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If Your Dental Office Isn’t Using Medical Billing, Your Patients May Suffer

If Your Dental Office Isn’t Using Medical Billing, Your Patients May Suffer
Christine Taxin

Dental care is expensive, and many of your patients may only have minimal dental coverage. This can cause big problems when they need extensive treatments due to medical conditions. Too many people avoid getting adequate treatment for conditions like TMD, sleep apnea, and even oral conditions related to diabetes because they worry about affording the treatments. They’re suffering, and putting their health at risk because they worry about the cost.


There is a way that you can help your patients afford care plans and improve their overall oral health. You can bill medical insurance for certain covered conditions. When you learn the ins and outs of medical billing for qualifying dental treatments, you can save your patients money and help them accept the care that they need.

Dentists are Doctors Too

Some dental offices avoid billing medical insurance for covered dental procedures because they fear that they’ll be accused of fraud. However, most states have laws recognizing both DDS and DMD providers as capable of billing medical insurance for conditions that fall under their specialties. The American Dental Association has put together an overview of some of these state laws.  In most states, if an insurer covers a procedure when it’s performed by a physician or nurse practitioner, it must also cover the same procedure when it’s performed by a dentist.


For instance, in Wisconsin, the law states that “insurance companies are required to provide coverage for diagnosis or treatment of a condition or complaint performed by a licensed dentist if the policy covers diagnosis and treatment of the condition if performed by any other health care provider.”


The odds are that your own state has a similar law. After all, the dentist is an expert on the mouth, jaw, and teeth. It makes sense for patients to receive care from someone who has a deep understanding of their conditions.  Some of the most common medically-covered procedures that occur in dental offices include certain kinds of medical imaging, sedation and anesthesia, special treatments related to cancer or diabetes, and appliances to help patients suffering from TMD or sleep apnea.


When you propose a treatment plan to a patient, take the time to ask about their medical insurance. In many cases a quick phone call to the insurer can put your patients on the path to big savings on the cost of treatment.


Medical Billing: Not as Difficult as You Fear

Since medical billing is legal and helps patients get needed care, why do so many dental offices avoid it? Many practice managers and billing professionals fear that medical billing for covered dental procedures is difficult. They believe they won’t be able to do it correctly, so they don’t do it at all.


Basically, these offices are letting irrational fear stand in the way of helping patients. With training, most billing staff members can learn to bill medical insurance companies as easily as they currently bill dental insurance companies. They just need to learn how to cross-code dental procedures as medical procedures. In addition, they have to learn how to include ICD-10 codes, that is diagnostic codes, along with the treatment codes. Basically, medical insurers want to be sure that the treatment your office provided is aligned with a covered diagnosis.

Some offices are already adept at using ICD-10 codes. For instance, dental offices that accept Medicaid patients have already had to use ICD-10 (and before that, ICD-9) codes for quite some time. In addition, certain providers who work with Medicare use the codes to help their patients achieve reimbursement for claims.


Taking the Opportunity to Help Your Patients

In my work with Links2Success, I’ve helped many dental billing staffs learn how to code for medical billing. While the initial learning curve can be steep, medical billing reaps huge rewards for dental practices and dental patients. With medical billing, your patients are more likely to accept the need for diagnostic imaging, oral appliances, and treatments related to chronic, systemic diseases that affect the whole body, including the mouth. They’re also more likely to be pleased with their treatment and to recommend you practice to family and friends. After all, you didn’t just diagnose and treat their medical condition. You also went out of your way to ensure that their treatment would be affordable.

Oral health is an important component of long-term health and aging well. You owe it to your patients to provide the support they need to accept treatment.  It’s time to overcome your fear of billing medical insurance for covered procedures. It’s legal, it’s a helpful service, and for many of your patients, it is absolutely necessary.

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