Whether on purpose or accidental, illegal dental billing practices can do a lot of damage to your dental practice. Illegal dental billing practices are so specific to their industry, that many professionals might not even know what is and what is not legal.
But ignorance is no excuse, and the reputation of you and your practice is at stake.
As a dental billing friend to practices around the United States, Dental ClaimSupport has spent years educating teams on illegal dental billing practices. And this knowledge has allowed us to advise dental teams on what mistakes to avoid to remain legal and compliant.
In this article, we will share 3 common, illegal dental billing practices that may hurt your practice. By understanding each of these practices, you will not only know what to avoid in order to remain legal but also what to look out for in your team’s actions.
Please refer to state and federal dental billing laws for specific guidelines.
1. Editing seat dates
Editing seat dates is a common illegal dental billing practice among dental teams.
Some dental professionals aren’t aware that prep date and seat date are important when it comes to a patient’s dental insurance. But the different treatment dates impact the way insurance benefits are used. Be consistent with your billing and do not manipulate the dates to get the best coverage.
Some plans may pay on the start date and others on the seat date.
For example, if a patient is receiving a crown, the seat date is the date the definitive crown is delivered to the patient. This date would be recorded on an insurance claim. Depending on how the patient’s insurance works, what their maximum is, and when their benefits start over - that date can impact the insurance coverage for the crown. Again remember to be consistent with your billing method.
If this date is edited to ensure the cost is covered (or mostly covered) by insurance, this is illegal. One might go into the dental software and edit the seat date to help out the patient’s out-of-pocket, or to ensure the practice is paid by insurance - but that doesn’t make it right!
2. Inaccurate or missing information on clinical notes
This one is typically accidental, but it’s still a legal mistake you should avoid. Clinical notes are proof that the treatment you performed was necessary for the health of the dental patient. This information will include:
- The patient’s name, date of birth, and contact details
- Up-to-date medical history
- Prior and current treatment information
- Any missed appointments or unscheduled treatment - when or if you have offered treatment to a patient and they have declined
- Prescriptions, medications (with details of amount, dosages, and frequency) dispensed or injected during the appointment.
The accuracy of this information will increase your claim reimbursement rate. You could face a denial if anything is inaccurate on your clinical notes. You could also face legal issues.
For example, let’s say a patient comes in with a toothache. You perform an exam and x-ray, and let them know they need the tooth extracted. You schedule a time and day for the extraction - but the patient doesn’t show up for the extraction. You try to reschedule but they keep not showing up to their appointment.
Then, the patient takes legal action because their tooth has an infection. Did you document every time you tried to schedule an extraction appointment with them, and they were a no-show? This should be recorded in your clinical notes. If it isn’t - you don’t have time-stamped proof that you offered a solution to your dental patient.
This is obviously a more dramatic, worst-case scenario that we’re using to make a point. Moral of the story - document everything in your clinical notes.
3. Not billing out things you do
As an oral health provider, everything you do for patients should be documented and billed out.
Billing every patient is crucial for the legality of your dental practice. Even if you are giving some kind of friend or family discount, there needs to be some kind of bill, with that discount mentioned as a write-off or courtesy.
This ensures you have documentation for every penny you’ve earned, even if you aren’t really collecting it due to a discount. Our experts do not recommend giving discounted services often, but if you do - there should still be a bill on file and the discounted fee should be listed on the actual claim form.
It is fraudulent to bill the patient a different fee than the insurance carrier. All patients should be charged the same fee and all efforts to collect the full fee made.
This might seem like a silly recommendation. It’s your friends and family, what’s the harm in not billing them at all? If your dental practice is ever audited, you need to have the bill on file to present to the auditor. Even if there is a discount on the bill, the auditor will see where that money is missing, and there shouldn’t be any issues.
Some insurance carriers actually prohibit providers from treating their own immediate family members.
Stay legal and compliant at your dental practice through outsourcing your billing
Illegal dental billing practices can often be the result of a careless mistake. But those mistakes can lead to a stain on your practice’s reputation or even the loss of your dental license.
You now know what illegal dental billing practices to avoid in order to remain legal and compliant, ensuring the success of your dental practice.
Dental ClaimSupport is a trusted dental billing partner that can help your dental practice remain compliant as well. Our billers stay up to date on all insurance rules and regulations and will work to help your practice avoid any mistakes that could lead to legal trouble.
To learn more about how outsourcing can help your practice remain legal and compliant while increasing your claims income, schedule a call with one of our experts.
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