The fact that something is legal doesn’t always guarantee acceptance. That’s the tension often felt when the opportunity presents to determine the procedures your dental practice can bill to medical insurance.
Tension aside…it IS completely legal and recommended that you take advantage of the opportunity to bill a patient’s medical insurance for certain dental procedures.
Why your dental practice should be comfortable with billing procedures to medical insurance
A boost to your revenue cycle
This isn’t about self-interest. It’s more about taking advantage of an often untapped revenue stream.
Cross billing is shown to add 30 to 40 percent more revenue to practices than those that only bill to dental insurance. Depending on the procedure, billing medical insurance for dental treatment could be the difference of reimbursements in the hundreds or thousands.
An increase in case acceptance
Cost prevents many from seeking dental treatment. The ADA (American Dental Association) confirms that 59% of patients postpone dental care due to cost.
The same patients are perhaps unaware that their medical insurance plan could potentially cover their necessary dental procedures - again depending on the procedure. Being uninformed will impact case acceptance especially for patients who have limited cash flow to pay for essential treatment.
- Dental insurance plans pay (on average) an annual plan maximum of $1000 to $2000
- Medical insurance providers typically have no annual maximum
This is good news for your patients and your dental practice.
Improve patient relationships and overall patient health
Give your patients an additional financial solution and you could increase their loyalty to your practice. Your patients will welcome your advocacy when you provide them another way to get the treatment they need or desire.
- Your patient’s health will be maintained more consistently
- Timely treatment can save them longterm care costs
Billing a patient’s medical insurance for accepted dental procedures gives them a health advantage. And your advocacy with insurance providers deepens your patient’s relationship with you and your practice.
The procedures your dental practice can (and perhaps already is) billing to medical insurance
It could be fair to say that over 70% of the procedures you can bill to medical insurance are procedures you’re already doing day to day.
Clarify your opportunities by thinking “categorically” about your patient treatment
According to a related article in Dentistry IQ there are four categories you can use to evaluate billing decisions.
- “Category 1: Diagnostic procedures” - these are procedures used to diagnose a recognized medical condition. For example, an x-ray to pinpoint the location of impacted teeth or imaging that attempts to source jaw pain - each are considered a medically diagnostic procedure.
- “Category 2: Non-surgical medical treatments”- certain treatments can be billed as medical if they’re unrelated to traumatic injuries and can treat a medical condition. Conditions include “…emergency treatment for infection or inflammation, incisions and drainage of abscesses, curettage of periodontal abscesses, appliances such as night guards, TMD orthotics and sleep appliances, at-home fluoride trays for patients undergoing cancer treatments, or for patients who suffer from anorexia or bulimia.” It’s key that the dental treatment is linked to a diagnosed medical condition that’s covered by your patient’s insurance policy.
- “Category 3: Surgical treatments” - surgery is typically billed as a medical treatment. Tooth removal that is medically necessary can include impacted teeth and teeth that require removal prior to radiation therapy or an organ transplant. These can be billed to medical insurance as can soft and hard tissue biopsies, extractions, and the surgical placement of dental implants.
- “Category 4: Treatment for traumatic injuries” - before seeking coverage for these via medical insurance confirm that the injury isn’t already covered by auto, homeowners, or other liability coverage. Liability insurance must be billed first before billing medical insurance. And an injury that requires treatment to restore a patient’s original oral appearance or function (e.g. restorative care, endodontic treatment, oral surgery, implants, and prosthodontics) can be covered.
Confirm your billable opportunities and get comfortable with the options available to your dental practice
A comprehensive overview of the medical billing process and the specific procedures your dental practice can bill to medical insurance is available in the following resource.
Implement the right system and you can help your patients consistently maximize their insurance coverage. Patient relationships will improve as you become their insurance advocates.
Planet DDS’s Denticon Dental Practice Management Software helps you standardize those systems that also help you assist your patients with their insurance benefits.
Contact us for more information about how Denticon can streamline your systems that help you manage all aspects of your dental practice - including insurance reimbursements.