For people all over the world, a trip to the dentist can be fairly anxiety-inducing for patients – and that’s without having to worry about how they should handle the insurance billing for any of their dental procedures. For the owners of dental practices, understanding how to bill medical insurance for dental procedures is vital for any practice operating throughout the country. This isn’t strictly for the success of your practice but is generally a crucial factor for giving your patients quality medical treatment.

Once you’ve gained a more solid understanding of your patient’s medical insurance, it’s a lot easier to find ways of providing them with more affordable options and ultimately build stronger relationships with them.

Throughout this article, we aim to break down all you need to know about how to bill medical insurance for dental procedures – from understanding your patient’s medical plan to the various dental services/dental benefits. So let’s get started!

Understanding Medical Insurance & Dental Procedures

Though they certainly share their similarities, there are a few distinct differences in their claim submission process that are vital to come to terms with.

Dental Insurance vs. Medical Insurance

These are separate forms of insurance that, while similar, ultimately cover different aspects of healthcare. Starting with the topic of the article, dental insurance, this normally refers to any oral health-related expenses, including a range of things from emergency oral surgery and cleanings to the more basic surgical procedures in between, like fillings and extractions.

On the other hand, the more commonly studied medical insurance covers expenses for all things healthcare, meaning costs like illnesses, injuries, or any other condition that might affect the body.

Obviously, dental and medical care are both necessary for maintaining your patient’s overall health, but they’re still treated as separate issues when it comes to filing claims for insurance coverage. Simply put, dental insurance is meant to cover the cost of any dental surgical procedures performed, whereas medical insurance is more for general medical procedures and treatments.

Benefits Of Effective Medical Insurance For Dental Procedures

As mentioned, your dental practice isn’t the only people who benefit from a straightforward billing process; your patients do too. Naturally, your practice is always looking for ways to boost revenue, and that’s exactly what you’ll get with an effective billing system in place. For your patients, it might mean much lower out-of-pocket costs as well as more streamlined access to the care they need.

Furthermore, by working together with medical insurers to see which procedures are covered and which are not, your practice has a much easier time providing your patients with the right care without the risk of unexpected costs or a denied medical claim.

Guide For How To Bill Medical Insurance For Dental Procedures

Like all kinds of medical billing, there are a few key steps that should be taken in order to submit claims with the utmost accuracy. Let’s have a closer look at each of these steps in more detail:

1. Check Medical Necessity

Before you begin, it’s worth checking if the dental procedure your staff are going to perform is actually medically necessary, meaning it’s a vital treatment required to diagnose or treat a medical condition, not just for cosmetic or aesthetic purposes.

It’s likely that your team already knows how to deduce the medical necessity of any given procedure, but it’s always worth being confident by having it confirmed by a medical billing team.

2. Proper Documentation & Coding

For any part of the medical billing process, you know how vital a role proper documentation and coding play to ensure there are no hiccups or issues with any of your claims. Make sure your team is documenting the procedure accurately, including all the relevant information regarding the patient’s medical necessity and condition.

Furthermore, it’s crucial that your medical billing team are using the correct CPT codes to bill your patient’s insurance providers, as any errors in coding can be a nightmare to resubmit – not to mention the waiting time for your patient.

3. Submit Claims & Follow Up

After you’ve fully completed the medical procedure for your patient, the medical billing team will begin issuing the claim to the insurance provider. After some time has passed, they’ll follow up with the insurer to ensure the claim has been processed so your practice can get paid for the services rendered. If, for whatever reason, there’s been a rejection,

After the procedure has been completed, the medical billing team will submit a claim to the insurance provider. They will then follow up to ensure the claim is processed and paid in a timely manner.

Why Consider Outsourcing to PMN?

As a smaller practice in the United States, there’s a good chance your staff may be struggling with an effective medical billing process – mostly down to a lack of resources and time allocation. To gain a firmer understanding, consider outsourcing to PMN!

PMN’s team has extensive experience in all disciplines of medicine, including an understanding of how to bill medical insurance for dental procedures. From A/R and patient collection management to reports and claim submission, there’s a range of ways you can utilize PMN to free up your staff’s time and resources. If you’re interested in learning more about PMN, get in touch today at (949) 215-5055 or by visiting their office in Laguna Hills, Orange County, California!

FAQs

Is It Possible To Bill Annual Dental Insurance Benefits For Routine Dental Cleanings?

Unfortunately, a lot of routine dental cleanings or preventive dental procedures are not covered by medical insurance, but the patient’s annual dental insurance benefits instead (which are billed separately from medical insurance). Having said this, there are still a few procedures that may be considered medically necessary, and these will be covered by medical insurance instead.

How Can I Determine If a Dental Procedure Is Medically Necessary?

Aside from performing a careful assessment of your patient’s medical history, it’s vital to consider their oral health condition too. To be classified as “medically necessary”, the surgery has to have a direct impact on their overall health or address an underlying medical condition. If your dental office is struggling to obtain the right information to determine this, they can always contact the patient’s primary care physician to gain some clarity.