Did you know that approximately 80% of medical bills have some sort of error? And dental practices are not immune to this problem. As per research estimates, between 5% to 10% of annual revenues for dental practices are lost every year due to billing errors that could have been prevented. Therefore, if your dental practice earns $500,000 per year, you will lose between $25,000 $50,000 on an annual basis. Additionally, billing errors are not just about the loss of money; they are also about protecting your practice’s revenue and your patients’ trust.
Let us explore some examples of common dental billing errors and their corresponding solutions to ensure you maintain good financial health within your dental practice.
Top Common Dental Billing Errors That Cost Practices Money
These errors account for most claim denials and lost revenue in dental practices. Let’s take a look at them along with the effective solutions to overcome them:
1. Incorrect or Outdated CDT Codes
The ADA updates CDT codes annually on January 1st, and using outdated codes causes automatic denials. Your billing software may not update automatically, leaving your team submitting invalid codes. That’s why it is best to:
- Update your practice management software with new CDT codes each January
- Subscribe to ADA updates and train your billing team annually on code changes
- Set calendar reminders to review and update codes each December
If your administration team is overburdened with work, then you can outsource your medical billing requirements to an offshore partner, like CEC, to ensure that your payment isn’t denied due to errors in writing the right CDT codes.
2. Missing or Incomplete Clinical Documentation
Insurance companies require detailed clinical documentation to justify treatment necessity. Missing radiographs, inadequate descriptions, or incomplete charting lead to denials. Here’s what you can do to fix it:
- Create and use a structured digital template, like EHR-based forms, to ensure that every patient interaction is captured.
- Ensure essential formalities, like patient identification, insurance details, consent forms, and referrals, are completed upfront before admitting the patient.
- Equip clinicians with mobile devices, voice-to-text, or scribe assistance so that documentation simultaneously happens during patient care instead of being postponed.
In fact, you can use advanced softwares that notifies staff when any important information is missing or triggers automatic records updates and reminders through workflows tied to admission, discharge, or transfer events.
3. Incorrect Insurance Verification
Front-fesk teams only check and verify the dental insurance when scheduling an appointment. However, sometimes, just before the patient’s admission for the treatment, many things are possible, like coverage can change due to missed premium payments, employer changes, benefit resets at the start of a month, or policy termination. So, if eligibility or insurance details aren’t cross-checked during patient check-ins, clinics may treat patients with inactive coverage, leading to denials, rework, and payment delays.
Solutions:
- Perform a quick eligibility check when the patient arrives to confirm active coverage, deductibles, and co-pay details.
- Use automated eligibility tools and enable real-time verification through your PMS or EHR converge.
- Send reminders to patients to update their insurance details if anything has changed.
Ensure to stay updated with the latest payer rules, and keep the portal links handy so staff can quickly confirm the changes when required.
4. Failure to Check Patient Benefits Before Treatment
Simply confirming that a patient has an active insurance plan doesn’t guarantee that their planned treatment is covered. Different procedures fall under different categories, and the coverage percentage, authorization requirements, waiting period, annual maximum limits, and frequency restrictions may change. So, if these details are not thoroughly cross-checked before, the clinic may perform the procedure that the insurer will not pay for, and it will lead to out-of-pocket costs for the patient and lost revenue for the provider.
Solutions:
- Verify eligibility for the exact procedure, including coverage percentage, exclusions, required authorizations, and whether the benefit period still has a remaining allowance.
- Assign a trained staff member to explain the benefits, limitations, and out-of-pocket costs, so patients can make informed decisions and avoid billing disputes later.
- Share a transparent cost estimate based on verified benefits, not assumptions, so patients understand expected expenses before treatment begins.
5. Coding at the Wrong Level of Service
Coding is one of the difficult parts of dental billing, and besides, CDT procedure codes change every year, so it becomes too difficult to keep up with the changes. However, it is essential for your team to get the codes right and be properly trained. Otherwise, it can only lead to claim rejection and sometimes, even you could unintentionally commit fraud by not coding correctly. This could cost your practice more than just some unpaid claims.
- The best way to avoid coding errors is to just simply to stay updated with the changes.
- Keep current coding manuals, payer guidelines, and digital coding tools accessible during the billing tasks to reduce guesswork.
- Ensure to document all the required clinical details, so coders can assign the correct level of service on the actual treatment provided.
Sometimes, it is best to hire a coding lead or specialist who could oversee complex cases, verify submissions, and support others with coding questions.
Wrapping Up: Protect Your Practice Revenue
Common dental billing errors silently drain thousands from practices every year through denied claims and missed revenue. However, they’re preventable with proper systems, training, and sometimes professional help. Your practice’s financial health depends on getting billing right. Every claim matters. Every code counts. Every follow-up affects your bottom line.
If your practice is struggling to manage medical revenue operations in-house, and it is expensive for you to set up a team, then one of the best ways to avoid revenue loss is by outsourcing the operations to a reliable offshore team, like CEC. We have a team of experts, AI-powered software, and other resources to get your claims cleared in the first go.
FAQs (Frequently Asked Questions)
Q1. What is the most common dental billing error?
Incorrect patient information tops the list. Misspelled names, wrong birthdates, and inaccurate insurance numbers cause immediate claim denials. Always verify patient data at every visit before submitting claims.
Q2. How long should I wait before following up on a claim?
Check claim status 14 days after submission. Most insurance companies process claims within 15-30 days. Earlier follow-ups catch problems before they become permanent denials. Set up automated tracking systems for efficiency.
Q3. Should small dental practices outsource billing or handle it in-house?
Small practices benefit from outsourcing when denial rates exceed 10%. In-house billing works when you have dedicated, trained staff and maintain clean claim rates above 90%.
