Medical billing: Are dentists and hygienists at the tipping point of change?

By Christine Taxin

Oral physicians and oral hygienists are at the tipping point of change. The opportunities for us to provide treatment that helps our patients’ overall health are here and expanding rapidly. Dentists and physicians are now able to interact, providing wellness plans for their mutual patients. Setting up communications with a patient’s physician is imperative in today’s world. These communications provide seamless interactions with regard to medications and changes to health history. It is important for the physician to know if the patient has active periodontal disease and the dentist to know if the patient has systemic problems such as diabetes. The patient will benefit with better treatment.

Understanding Risk Assessment
• Understand which patients are at risk and the steps to take that will maximize your treatment collaboration with medical doctors
• Provide a wellness plan
• Referral program with medical doctors, hospitals, and sleep labs
• Work with dental plans that will allow you to bill for procedures beyond the maximum dental allowance. Patients with “at-risk” medical conditions are eligible for additional dental coverage. Did you know that your patients with Cigna Dental coverage who have eligible medical conditions could receive 100% reimbursement of their out-of-pocket expenses for certain dental procedures? Delta and others have added these benefit packages, so our offices can and should bill more treatment than we have in the past.

*Medicare will require all dentists to fill out forms in order to refer patients for any tests, biopsies, or other treatments that require a referral. Contact www.links2success.biz or [email protected] for more information.

We are also learning about the procedures that fall within the dental scope of practice that are considered medically necessary. Examples:
• Dental trauma procedures
• Oral cancer screening, OralDNA, biopsies
• TMD procedures
• Sleep apnea appliances
• Dental procedures necessary because a medical condition or treatment has compromised the patient medically

By providing these procedures, we are now able to help our patients financially by billing their medical insurance. Patients will accept treatment more readily when they know we can work with their medical insurance to obtain benefits.

The procedure for gathering health histories also needs to follow the medical model, with all documentation noted and signed by patient and provider.

The entire team will need to understand what the indicators of systemic disease are and why treatment is medically necessary. This way we are all collecting information needed from the first phone call to treatment planning and through treatment. If the team is not functioning as a whole, this process will not become the fine-tuned program you should be providing.

Treatment is evolving and improving when the appointment is no longer about “fixing the problem,” but instead we are focusing on thorough, systemic-based care. Providing diagnostic testing to formulate a treatment plan is the most efficient way to go. Many doctors have already added the following tools: Florida Probe, OralDNA, digital X-rays, CT scans, blood testing for sugar and C-reactive protein. Go to www.links2success.biz for a list of medical necessity diagnostic codes.

Other staff members have trained most of us working in the practice in dental billing. Why is it that dental offices do not see the need for a trained expert in medical billing? Do you want to learn? Besides learning how to bill more effectively both in dental and medical, you will also learn about all the changes we are seeing with health-care reform. Do not be last to begin this process in your practice. Learning how to cross code can only be a win-win experience.

Christine Taxin is the president of Links2Success. With more than 20 years’ experience as a consultant, Christine's passion is improving practice performance and increasing profitability through communication, team training, and goal setting. Her clients and workshop attendees benefit from her expertise in administration, internal and external marketing, financial planning, and insurance billing. Christine is a member of the Speaking Consulting Network and the Academy of Dental Management Consultants. She is an adjunct instructor at NYU Dental School and teaches in the residency programs at Maimonides Medical Center and Jamaica Hospital. You can reach Christine at [email protected].