Ten Common Dental Billing Issues

Ah, the dentist's office—a place where we entrust our pearly whites to professionals wielding tiny mirrors and sharp tools. But behind the scenes, there's a world of billing codes and insurance claims that can be as tangled as a ball of dental floss. Let's sink our teeth into some of the most common dental billing mistakes and frauds ...

Upcoding: Making a Mountain Out of a Molar

Imagine going in for a routine cleaning and later discovering you were billed for a full-blown periodontal deep cleaning. That's upcoding—charging for a more expensive procedure than was actually performed. It's like ordering a salad and being billed for a steak dinner. Not only is it unethical, but it's also a surefire way to get into hot water with insurance companies and regulators.

Unbundling: Separating the Unseparable

Some procedures are like peanut butter and jelly—they're meant to go together. Unbundling is when a dentist bills separately for procedures that should be billed as a package, inflating the total cost. It's the billing equivalent of selling each piece of a puzzle separately. ​

Altering Dates: Time Travel Isn't a Billing Strategy

Changing the date of service on a claim might seem harmless, but it's a big no-no. Whether it's to align with insurance coverage periods or to meet filing deadlines, altering dates is considered fraudulent. Remember, the only time travel we should be doing is reminiscing about our last vacation. ​

Billing for Non-Performed Services: Ghost Dentistry

Billing for services that were never performed is like charging someone for a meal they never ate. It's dishonest and illegal. Patients should always review their statements to ensure they're only paying for services they actually received. ​

Waiving Copayments: A Generous Gesture with Hidden Costs

While waiving a patient's copayment might seem like a kind act, it can be considered fraudulent if not disclosed to the insurance company. It misrepresents the actual cost of the service and can lead to serious consequences for the dental practice. ​

Misrepresentation: Diagnosing for Dollars

Some unscrupulous providers might exaggerate or fabricate diagnoses to justify unnecessary procedures, all in the name of higher reimbursements. It's a practice that not only defrauds insurance companies but also puts patients through needless treatments. ​

Incorrect or Incomplete Coding: The Devil's in the Details

Using outdated or incorrect procedure codes can lead to claim denials and delays. It's essential for dental offices to stay updated on coding standards to ensure accurate billing. After all, precision isn't just for dental work—it's crucial for paperwork too. ​

Late Claim Submission: Better Late Than Never? Not Here.

Insurance companies have strict deadlines for claim submissions. Missing these can result in denied claims, leaving the patient or the practice to foot the bill. Timely filing is as important as timely flossing. ​

Missing Documentation: The Case of the Missing X-Ray

Failing to include necessary documentation, like X-rays or treatment notes, can lead to claim denials. It's like trying to solve a mystery without any clues. Proper documentation ensures transparency and smooth processing. ​

Incorrect Patient Information: A Name Game Gone Wrong

Simple errors like misspelled names or incorrect insurance IDs can cause claim rejections. It's a reminder that attention to detail is vital—not just in dental procedures but in paperwork too.

And now to introduce Slash Dental ...

Slash Dental is fusing proprietary data and regulatory knowledge with automation to make identifying--and negotiating or resolving--all of these billing flaws as carefree for patients as possible. While we continue to develop our processes and technology, we're looking for patients who have billing issues or upcoming dental procedures to use as test cases with our proof-of-concept product. If you're interested in FREE patient advocacy for your dental care, please reach out to max@slashhealth.co or ben@slashhealth.co, or leave your email below.