Dental billing and collections in New Jersey require a detailed understanding of both state-specific regulations and federal laws. Dental practices must navigate insurance claims, patient billing, and debt collection with care to ensure compliance and maintain good patient relationships.
Dental Billing and Claims
Submitting a clean claim is the most crucial step in the billing process. A clean claim is one that contains all the necessary information for a dental carrier to process it without requiring additional documentation. New Jersey has prompt payment laws, which mandate that carriers must pay a clean claim within a specific timeframe—typically within 30 or 40 calendar days of receipt, depending on how the claim was submitted.
Key elements of a clean claim in New Jersey include:
- Complete Information: All claim forms must be filled out completely and accurately, including the patient’s and subscriber’s full names, birth dates, member ID numbers, and group numbers.
- Accurate Codes: Using correct CDT codes (Current Dental Terminology) is essential. These codes are specific to dental procedures and ensure the claim is processed correctly.
- Supporting Documentation: For more extensive procedures like crowns or implants, a carrier may require additional documentation like radiographs (x-rays) or a detailed narrative explaining the clinical necessity of the treatment.
For dual coverage claims, it’s vital to include information for both the primary and secondary insurance companies, along with the Explanation of Benefits (EOB) from the primary carrier.
Patient Collections
Collecting patient portions, such as co-payments, deductibles, and co-insurance, is a critical part of a dental practice’s financial health. It’s often recommended that practices collect these amounts at the time of service to avoid future collection issues.
In New Jersey, a recent law has given patients more control over their dental care and billing. It prohibits dental insurance plans from preventing a dentist from collecting payment for covered services if the dentist has obtained a patient’s written informed consent prior to the procedure. This is a significant change that provides clarity on a patient’s financial responsibility, especially when a dentist provides a service that the insurance carrier may not fully cover.
Debt Collection Regulations
If a patient account becomes delinquent, dental practices must adhere to both federal and New Jersey state laws when attempting to collect the debt. The primary federal law is the Fair Debt Collection Practices Act (FDCPA), which applies to third-party debt collectors but also sets a standard for original creditors. New Jersey also has its own specific regulations.
Key regulations to be aware of include:
- Prohibition on Reporting to Credit Agencies: Under the Louisa Carman Medical Debt Relief Act, a medical creditor (which includes dental practices) cannot report medical debt to a credit reporting agency for services performed on or after a certain date. This law also bans reporting on paid medical debt or any debt less than $500, regardless of when it was incurred.
- Time Before Collection Actions: A medical creditor or debt collector cannot initiate collection actions, such as selling the debt to another party or placing a lien, until at least 120 days after the first bill was sent. They are also prohibited from engaging in collection efforts if the patient accepts and complies with a reasonable payment plan.
- Interest Rate Caps: The Louisa Carman Act also caps the interest rate on a medical debt at no more than three percent per year.
- Statute of Limitations: For most consumer debts in New Jersey, including medical bills, the statute of limitations is six years. After this period, a lawsuit cannot be filed to collect the debt.
If a dental practice chooses to use a third-party collection agency, it’s crucial to ensure the agency is aware of and compliant with all New Jersey and federal regulations, including the new protections afforded by the Louisa Carman Act.