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Dental billing has undergone a dramatic transformation since the carefree days of the late 1990s. What was once a straightforward process—send a claim, get paid, move on—has evolved into a complex system demanding meticulous attention to detail and strict compliance measures. The reason? Insurance companies have woken up to the staggering $12.5 billion lost annually to dental fraud, and they're scrutinizing claims like never before.

You don't need to be committing actual fraud to get caught in this web. Cutting corners, skipping steps, and clinging to outdated "backyard billing" habits can quickly put a target on your practice. Are you submitting claims without checking clinical notes? Skipping attachments to get claims out faster? Using coding loopholes that worked a decade ago? These practices aren't just inefficient—they're potentially putting your practice at risk for denials, audits, and recoupment demands.

True billing expertise isn't defined by years of experience but by commitment to compliance and continuous education. It means verifying clinical documentation matches what you're billing, understanding dental necessity requirements, staying current with coding changes, and implementing robust follow-up systems. It means knowing when to push back when insurance companies request additional information despite receiving sufficient evidence the first time. Most importantly, it means understanding your state's prompt pay laws and holding insurance companies accountable when they attempt to delay payment beyond legal timeframes.

The transition from backyard billing to compliant billing isn't complicated, but it requires intentionality. Start by implementing daily report monitoring, creating standardized billing protocols, and ensuring your team understands compliance requirements. The reward? Fewer denials, faster reimbursements, and significantly less stress from chasing payments that should have been received the first time. Remember: the goal isn't just getting claims paid—it's getting them done right.

Want to learn Dental Coding and Billing? Join here:

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Would you like to set-up a billing consultation with Ericka? We would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

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Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Want to know what your fee should be for D4346? Send Ericka an email to [email protected]