Dodging Dental Billing Blunders: Common Mistakes and How to Steer Clear
Filing dental claims can be tricky, and there are several common mistakes that can lead to delays, denials, or missed payments.
Below are some of the most frequent billing mistakes in dental practices and tips on how to avoid them.
Common Causes of Dental Claim Denials
Invalid or missing patient information will lead to dental denials. Make sure that you’re obtaining the correct patient’s name, date of birth, insurance carrier, and claims address. Entering the correct information into your dental software system is key to sending out cleanest claim.
Updating and verifying insurance regularly will avoid claim denials. Failure to verify the patient’s insurance to confirm that their coverage is active is so important. Knowing ahead of time if a patient’s plan has terminated or changed will make all the difference when submitting your dental claim.
Coding errors will also lead to dental denials or rejections. Make sure you’re not filing outdated codes and staying up to date with the annual updates of CPT codes.
Annually the ADA adds and removes CPT codes. Updating those codes in your software system and notifying your team will help when treatment planning and educating your team on what codes to use when the dentist is diagnosing treatment.
Don’t forget to submit the correct codes for the treatment performed.
Obtaining a pre-determination is vital for procedures that require them. Not submitting them for approval could lead to denials.
It’s important when obtaining your insurance breakdown that you’re asking these questions for basic and major procedures and notating that plan’s insurance with notes, so you know which ones apply when presenting treatment plans to your patients.
In urgent situations for patients who can’t wait for these and need to proceed with treatment, make sure your treatment plan states that everything listed is merely an estimate and not a guarantee of payment.
Missing deadlines for submitting claims to insurance carriers is a frequent cause of denials. Make sure to set up a system to track claim submission deadlines. File claims promptly and regularly check your outstanding claims report.
Follow up with the insurance carriers if it’s been more than 30 days of not receiving a payment. This could lead to lost revenue and frustrate your patients. If a claim is denied, be prepared to appeal promptly if necessary. Create a claims tracker to avoid missing follow-ups.
The Importance of Accurate Insurance Verification
When verifying a patient’s insurance, make sure you’re getting a full breakdown of their dental benefits and patient history.
Inputting that information into your dental software system accurately is vital so you’re not providing inaccurate estimates for treatment, billing for non-covered services, and collecting incorrect patient estimates. By doing so, that could lead to lost revenue and will affect your collections.
Always communicate with your patient what their insurance covers and what they’ll be expected to pay out-of-pocket before treatment begins. Even when presenting the most accurate estimate, it still needs to be documented on the treatment plan that everything presented is merely an estimate and not a guarantee of payment from their insurance.
Anything not covered by their insurance carried will then be the responsibility of the patient rendering treatment.
Effective Communication and Documentation
Communication is key when presenting treatment plans. Not explaining treatment, costs, and payment expectations can lead to confusion, possibly having delayed payments. When presenting treatment plans, make sure you have your patient sign and scan a copy to go in their chart. F
rom time to time, you’ll need to reference back to those treatment plans to remember what was discussed at that time and provide proof if a patient tries to avoid their payment estimate. Also make sure to notate in the patient’s chart what was discussed in full at that time it was presented.
When services are rendered it’s important that your clinical team provides proper notes for the narratives in the patient’s chart of all services completed that are being filed. Most treatment services codes require attachments to be filed with the dental claim.
Having a detailed narrative to provide what was completed that day, reason for diagnoses, sharing initial placement dates, and updating their tooth chart with any missing teeth will help assist the dental consultant reviewing the claim once it’s received by the insurance carrier.
Imaging is another key component when submitting dental claims for treatment. Checking to make sure you have all the imaging needed before treatment is performed will help prevent denials. Make sure that radiographs and intra-orals photos are taken recently or within the last 6 months.
If the imaging you have on file is older than that, you’ll need to request your clinical team to take them before starting treatment when the patient is seated. Also make sure your clinical team is taking the appropriate imaging after treatment is completed and before the patient is discharged.
If no imaging is available when filing the dental claim, it will likely be denied, and you won’t have supporting proof to appeal, and the patient will then become responsible for the services rendered in full.
Paying attention to these common dental billing mistakes and taking proactive measures to address them, practices can ensure smoother billing cycles, fewer denials, and better revenue flow.
About the Author
Christin Alapai, FAADOM
Dedicated, detail-obsessed, and driven by the perfect smile — I’m an Office Manager with deep roots in the dental community and a serious passion for keeping things running like clockwork. Whether it’s juggling schedules, supporting an all-star dental team, or making every patient feel like a VIP, I’m all about smooth operations and even smoother experiences.
Known for my strong work ethic, top-tier customer service, and genuine love for helping practices thrive — I bring the polish to every part of the patient journey.
