How to avoid denials due to frequency in dental billing?

As you know, most (not all but most) insurance plans start on January 1 of each year. These dental plans are now starting to deny certain procedure codes due to frequency and here’s why; Most dental plans only allow 2 exams per year.

These exams range from Periodic (D0120), Limited (D0140), and Comprehensive Exams (D0150). If a patient came in for the regular two Periodics this year, but also came in for a Limited – whether it be in your office or another dental practice OR specialty practice – they are still only allowed TWO exams per year, thus they will deny the 3rd, 4th, and so on. These will be the patient’s responsibility to pay for these, and collecting this money up front will SAVE you the headache of TRYING to collect later. IT’S ALWAYS BETTER TO COLLECT UP FRONT!!

ALL INSURANCE PLANS ARE DIFFERENT

The other codes we see being denied this time of year due to frequencies are Fluorides, Prophys, and Xrays. Please remember that many insurance plans are different, some allow more frequencies and some allow less, but the majority of plans allow:

• 2 Evaluations Per Year
• 2 Cleanings Per Year (Some must be spaced out 6 months+1 Day)
• 1 Fluoride Per Year (Over age 18)
• 1 Set of BWX Per 12 months
• 1 FMX or Pano every 3 Years (Some are 5!!)

INSURANCE AND X-RAYS

On the topic of Xrays, be aware that insurance companies will downgrade BWX + Pano taken on the same day to an FMX. If you are in-network, you must take this adjustment down to the FMX fee. Also, if you take BWX + 4 PA’s, this will also likely be downgraded to an FMX, and if the patient recently had a Pano or FMX in the past 3 years, they will not pay for any of it!
VERIFY INSURANCE!
ASK FOR FREQUENCIES!
ASK FOR XRAY HISTORIES!
Get that patient payment before they walk out of your office and avoid denials due to frequency!

DENTAL BILLING SERVICES

At One Dental Billing, we know the most common dental billing issues that plague most offices and our billing experts are passionate about helping you avoid the headaches of dental insurance billing to assure that you collect 100% of the profit your practice generates.

When you choose One Dental Billing dental billing services, you’re choosing to have a more productive and profitable office where you and your employees can focus 100% of your care and attention towards your patients. You’re experts at dental care and we’re experts at Dental Billing. Why not leave the billing to us?