Sarah Beth Herman
Medical Billing for Dental 5 Part Series: Part 3
Updated: Mar 22
Aaaand we're back! Welcome to part three of Dentistry Support's free training series on medical billing for dental procedures. In part one and two, we covered the foundation of medical billing, including the differences between ICD-10, CPT, and ADA codes, medical billing software and common do's and don'ts. Let's talk about the key strategies you should have in place in your dental office. This is going to dive deep into how to set your dental office up for success in medical billing for dental procedures. Let's go.
There are statistics available that demonstrate how medical billing in dental can increase revenue. According to a report by the ADA's Health Policy Institute, dental practices that incorporate medical billing into their operations can see a significant increase in revenue.
The report found that practices that billed medical insurance in addition to dental insurance saw an average increase in revenue of 21% per patient. Additionally, practices that billed medical insurance for sleep apnea and TMJ treatment had an even higher increase in revenue, averaging 50% per patient.
Another study by the Medical Dental Integration Consortium found that dental practices that implemented medical billing saw an average increase in revenue of $65,000 per dentist per year.
It's important to note, however, that medical billing can be complex and requires a thorough understanding of medical coding and billing regulations. Dental practices interested in incorporating medical billing into their operations should consider partnering with a medical billing company or consulting with a medical billing expert to ensure they are billing correctly and maximizing their revenue potential.
Coding: Accurate coding is crucial in medical billing for dental procedures. To ensure proper billing and reimbursement, it's essential to use specific codes for each procedure, diagnosis, and treatment plan. CDT codes (Current Dental Terminology) are used to describe dental procedures, while ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) codes are used to classify and code medical diagnoses. HCPCS (Healthcare Common Procedure Coding System) codes are used for services and procedures not covered by CDT or ICD-10 codes, such as durable medical equipment.
Insurance verification: Before billing for a dental procedure, it's important to verify the patient's insurance coverage and benefits. This includes understanding which dental procedures are covered by medical insurance and which ones are not. Insurance verification also involves determining the patient's deductible, copayment, and coinsurance, as well as any prior authorization requirements. Verifying insurance coverage upfront can help prevent claim denials and ensure that patients receive the appropriate level of care.
Documentation: Complete and accurate documentation is crucial in medical billing for dental procedures. Proper documentation includes the patient's medical history, the reason for the dental procedure, the treatment plan, and the outcome of the procedure. Documentation must be clear and concise, and it should include all relevant information needed for billing and reimbursement. Proper documentation is important not only for accurate billing but also for patient care and communication among healthcare providers.
Coordination of benefits: When a patient has both dental and medical insurance, coordination of benefits is necessary to determine which insurance company is responsible for paying for the dental procedure. This involves submitting claims to both insurance companies and ensuring that payments are correctly applied. Coordination of benefits can be complex, as different insurance companies have different rules and requirements. Proper coordination of benefits is essential for accurate billing and to prevent patient confusion and frustration.
Compliance: There are various laws and regulations that govern medical billing, including HIPAA (Health Insurance Portability and Accountability Act) and the False Claims Act. It's important to be familiar with these laws and ensure that all billing practices are in compliance. Failure to comply with these laws can result in legal and financial consequences. Compliance with legal and regulatory requirements is essential not only for proper billing and reimbursement but also for protecting patient privacy and ensuring ethical practices in healthcare.
Here is a helpful checklist you can use to make sure you have a base point to start at:
Accurate coding is essential in medical billing for dental procedures
Specific codes must be used for each procedure, diagnosis, and treatment plan
CDT codes describe dental procedures
ICD-10-CM codes classify and code medical diagnoses
HCPCS codes are used for services and procedures not covered by CDT or ICD-10 codes
Verifying insurance coverage and benefits is important before billing for a dental procedure
Understanding which dental procedures are covered by medical insurance is crucial
Determining the patient's deductible, copayment, and coinsurance is necessary
Verifying insurance coverage upfront can help prevent claim denials and ensure proper care
Prior authorization requirements should also be checked
Complete and accurate documentation is crucial in medical billing for dental procedures
Patient's medical history, reason for the dental procedure, treatment plan, and outcome must be documented
Documentation must be clear and concise
Proper documentation is essential for accurate billing, patient care, and communication among healthcare providers
Coordination of benefits:
Coordination of benefits is necessary when a patient has both dental and medical insurance
Claims must be submitted to both insurance companies and payments correctly applied
Different insurance companies have different rules and requirements
Proper coordination of benefits is essential for accurate billing and to prevent patient confusion and frustration
Compliance with laws and regulations governing medical billing is essential
HIPAA and the False Claims Act are examples of laws that govern medical billing
Failure to comply with these laws can result in legal and financial consequences
Compliance is essential not only for proper billing and reimbursement but also for protecting patient privacy and ensuring ethical practices in healthcare
A dental office should have a strategy for implementing medical billing for dental in their business for several reasons:
Increased revenue: One of the primary reasons to implement medical billing for dental is that it can lead to increased revenue for the dental office. By billing medical insurance for procedures that have a medical necessity, dental offices can potentially receive higher reimbursement rates than they would from dental insurance.
Expanded patient base: Implementing medical billing for dental can also expand the patient base for the dental office. Patients who may not have dental insurance or have limited dental benefits may have medical insurance that can cover certain dental procedures.
Improved patient care: Medical billing for dental can also lead to improved patient care. Patients who have medical conditions that impact their oral health may require dental procedures that are medically necessary. By billing medical insurance for these procedures, patients may be more likely to receive the care they need.
Compliance with regulations: Another reason to implement medical billing for dental is to ensure compliance with regulations. There are certain procedures that must be billed to medical insurance rather than dental insurance due to regulations set by government entities such as HIPAA and CMS.
Overall, implementing a strategy for medical billing for dental can benefit a dental office in several ways, including increased revenue, expanded patient base, improved patient care, and compliance with regulations.
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.
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