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. It takes a special talent to make billing and insurance issues interesting and understandable, and Christine Taxin has that talent. The day went by so quickly and I learned so many helpful tasks which will benefit my practice and patients. Billing and Coding for the dental practice continues to advance and involve the medical carrier with obtaining. Unfortunately, the perception that any procedure performed by a dentist is a dental procedure is pervasive. For example, Medicare Part B, which covers provider services, considers dentists "physicians" to be reimbursed for performing procedures that are Medicare benefits. So when…. We may be able to use your medical benefits to take care of some of your dental health needs. Medical billing and coding allows coverage for procedures many dentists are not aware of. • Add new revenue streams, and referrals from physicians and patients. Many dental plans now require that you submit certain procedures to the medical plan before it can be sent to the dental plan. But it is a complicated process. 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. I thoroughly enjoyed your seminar on Saturday! This can increase your reimbursement while saving the patient’s dental benefits for other procedures. Even in some cases, you can help eliminate the cost entirely. How Will Coronavirus Damage the Dental Industry? Finally, the myth may come from the fact that the idea to bill medically for dental practices just seems wrong. Any time you have a procedure done that is medical and not just dental, you may bill medical insurance. Dental coding, on the other hand, uses a text called Current Dental Terminology (CDT) , which is published and maintained by the American Dental Association. Due to COVID-19 restrictions, our best and most popular medical billing presentations and topics have gone virtual as webinars! Your email address will not be published. It helps in collecting maximum reimbursements from the payers. However, many dental plans cover preventive oral care with no waiting periods. 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? reduction of a jaw fracture requiring a dentist). Great news! Long answer: Yes. We engaged her services in November of 2010 to help review our office procedures and staff personnel. There are very few codes in dental that translate to one code. 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. Employers are increasingly integrating their health benefits to achieve cost savings, according to a new report from Anthem. Do you have health care that doesn’t include dental benefits? Increase the overall patient health; It keeps your practice healthy; See also: The 5 Critical Things to Look for in a Medical Billing Company In terms of income, offices doing both dental and medical billing could make 30-40% more revenue than traditional practices billing dental only. 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. In terms of income, offices doing both dental and medical billing could make 30-40% more revenue than traditional practices billing dental only. Dental services that have corresponding medical codes will be reimbursed by medical insurers. 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. Dental practices can bill medical insurance for medically necessary care and treatment. Dentists solving this patient’s condition can clearly bill the procedures to medical insurance carriers. Currently, there are four medical billing code categories for dental procedures: Get exclusive coupon codes only for subscribers! Bookmark our site and come back often! Please note that the opinions expressed here do not necessarily reflect those of Dental Medical Billing University. 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. I’ve never had anyone ask to be adopted on their evaluation. Therefore, dentists keep spreading the false myth to one another. i. Inpatient hospital services in connection with covered dental procedures (i.e. According to many dental policies, the dental office must bill surgical procedures, first, to medical, before billing the dental insurance. In our opinion, expecting your team to learn medi… The California Dental Association has listed the procedures that could qualify for medical billing. Because after all, oral health and overall health have a really tight connection. Get all the latest information on Events, Sales and Offers. 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.”. Dentists just need to know the rules and follow the steps that medical coding and billing requires. 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. Medical billing is a payment practice within the U.S. health system. We publish helpful, informative articles frequently. 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. She brings over 16 years of experience educating dental practices on billing medical insurance and the techniques to get claims paid. While medical coding relies on Current Procedural Terminology (CPT), medical billing codes for dental procedures utilizes Current Dental Terminology (CDT). The Federal health care law states the following: “(a) PROVIDERS. 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. Since medical billing is a complicated process, our goal is to offer consulting, guidance, and support dental offices in this whole process. 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. Medical coding relies on three main texts: HCPCS , CPT , and ICD-9 . Dentists are beginning to realize how beneficial a certified professional is to managing the billing side of their practice. 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. Sign up for our email list today. Now, you don’t need a dental plan to find dental coverage. Learn the most interesting facts about the Oral System and its connection to your clients' overall health. However, if you look at the myth from another perspective, it also doesn’t make much sense. Medicare Part A will provide coverage for services done in a hospital setting that meet certain medical necessity criteria. Nitrile Gloves Examination Grade - Powder Free, Suction Hood for PAX1000 | PAX2000 | PAX2000X. Medical versus Dental Insurance At this point in time, dental insurance provides little to no reimbursement for implants. 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. See what some of them have to say…. (although my notes look like I wrote them in Greek!) Copyright 2020 by pH Dental Inc. All Rights Reserved. Some dental plans cover cosmetic procedures after a waiting period through an optional rider. Coding when dental procedures fall under medical guidelines. 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. She has been a great help in streamlining our dental office and making it more efficient. On the other hand, a patient with missing teeth may not be able to eat normally, which severely affects his overall health. Laurie Owens, CPC, CPB is the Director of Medical Billing Education for Devdent. This is the renowned course that has helped thousands of dental practices become successful cross-coders and: • Increase monthly case acceptance and production. “I’m sure that medical billing for dental procedures is not legal. At that time, the claim may be submitted to the dental payer with the medical explanation of benefits (EOB). 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. 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. Thank you so much this information it is really helpful and I will be showing it to my hygienists. It is stated by medical insurance carriers that their coverage is determined by the procedures performed, not title or capacity of the service provider. Your Ultimate Source For Tips, News, & Updates on Safety Supplies, Dental, & Medical Industries. Your course on medical billing was amazing, wish it was longer. Medical Billing for Dental is an add-on service or stand alone program starting at $1400 per month. Starting the New Year make sure you are not just asking if insurance is the same, take time to ask for their new cards! 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. 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. So obviously medical insurance is not. Dentists can only bill dental insurance”. 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. Medical coders interested in working in dentistry will require specialized training to understand and apply these differences. That is a very common answer that we encounter from our partnered dentists. j. I thank you for such a wonderful job teaching the seminar and I look forward to the other information you offered! Individuals posting in these forums are solely responsible for their posts and are expected to follow all rules and HIPAA privacy requirements. • Set their practice apart and help more patients. Visit our page to learn more. We’ll send your presentation today, as well as more offers and updates in the future. payment for certain procedures. Typically, when a procedure is considered medical in nature, the medical plan should be filed first. Medical Billing for Dental Procedures . 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. Laurie believes that patients should be able to utilize their medical insurance for procedures due to oral systemic conditions. Using the correct dental procedure code is critical, and often confusing. Additionally, the process hasn’t been addressed by professional dentistry for decades. Greatly appreciate it. Within the varied procedure mix of a dental practice there are many procedures that actually have a medical necessity. pH Dental Inc. is a premier dental consulting company and distributor of safety supplies and medical/dental equipment. There is clearly a “medical” part of dental practice, as your teeth could severely affect other parts of your body and vice versa. There has always been a popular myth among the dental industry that dental procedures are illegal to bill medically. Doing medical billing for dental procedures have brought several benefits, such as: Increase in revenue; Increase in patient base; Increase in case acceptance. General Dentistry. 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. 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. 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. 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