Are you working harder but getting paid less? What if you’re working 10 hours but getting paid for only eight? Is this something you’d like to change?
How many hours a week do you dedicate to patient care? According to the staffing experts at Indeed, it’s about 35 to 40 hours a week.1 That's total patient care and related duties, but what about the other necessary tasks related to building your dentistry business?
If you own your practice, you have administrative duties that aren't involved with directly producing dental care but, if managed correctly, can increase practice revenue. Detailing patients' chief complaints and carefully coding treatment plans that best suit patients’ needs takes extra time and focus but results in a more comprehensive approach.
Busy dentists with overlapping scheduling often skip essential steps when documenting clinical accounts of services rendered to patients. They use a cryptic shorthand that, although understood by the provider, is less than acceptable as a legal record. And all too frequently, they misuse or underutilize dental codes, resulting in lost revenue and lost time.
The habit of saving time by skipping necessary documentation can cost you future revenue and put you at risk for an insurance audit. Good documentation is your best defense if a patient complaint puts you before a peer review board. What if you think about what you provided but don't write it down, such as the diagnosis? Could you recall it a few days, weeks, or even months later? The memory of a past event is not a credible record.
You might also be interested in: A deep dive into medical billing
Tip 1: Reduce administrative time that reduces revenue
Delegate some administrative tasks (allowed by law) to trained team members, such as insurance coordinators, licensed or certified dental assistants, or licensed hygienists. Qualified staff can verify the schedule and check for the accuracy of proposed charges and codes before they’re posted as complete on the ledger.
Other team members can ensure the accuracy of clinical notes and treatment plans and check for informed consents. Clinical or business team members can check that an insurance verification is in the patient's chart before treatment, and that it has been discussed with the patient.
A crucial administrative task for increasing revenue is staff training. Areas to train the team include clinical charting, coding, documenting correctly, and choosing the correct attachments (so the dentist doesn't have to choose).
Implement electronic health records and other software tools to streamline the documentation and billing processes. Avoid paper or the double entry associated with paper and computer entries. Schedule a specific time of the day to focus on administrative tasks and avoid interruptions. Prevent record keeping from stacking up for days or weeks.
Tip 2: Dental records are insurance against financial risk
The dental record is your legal and official document that details all diagnostic information such as chief complaint, clinical notes, patient health history, clinical observations, services rendered, and patient communication. The record is to accurately document a patient encounter so it can be understood and recognized not only by other health-care providers and insurance companies, but by a court of law. Health-care providers know and understand the maxim, "If it's not written down legibly, it didn't happen."
Supporting documentation is vital to avoiding audits and claims being paid. Proper coding of procedures originates in the clinical charting of the patient's complaints and conditions. When billing out insurance claims for third-party payment, bill for what you do and use the codes that fit the description of treatment rendered, not those that will most likely get paid or be paid at a higher amount. Accurate, legible records protect against charges of fraud and malpractice. Insurance claims sent electronically are a legal record protected by HIPAA and state laws.
Make CDT coding and using ICD-10 diagnostic codes a standard for your treatment planning. When codes are chosen to fit the description of the services rendered, familiarity often plays a role. It's important to note that some newer codes you should use are often left off due to the lack of knowledge of their existence.
CDT codes document services rendered to patients; they are not insurance codes documented only to bill insurance companies. Remember that CDT codes change annually,2 and what you chose in the past may now be deleted or revised and may not fit the situation.
Note: Ensure daily (delegate) that all providers have completed their clinical notes, supportive documentation, x-rays, and images, and that they’re all labeled and saved in the appropriate area of the patient chart in your software. If not, the claims may not be able to be filed, which will cause claim delays and denials and further loss of revenue.
Tip 3: Know the current CDT codes and how they affect production
Misused or underutilized dental codes result in lost revenue and lost time. Purchase new coding manuals before the start of the new year. Include coding updates in your morning huddles, staff meetings, or lunch and learns.
Subscribe to coding products that not only provide the complete codes as issued by the ADA, but also coach you in using codes correctly and combining codes that create a better record and complement the services provided.3 You must do more than update your computer software because it will not provide the entire description of each code or give advice on choosing codes that better fit the treatment.
Here are examples of frequently submitted procedures that are denied by dental plans due to inaccurate, incomplete, and unsubstantiated clinical evidence:
D7250 removal of residual tooth roots (cutting procedure): Includes cutting soft tissue and bone, removal of tooth structure, and closure. The clinical notes and supporting documentation must demonstrate the cutting of soft tissue and bone and closure.
D2950 core build-up, including any pins when required: Refers to the building up of coronal structure when there is insufficient retention for a separate extra coronal restorative procedure. A core build-up is not a filler to eliminate any undercut, box form, or concave irregularity in a preparation. A core build-up must demonstrate that it is for the retention of the crown. If the procedure is not for the retention of a crown and doesn't include any pins, then code D2949, the restorative foundation for an indirect restoration, would be the appropriate choice.
D4342 periodontal scaling and root planing, one to three teeth per quadrant: The treatment is indicated for patients with (diagnosed) periodontal disease and is therapeutic, not prophylactic inclusive. It is essential to read and understand the full scope of the code descriptor before listing this procedure on a claim form. Dental plans have stated that a common reason for SRP claim denials or requests for additional information is due to receiving radiographs that are not of diagnostic quality with no evidence of attachment loss and a substandard periodontal charting that does not include six points (six sites around each affected tooth).
Underutilized dental codes
Underutilized codes come from a need for more knowledge. Refer to the 2023 coding manuals for complete descriptors and applications.2
- D3221 pulpal debridement, primary and permanent teeth
- D1354 application of caries arresting medicament, per tooth
- D2940 protective restorations (to relieve pain, promote healing, and prevent further deterioration)
- D2799 interim crown-further treatment or completion of diagnosis necessary before final impressions (not a temporary crown)
Coding expert Dr. Charles Blair said, “Correct coding often results in higher revenue, as practices obtain reimbursements that were once unpaid because of misunderstanding or misreported codes."3 Get the team involved in proper documentation and coding so that you will all benefit from increased revenue and superior dental records.
Editor's note: This article appeared in the September 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
References
- Dentist salary in United States. Indeed. Updated July 27, 2023. https://www.indeed.com/career/dentist/salaries?cgtk=e902ec98-5cc4-4395-bbf5-13cfac4d4b0f&from=careeradvice-US
- CDT 2023 Coding Companion. American Dental Association. https://store.ada.org/catalog/cdt-2023-coding-companion-training-guide-for-the-dental-team-102515
- Preventing dental coding errors. AmeriDent. 2017. http://www.ameridenti.com/resource-preventing-dental-coding-errors.html
