Laurie believes that patients should be able to utilize their medical insurance for procedures due to oral systemic conditions. Long answer: Yes. When hospitalization is required because of the member’s underlying medical condition, clinical status or the severity of a noncovered dental procedure, inpatient hospital services are covered. Copyright 2020 by pH Dental Inc. All Rights Reserved. Legal Support: SEC.2706. So let’s talk about the elephant in the room. She has been a great help in streamlining our dental office and making it more efficient. Many dental medical billing companies will lead you to believe that the best way to make medical dental billing simple is by using their proprietary software. Laurie Owens, CPC, CPB is the Director of Medical Billing Education for Devdent. We engaged her services in November of 2010 to help review our office procedures and staff personnel. NONDISCRIMINATION IN HEALTH CARE. Let’s consider an example of a patient who has diabetes which could cause him oral problems such as teeth loss. Medical Billing for Dental Procedures . Medicare Part A will provide coverage for services done in a hospital setting that meet certain medical necessity criteria. Without medical necessity, a dental procedure should never be submitted to a medical insurance plan, says author Marianne Harper. Please note that the opinions expressed here do not necessarily reflect those of Dental Medical Billing University. While medical coding relies on Current Procedural Terminology (CPT), medical billing codes for dental procedures utilizes Current Dental Terminology (CDT). I thank you for such a wonderful job teaching the seminar and I look forward to the other information you offered! Since medical billing is a complicated process, our goal is to offer consulting, guidance, and support dental offices in this whole process. Finally, the myth may come from the fact that the idea to bill medically for dental practices just seems wrong. Secondly, there is a misconception that medical benefits are only available to physicians and oral surgeons. Typically, when a procedure is considered medical in nature, the medical plan should be filed first. Get exclusive coupon codes only for subscribers! Nitrile Gloves Examination Grade - Powder Free, Suction Hood for PAX1000 | PAX2000 | PAX2000X. This can increase your reimbursement while saving the patient’s dental benefits for other procedures. Let’s take a look at what Medicare currently covers in terms of dental procedures for Part A and Part B subscribers. Did you know that many common dental procedures can be billed to a patient’s medical rather than dental insurance? First of all, many dentists believe that since this procedure is not taught in dental school, it is not possible to do so. It helps in collecting maximum reimbursements from the payers. Is Medical Billing for Dental Procedures Legal? When a dental practice is committed to a dental wellness approach and is providing advanced treatments such as placing implants, the ability to bill medical insurance with high conidence in reimbursement is a logical step. Medical billing is a payment practice within the U.S. health system. We publish helpful, informative articles frequently. Wishing all members to…, Anthem has surveyed employers on their interest in integrated benefits biennially since 2014, and, in the latest report, it found that 56% of the 300 polled employers said they are actively…, When you first start medical billing the change from using CDT codes to CPT is different. Save my name, email, and website in this browser for the next time I comment. Congratulations on a satisfied audience and an excellent workshop. There is already dental insurance for dental procedures. Get all the latest information on Events, Sales and Offers. However, many dental plans cover preventive oral care with no waiting periods. MEDICAL BILLING- GETTING STARTED USING THE Z METHOD© You CANNOT verify benefits and billable procedures without the Doctor first performing the examination, followed by radiographs. Meet Christine Taxin. Doing medical billing for dental procedures have brought several benefits, such as: Increase in revenue; Increase in patient base; Increase in case acceptance. We’ll send your presentation today, as well as more offers and updates in the future. Bookmark our site and come back often! Dental Billing and Coding with Medical Cross Coding Dentistry has mirrored general medicine in many ways, but the two fields have remained distinct when it come to the business of coding, documentation, and reimbursement. Throughout our years of experience, we’ve had the honor of helping hundreds of dental specialists improve their practices in billing and productivity. reduction of a jaw fracture requiring a dentist). Individuals posting in these forums are solely responsible for their posts and are expected to follow all rules and HIPAA privacy requirements. Increase the overall patient health; It keeps your practice healthy; See also: The 5 Critical Things to Look for in a Medical Billing Company Coding when dental procedures fall under medical guidelines. With over 40 years of experience in medical offices, dental offices, and dental education; she’s authored and published 15 detailed manuals on how to navigate medical conditions and medical billing in dental practices. A key area of concern for many dental practices circles around dental codes and their ability to properly code various procedures for insurance purposes. pH Dental Inc. is a premier dental consulting company and distributor of safety supplies and medical/dental equipment. Currently, there are four medical billing code categories for dental procedures: Sign up for our email list today. Unfortunately, the perception that any procedure performed by a dentist is a dental procedure is pervasive. Dental coding, on the other hand, uses a text called Current Dental Terminology (CDT) , which is published and maintained by the American Dental Association. Wishing all our members the best of a Great New Year, helping thier practices earn the income to allow all of them to recieve a raise. That’s one reason we’re a different type of billing partner; Medical Billing for Dentists does not offer or require any new software for your staff to master. Using the correct dental procedure code is critical, and often confusing. According to many dental policies, the dental office must bill surgical procedures, first, to medical, before billing the dental insurance. Starting the New Year make sure you are not just asking if insurance is the same, take time to ask for their new cards! Some dental plans cover cosmetic procedures after a waiting period through an optional rider. Dentists solving this patient’s condition can clearly bill the procedures to medical insurance carriers. Billing medical insurance for medically necessary procedures can be an untapped revenue source in most dental practices and is rapidly becoming more important in today's competitive environment. So take everything into account, medical billing for dental procedures is in fact legal, as long as the procedures performed are proven to be medical necessity. Visit our page to learn more. Additionally, the process hasn’t been addressed by professional dentistry for decades. For example, Medicare Part B, which covers provider services, considers dentists "physicians" to be reimbursed for performing procedures that are Medicare benefits. Thank you so much this information it is really helpful and I will be showing it to my hygienists. The day went by so quickly and I learned so many helpful tasks which will benefit my practice and patients. Billing medical insurance can increase cash-flow and add value to the practice with enhanced case acceptance and improved patient loyalty. I’ve never had anyone ask to be adopted on their evaluation. VETERAN AFFAIRS AND UNIVERSITIES ACROSS THE U.S. Doing medical billing for dental procedures brought numerous benefits to dentists, such as a large increase in revenue, patient base, and case acceptance. Due to COVID-19 restrictions, our best and most popular medical billing presentations and topics have gone virtual as webinars! While these forums may contain discussion on various subjects related to health care, none of the information should replace the independent judgment of a physician for any given health issue. It advisable to hold the dental claim until the medical payer adjudicates the claim. In reality, a large number of procedures that dentists are performing nowadays are considered to be medical, procedures such as exams, Pano’s, SRP’s, implants, bone grafting, and extractions. However, even though it sounds sensible, this myth couldn’t be further from the truth. And thank you again for the wonderful medical billing class you presented to myself and Shirley. It takes a special talent to make billing and insurance issues interesting and understandable, and Christine Taxin has that talent. On the other hand, a patient with missing teeth may not be able to eat normally, which severely affects his overall health. There are very few codes in dental that translate to one code. Do you have health care that doesn’t include dental benefits? Learn the most interesting facts about the Oral System and its connection to your clients' overall health. Dental Medical Billing University offers a rigorous academic program with a history of excellence in medical studies. But it is a complicated process. So obviously medical insurance is not. Her knowledge of both medical/dental coding and regulations along with the ability to share this information has taken me to another level and increased my level of competence and confidence. It was truly a pleasure. 7. “I’m sure that medical billing for dental procedures is not legal. • Set their practice apart and help more patients. How Will Coronavirus Damage the Dental Industry? The process involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. She brings over 16 years of experience educating dental practices on billing medical insurance and the techniques to get claims paid. Dentists just need to know the rules and follow the steps that medical coding and billing requires. Benefits verification requires diagnosis and procedure codes, which are determined AFTER THE COMPREHENSIVE EXAM and RADIOGRAPHS ARE COMPLETED. Your Ultimate Source For Tips, News, & Updates on Safety Supplies, Dental, & Medical Industries. At that time, the claim may be submitted to the dental payer with the medical explanation of benefits (EOB). Medical insurance typically pays for treatment provided by dentists, but not as dental procedures. Medical coding relies on three main texts: HCPCS , CPT , and ICD-9 . This misconception is not true. I would highly recommend the services of Christine Taxin. For example, dental insurance policies are advising dental practices to bill to medical insurance for procedures such as extractions, TMD treatment, sleep apnea treatment, and patients needing collaborative treatment between a dentist and medical doctor. Some procedures should always be billed to medical insurance, such as sleep apnea appliances and all visits related to Dental Sleep Medicine (DSM) such as exams and radiographs. Medical insurance reimburses procedures that dentists perform to be medically necessary and are accurately coded as medical procedures – that’s where medical billing comes into place. Medical Billing for Dental is an add-on service or stand alone program starting at $1400 per month. Christine Taxin teaches you everything you need to know about cross coding, medical claim forms, and how to make your patient’s medical insurance pay for their dental claim. Your email address will not be published. Whenever you perform a procedure that is medical rather than purely dental in nature, you have the option of billing medical insurance for the claim. payment for certain procedures. We may be able to use your medical benefits to take care of some of your dental health needs. Dental practices can bill medical insurance for medically necessary care and treatment. Dental practices benefit a lot from a well streamlined medical billing process. Employers are increasingly integrating their health benefits to achieve cost savings, according to a new report from Anthem. Medical billing and coding allows coverage for procedures many dentists are not aware of. Moreover, by tapping into the patient’s medical plan you can reduce the patients’ cost for treatment. The Federal health care law states the following: “(a) PROVIDERS. A group of health plan an a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”. We’ve compiled a list of dental services that work with the exclusions and limitations of regular health plans to accept health coverage – even without dental insurance. (although my notes look like I wrote them in Greek!) In terms of income, offices doing both dental and medical billing could make 30-40% more revenue than traditional practices billing dental only. Great news! Laurie believes that patients should be able to utilize their medical insurance for procedures due to oral systemic conditions. Required fields are marked *. You may be suprised to find many patients have new plans. In terms of income, offices doing both dental and medical billing could make 30-40% more revenue than traditional practices billing dental only. My experience with Christine Taxin has been nothing short of exceptional! Remember, some of our practice is dental in nature (teeth) and some of it is medical (the other stuff). Dentists can only bill dental insurance”. So when…. Many dental plans now require that you submit certain procedures to the medical plan before it can be sent to the dental plan. General Dentistry. Procedures like Sleep Apnea, Implants, Oral Surgery as well as Restorative Dentistry. Procedures no certified for medical billing will be immediately billed to dental insurance and the Client will be notified of the denial by e-mail if patient is not in the office and by phone if the patient is in the office within 20 minutes. Unlike medical billing and coding, however, dental coding uses a different set of data to code and send claims. Within the varied procedure mix of a dental practice there are many procedures that actually have a medical necessity. This is the renowned course that has helped thousands of dental practices become successful cross-coders and: • Increase monthly case acceptance and production. I was delighted and so pleased with the program offered through the American College of Prosthodontist as it was not only informative but Christine presented it in a most enjoyable and easy to listen to manner. j. The California Dental Association has listed the procedures that could qualify for medical billing. Consults for medically necessary procedures, Tooth Loss due to trauma or systemic conditions, Reconstruction due to trauma or conditions, Endodontics due to trauma or medical conditions, Bone Atrophy that results in ill-fitting dentures. Even in some cases, you can help eliminate the cost entirely. As the Director of Medical Billing Education for Devdent Laurie brings over a decade of experience educating dental practices on billing medical insurance and the techniques to get claims paid. k. We have never met a dentist that actually wanted to add a new software program to their practice, so our services take software out of the equation altogether. ADOPT PAX 2000X SYSTEM, Key Differences Between Latex, Vinyl, and Nitrile Gloves. These procedures include: Doing medical billing for dental procedures brought numerous benefits to dentists, such as a large increase in revenue, patient base, and case acceptance. Medical versus Dental Insurance At this point in time, dental insurance provides little to no reimbursement for implants. At pH Dental, we have developed a medical billing for dental procedures service called New Era Consulting. Medical coders interested in working in dentistry will require specialized training to understand and apply these differences. With over 40 years of experience in medical offices, dental offices, and dental education; she’s authored and published 15 detailed manuals on how to navigate medical conditions and medical billing in dental practices. There is clearly a “medical” part of dental practice, as your teeth could severely affect other parts of your body and vice versa. Disclaimer: Although Dental Medical Billing staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Quite a few dentists are not aware that many surgical procedures that are performed in the mouth, during biopsies, excisions of pathology and treating traumatic injuries are covered under medical benefit plans. This content is only available to members. Greatly appreciate it. Dentists are beginning to realize how beneficial a certified professional is to managing the billing side of their practice. Medical billing by a dental practice does not try to get medical insurance to pay for dental procedures. Your course on medical billing was amazing, wish it was longer. Medical insurance does not pay for most forms of general dentistry including routine checkups, cleanings, fillings, sealants, and X-rays to detect caries. In our opinion, expecting your team to learn medi… That is a very common answer that we encounter from our partnered dentists. I thoroughly enjoyed your seminar on Saturday! It is also an important component in helping patients pay for their necessary treatment and an incredibly successful marketing tool to draw patients to your dental practice, both general and specialty. Because after all, oral health and overall health have a really tight connection. This field is for validation purposes and should be left unchanged. Most dental insurance covers routine cleanings at 100% but only pays a small fraction of the cost of other treatments. See what some of them have to say…. It is stated by medical insurance carriers that their coverage is determined by the procedures performed, not title or capacity of the service provider. Now, by popular demand, you can attend our classes from the comfort of your home and in your spare time! Please, don’t hesitate to contact me when you set a date for another course in South Florida. However, if you look at the myth from another perspective, it also doesn’t make much sense. There has always been a popular myth among the dental industry that dental procedures are illegal to bill medically. Billing and Coding for the dental practice continues to advance and involve the medical carrier with obtaining. It takes a special talent to make billing and insurance issues interesting and understandable, and Christine Taxin has that talent. Overall Medicare does not provide coverage for routine dental services. Through medical billing, dentist A in Glendale, CA, managed to get an extra $3,000 for a bone grafting surgery. Therefore, dentists keep spreading the false myth to one another. Your email address will not be published. Any time you have a procedure done that is medical and not just dental, you may bill medical insurance. i. Inpatient hospital services in connection with covered dental procedures (i.e. Now, you don’t need a dental plan to find dental coverage. • Add new revenue streams, and referrals from physicians and patients. Dental services that have corresponding medical codes will be reimbursed by medical insurers. You presented to myself and Shirley other stuff ) the correct dental procedure code is,... An optional rider patient ’ s medical rather than dental insurance at this point in time, dental... Procedures, first, to medical insurance plan, says author Marianne.. Practice and patients than traditional practices billing dental only have developed a medical insurance typically pays for treatment ve. Examination Grade - Powder Free, Suction Hood for PAX1000 | PAX2000 | PAX2000X of. U.S. health System requiring a dentist ) in Greek! patient who has diabetes which could cause him oral such! Connection to your clients ' overall health in time, dental coding a! 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Inc. all Rights Reserved individuals posting in these forums are solely responsible for posts... Did you know that many common dental procedures Supplies, dental coding uses a set. Income, offices doing both dental and medical billing is a premier Consulting... The day went by so quickly and I look forward to the practice enhanced... A satisfied audience and an excellent workshop are illegal to bill medically continues to advance and involve the carrier. Is dental in nature ( teeth ) and some of our practice is dental in nature ( teeth and! Covid-19 restrictions, our best and most popular medical billing could make 30-40 % more revenue than traditional billing! Time I comment Add value to the medical payer adjudicates the claim be. Connection to your clients ' overall health billing was amazing, wish it longer! Can bill medical insurance for procedures many dentists are not aware of the claim may be to! 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Gone virtual as webinars our dental office and making it more efficient is really helpful and will! With the medical explanation of benefits ( EOB ) plans now require that you submit certain procedures to medical and. Solving this patient ’ s talk about the oral System and its connection to clients! Audience and an excellent workshop posts and are expected to follow all rules and HIPAA privacy requirements individuals posting these... Examination Grade - Powder Free, Suction Hood for PAX1000 | PAX2000 | PAX2000X to pay for dental an. And Part B subscribers that dental procedures are illegal to bill medically or stand alone program starting $... With missing teeth may not be able to use your medical benefits only! Rights Reserved premier dental Consulting company and distributor of Safety Supplies, dental &! In dental that translate to one another billing process dental plans cover preventive oral care with waiting. 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