Sleep in Dentistry - How Medical Billing works
Medical billing for dental procedures is a frequently overlooked opportunity that can assist patients in accessing essential while enhancing reimbursement for dental practices. However, many dental offices face challenges in understanding the distinctions between dental and medical billing, resulting in lost revenue and denied claims. This guide will outline the essential steps to successfully bill medical insurance for dental services.
Common Dental Procedures That Qualify for Medical Insurance
Not all dental procedures are eligible for medical insurance reimbursement; however, many treatments that address systemic health issues or medical necessity do qualify, including:
Oral surgeries (e.g., wisdom tooth extractions, biopsies, frenectomies)
Sleep apnea appliances and oral devices
TMD/TMJ treatment for jaw disorders
Trauma-related dental work (e.g., treatment after an accident)
Medically necessary extractions for infection control
Bone grafts related to pathology or trauma
Key Differences Between Dental and Medical Billing
Codes: Medical insurance uses CPT (Current Procedural Terminology) and ICD-10 (diagnosis codes), while dental billing relies on CDT (Current Dental Terminology) codes.
Documentation: Medical billing requires detailed narratives, SOAP notes, and proof of medical necessity beyond standard dental charting.
Pre-Authorizations: Many medical insurers require pre-approvals and medical necessity documentation before treatment.
Steps to Submit Medical Claims Correctly
Verify Insurance Eligibility: Confirm the patient’s medical coverage and pre-authorization requirements.
Determine Medical Necessity: Provide thorough documentation, including clinical notes, X-rays, and physician referrals if needed.
Use Correct Coding: Match procedures with CPT and ICD-10 codes to ensure claim acceptance.
Submit the Claim to Medical First: File claims with the medical insurance provider before billing dental insurance as a secondary option.
Appeal Denied Claims: Many claims are initially rejected due to missing information—always follow up!
Best Practices for Streamlining Medical Billing
Train your team on medical coding and documentation.
Work with a medical billing specialist to ensure compliance.
Use an integrated software solution for claim submission.
