Shopping Cart
Your Cart is Empty
Quantity:
Subtotal
Taxes
Shipping
Total
There was an error with PayPalClick here to try again
CelebrateThank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping Cart


National Dental Billing Services

1810 Erie Blvd. Syracuse, NY 13210

[email protected]

800-652-3431

Blog

Blog

Billing Medical Insurance for Dental Services

Posted on December 10, 2016 at 8:10 AM


In response to the changes in the healthcare reimbursement plans, billing medical insurance for dental procedures is becoming a necessity. Currently, the dental industry may not be ready for billing medical insurances for dental procedures. Dental Claims Cleanup has been developing cross over systems and protocols to aid Dentists in the task of billing medical insurances for dental procedures. This article will review commonalities and differences in medical and dental billing, as well as, provide pointers in the medical billing process for dental procedures.

 

Medical and dental billing share the following:

 

Patient and insurance information has to be obtained, verified, and correctly set-up in the practice management system

Procedures must be coded and fees established

A claim form is submitted

Payment is received with and explanation of benefits (EOB) that needs to be broken down in the practice management system

claims need to be followed until payment is received and re-submission and appeals are performed until payment is reached

patient's portion must be collected after the insurance claim resolves or must be collected prior to the procedure (if an estimate of patient's portion is possible)

 

Differences between medical billing and dental billing:

 

Medical billing requires diagnostic codes to support medical necessity of procedure codes to be submitted with the claim; there is no requirement yet for diagnostic codes in dental billing, however, diagnostic reasons for dental procedures are provided upon request by the dental insurance, during narrative submission with claims, and during claim appeal process, and must be documented in the patient’s chart.

Insurance coverage depends on an exact match of plan coverage and diagnostic codes for procedure codes. Claim denial is more likely with medical claims, due to the requirements necessary for a "clean" claim submission, therefore, it is important to find out information requirements for certain procedures before the claim is submitted during the coverage verification process (pre-certification and re-authorization)

Sending "clean" claims in medical billing is crucial to obtaining coverage and payment. All information must be accurate including patient, provider, and insurance demographics, diagnostic codes and procedure codes, modifiers, narrative submission, etc.

Pre-certifications (“pre-certs”) for treatment are important prior to proceeding with treatment. Decisions are made, once pre-certs or denials are obtained, to submit to dental insurance instead. The patient can make a decision whether or not to proceed with treatment, based on the information received from the pre-certs. Other pertinent information is discovered during the pre-cert step that aid in claim submission and claim coverage based on the information disclosed in the pre-cert. The insurance company will determine whether the procedure needs to be pre-certified or pre-authorized. Pre-certifications establish that the procedure “may be” medically necessary and needs a review prior to payment. Pre-authorizations establish that the procedure will be covered, but the insurance company does not disclose any fees.

ADA codes for dental treatment encompass many procedures that are not coded, but are part of the fee (ex: lab materials, lab fee, temporary crown fabrication, visit for insert of the crown, x-ray when crown was seated etc.) Those parts of the treatment are included in one crown fee. In medical billing there is a service CPT (reports medical, surgical, & diagnostic procedures and services) or HCPCS code (products, supplies, & services not included in the CPT codes) for all the parts of treatment or a procedure which would add up to the analogous one fee in dental coding. The fee for medical treatment is obtained from coding all parts of the treatment. Dental billing bills for a “product” provided and this product has one fee that is coded. In medical billing, we bill for treatment of a “condition” provided (includes services performed based on time and complexity, products/devices, materials used and amounts, and diagnostics procedures, the procedure can be broken into technical service and professional service provided).

Medical claim submission has 90 days from day of service prior to expiration, while dental insurances allow up to 6 months, or even up to 1 year, for claim submission from date of service. Therefore, if medical insurance does not pay for the dental procedure, there is time to submit the claim to dental insurance. The claim can not ethically be submitted simultaneously to dental and medical insurance. If you submit $500 to medical for a procedure, that gets denied, you have to submit $500 to dental insurance for the same procedure. This is why, the price for the procedure, billed to dental or medical, has to be the same. Several medical codes (which will include services, products/devices, materials, and diagnostic procedures) may need to be used for the analogous ADA code, but the price for the treatment should be the same. Many ADA codes include procedures that in medical coding are billed separately. Ex: x-rays in dental billing include the diagnosis and reporting while x-rays in medical can be billed as service fee (technical component) and the reporting fee (professional component) with a modifier 26.

Narratives/letters to support medical necessity are crucial to obtain medical claim coverage; in dental billing, letters of medical necessity are only necessary for ADA codes that ask for narratives by report or during the appeal process, or as a follow-up to referring provider.

Medical reimbursement for exams/office visits/consultations depends on time spent with the patient encounters, complexity of the encounter/exam, and reimburses for each encounter for previously diagnosed condition, in dental follow-up visits and visits for previously diagnosed condition are considered part of the dental procedure.

Medical insurance does not provide fees for treatment during the benefits verification process, or pre-certification process, but rather, informs if treatment is eligible for medical billing after claim examiner review. Pre-authorization will tell you it will be covered by the plan but the insurance company will not disclose the fees. The reimbursement depends on the medical plan’s reimbursement schedule, covered benefit, and if it is a medically billable procedure. It is not possible to do a sound pre-estimate and figure out the patient’s responsibility for the treatment, therefore, the provider must decide what will be collected at time of service. If the medical insurance reports that the services will be covered (pre-authorized) and can be submitted, a minimum of 1/3 should be collected from the patient, as a down payment, at the time of service. Some medical insurances are known to take a long time to pay out. Providers might consider to collect the total amount, from the patient, at time of service, and the insurance payment is sent to the patient directly.

Most of the time, medical insurance has a higher reimbursement for dental services than dental insurance resulting in a lower patient balance. This is because several parts of one dental code are billable to medical. Payment for several more codes results in a total higher insurance reimbursement. In addition, there are no clear provisions or history for payments on dental procedures, therefore, often times the medical insurance pays well on those codes.

Dental insurance allows to charge out indirect procedures, involving a laboratory, on the day of impressions, while indirect procedures can only be billed out to medical insurance on the day of the insert.

1. How to get started? The Dentist must decide which procedures that they perform will be eligible for medical billing.

1. traumatic injury

2. inflammation or infection

3. surgery required

4. diagnosing/diagnosed medical condition

5. suffering from loss of function

6. referral from medical Doctor

 

2. The Dentist has to make a medical connection based on the medical history to the dental treatment that needs to be provided. A letter of medical necessity needs to be written and submitted with the claim.

 

3. Next, we suggest the Dentist runs a report of those medically-billable procedures, that were already treatment-planned, form the practice management software. Call the patients and obtain their medical insurance information. Inform the patient that you will attempt to check with their medical insurance for assistance with this treatment. Only when there is pre-certification, pre-authorization, the patient is scheduled. When calling the patient to schedule, make sure that at least 1/3 of the fee is discussed to be collected at time of service towards the treatment for pre-authorizations. Also, discuss the full fee for the treatment, for pre-cetifications, in the event that medical insurance does not pay at all. Have a back-up plan to submit to dental insurance and quote the patient the dental insurance breakdown based on dental insurance coverage history.

 

If you need help implementing medical billing in your office, please give us a call. Dental Claims Cleanup will setup your medical billing program including your medical billing software, worksheets, and train your team for $500 one time fee. Phone support service of $100/month is available. If you are interested in completely outsourcing medical billing with us, we charge a flat fee of $500/month for up to 50 claims and $10 each additional claim. Please visit our website for more information www.dentalclaimscleanup.com

Categories: dental insurance, accounts receivable

Post a Comment

Oops!

Oops, you forgot something.

Oops!

The words you entered did not match the given text. Please try again.

4757 Comments

Reply kamagra 100mg oral jelly sildenafil
5:44 AM on May 11, 2021 
finasteride generic cialis online cheap viagra generic https://kamagraday.com kamagra vs viagra
Reply cheap jordans
5:57 AM on May 11, 2021 
I simply needed to appreciate you once again. I am not sure the things I would've achieved in the absence of these thoughts provided by you over my subject. It had become a troublesome case for me, nevertheless understanding the very well-written technique you solved the issue took me to weep over joy. Extremely happier for this assistance as well as have high hopes you recognize what a great job that you're providing instructing men and women through your website. Most probably you haven't encountered all of us.
cheap jordans http://www.jordansforcheap.us.com
Reply Gaifaws
6:46 AM on May 11, 2021 
ivermectin for humans for sale
Reply GogeRoora
11:05 AM on May 11, 2021 
buy cialis pills
Reply lebron 16
3:52 PM on May 11, 2021 
I'm also commenting to make you be aware of what a fantastic discovery my wife's princess went through viewing yuor web blog. She noticed several details, which include what it's like to have an awesome coaching mood to get the others clearly completely grasp specific tortuous topics. You truly did more than our own desires. Many thanks for producing the necessary, trustworthy, edifying as well as fun tips about the topic to Ethel.
lebron 16 http://www.lebron16.us
Reply pg 1
3:54 PM on May 11, 2021 
I not to mention my guys appeared to be checking the excellent secrets found on your web site and then immediately I had an awful suspicion I had not thanked the web site owner for those tips. The people happened to be stimulated to learn all of them and have in effect simply been taking pleasure in these things. Appreciate your really being really accommodating and for considering certain really good subjects millions of individuals are really eager to learn about. Our own honest apologies for not saying thanks to you earlier.
pg 1 http://www.paulgeorgeshoes.us.com
Reply kyrie 4
3:55 PM on May 11, 2021 
I simply desired to appreciate you all over again. I'm not certain the things I might have gone through without the entire suggestions revealed by you directly on my situation. Certainly was an absolute fearsome concern for me personally, but being able to see a specialised approach you resolved the issue took me to weep over contentment. I am just happier for this assistance and even trust you realize what an amazing job you are always undertaking instructing the rest with the aid of your website. I am sure you've never encountered all of us.
kyrie 4 http://www.kyrie4shoes.us
Reply supreme clothing
5:32 PM on May 11, 2021 
I must express some thanks to this writer just for bailing me out of this problem. As a result of exploring through the world-wide-web and seeing solutions that were not beneficial, I assumed my life was over. Existing without the strategies to the difficulties you've fixed all through your good posting is a serious case, as well as the kind that might have in a wrong way affected my entire career if I hadn't discovered the website. Your main talents and kindness in maneuvering almost everything was important. I'm not sure what I would have done if I had not come upon such a point like this. I'm able to at this time look forward to my future. Thanks for your time very much for your high quality and amazing help. I won't think twice to suggest the sites to any person who will need support on this matter.
supreme clothing http://www.supremes-clothing.com
Reply off white x jordan 1
8:08 PM on May 11, 2021 
I precisely wanted to appreciate you again. I'm not certain the things that I would've gone through in the absence of the actual thoughts contributed by you on such question. Certainly was the troublesome problem for me, nevertheless looking at the well-written approach you managed that made me to weep for gladness. I'm just grateful for the information and as well , hope that you really know what an amazing job you are getting into educating people using your webpage. I am sure you've never encountered any of us.
off white x jordan 1 http://www.offwhitexjordan1.com
Reply lebron 18
12:35 AM on May 12, 2021 
I would like to convey my passion for your generosity giving support to women who absolutely need guidance on the niche. Your personal commitment to getting the message up and down appears to be rather advantageous and have in most cases allowed associates just like me to attain their endeavors. The insightful recommendations means a lot to me and extremely more to my office colleagues. Best wishes; from everyone of us.
lebron 18 http://www.lebron18shoes.us
Reply yeezy supply
4:54 AM on May 12, 2021 
I wanted to write you the tiny observation to help say thanks a lot yet again for those extraordinary knowledge you have documented above. It was really surprisingly generous of people like you to supply unreservedly precisely what numerous people might have offered for sale as an electronic book to help with making some money for themselves, most notably given that you could have done it in the event you decided. These solutions likewise served like the fantastic way to be aware that someone else have the identical passion really like my personal own to know a little more in regard to this condition. I am certain there are many more enjoyable times ahead for individuals who discover your blog post.
yeezy supply http://www.yeezy-supply.us.org
Reply occulty
5:17 AM on May 12, 2021 
cialis otc
Reply GogeRoora
5:40 AM on May 12, 2021 
worldwide pharmacy kamagra
Reply moncler jackets
7:36 AM on May 12, 2021 
I am writing to make you know what a incredible experience my child found visiting your web site. She mastered such a lot of pieces, which included what it is like to have a marvelous giving nature to make the mediocre ones quite simply completely grasp specified tricky matters. You undoubtedly surpassed her expectations. Many thanks for offering such informative, safe, informative and also easy tips on the topic to Janet.
moncler jackets http://www.monclerjackets.us
Reply off white shoes
8:27 AM on May 12, 2021 
I truly wanted to send a message so as to express gratitude to you for these wonderful ideas you are sharing at this website. My extended internet investigation has at the end of the day been honored with good knowledge to exchange with my family and friends. I 'd point out that most of us site visitors actually are very much blessed to exist in a really good place with many perfect individuals with good things. I feel rather privileged to have encountered your weblog and look forward to many more enjoyable minutes reading here. Thanks a lot once again for a lot of things.
off white shoes http://www.offwhiteshoes.us.com
Reply jordan shoes
9:12 AM on May 12, 2021 
My wife and i were really comfortable that Albert managed to complete his web research through your precious recommendations he gained out of the web pages. It is now and again perplexing just to find yourself giving out tricks that others have been selling. We really understand we have got the website owner to give thanks to for this. The most important explanations you have made, the simple web site navigation, the relationships your site aid to foster - it is many astounding, and it is facilitating our son and us reason why this topic is awesome, which is exceedingly serious. Thank you for the whole lot!
jordan shoes http://www.shoesjordan.us.com
Reply GogeRoora
1:00 PM on May 12, 2021 
36 hour cialis online
Reply stone island jacket
5:14 PM on May 12, 2021 
My husband and i were really thrilled Jordan could finish up his research while using the ideas he came across while using the weblog. It is now and again perplexing just to be handing out guides that some other people have been trying to sell. And now we consider we have the website owner to give thanks to for that. The main illustrations you have made, the straightforward web site navigation, the relationships you can give support to instill - it's got many astonishing, and it is helping our son and our family imagine that the matter is satisfying, which is very mandatory. Thanks for everything!
stone island jacket http://www.stoneislands.us
Reply supreme shirt
8:02 PM on May 12, 2021 
I would like to show some thanks to you just for bailing me out of this particular circumstance. As a result of searching through the world wide web and finding notions which were not powerful, I figured my entire life was over. Existing without the presence of strategies to the problems you have solved by way of your entire review is a critical case, as well as those that would have adversely damaged my entire career if I hadn't encountered the blog. Your own personal understanding and kindness in touching every item was important. I am not sure what I would have done if I hadn't come across such a point like this. I am able to at this moment relish my future. Thanks a lot very much for your specialized and result oriented guide. I will not be reluctant to propose your web sites to anybody who should get guidelines about this topic.
supreme shirt http://www.supremeshirt.us.com
Reply yeezys
6:54 AM on May 13, 2021 
I simply had to thank you very much yet again. I am not sure what I could possibly have made to happen without the type of techniques discussed by you concerning this area. It truly was a real terrifying problem in my view, nevertheless understanding the specialised technique you resolved the issue forced me to cry over gladness. I am just grateful for your help as well as pray you know what a great job you happen to be accomplishing training many others through the use of your web site. More than likely you've never encountered any of us.
yeezys http://www.supplyyeezys.com
0