Is Medical Billing for Dentists Legal? [ANSWERED]

Is medical billing for dentists legal? This is one of the most concerning questions asked by dentists. It has always been a common belief that dentists are not legally allowed to bill their procedures through medicare or to even utilize medical billing as a means of collections vs simply taking traditional dental insurance. However, this couldn’t be further from the truth. There are numerous misconceptions regarding the legality of dentists billing their procedures and services through medicare or utilizing medical billing and these misconceptions very much affect the delivery of dental services to patients who really need them (such as Babyboomers).

It goes without saying that dental health care is expensive. Since many patients have minimal dental coverage (or are on fixed income), they avoid seeking treatments for conditions that require extensive treatment, for example: TMD, sleep apnea and other types of oral conditions, worrying that they might not be able to afford it. Some of these oral conditions have a direct impact on their overall physical health and they end up putting their lives at risk due to fear of expensive treatments. Because of this exact reason medical necessities often develop (and in some cases worsen) with this older demographic of patients and make it even more important for them to get the help they need.

Is Medical Billing for Dentists Legal in 2019?

Whether you’re reading this in: 2019, 2020, 2021 or beyond – in order to ensure that patients can get the help they need from the services you provide as well as being able to have the highest acceptance rate possible, it is important to first get rid of all the erroneous misconceptions regarding medical billing for dentists.

The first misconception is that medical benefits are only available to physicians. This isn’t true however since the Federal health care law states that as long as a health care provider is acting within the scope of their license, a health insurance provider should not discriminate against the health care provider in regards to participation under the coverage. In other words: it is against Federal law for insurance companies to discriminate against dentists who perform medical procedures in their practice and utilize medical billing or bill through medicare.

The second misconception is that only oral surgeons can obtain medical benefits for the services they provide. This is also not true since dentists who perform similar operations to the oral surgeons are also entitled to the same coverage. It is important to note that the coverage of medical plans is not determined by the capacity of the service provider but rather the covered procedure itself. Therefore everything should be looked at on a case-by-case basis as to what actual medical procedures were performed by the Dentist/physician of the mouth.

The third and most common misconception is that it is illegal for dentists to bill their services to medical insurance. Many dentists fail to include medical billing in their practice as they fear it may have legal ramifications. So, are their fears justified or is medical billing for dentists legal?

Let’s find out.

The law states that if the dentist is properly trained and licensed to carry out a procedure and that procedure is covered by the patient’s medical plan, then the dentist has the right to bill the plan. It is, however, important to ensure that the rules and steps stipulated by the medical coding and billing are adhered to.

A wide range of procedures offered by general and specialty dental practitioners are usually covered by the patients medical plans. What’s more, there are numerous procedures that can be billed simultaneously to both dental plans and medical benefit plans. However, it is important to learn the rules that apply.

See this Article on: Understanding Medical Billing for Dentists to learn more.

Procedures Covered Under Medical Plans

Procedures can either be oral or dental. Oral procedures are operations performed on the soft tissues and bones while dental procedures are operations performed on the tooth itself. In this section, we are going to take a look at the procedures that are medically billable. Procedures that are covered by medical benefits plans fall under four main categories.

The First category is Inflammations and Infections: These procedures relate to conditions of the tooth that are not treatable through invasive treatment.

The Second category is Pathology: These procedures relate to hard and soft tissues.

The Third category is Dysfunction: These are procedures aimed at treating oral dysfunction, sleep apnea and skeletal dysplasias.

The Fourth category is Trauma: These are procedures related to traumatic injury.

Any treatments and procedures provided by a dentist can be billed under medical plans as long as they fall in any of the above categories. In addition, ancillary services, for example, diagnostics which include examinations, consultations, and radiographs are also covered as long as the primary procedure falls under any of the four categories above.

Is Medical Billing for Dentists Legal in California?

Whether you’re in California or any other state, the answer to the question: is medical billing for dentists legal? Is a resounding Yes. As a dentist, you should never be afraid to bill procedures to your patients’ medical plans. However, it is very important to ensure that you understand the codes, claim-filing requirements, and the billing protocol. If you are not confident that you or your staff have the necessary knowledge or expertise to serve as an in-house medical biller/coder then it may make sense to find a company who provides medical billing services for dentists.

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