Help: FAQs, tutorials, videos, page index and more
Viewing:  Sep 17, 2019

A Step by Step Guide to Medical Billing

By:  Christine Taxin
Published:  August 20th, 2019

The next 4 weeks we will be providing you with a step by step guide to why medical billing is now part of our Dental future.

Dental surgery is performed to treat various conditions of the teeth, jaws, and gums. Surgical procedures that dentists perform include dental implants, treatment for temporomandibular joint (TMJ) disorder, wisdom teeth removal, facial trauma, corrective jaw surgery, and periodontal surgery to treat gum conditions such as gingivitis or periodontitis. Billing medical insurance for dental surgery that is medically necessary can help patients maximize health insurance benefits. Today, many dental offices are relying on dental billing services to ease this task. In fact, with declining reimbursement rates, practices need to make the most of both the patient’s medical and dental insurance to receive maximum reimbursement for dental surgery. Here are some important things dentists need to know about medical billing for dental surgery:

1. Understanding the need to understand what is medical necessity and WHY!

Establish medical necessity:

One of the tools my students use is PreViser. It will show a risk assessment score that shows the patient and the medical team Low, Moderate, or High risk.  Medical insurance plans will reimburse procedures that dentists perform, provided they are medically necessary and properly coded as medical procedures. Medically necessary treatment is that which is provided when the patient is medically compromised by a problem that the dentist treats. For example, medically necessary tooth removal, the removal of impacted teeth, and the removal of teeth before radiation therapy or an organ transplant can be billed to medical insurance. Medical plans also cover soft and hard tissue biopsies and extractions and the surgical placement of dental implants. A Dental Practice Management article points out that for success with medical billing claims, dental practices need use the correct ICD-10 codes and CPT codes to document all aspects of the care provided. Go to www.dentalmedicalbilling.com and look under resources to download PreViser.  

P.S. you can code that for billing dental.

Then make sure you collect the following information:

  • The chief presenting problem
  • Any secondary, supporting diagnosis
  • The diagnostic code for the treatment planned
  • Surgical pre-authorization
  • A letter of medical necessity outlining the case for surgery
  • Supporting letter of medical necessity from the patient’s Primary Care Physician
  • The procedures performed at each surgery location

The documentation should inform the payer that the patient’s concern was a medical one and not just a dental problem. For instance, in the case of implants, the documentation should explain two things: the reason for the tooth loss and why the tooth needs to be replaced. All contributing factors from the patient’s medical history can be stated in the Letter of Medical Necessity.


References:

###

Provided by Christine Taxin of Links2Success Dental Management & Consulting Service

Links2Success Dental Management & Consulting Service provides practice management support to medical & dental practices and offers opportunities for individuals looking for Continuing Education in Dental Management to develop the necessary communication and organizational tools. Christine Taxin's presentations and webinars on practice management are packed full of concepts and systems that can be applied immediately in your business. Her seminars address the doctor and the entire team with positive and fun solutions for a productive and successful practice in today’s changing economy.

Visit Links2Success.biz for more information.

Article Tags  (click on a tag to see related articles)



Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


Our contact information

Find A Code, LLC
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Fax: 801-770-4428
Email:
Free 14 Day Trial
No Credit Card Required
Pricing
Starting at $10/month
Sign In
Welcome back!