Important Considerations for Dental Claims Billing for Dental Surgery

Dental Claims Billing for dental surgery that is medically essential can assist patients in maximizes health insurance advantages. Today, most dental offices are depending on dental billing services to simplify this job. In fact, with declining rates of reimbursement, practices require to make the most of both the patient’s dental and medical insurance to get maximum reimbursement for dental surgery. Here are some crucial things dentists require to know about medical billing for dental surgery:

Dental surgery is executed to treat different conditions of the jaws, gums, and teeth. Surgical processes that dentists do include treatment for temporomandibular joint (TMJ) disorder, wisdom teeth removal, facial trauma, corrective jaw surgery, periodontal surgery, and dental implants to treat gum conditions like periodontitis or gingivitis.

Establish medical requirement: Medical insurance plans will reimburse procedures dentists do provided they are medically essential and coded properly as medical procedures. Medically essential treatment is provided when the patient is compromised medically by an issue that the dentist treats. For example, the removal of impacted teeth, medically essential tooth removal, and teeth removal before an organ transplant or radiation therapy can be billed to medical insurance.

Medical plans also cover hard and soft tissue extractions and biopsies and the surgical placement of implants of dental. According to a Dental Practice Management article that for success with dental claims billing, dental practices require to deploy the right ICD-10codes and CPT Codes to document all aspects of the provided care. The documentation must cover:

Any secondary, helping diagnosis

The chief displaying issue

The code of diagnostic for the planned treatment

Pre-authorization Surgical

A medical necessity letter outlining the case for surgery

Assisting medical necessity letter from the Primary Care Physician of the patient

The procedures accomplished at every location of surgery

The documentation must inform the payer that the concern of the patient was a medical one and not just a dental issue. For example, in the case of implants, the documentation must explain two things: the cause for the tooth loss and why the tooth requires to be changed. All contributing factors from the medical history of the patient can be stated in the Medical Necessity letter.

Attain preauthorization: All claims of dental surgery require pre-authorization from the medical plan and dentists should get the authorization before the procedure is done. Pre-authorization comprises connecting with the insurer by phone and discussing the date and the procedure. Not getting pre-authorization can result in rejection of the claim.

Insurance verification: The patient’s dental ability must be confirmed, that is, gather data on the coverage of the patient and how the insurer will pay for incision. When a new patient calls to make an appointment, gather the following information:

Name of the primary insured

Patient’s date of birth and name

Primary insured social security number

Carrier of insurance

ID number

Group number

Contact details for the insurance company containing website, address for submitting claims, and phone number.

With these details in hand, call the insurer to confirm the patient’s eligibility for effective dates, in-network or out-of-network coverage, whether surgery needs pre-authorization, and co-pays, coinsurance and deductibles, and insurance coverage. Gathering details on what their insurance will cover will assist patients plan for their out-of-pocket payments. Hiring an insurance verification expert can make these jobs simple.

Comprehend coding: Knowledge of ICD-10 codes and their right deployment in the Medical Necessity letter is important to convey the insurer about the requirement for surgery. As per Dental Practice Management, providers must restrict themselves to listing 4 codes of diagnostic in the letter.

 The first diagnosis listed should relate to the highly crucial procedure performed, pursued by those of reduced importance. For example, if the first ICD-10 code pertains to periodontal disease, the secondary codes of diagnostic might pertain to disuse osteoporosis, pursued by medical history factors involving the surgery like the HIV, immunoglobulin deficiencies, and diabetes, etc.

The CPT codes on the form of claim must be listed from the highly costly down to the less expensive in every jaw or surgical site and not in the order they arise. The cause is that payers reimburse the first surgical procedure listed in every site at the highest advantages level and every subsequent procedure at a lesser rate. For example, while the first procedure on the list might be paid at 100 percent, the second might be paid at 75 percent and extra procedures at 50 (Dental Practice Management).

Filling out and claim submission: Once the dental surgery has been done, the claim must be completed properly. Forms must be scrutinized as typos and other issues can result in delayed payments or rejection. When submitting the claim to the insurer, it should be accompanied by suitable documentation. Comprising supporting documentation like the diagnostic or lab imaging reports can assist in claim support.

In Boston, Erinne Kennedy, DMD, a dentist at a community health center, told Dental Products Report: “The insurance company is searching for certain criteria in your documentation, so if you can provide them precisely the information they require with the right verbiage, easier is the reimbursement. Detailed and accurate documentation, comprising intraoral or radiographs images, decreases a chance for the insurance company to refuse the claim.”

Outsourcing is an excellent alternative to maximize efficiency in dental claims billing. Experienced outsourcing companies that provide dental billing services have specialist teams that possess knowledge regarding insurance companies, their rules, claims submission procedures, pricing, coverage, and even the individual plans in every state. Partnership with a trusted medical billing company can make sure the right dental eligibility verification ahead of time and glitch-free dental surgery billing.