By Rose Nierman, RDH
Are you aware that many of the specialized services you provide can be successfully billed to a patient’s medical insurance? This ability to bill and receive compensation from medical insurance is a win-win for your patients and your practice. Your patients are more likely to seek needed treatment, thus taking advantage of care that their medical insurance is intended to provide. Your practice benefits because your expertise and skills are sought and compensated in both the medical and dental realms. Successful billing of medical insurance for splints, bone grafts, oral implants, and accidental injury to teeth calls for careful and well-documented reports and medical insurance coding. The results can be gratifying for patients because the insurance can assist with medically necessary services.
Medical billing for dental services is not always understood. Knowing the difference between evaluation and management levels of coding will help you choose the appropriate history, exam, and workup codes to document each patient visit.
You provide your patients with the best possible care, so it is important to learn to confidently document and code to medical when a treatment is medically necessary.
Medical billing with confidence
Medical billing requires diagnosis-based documentation, and there are numerous codes available for bone grafting, implant surgical reconstruction, TMD, sleep apnea appliances, and other oral problems and diseases. Emulating the “medical model” in your record keeping will be an important first step in confident coding. Among the standardized forms and procedures that you will need for successful claims are:
- Medical claim form CMS 1500
- ICD diagnostic codes showing the condition, disease, or symptoms
- CPT procedure codes to specify your services
- Written SOAP reports (Subjective complaints, Objective exam findings, Assessment, and Plan) of medical necessity because claims are subject to review. SOAP reports should include such medical model elements as medical history and review of systems, social history, history of present illness, exam and plan, as well as other essential elements of patient diagnostic and reports.
SOAP reports and letters should be sent to medical insurance for appropriate reimbursement and, with your patient’s signed permission, they should also be sent to physicians who have treated the patient. This informs the physicians about treatments underway for your mutual patient and provides coordinated care. An added benefit is that these reports provided to the physician help spread the word about your expertise and specialized services. Few dentists send such important details to a patient’s physicians, so such attention to detail will set your practice apart and possibly generate future referrals.
Once you learn the rules, choosing the appropriate medical billing codes is easier than you think. Learning these standards and a few common codes has many benefits. Your patients’ oral health goals will be more achievable. For your practice, attention to rules and treatment codes will result in more timely reimbursement and less need for filing claims numerous times to comply with insurance standards.
Rose Nierman is the president of Nierman Practice Management and the creator of DentalWriter SOAP Diagnostic Report Software, CrossCode Software for dental to medical CrossCoding, and the “Successful Medical Insurance in Dentistry” manual. She can be reached at (800) 879-6468 or at [email protected]. Visit her Web site at www.DentalWriter.com.