An important aspect of proper documentation for the Medicare and Medicaid programs is appropriate coding and billing practices. A dental practice may choose to appoint a person, such as the Compliance Officer, to ensure that that the organization is following established coding and billing procedures. This person should also ensure that all employees have up-to-date CDT, CPT®, HCPSC II, and ICD-9CM (ICD-10CM) training.
In addition to training, dental offices should have coding and billing procedures in place that:
- Provide correction measures for bad debts, miscoding, double billing, and other potential coding or billing errors.
- Certify that all documentation is accurate, complete, and done in a timely manner. Documentation must also be entered into the medical record for all dental services before the claim is submitted to guarantee that only proper services are billed.
- Make certain that claims are only billed when appropriately documented and maintained for audit and review.
- Ensure that dental notes are organized an legible so they can be audited and reviewed. X-rays must also be legible; illegible x-rays will not be accepted in disciplinary reviews and proceedings.[1]
- Confirm that the diagnosis on reimbursement claims are based on dental records and that this documentation is available to coding staff; and
- Assure that compensation for coders, billers, and billing consultants do not provide financial incentives to improperly upcode claims.
In addition to these procedures, dental offices should periodically conduct reviews to ensure that billing office service claims are appropriate.
Liles Parker attorneys have experience assisting dental providers with establishing and reviewing coding and billing practices. In addition, we can help create and incorporate proper coding and billing procedures into a Compliance Plan and can help train your staff on your coding and billing practices. Call today for a free consultation: 1 (800) 475-1906.
[1] Tex. Admin. Code tit. 22, § 108.8