Know the Facts Regarding Dental Billing Abuse & Fraud

Posted by dentalRCM on February 6th, 2020

Know Dental Billing Abuse Fraud Dental practices are under enhancing scrutiny by Medicare, regulatory bodies and commercial insurance companies after the latest reports of dental billing fraud and abuse. While collaboration with a dental billing company can assist manage practice compliance and integrity, it is crucial for dental practitioners to be conscious of what makes billing fraud to ignore inadvertent errors.

Having an unlicensed employee do dental procedures:

 A Connecticut dentist creates headlines for the incorrect causes in August this year after a judge discovers that he had billed illegally Medicare for fluoride treatments and pediatric dental cleanings performed by unlicensed assistants. The court ordered him to pay 1,047 for wrong billing of these dental procedures done between April 2002 and December 2009.

Submitting false and inflated insurance claims:

Billing insurance for more costly procedures than those really done or billing for procedures that were not done are serious offenses or crime. Examples comprise upcoding a general extraction to a highly complicated procedure or wrongly representing a routine cleaning as an expensive deep cleaning.


As per the American Dental Association, separation of procedures is: “the separating of a dental procedure into parts component with every component having a charge, so that the cumulative charge of the parts is more than the total charge to patients who are not a dental benefit plan beneficiaries for the similar procedure.” Separation refers to deploying various codes to mention service on a claim where one code is enough. For example, the dentist does an extraction and bills for flap elevating, incision, drainage, suturing, and curetting out the tissue when all these procedures are really component of the international fee for the tooth extraction.

Rejecting deductibles and copayments:

Deductibles and co-payments are considered to be necessary components of the insurance company’s contract cost structure. Routinely rejecting these parts is considered illegal. For example, if a patient is charged 0 and the payer is billed for , the patient’s copay is . If the dentist does not gather the from the patient, this signifies that the charge for the service offered is and not 0. This signifies that the insurance company$ owes only 70% of , which is a falsification of the price of the service. Various states have different policies on what makes fraud and dentists require awareness of their state’s regulations and rules.

Fraudulent billing and diagnosis:

An outright corrupt examination would be when a dentist suggests bridgework or implants where a basic removable machine would be enough.

Misrepresentation of identities of patient and service dates:

Treating a patient and sending the claim for this patient as someone another is an obvious instance of fraud. The date on which a procedure is done is connected to the patient’s waiting periods and medical eligibility.

Fraud can result in penalties, heavy fines, and even exclusions from particular healthcare programs. It has been discovered that most dentists are not aware that their office might be doing fraud. Dental practices can ignore questionable billing practices by choosing for outsourced dental billing services. An established dental billing company will have professionals on the job that will scrutinize and audit every claim before submission to make sure that data is reported consistently and accurately and in compliance with HIPAA needs and the regulations and rules of commercial and government insurance carriers.

Dental Billing Services

Billing procedures complexities and changing healthcare plans policies can create in-house processing of dental claims rather than taxing. DentalRCM provides a comprehensive suite of dental billing services for dentists to bill successfully for their services and concentrates better on their core jobs. Our in-depth knowledge in the field of medical billing enables us to give accurate, timely, and consistent services. Our billing professionals work to make sure that your practice has less unresolved dental claims and accounts receivable.

Receive maximum repayment for bone grafts, oral implants, splints, and tooth fractures with our dental billing. You can also save up to 30% to 40% of your operational costs. Call our toll-free number 1-888-315-2050 today and discuss your needs with our solutions manager.

Free Billing Analysis

Comprehensive Suite of Solutions

Our medical billing company provides customized solutions for big and small practices. Our comprehensive, HIPAA-compliant medical billing services comprise:

A/R follow-up and collections

Eligibility / benefits verification

Payment posting/adjudication, adjustments and denial processing

Audits and coding

Accounts Reconciliation

Ask for our no-hassle Free Billing Analysis.

We have AAPC-certified coders with excellent knowledge in the recent CDT, ICD-9 and ICD-10 codes. Our coding team fulfills all ADA standards for documentation guidelines and coding compliance.

Distinguishing Attributes that Set DentalRCM Apart

We have full knowledge of dental insurances comprising Cigna, Delta Dental, Aetna, MetLife, etc. and benefits under Medicare Part A. We thoroughly confirm whether the plan comprises GAP exclusions or missing tooth clause.

We verify the medical necessity of a procedure and assist you to obtain pre-authorization for procedures like oral appliance therapy.

Detailed documentation (SOAP notes) is dispatch to medical insurance for suitable repayment.

Electronic claims processing for instant payment

We can work on your software and login through VPN or deploy our own software packages comprising Practice Manager, AR Interactive, Global Paperless System, Clinical Manager, and Enterprise Suite.

We can also offer the services of trained and skilled Full-Time Equivalent (FTE) professionals having expertise in many areas of dental insurance verification and pre-authorization, comprising patient registration and enrollment.

Pay per verification or dedicate a team or employee to your practice!

Major Advantages of Our Services

Daily QA checking

QA in all departments

System-based eligibility checking

Access to our software all the time

Full work support from the U.S. and offshore locations

Daily, weekly and monthly status reports

No long term yearly contracts

For more information on our dental billing services, call 1-888-315-2050.

We are a group of Certified Dental Coders and Billers. We have been serving America's highly respected Dentists for the last 10 years. People want to smile louder when their teeth are healthy and look good and a beautiful smile is as valuable as making them smile. We value our Dentists and always provide them top priority, so they can smile also while we handle their Insurance verification billing, posting and full revenue cycle with perfection.

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Joined: February 6th, 2020
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