As a small business and dental practice owner, you bear a lot of responsibility. You have the largest financial stake, and you are in charge of whether it succeeds or fails, but that doesn’t mean you can take illegal shortcuts. In fact, if you make egregious, fraudulent mistakes in your insurance claims, you could face devastating consequences. To keep out of trouble, make sure you avoid these mistakes.
Just as you wouldn’t want a cashier at a store to scan a single item twice, you shouldn’t double bill an insurance company for one procedure or service. In fact, it’s a serious, illegal offense that could result not only in fines but also in license revocation or even time in jail! Make sure that you are sending just one claim for each service rendered and that you are being honest and fair in your claims.
Billing for Unperformed Services
In dentistry, treatment plans can get a little tricky when it comes to dental insurance claims. Even if your patient is going to have a procedure, you can’t charge insurance companies until the procedure has already been done. If you haven’t completed a dental service yet, don’t submit an insurance claim for it. Wait until the appropriate time—after procedures are completed—otherwise, you’ll get in serious trouble.
Every business owner wants to bring in more money, but you have to be fair in your fees. The term upcoding refers to the dentist charging a higher-than-necessary bill for a particular service in order to collect more money from the insurance company or patient. In addition to paying back the amount for the fraudulent claim, you could lose your license.
Changing Claims Forms
To properly process claims, insurance companies rely on accurate forms and paperwork to make payments, which means that altering these forms is considered a form of fraud. If changes to the forms result in inaccurate payments, you could be held liable for any discrepancies and even lose your license.
For certain procedures, services should be bundled together in one claim instead of filed for separately. Unbundling, or filing for services that should be filed under a single service, is a fraudulent way to attempt to get more money out of dental insurance companies.
In all these cases and more, avoiding illegal mistakes requires an experienced, knowledgeable professional who is familiar with insurance companies, claims, and current regulations. The consequences of these bad dental business practices are not worth the risk, so take the time to make sure every claim is filled out accurately and honestly.
About Dental Support Specialties
Dental Support Specialties has a team of highly trained and experienced dental administrators who know how to handle insurance claims fairly and legally. As a result, we can take the stress out of this billing process and vastly reduce the odds of fraud in your practice. Interested in learning more about our insurance billing services? Contact our team to see if our team can help your practice run more smoothly.