can rely on professional dental billing companies to submit timely claims with the correct codes. Outsource Strategies International (OSI) provides a comprehensive suite of dental billing services to help practices bill various dental services and optimize reimbursement.

In today’s podcast, Meghann Drella, one of our Senior Solutions Managers, discusses the CDT codes to report dental restorations and restorative dentistry.

Podcast Highlights

00:14 What is dental restoration?

00:35 Purpose of restorative dentistry

00:55 Assign the right CDT codes

Read Transcript

Hello and welcome to our podcast series. My name is Meghann Drella and I’m a Senior Solutions Manager here at Outsource Strategies International. Today, we’ll be discussing the CDT codes to report dental restorations and restorative dentistry.

00:14 What is dental restoration?

Dental restorations or restorative dentistry refers to dental procedures that repair or replace a tooth. The tooth structures could be missing due to decay, deterioration or fracture of the tooth. Dental restorations can fix those problems. Restorative procedures include fillings, crowns, implants, bridges, dentures, and root canals.

00:35 Purpose of restorative dentistry

These procedures are done for diverse purposes such as – to restore the function of the teeth, improve the appearance of the teeth, prevent further dental issues, eliminate the pain caused by infections or preserve the bone density.

A full list of codes associated with each of these procedures will be attached to this podcast.

00:55 Assign the right CDT codes

To get the CDT codes assigned right though, it’s really important for the practice’s billing and coding team to be up to date with the coding changes and guidelines. It is also extremely important to make sure a full comprehensive dental eligibility verification check is done prior to the patient’s procedure to verify what is covered and what is not covered.

I hope this helps but always remember that documentation as well as a thorough knowledge of peer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thanks for joining me and stay tuned for my next podcast.

Benefits of Outsourcing Dental Back Office Functions During COVID-19

Benefits of Outsourcing Dental Back Office Functions During COVID-19

Outsource Strategies International (OSI) is a dental billing company that provides a comprehensive suite of services to help dental practices provide quality care and successfully bill for their services.

In today’s podcast, Loralee Kapp, one of our Solutions Managers, discusses the benefits of outsourcing dental back office functions during COVID-19.

Podcast Highlights

00:13 Why Outsource Dental Back Office Tasks

01:07 Comprehensive Medical Billing Support from MOS

Read Transcript

Hi my name is Loralee Kapp, I’m a solutions manager with Managed Outsourced Solutions, and today, I want to discuss with you briefly the benefits of outsourcing your dental back office functions during the COVID-19 pandemic.

00:13 Why Outsource Dental Back Office Tasks

It’s no surprise that while we are navigating through the new normal of life with COVID-19 that we are seeing dental practices effected in a big way. These impacts can be seen in limited staffing, decreased revenue due to mandated shutdowns or social distancing, and an increasing amount of back-office duties due to limited staffing. One way to help relieve some of the stresses brought on by such demands is outsourcing your back office needs to a reputable billing company such as Managed Outsource Solutions.

You can put your mind at ease knowing that you have experienced medical coders who are up to date on all the industry changes, as well as ensuring that your accounts receivable are being managed accurately with claims filed and followed up with in a timely manner — all while improving your practices bottom line and freeing up more of your valuable time to focus on patient care.

01:07 Comprehensive Medical Billing Support from MOS

Managed Outsource Solutions can streamline your back office needs by working within your software as an extension of your office, helping you provide a better continuation of care, knowing that their insurance verifications and authorizations are completed before the appointments, which is a crucial step in preventing claim denials due to eligibility issues.