In Dental Billing, Dental Coding

Do you see your team’s frustration and struggles with insurance and billing? Do you find your team needs additional training regarding insurance and billing? Finding a reliable source for training can be challenging so that is why it’s important to look to the billing experts as they are most knowledgeable in this area. 

Dental ClaimSupport provides outsourced dental billing services and PPO credentialing services for practices nationwide. Much pride is taken in our rigorous selection and training of our dental billing team. We are committed to providing ongoing education to our team as well as within the dental community. 

Our dental billing team and your dental team must stay up to date on coding and insurance administration to ensure they are providing the highest level of dental billing services possible. Proper knowledge of coding and administration, particularly related to PPO contract provisions, allows the outsourced dental billing team to meet your goals efficiently and effectively. 

While there is training available from other sources, why not consider receiving training from the outsourced dental billing provider who is working directly with your in-house team. Communication is a vital part of success when it comes to working with an outsourced dental billing company.

The outsourced dental billing company becomes a member of your onsite team. They do their best to work with your dental team when it comes to selecting the proper code and administration of claims at the practice level. After receiving training from the billing experts, you will have a clear understanding of how to select the proper procedure codes, knowledge of the level of documentation required to do so, and how to navigate PPO agreements. 

Understanding Dental Coding Guidelines Can be a Challenge For Most Dental Team Members 

Proper dental coding is just one of the many areas of compliance for the dental practice. The treating provider is responsible for documenting and reporting to payers the code describing the procedure performed using the Current Dental Terminology (CDT) code set. 

The CDT coding guidelines state the dentist must document and report rendered procedures with the code that best represents the service provided, selecting the code from the current CDT code set. Failure to follow proper coding guidelines when reporting procedures to a third-party payer for reimbursement consideration is a misrepresentation and inappropriate.

The provider of service is responsible for reviewing the code nomenclature and descriptor to determine the appropriate code based on the code definition. It is important to note that the CDT code set is maintained by the American Dental Association (ADA) and is updated annually. The CDT code set is effective for all dates of service beginning January 1 of each calendar year. 

Your entire dental team must be educated on all code additions, deletions, and revisions to ensure proper coding. This training should be provided on an annual basis prior to January 1.

The addition or deletion of one word in the CDT nomenclature or descriptor can change how a dental practice utilizes the code. Most dental practice management software includes the CDT codes with a brief description of the code. However, there is not enough space within the description area to include the entire code language. As a result, the code’s intended use may be misinterpreted. 

The dentist and dental team should review the entire code language to prevent codes submitted in error, creating claims adjudication delays. Once a claim is submitted with incorrect codes, unnecessary time is spent submitting corrected claims creating reimbursement delays. These incorrect code submissions and delays frequently happen in the first quarter of a new calendar year after codes have changed.

For example, the code D1208 application of fluoride was revised a few years ago to include the language, “excluding varnish”. Fluoride varnish is applied, D1208 is submitted, the error is often revealed in an audit, and thousands of dollars are recouped from you.

This code remains one of the most common coding mistakes. As with all areas of compliance, continuing education, and documented training of the dental team is key to maintaining compliance. This includes dental procedure coding.

Do you find the  administration of dental claims baffling?

Insurance claim administration is another area of compliance often overlooked by dentists and team members. Insurance claim administration includes but is not limited to processing the Explanation of Benefits (EOB) payment and nonpayment, understanding the EOB language involving requests for additional information, calculation of PPO write-offs, appealing claim denials, sending proper documentation as attachments, etc.

When a doctor is in-network, this can further complicate the administration of insurance claims. As an in-network doctor and person responsible for proper billing, you should read the PPO contract, processing policy manual, and any amendments to the manual to understand all requirements of the agreement. A good understanding of PPO contract provisions is key to insurance claim administration.

Understanding the provisions of a PPO contract not only ensures compliance but can significantly increase profitability for the PPO practice.

When a doctor signs a PPO contract, they agree to abide by the payer processing policies. These policies are provisions of the PPO contract. They may be found in the processing policy manual, sometimes referred to as the dentist handbook. This manual outlines the conditions of the contract-the dos and don’ts.

The manual may be downloaded from the password-protected provider payer website or by requesting a copy from your provider relations representative. 

How Can Your Dental Practice Maintain Coding and Insurance Administration Compliance?

Stay informed. Invest in team training to ensure appropriate submission of claims. Proper coding and insurance administration resources, such as the current CDT Current Dental Terminology and Coding Companion available from the American Dental Association can help keep your dental team up to date with changes to coding and insurance administration.

Our team of experts at Dental ClaimSupport is committed to providing quality continuing education for the dental community. Even if you elect not to outsource your dental billing, look to us for training opportunities and continuing education. Join one of our experts for an upcoming webinar, onsite and virtual coaching session, or a live in-person event.

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