1. Incomplete or Inaccurate Patient Information

Patient data is the backbone of the revenue cycle — if it’s wrong at intake, it can trigger a chain reaction of billing issues. Errors in names, dates of birth, insurance IDs, or policy details are surprisingly common, especially when staff are rushed or using outdated intake forms. 

According to industry data, nearly 1 in 5 claim denials are caused by administrative errors like these. These mistakes delay reimbursement, frustrate patients, and often require time-consuming back-and-forth with payers. To avoid this, many practices now verify insurance eligibility in real time and train front office staff to double-check demographics during every visit, not just during new patient intake.

Root-Cause Checklist

To prevent repeat issues, it helps to audit intake processes regularly and identify where breakdowns happen most often. Many practices also benefit from using automated verification tools and setting clear protocols for reviewing patient data at every point of contact. The most common causes of patient information errors include:

• Rushed verification during busy periods

• Accepting patients' self-reported coverage without checking

• Manual data entry without validation safeguards

• Not updating patient information at each visit

• No dedicated staff for information verification

Step-by-Step Fix

If you find your process is causing regular administrative errors, it may be a good idea to implement some changes. Adding the following checks to your system can help reduce errors for smoother processing. 

1. Set up pre-visit digital intake through patient portals that validate required fields and flag incomplete entries before the appointment.

2. Institute two-point ID validation at check-in, requiring both photo identification and current insurance card verification.

3. Run nightly EHR audit reports to catch discrepancies between patient records and submitted claims before they reach payers.

Consistency prevents these errors even during your busiest days. Create clear checklists for your front desk and establish standard protocols. When short-staffed or overwhelmed with patients, consider outsourcing insurance verification to specialized professionals who can maintain these accuracy standards without compromising your verification process.

2. Incorrect CDT / CPT Coding

Coding errors hit your bottom line harder than almost any other billing mistake. Submit claims with wrong, incomplete, or outdated codes, and you'll face denials or downcoding (where insurance pays less than expected).

High-Risk Codes to Watch

Some procedure codes are more prone to errors, and more likely to trigger audits or denials, because they involve higher dollar amounts, are frequently misused, or have specific documentation requirements. These high-risk codes often fall into categories like oral surgery, periodontics, or multi-surface restorations, where even small documentation gaps can lead to payment delays or reduced reimbursement. 

• Periodontal procedures versus routine prophylaxis create frequent confusion in dental billing. For example, using D1110 (adult prophylaxis) when D4346 (scaling with generalized moderate inflammation) is correct consistently triggers denials. This distinction is important because insurers scrutinize periodontal treatments closely and require specific documentation of pocket depths and inflammation.

• Restorative procedures with different materials present another problem area. Codes vary significantly between amalgam, composite, and porcelain restorations, and selecting the wrong material code can result in downcoding or outright denials. 

• Diagnostic procedures also frequently create issues: comprehensive evaluations (D0150) and problem-focused exams (D0140) are often confused, primarily when documentation doesn't support the service level.

• Procedures that require supporting radiographs can also present challenges. Claims for root canals, extractions, or periodontal therapy often get denied when the submitted images don't clearly show the clinical findings that justify the treatment code.

 Preventing Denials and Downcoding 

Problems often start with staff who aren't trained on the latest CDT changes, misinterpretation of clinical notes, and rushed entries during busy times. Get ahead of denials and downcoding by implementing these preventative measures:

• Train office staff on dental billing basics is essential to prevent coding errors

• Coach dental staff on accurate dental charting practices to reduce misinterpretations and ensure correct coding. 

• Use automated tools for daily code validation that flag unusual combinations or missing documentation. These systems catch obvious errors, like submitting adult prophylaxis codes for children or billing multiple cleanings within restricted timeframes.

• Set up quality checks before submission, where senior billing staff review high-dollar claims and procedures with frequent denial patterns. This final review catches errors before they reach insurance companies and helps train newer staff on proper protocols.