Learn the secrets of medical billing in dentistry success through online course training with Cross-Coding pioneer Rose Nierman.
Mastering medical billing helps your patients have access to essential services. Medical billing knowledge increases case acceptance, differentiates your practice and allows the practice to implement additional services that are rewarding for both the patient and the practice.
Dental insurance doesn’t reimburse for some procedures. Most dental insurance now requires that the dental office bill medical first before dental benefits will be processed. When medical benefits are available, dental benefits can then be saved for basic dental procedures such as restorative dentistry. Some services such as oral appliances for obstructive sleep apnea will almost always be billed to medical, not dental. The majority of US states also have mandates that TMJ treatment (excluding bruxism devices) is covered under medical policies.
Examples of procedures that can be billed: Oral appliances for obstructive sleep apnea, TMJ treatment, oral surgeries, radiographs, evaluation & management office visits and other services performed in the dental office. For example, a major medical policy coverage states coverage includes treatment for diseases of the facial bones, trauma to soft and hard tissue structures of oral cavity, oral Infection, TMJ treatment and obstructive sleep apnea services.
Narrative reports and clinical documenation should indicate the pain, symptoms or chief complaints that the patient presents with as well as physical or clinical observations such as jawbone atrophy, clicking, infection, reduced airway due to tongue impingement, etc.
Nierman Practice Management’s detailed questionnaire and exam forms are designed to demonstrate medical necessity, when appropriate. For medical reimbursement of bigger cases, a medical-model type SOAP (narrative) report of medical necessity should be generated and forwarded to the insurer.
A minimum of one ICD-10 diagnosis code is needed to bill medical insurance. More that one ICD-10 code many be needed to for medical necessity of treatment.
Healthcare Provider Taxonomy Codes categorize the type and/or specialization of health care providers, such as general dentist, oral surgeon, etc. and are to be placed on the medical claim form
Fairhealthconsumer.org is a web tool or resource to search for consumer medical costs and UCR Fees for medical and dental claims.
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