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Top 6 Illegal Dental Billing Mistakes

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Illegal Dental Billing Mistakes

Dental billing can be complex, and mistakes are bound to happen. However, some mistakes are illegal and can lead to repercussions for a dental practice. 

This article highlights the illegal dental billing mistakes that dental practices should avoid. It also highlights the reasons why investing in dental billing software is a good idea. 

Here are the top six illegal dental billing mistakes to avoid:

1. Double Billing

Double billing means submitting claims for the same service or procedure more than once. This is a serious violation of the False Claims Act and can lead to hefty fines and penalties for the practice. 

Common penalties include repayment of the amount billed in excess, fines, suspension or revocation of a dentist’s license, or even jail time. In some cases, a patient can also sue for damages.

To avoid double billing, dentists should make sure that all billing information is accurate and up-to-date. They should also be aware of any changes in insurance coverage or billing codes and double-check all claims before submission.

2. Billing for services not rendered

This is another violation of the False Claims Act, and it occurs when a practice bills a patient or insurer for services and procedures that were not actually provided. So, billing for services not rendered is an illegal dental billing practice and carries with it serious penalties.

Dental professionals should make sure they understand the laws and regulations surrounding dental billing and take measures to ensure their practices are compliant. Failure to do so could result in significant consequences for the professional and the practice.

3. Upcoding 

Upcoding is an illegal dental billing practice in which a dentist charges a higher fee than is necessary for a procedure in order to get more money from a patient or insurance company. This practice is considered fraud and is illegal under both federal and state laws.

The penalties associated with upcoding can be severe. A dentist found guilty of upcoding can be fined, have their license revoked, and/or face criminal charges. These penalties can vary depending on the severity of the case but can also include paying back any money received as part of the fraudulent billing practice.

4. Unbundling

Unbundling is the practice of submitting separate claims for services and procedures that should be billed as a single service. The American Dental Association (ADA) considers unbundling to be a serious violation of ethical and legal standards and has taken steps to discourage the practice.

Unbundling is not just an easy way for a dental provider to make more money, but it is also a form of fraud. This practice is illegal because it is considered a form of overcharging, as individual services are usually less expensive when they are billed together as a bundled service. As such, unbundling is an illegal dental billing mistake that can lead to serious consequences.


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5. Waiving co-payments/deductibles

Co-payments and deductibles are both amounts of money that patients pay when they receive certain dental services. For example, a co-payment is an amount that is determined by an insurance provider and is due at the time of service. A deductible is an amount that a patient must pay before their insurance provider starts covering the cost of treatment.

Waiving co-payments and deductibles is illegal because it encourages patients to purchase services they may not need. It also undermines the insurance system by allowing providers to avoid collecting the proper amounts from the patient. Furthermore, it gives the provider an unfair competitive advantage, as they can offer services at a lower cost than their competitors. 

The consequences of waiving co-payments and deductibles can be severe. Depending on the state, providers may face hefty fines and even the revocation of their license. Additionally, they may be subject to criminal charges, such as fraud and abuse. 

6. Altering Claim Forms

Insurance companies rely on accurate claim forms to process payments and determine whether or not a service was actually performed. When a claim form is altered, it can indicate that the dentist is attempting to inflate the cost of services or falsify information to receive payment.

Altering a claim form can lead to mistakes being made when entering information into the system or when verifying services. It can also lead to inaccurate claims processing and even insurance companies refusing to pay for services. 

Altering claim forms is an illegal dental billing mistake that can be extremely costly to dental practices. To avoid making this mistake, dentists should always ensure that claim forms are filled out accurately and completely.

Leverage Dental Billing Software to Avoid Illegal Dental Billing Mistakes

If you’re a dentist, you know how severe the repercussions of illegal dental billing mistakes can be. In addition to civil and criminal penalties, dental professionals who engage in illegal billing practices can face a range of other consequences. These can include loss of patients’ trust, sanctions from professional organizations, such as suspension or revocation of licenses, and even exclusion from participating in federal healthcare programs.

Since human error contributes to dental billing mistakes, dental practices should find solutions that can eliminate intentional and unintentional human errors. In addition to hiring qualified billing staff, dental practices should invest in dental billing software to avoid illegal billing mistakes. 

Having reliable dental billing software is essential for any dental practice as it helps streamline the entire billing process, from patient registration to claim submission and payment collection. It also helps ensure accuracy and compliance with the relevant regulations and laws governing dental billing.

At Apex EDI, our claims clearinghouse offers software solutions that help automate and optimize the dental billing process.

Our dental billing software helps to prevent illegal dental billing mistakes by providing an automated system for submitting claims and collecting payments. With the software, all claims are properly formatted and delivered to the insurance company, ensuring that they meet the requirements for reimbursement. The software also helps to identify any potential errors in the claims, such as incorrect codes or incorrect patient information that could lead to potential problems with the claim submission.

Another way that our dental billing software can help to prevent illegal dental billing mistakes is by providing detailed reports that track all billing activities. This can be used to review the accuracy of the claims submitted, as well as to identify any discrepancies or billing errors that may have occurred. By having a detailed record of all billing activities, it is easier for your billing staff to identify and correct any billing errors.

Additionally, our dental billing software helps to ensure the security of patient information. With the software, patient information is encrypted and stored securely, making it difficult for any unauthorized personnel to access the data. This helps to protect the privacy of the patient and ensures that only authorized personnel can access the information.

Schedule a demo today to see how our dental billing software can help you streamline your billing process.

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