Medical billing for dentists – beyond the hype

By Shurna Decou

Is medical billing for dentists the new gold rush?

Medical billing for dentists has become a red hot topic. Weekend workshops are filled with dentists and office managers, sold by the promise of higher reimbursement and an easy transition into medical billing.

There is so much buzz that it has taken on the feel of a gold rush for dentists.

From a dental provider perspective, medical billing makes sense. After all, dentists are essentially physicians of the mouth. And research highlights the connection between oral health and overall health, especially when it comes to chronic diseases such as heart, kidney or diabetes.

But for many dentists, the reality of implementing medical billing into their practice isn’t as simple as they were led to believe.

Dental office experience

A few years ago, Dr. Robin Levy and her office manager Moira Easley from Levy and Vutera Family Dentistry in Baton Rouge, Louisiana went to a weekend course. Dr. Levy believed medical billing would be an excellent way to lower out of pocket expenses for patients.

The course was packed with information, forms and templates, along with detailed examples with diagnosis and treatment codes. They were excited about how this would help alleviate some of the financial burden for patients. The reality has been a mix of successes and challenges.

They had a patient who fell and sheered his teeth off. He needed a CT scan and extensive dental work in what should have been a clear cut approval for medical treatment.

After 1 ½ hours on the phone, Easley got the pre-authorization for the CT scan from the patient’s medical insurance plan. But the plan would only pay $20, a fraction of what was expected for this service.

Easley pressed on and filed the paperwork for his implants, but the patient’s medical insurance declined it, because it was coming from a dentist office.

“We are in a quandary, because the patient’s plan didn’t want to pay,” Easley said. “And if it didn’t pay, we are going to have to charge the patient, and we don’t want to do that.”

Learning Curve

Determining the diagnosis or ICD-10 codes for medical billing was another hurdle, Easley said. There could be multiple diagnosis codes needed for a medical claim. Was the tooth pulled? Why was it pulled? Did the patient fall from riding a bike? Did he fall off a ladder?

The biggest challenge of medical billing is the learning curve, according to dental billing consultant Dr. Charles Blair.

“A lot of these classes use hype to get dentists into their courses and they come back cross-eyed,” Dr. Blair said. “They will put in 10 claims and just a few of them will get paid, but the rest get declined. And they end up falling off the wagon.”

Resistance to change among staff can be another issue. And when an experienced billing employee gives two weeks’ notice, there may not be enough time to hire and train the new person.

High deductibles in medical plans present still another challenge.

“Many medical plans include a high deductible of $2,000 to 3,000 and higher. If the deductible hasn’t been met at the time of treatment, the patient isn’t any better off,” Dr. Blair said.

Diving in eyes open

Hiring staff who are committed to learning medical insurance billing is a good place to start, explains Dr. Blair. Also, buying the medical code books (ICD-10 and CPT) and getting the latest editions as they get updated every two or three years will help.

“For general dental practices, there will be some trial and error, so it’s important to keep expectations realistic on medical insurance payments,” Dr. Blair said.

Some medical plans pay for things such as frenectomies for newborns, biopsies, trauma, TMJ, CT scans and appliances for sleep apnea. Unfortunately, there are no statistics publicly available on how much medical billing will boost revenue at the time of publication. But dentists should consider doing some calculations of the total start-up costs, such as training and potential software, then comparing those numbers to potential revenue.

A course in medical billing is also going to be key in getting started. Dentists should keep in mind there is no wiggle room in submitting clean claims to medical insurance, so it’s worth the effort to get it right before sending them off. And, if possible, the dentist should attend a medical billing course along with the primary staff responsible for billing. Proper documentation is all important.

There are no hard and fast rules for determining whether a dentist should get into medical billing, but it’s definitely worth considering for specialties like oral surgeons and specialized procedures such as sleep apnea.

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About Unum Group

Unum Group provides a broad portfolio of financial protection benefits and services through the workplace, and is the leading provider of disability income protection worldwide. Through its Unum US, Unum UK, Unum Poland, and Colonial Life businesses, the company provides disability, life, accident, critical illness, dental and vision benefits that protect millions of working people and their families. Unum also provides leave and absence management services that streamline the leave experience for employers and employees, and stop-loss coverage to help self-insured employers protect against medical costs. Unum reported revenues of $12 billion in 2019 and paid $7.5 billion in benefits.

 

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