What You Need To Know About Medical Billing For Dentists

Getting a real grasp on medical billing for dentists may be a daunting task, but it’s one that is well worth it. One of the major challenges that dentists face is helping their patients figure out how to pay for procedures. Many dentists tend to forego payments or wait forever for low-income patients to fulfill their payments without realizing that medical billing for dentists exists. Medical billing for dental treatment means that dentists can seek payments from medical insurance.

Patients with oral conditions that can seriously affect their overall health tend to forego treatments with their main worry being the cost of the procedures. Integrating medical billing to your dental practice is not only beneficial to your bottom line, but it also helps patients afford treatments. It also helps the patients to conserve the annual benefits offered by their dental insurance plans. As a dental healthcare provider, the well-being of your patients should be a top priority.

Medical insurance is known to be very generous in terms of reimbursements while dental insurance has very low benefit caps. For example, if a procedure is medically necessary, the reimbursement from medical insurance may be up to 70%. Hence, medical billing for dentists significantly helps to reduce the financial burden of the patients and this helps to make their lives better.

See Also: Understanding Medical Billing for Dentists

However, in order to benefit from medical billing, your dental office must have the knowledge and capacity of filing and managing medical claims. In order to successfully integrate medical billing, your staff will need to be properly trained in order to manage medical billing and ensure that you are paid on time. Your practice will likely also need to become medicare certified as a dentist who decides to perform procedures in their practice.

Procedures Covered by Medical Plans

Basically, medical insurance will cover procedures that have corresponding medical codes and are within the scope of practice of the Dental Practice Act. In addition, procedures that are medically necessary will be covered by the insurance plan. This means that if a patient’s health is compromised by a condition that is treated by the dentist, then the procedure will be reimbursed by the medical insurer.

The list below entails some of the procedures covered by medical plans.

– Emergency trauma procedures
– Procedures to treat dysfunction
– Treatments related to hard and soft tissues
– Procedures related to inflammations and infections
– Wisdom tooth extraction under special circumstances
– Examinations for orofacial medical conditions

In order to successfully file a claim, there are some tips that you can use to help make the process a lot smoother.

Medical Billing for Dentists Requires Documenting Medical Necessity

When submitting claims to dental insurers, Current Dental Terminology (CDT) codes are used to identify the procedures provided to the patients. These procedures are not covered by medical plans. However, when submitting claims to medical plans, you need to have a clear understanding of the ICD-10 codes. ICD stands for International Classification of Diseases. This is a diagnostic coding system that helps to describe conditions for which the patient received treatment.

Be Pro-Active On Pre-Authorization

Once the procedure is scheduled it is important to contact the insurer in order to receive pre-authorization for the treatment. Being proactive on pre-authorization helps to avoid inconveniences in the future and increases your chances of success when filing a medical claim for the procedure. It also helps you to learn what coverage the patient has.

Writing The Letter Of Medical Necessity

The letter of medical necessity grants you the opportunity to present your case for the procedure. It is essential to properly and correctly use the ICD-10 codes for the insurer to accept to cover the procedure. The recommended maximum number of codes to include in the letter is four and they should be listed from most important to the least important. Explain and provide exhaustive medical evidence as to why the patient requires this procedure.

Conclusion of Medical Billing for Dentists

Filing Out The Claim Form

It is worth noting that insurers give preference to procedures in the order that they appear on the form. The procedures that appear first may be paid in full while the rest are paid for in percentages in descending order. Therefore, to ensure that you maximize the benefits of medical plans, list the most expensive procedures first.

As a dental healthcare provider, ensuring that your patients get the treatment they need when they need it is one of your key responsibilities. However, when there are financial constraints the delivery of dental services is compromised. Learning how medical billing for dentists works and how to properly integrate and manage it helps to ensure that the health and well-being of your patients are protected.

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