Avoiding Denials Due to Frequency

Here it is, already September, can you believe it??  This year seems to have flown by so quickly and it’s now football season, my favorite time of year (Go Dawgs!). However, this time can be stressful for your dental practice and in particular the person sending out patient statements and getting denials due to frequency.  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.  It 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!

1. VERIFY INSURANCE!
2. ASK FOR FREQUENCIES!
3. ASK FOR XRAY HISTORIES!

Get that patient payment before they walk out of your office and avoid denials due to frequency!

The Easy Solution

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 particularly when it comes to appealing dental claims. Our dental billing outsourcing services increase your production, maximize your profitability, and we handle any appeals to save you the headaches.