Welcome to The Biggest Coding Mistakes Practices Make brought to you by Crown Council, Total Patient Service (ToPS) and Roz Fulmer, a ToPS Practice Advisor.

Roz Fulmer is a ToPS Practice Advisor with 20 plus years experience as a practice administrator. She understands your daily challenges. When was the last time that someone offered solutions for the problems you encounter daily with insurance claims? Roz has suggestions on to handle these mistakes in a more positive result-oriented approach.

THE BIGGEST CODING MISTAKES PRACTICES MAKE

Denied Coverage! Are your claims clean of common

errors?

Delayed Coverage! What causes claims to be delayed?

Deprived Reimbursement!

Who becomes your best friend when filing a claim appeal?

Destroyed YOUR Claim!

How do you prevent your claims from being thrown into the trash?

THE BIGGEST CODING MISTAKES PRACTICES MAKE

THE FOUR D-GAME

Exam Codes – Do you use more than the common THREE?

• The Common Three are:

D0120 Periodic Exam

D0140 Limited Exam (ER)

D0150 Comprehensive Exam

What about these Exam Codes?

D0160 Detailed/Extensive Problem Focused (Cosmetic, TMJ, Oral Surgery, etc.

D0170 Re-evaluation, Limited, Problem-Focused (Existing pt only)

D0180 Perio Evaluation

What Claim Form are you using?

• The current ADA claim form to be

using is DX2007 and only this format!

Do you see the mistakes on this claim?

• Always begin at the top and scan your claim thoroughly!

The following errors are made in Box 15, 16, 36, 37, 39 and 43.

The Number one error made is in either Box 19 or 39.

Which system are you using to catch these errors?

Denied Coverage Why?

• Common Coding Errors that deny claims:

• Buildups for Crowns vs Bridges

• D2950 is for Crowns BU and

• D6973 is for Bridges BU

• D9940 Occusal Guards is not for TMJ but is for Buxism/Mobility

due to Perio

• D7880 use for TMJ Orthotic Device

• D4910 needs to have RDT’s completed within the past 24 months

only and at least one quadrant of RDT had to be treated. (Narrative

needed with Perio charting & x-rays.

• D4381 is to be used for Arestin, Atridox or any type of time-

released antimicrobials only, not to be used for Chlorhexidine

Irrigation products.

• D4210/4211 is the code to be using for “soft Tissue” laser

treatment, recontouring tissue for cosmetic treatment, including

“soft tissue crown lengthening” vs “crown lengthening” D4249.

• D2740/2750 not to be used for Implant Crowns, use Implant Crown

code D6065/6066 and if placing an abutment use DD6058/6059.

Delayed Coverage Why?

• Common Reasons from Insurance Carriers for delayed coverage:

• 1. Claims with Errors

• 2. Sent to “clearing-house” and never received the claim.

• 3. No one has worked the “Outstanding Insurance Aging Report”.

Five Secrets to getting your claim reviewed and paid!

• Keep your tone of voice soft and friendly.• Watch how your body language comes

across the phone.• When calling on the claim, thank the

person for taking your call.• ASK for their help! Share with them that

you know that they may not be able to help, you are asking anyway.

• Ask what more can you do to get coverage for the patient.

Deprived Coverage, Who should be your Best Friend NOW!

• Did you know that according to Delta, MetLife, Aetna and Cigna if more than three claims arrive in the same envelope, they only accept the first claim and cannot seem to find the others that were sent at the same time, in the same envelope.

• If there are any errors on the claim, the claim cannot be micro-filmed for processing so it is considered a un -received claim.

• Know the common procedures that REQUIRE additional information and send that information with your paper claims, ex: Perio charting, current x-rays, pre-op, post-op x-rays, IOC pictures, etc.

• Were you aware that a self-funded dental plan is NOT regulated by your state’s insurance laws? These plans are regulated by the US Department of Labor under the ERISA act of 1974.

• Look for key words on the patient’s dental card like:

Managed by …, Administrators for …, Dental Benefit Administrators, etc.

Destroyed the Claim, Why?

• ERROR FREE CLAIMS – Begin with entering all patient information correctly. If possible, check all boxes COMPLETELY

• Update your patient files when receiving error reports from your “clearing-house” daily.

• Research for a good “clearing-house” to use for Electronic Claims

• Establish better relationships with insurance carriers to make them our “friends”.

• Work your system weekly on “Outstanding Insurance Claims”.

• Look more closely to the Patient’s Dental Cards to see if their plan is self-funded or fully insured.

• If mailing claims, send in separate envelopes

Do not mail more than two claims to the same carrier in the same envelope.

ACTION PLAN

Ending Coding Errors

Roz Fulmer

ToPS Practice Advisor

Direct Phone : (815) 481-3851

E-mail : roz@rozfulmer.com

Website : www.rozfulmer.com and

www.totalpatientservice.com

THE BIGGEST CODING MISTAKES PRACTICES MAKE

Begin your action plan to Coding Correctly TODAY!