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    Medical billing for dental surgery: What you need to know

    It’s not always easy to get medical insurance to pay for dental operations, but these tips will help make the process a lot smoother.


    You can also expand, in writing, on other contributing factors from the patient’s medical history. For instance, a root canal may be related to an earlier auto accident, or tooth loss may be complicated because of a past history of cancer.

    The process of choosing codes can be confusing, but often it’s simply a matter of telling a clear, accurate story. For instance, consider implants. The insurer wants you to answer two main questions about medical necessity. First of all, you have to explain why they lost the tooth. In general, the cause is either going to be an accident or bone loss. Then you need to explain why the tooth must be replaced. Usually the reason is either that they’re suffering a loss of function or that tooth replacement is covered because of some other medical condition, such as cancer.

    Related article: Are you overlooking your most valuable practice management asset?

    In addition to your LMN, it can be helpful to get a supporting letter signed by your patient’s PCP. This provides the insurance company with more evidence that your procedure is necessary. Remember, you’re trying to build an ironclad case for your treatment plan, so that the insurer understands that treatment is necessary and that your treatment addresses the patient’s problems.

    Filling out a claim form: tricks of the trade

    When you reach the Medical Claim form, there’s a right way and a wrong way to fill it out, and it’s not covered in the form’s instructions. Insurers pay claims for procedures at a given surgical site in the order they’re listed on the form. The first procedure listed may be paid at 100 percent, for instance, the second at 75 percent and additional procedures at 50 percent. If you list the procedures in the order they occurred, you may lose money.

    Instead, list the procedures for each surgical site in order from the most expensive to the least expensive procedure. This will help you maximize your reimbursement from the insurer.

    Always double check your codes before submitting a form. Take the time to read over the patient information as well. Typos and other errors can cause the insurer to reject your claim or delay your reimbursement.

    Include supporting documentation with your claim. Lab reports or diagnostic imaging can help prove your case. Send copies of your letter of medical necessity, any medical review results and pre-authorization. It doesn’t matter if the insurer already has these documents somewhere in the system. Submitting them with your claim can speed up processing.

    An art, a science and a learnable skill

    Finally, remember that medical billing is a both an art and science. Forms need to be filled out correctly, and you have to carefully follow each insurer’s rules and processes. On the other hand, within those rules, you need to learn how to paint a compelling picture of medical necessity.

    Related article: 8 ways to make insurance less of a pain

    You and your office staff may benefit from training so that you can get the most from your medical billing efforts. A crash course in anatomy, medical terminology, and surgical modifiers and qualifiers will help you billing department prepare and proofread claims so that insurers accept them and reimburse in a timely manner.

    Your patients deserve to receive the treatment they need when they need it. Learning to work with medical insurers can be an important step as you strive to protect their health and improve their lives.

    Christine Taxin
    Christine Taxin is the founder and president of Links2Success, a practice management consulting company to the dental and medical ...


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