Sarah Beth Herman
Medical Billing for Dental 5 Part Series: Part 2
Hey there, dental superheroes! Welcome to part two of Dentistry Support's free training series on medical billing for dental procedures. In part one, we covered the foundation of medical billing, including the differences between ICD-10, CPT, and ADA codes. Now, it's time to dive into the importance of having a medical billing software for dental offices.
At Dentistry Support, we understand the importance of having a streamlined process for medical billing. That's why we offer a free medical billing software for our clients who are enrolled in our support. On average, third-party companies charge $250+ per month for their software, but we provide it to our clients for free.
Our software allows us to track claims in real-time, including claim submission and adjudication information.
This means that we can quickly identify any issues with claims and resolve them in a timely manner. With our software, dental offices can have a seamless medical billing process and avoid any delays or denials of claims.
While having a medical billing software is incredible for this process, it's important to note that it won't guarantee payment or the success of your practice. That's why Dentistry Support is here to offer our expertise and support in understanding medical billing terminology, navigating the insurance maze, and helping
you learn to ensure that you're getting paid for the services you provide.
Moving on to eligibility verification, it's crucial to understand that it requires a diagnosis and procedure codes that are determined after an exam and radiographs are completed.
Unlike dental insurance, there is typically no advanced eligibility or pre-designed breakdown of benefits for dental patients using medical insurance.
At Dentistry Support, we provide a custom-designed portal accessible by the dental office to submit verification requests. Eligibility verification is submitted by the office to Dentistry Support and completed within 24-48 hours, depending on the dental insurance company. Typically, there are five or fewer codes for each eligibility verification completed.
In addition to understanding eligibility verification, it's important to know the dos and don'ts of medical billing. For instance, do make sure you're using the correct codes and submitting clean claims. Don't upcode or miscode claims. Here are a few "Make sure you don'ts".
Make sure you don't...
Bill for non-covered services
Avoid billing medical insurance for services that are not covered by the patient's insurance plan to avoid denials and delays in reimbursement.
Fail to properly document procedures
Accurate and complete documentation of procedures performed and medical necessity is crucial to avoid denials or delays in reimbursement. This includes providing detailed narratives in SOAP format and utilization of medical nomenclature.
Submit inaccurate or incomplete claims
Claims that contain errors or missing information can lead to delayed or denied payments and require additional time and resources to correct and resubmit. It is worth noting that the medical insurance claim form must follow a specific order. Sending claims with codes simply entered in will not work. You must follow the proper order of the coding.
Forget to verify coverage for diagnosed procedures prior to sending the claim
Verification of coverage is important to confirm that the services provided are covered by the patient's insurance plan and to avoid unexpected out-of-pocket costs for the patient. In addition, if you fail to contact the insurance with a direct diagnosis for the patient and confirm eligibility and receive a pre-authorization or pre-certification you will receive a denied claim. Do not send any medical insurance claim for dental procedures without first obtaining eligibility.
Use incorrect billing codes for procedures performed
Accurate coding is essential to ensure proper reimbursement and to avoid denials or delays in payment. Coding for both ICD-10 and CPT is provided by your dentist. However, if you need help, Dentistry Support provides all patterns of typical coding for procedures and what medical insurances typically require for that code by way of attachments. Our easy-to-use portal will walk your team through selecting the proper codes and attachments in less than 5 minutes.
Submit claims outside of the timely filing period
Claims that are submitted after the insurance plan's filing deadline may be denied, and the dental office may not be able to bill the patient for the unpaid amount. This may seem like a typical no brainer but we can promise you we have seen scenarios where a patient received a medically billable dental procedure and billing was not done on time and then the patient was stuck with the full bill. Always bill right away for any medically billable dental procedures.
Fail to properly identify the primary payer
Dental offices should properly identify the primary payer for dental procedures to avoid billing errors and ensure proper coordination of benefits with medical insurance plans. When obtaining medical insurance details from a patient always ask them if this is their only insurance. Failure to do this upfront could lead to a delay in payment when the claim is filed.
Forget about claim follow up limits
When submitting medical claims to medical insurance for dental procedures, the follow up is very different than dental insurance. Any updated claim or updated information sent regarding an already submitted claim cannot be followed up on for 30 days. The medical insurance company will not provide an update until they have one and typicallly this is 30 days after you send the informtation. It is best to understand this so all information is sent early and at the initial submission.
Bill for services not related to a medical condition
Medical insurance only covers dental procedures that are related to a medical condition. Billing for services that are not medically necessary or not related to a medical condition can lead to denials and delays in reimbursement. You may attend seminars or training that promise various procedure codes in dental will be covered. That does not mean every insurance will pay for that procedure. It is not advisable to simply 'bill and see what happens'. Always follow the proper protocol of eligibility verification, pre-certification, and proper documentation.
Forget to properly document medical necessity
Dental offices should ensure that the medical necessity of each procedure is well documented in the patient's chart to avoid denials or delays in reimbursement.
Forget to keep up with changes in medical insurance policies
Medical insurance policies and coverage can change frequently, and dental offices should stay up-to-date with any changes in order to ensure proper billing practices and avoid denials or delays in reimbursement.
Fail to collect co-payments, deductibles, or co-insurance
Dental offices should collect any co-payments, deductibles, or co-insurance required by the patient's insurance plan at the time of service to avoid unpaid balances and collections issues. Your team at Dentistry Support encourages you to pre-collect everything from the patient when possible and allocate the medical insurance to pay the patient directly.
Forget to properly handle coordination of benefits
Dental offices should properly handle the coordination of benefits when a patient has more than one insurance plan to avoid billing errors and ensure proper reimbursement. Dentistry Support will assist in the coordination of benefits. You will be able to communicate this with us through our portal and we will handle the rest.
Fail to appeal denied claims
Our best practice here at Dentistry Support is to appeal all claims up to 3 times. We will fight for your claims and given all steps prior to initial claim submission are followed properly, your claims can be adjudicated properly. Dental offices should appeal denied claims when appropriate to ensure proper reimbursement for the services provided. Failure to appeal denied claims can result in lost revenue for the dental office.
Thanks for joining us for part two of our medical billing training series. Stay tuned for part three where we'll cover the importance of documentation and how it impacts your medical billing success. Remember, while understanding medical billing is the foundation to success, it does not guarantee payment or success of your practice. But you can lean on Dentistry Support for support in understanding medical billing terminology and software.
Dentistry Support ® provides remote support for dental offices nationwide. We serve the needs of any size dental office including those with Spanish-speaking needs on both the east and west coasts of the United States of America. Learn more.