There are many good reasons to bill medical insurance from the dental practice, and one of them is that dental insurers require the dental practice to file some services to the medical insurer first! Suppose you have not run into this scenario already in your dental practice. In that case, you likely will soon.

Here at Nierman Practice Management (NPM), we assist dental practices in billing medical insurance. We hear from our clients that dental insurers return claims without processing them, stating that “the service(s) must be filed to the medical insurer before we will process the claim.” This proclamation by dental insurers has become more frequent!

Services that dental insurers require dental practices to file to the medical insurer first run the gamut from extractions, bone grafts to surgeries such as cyst removals or accident cases.

Some claims, such as sleep apnea appliance claims, should always be billed to medical insurance. But why do dental insurers require other services to be filed to the medical insurer first? Because the services may be considered medical in nature (medically necessary) instead of dental in nature. Dental insurers are starting to “pass the buck” as lines between medical and dental insurance blur.

What’s needed to bill medical?

Your practice must be equipped with the proper education and systems to code and file these services to medical successfully! This includes:

  • Utilizing medical diagnosis (ICD-10) and procedure (CPT) codes
  • Completing the medical claim form (CMS 1500)
  • Thoroughly document the patient’s chief complaints (they may be medically necessary), your diagnostic findings, and the treatment plan in a medically necessary format.

Other significant benefits of dental practices filing to their patient’s medical insurer for medically necessary services include:

  • Increasing case acceptance by maximizing the patient’s benefits
  • Setting the practice apart from other dental practices
  • Increasing access to care
  • Increasing both patient word of mouth and physician referrals
  • Saving the limited dental benefits for other needed care

Whether you bill medical insurance on behalf of your patient or outsource your medical billing to a third-party company, dental practices can learn how to bill medically using a repeatable system.

 

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Nierman Practice Management also offers Nierman Medical Billing Services to help dental practices with all their medical billing needs. Nierman simplifies medical billing in dentistry, allowing dentists to stay focused on the patient work, while we do the paperwork. Learn more here.

Article by: Rose Nierman and Courtney Snow

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