Is Medical Billing for Dental Practice and Procedures Legal?

There has always been a widespread belief that medical billing in some dental procedures are illegal.

It is common for many dentists and medical practitioners that medical benefits are only offered to physicians and oral surgeons. And since this process is not included in the dental curriculum, many dental experts believe it is impossible.

These misconceptions are not correct.

See also: Answers to: Medical Billing Commonly Asked Questions

Let us look at Section 2706 from the Affordable Care Act (ACA) entitled NONDISCRIMINATION IN HEALTHCARE. It is stated that

“A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate concerning 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.

This section shall not require a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer.

Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.”

So, is medical billing for dental practice legal?

The answer is a big YES!

It is legal but is a complicated process.

What is Medical Billing? How can it affect dental practice and the patient’s overall welfare?

It is a process of submitting and following up health insurance claims to receive payment for healthcare providers’ services and procedures.

See also: How Does Medical Billing Work in General Dental Practice

From a dental specialist point of view, medical billing makes sense and is essential to their practice. This service for dental procedures is legal, as long as operations that are performed are confirmed to be a medical necessity.

Dentists are practically physicians of the mouth, and there is, after all, a connection between patients’ oral health and general health, especially when it comes to chronic diseases.

Research shows that many medical conditions may affect oral health and vice versa, including ailments like Diabetes and heart and kidney diseases.

Years before, medical billing for dentists has been the ‘elephant in the room’ because of the uncertainty.  But now that’s the process has been cleared to be legal, the promise convinces many dental specialists of higher reimbursement and an easy transition into this service.

The CDA or the California Dental Association released The Procedure Lists that could be eligible for medical billing.

Here are the medically billable procedures that are included:

  • CT scans & exams
  • Consults for medically necessary procedures
  • Sleep Apnea Appliances
  • Oral Surgery
  • TMJ Disorder Treatment and appliances
  • Sinus Lifts and Bone Grafts
  • Mucositis
  • Tooth Loss due to trauma or systemic conditions
  • Oral Systemic Infection
  • Botox injections for painful bruxism
  • Excisions
  • Biopsies
  • Reconstruction due to trauma or conditions
  • Endodontics due to trauma or medical conditions
  • Oral Cancer Screening
  • Bone Atrophy that results in ill-fitting dentures
  • Denture Pressure ulcers
  • Many More Procedures

However, for many healthcare practitioners, especially dentistry, medical billing into their practice isn’t as easy as they were headed to believe. It’s a long and complicated process.

For dentists to attend a medical billing course and the staff responsible for billing is a great place and way to start. Get the whole team involved!

Medical billing for dental practices works best and effectively when your whole staff is educated. There are two ways you can complete this job:

  • On-site training: to avoid the hassle, you have the choice to bring an expert into your office for a short but extensive two-day training
  • Dental Courses: you and your team can attend dental practice seminars and courses

Dentists should remember that there is no hard and fast rule for determining whether they should get into medical billing, but it’s worth considering for areas like oral surgeons and specialized procedures.

Doing medical billing for dental procedures have brought several benefits, such as:

  1. Increase in revenue
  2. Increase in patient base
  3. Increase in case acceptance.
  4. Increase the overall patient health
  5. It keeps your practice healthy
See also: The 5 Critical Things to Look for in a Medical Billing Company

To conclude, medical billing is a crucial and essential process that dental practice needs to implement at once.

A complete understanding of dental, medical billing combined with continuous learning by frequently attending seminars can ensure legal compliance, patient satisfaction, and stable cash flow.

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