You know a scam when you see one. You don’t fall for get-rich-quick schemes, and you certainly didn’t cheat your way through dental school to get where you are! However, perhaps after an appointment with a rude patient, it may sometimes be tempting to fudge the billing paperwork a bit, so you get a little extra money from the insurance company and the patient for their treatment.
However, this choice, called upcoding, is a huge mistake in dental billing! In this post, you’ll learn about upcoding, why you should take it seriously, and how to avoid it in your dental practice.
What Is Upcoding?
Simply put, upcoding occurs when you intentionally use an incorrect code for a dental service, namely one that is more complicated or more expensive, enabling you to collect more money from the patient and the insurance company. In other words, it is a form of overcharging and fraudulently collecting more than you are entitled to.
Depending on the disparity in the amount between the accurate service and the false one, this form of fraud may be considered either a misdemeanor or a felony at the state or even federal level.
Why Should You Care about Upcoding?
Any criminal charge doesn’t look good for a healthcare provider in any community, but fraud can be particularly damaging for a dental practice. Even if you try to be perfectly transparent with your patients, many of them feel like they take a risk when they select a dentist. They trust that you will be honest and professional, will not push services they don’t need, and will charge them fairly for the work you do. Fraud charges or convictions can make your patient pool question your integrity and convince them to choose a different dental office, drastically affecting your revenue stream.
Plus, a felony conviction typically results in the revocation of your dental license, which means you won’t be able to continue growing your career. If you are the sole dentist in your office and don’t find an associate to take your place, your inability to practice could take away your team’s income as well.
How Can You Prevent Upcoding?
Anyone can make an occasional, inadvertent mistake with a slightly wrong billing code without facing charges, but upcoding is a serious offence that you cannot afford to commit. In addition to conducting business honestly in general, you or someone on your team should consciously take a little extra time to double check accuracy in your codes as well as make sure your appointment notes are as thorough and descriptive as possible to substantiate and corroborate the procedure being billed for. You can also consider outsourcing your billing process, delegating this responsibility to a company that specializes in these matters.
Just as schemes and scams rarely turn out well for those who try to trick others, upcoding will only hurt you in the end. It could ruin your hard-earned dental career or at least set you back significantly in achieving life goals. These steps can help your claims go through more smoothly, get you paid on time, and protect you from prosecution.
About Dental Support Specialties
Like you and your staff members, the administrative team at Dental Support Specialties consists of humans, but our group of professionals have years of dentistry experience in filing claims and addressing billing issues correctly and promptly. We know how to deal with insurance companies, and we are completely HIPAA compliant. We can respectfully represent your practice and help you maintain your strong reputation. To learn more about our team and services, contact us online here.