Should you be billing medical insurance instead of dental?

Rose Nierman and Courtney Snow discuss the steps you can take to help patients access care, especially for larger cases

What steps can you take to help patients access care in today’s economic environment, especially for larger cases? Dental practices are offering great financing options to make care accessible, and many are taking it a step further by filing medical insurance for patients that want to move forward. Medical insurance billing for oral surgery such as cone-beam CT, bone grafts, and implants can be the icing on the cake as patients gain extra financial help from their medical plan. Keep in mind, you can remain fee-for-service and file a patient’s medical benefits as courtesy billing. Here are three common questions we get from practices wanting to get started with medical billing:

• Why bill medical insurance?
• When would you file for medical instead of dental?
• How do you start and make it easy for you and your team?

The Why

Case acceptance increases when patients know their insurance benefits are being maximized, reducing the out-of-pocket cost for services or helping satisfy medical deductibles. In the current economy, flexible financial options (outside financing and medical billing combined) make it more possible for many patients to afford treatment. The more affordable the treatment, the more likely patients will say “yes.” Happy patients lead to increased word-of-mouth referrals, and many are thrilled to find a dental practice that files medical. Here at Nierman Practice Management, we frequently receive inquiries via email, phone, and live chat directly from patients seeking a dental practice that knows how to file medical! Patients are increasingly asking dental providers if they can tap into their medical benefits and are even shopping around for those providers. You may also run into situations where dental insurance requires filing of medical plans first.

The When

Criteria for bone grafts and implants to qualify for medical coverage are accidental injury, cyst or tumor removal, and functional impairment. For accidental trauma, the medical plan must cover services to return the patient to pre-accident condition. If teeth need to be removed to excise or drain a cyst, some medical plans will cover the replacement of those teeth. For functional impairments, you may encounter patients whose condition limits their diet to semisolid, soft, or liquid food, and who cannot tolerate or accommodate a denture. Other billable procedures include exams, radiographs, frenectomies, mucositis, myofascial pain dysfunction (Botox^®), third molar extractions, obstructive sleep apnea and TMJ appliance therapy.

The How

The first step is to obtain a verification of medical benefits. This will give us a good snapshot of their coverage and out-of-network benefits. If it looks good, then the next step is to have a conversation to set proper expectations on reimbursement. Then gather the pertinent chief complaints and document your exam findings and diagnosis in a medical necessity format (SOAP reports) and complete the medical claim. If that sounds like a lot of work, don’t worry; there is software that can do it for you. Many practices outsource the billing to make it easy, taking less dental team-member time away from patient care.

Now that you know the why, when, and how, it’s time to take action! You can incorporate medical billing in your practice with the right tools. Now is the time to transform your practice by offering another financial option to help patients move forward while setting your dental practice apart — above the rest.