Dental codes are an integral part of filing claims and getting paid in dentistry. These codes convey a lot of information to the payer about each visit. The correct codes will tell the insurance company what procedures were performed and why. It’s a standardized method of sharing data about diagnosis, treatment, and procedures.
Why Should You Train Your Staff about Dental Codes?
Dental codes are not written in stone – new ones are being added each year. With hundreds of dental codes currently in use, it is vital that your practice codes procedures correctly. It is not only the job of the person who prepares the claim submission but everyone involved in the process. If the dentist or hygienist does not know the correct codes for a particular diagnosis, mistakes can happen.
Therefore, staff training on coding is essential. Preventable mistakes such as using incorrect codes can cost your practice in terms of reputation, revenue, and even lawsuits.
- Overpayment/Underpayment
One readily apparent consequence of incorrect codes is that your practice will not get paid appropriately. If you use the code for a different procedure than what was actually performed during the patient visit, the insurer is not going to pay the correct amount. They will only pay for the code submitted in your claim. So, it can easily result in underpayment. If this occurs on a regular basis, your practice is taking a significant loss in financial terms.
You can also be overpaid because the code you used was for a more complex or expensive procedure. While this presents no immediate risk to the financial stability of your office, it can leave you vulnerable to more drastic consequences.
- Insurance Fraud
Mistakes happen, even in a healthcare organization. However, wrong coding as a long-term pattern becomes insurance fraud. Whether it is through lack of training or deliberate actions, incorrect codes can give cause to the insurance company to pursue an investigation. From the perspective of the insurance company the cause doesn’t matter. They care about wrong claim payments, regardless of intent.
- Audits, Penalties, and Lawsuits
It’s not just the insurance companies who are interested in investigating dental insurance fraud. Federal authorities and other regulators may also investigate a practice for using incorrect codes. If this happens, your practice could be subject to insurance audits, fines, and other penalties. Using the wrong codes may even find you facing lawsuits from patients, insurance payers, and the government.
Even if the investigation shows that you are not at fault, you still have to spend time, effort, and financial resources to fight your case with the authorities. Such a messy situation could have been avoided altogether with a little training for your dental team.
Train and Repeat
Dental code training is not a one-off task. New codes are launched and existing ones redefined on a continuous basis. Your staff should be up to date with procedures and the appropriate diagnostic codes. Determine an appropriate interval for training and ensure every staff member – who needs it – attends the sessions. Remember that a little precaution before a crisis is always better than trying to fix it later.
