The greatest obstacle to dentists in medical billing is a lack of knowledge. There are many myths and misconceptions about medical billing that prevent dentists from implementing medical billing in their practices and from succeeding with medical reimbursements for their services.

dental benefits and billing

 

MYTH #1: “Dentists can’t bill medical insurance.” 

 

Dentistry has isolated itself from medicine. Even though dentists are licensed healthcare providers, the perception that dentistry is outside of medicine persists. That perception is perpetuated by the existence of dental insurance. Dentistry is paid by dental insurance; medicine is paid by medical insurance. The reality actually lies within the scope of our license. The American Dental Association has defined the scope of our practice, and each state’s statutes regulating the practice of dentistry codify this. Note that the defined scope of our practice does not even include the word tooth. The practice of dentistry is not limited to teeth, so our services are not limited to reimbursement by dental insurance. As licensed healthcare providers practicing within the scope of our license, services rendered beyond teeth are reimbursable by medical insurance.

Dentistry: The evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law.”

ADA House of Delegates

MYTH #2: “Medical billing is hard to do.”

Any new skill or protocol implemented in a dental practice will not succeed without proper planning and training. As a CEREC trainer, I know that implementing medical billing into the practice is almost exactly the same as adopting CEREC technology. Some learning has to occur and systems have to be established to create a smooth workflow.

MYTH #3: “Medical Billing is only for practices with CT.”

Absolutely not! While it certainly makes sense for practices with CT to medical bill, CT is not a requirement to medical bill. There are many other services billable to medical insurance beyond CT. These include (but are not limited to):

  • Exams
  • Consultations
  • 2D radiographs (such as orthopantograms, lateral cephs)
  • Trauma to the maxillofacial area (including teeth)
  • Surgical and Surgical-Prosthetic Procedures
  • Appliances (TMD and bruxism)
  • Durable Medical Equipment (Sleep Apnea)
  • And more!

MYTH #4: “My staff won’t have time to do this.”

The idea that medical billing is overwhelmingly time-consuming is a misperception equivalent to the idea that CEREC can’t be used in a busy practice. Training and case selection play a large role in success with both. Protocols and systems have to be implemented in the practice. In order to succeed, it is necessary to invest time to accomplish this. Once done, medical billing operates as smoothly as any other system in the practice.

MYTH #5: “I don’t need to learn medical coding because I only file dental claims.” 

The revised ADA dental claim form (v2012) includes the use of medical diagnosis codes, diagnosis pointers, and place of service codes exactly like the AMA medical claim form. Dentists and dental practices are going to have to explain WHY treatment is necessary and not just explain details of services rendered. 

MYTH #6: “High deductibles will prevent payment.”

This myth is based on a lack of knowledge of what a deductible actually represents. The federal government defines “deductible” with two sentences:

“The amount owed for health care services your health insurance or plan covers before your health insurance or plan begins to pay. The deductible may not apply to all services.”1

The second sentence is actually the most important part of the definition. It is a fact that the deductible is not applied to every procedure. The application of the deductible is a policy-specific provision and varies from policy to policy. Rather than asking: “What is the deductible?” a better question is: “How will the deductible be applied?”

Consider the case of a $500 claim to a policy that has a $1,000 unmet deductible. If the deductible is applied to all of the procedures on the claim, no payment will be made; however, if the deductible is NOT applied to the claim, payment will be made. Therefore, a $1,000 deductible that is not applied to a $500 claim is completely irrelevant.

patient making payment medical billing

Further, a trend in medicine is the shifting away from the full application of the deductible in January when the deductible “resets” to a piecemeal application of the deductible throughout the year. It is clear that the assumption that a deductible will be applied to your claim is not factual. That being said, the application of a large deductible to a small claim will stand in the way of payment; however, this is more a product of the quality of the insurance policy than anything else. Low quality, inexpensive medical insurance will generally apply the deductible more often than higher quality, higher cost plans. You truly get what you pay for!

Perhaps the biggest obstacle to payment is the inability of the dental practice to clearly identify what should and shouldn’t be billed to medical insurance. Like CEREC, case selection is an important component to success. Medical billing by a dental practice does not try to get medical insurance to pay for dental procedures. Remember, some of our practice is dental in nature (teeth) and some of it is medical (the other stuff).

Unfortunately, the perception that any procedure performed by a dentist is a dental procedure is pervasive. Nothing could be farther from the truth. And it is those services “beyond the teeth” that should be billed to medical insurance. With clarity in case selection, success is increased and frustration is decreased.

Chris Farrugia, D.D.S. and Contributing Author - www.successfulmedicalbilling.com