How to Bill Dental Surgeries to Medical Insurance?Med Miles LLC
Oral health plays a key role in the overall well-being of a human. Good oral health leads to a healthy lifestyle. So dental hygiene plays an important role in our life.
Dental billing Is more complicated compared to other medical billing activities. One of the most difficult tasks a dental surgeon faces is to guide their patient about how they are paying for the services.
The majority of the time patients are clueless about the consequences of their dental health which if not treated earlier can lead to serious health conditions. Dental surgeries are relatively more expensive and it has a very low benefit cap.
Meanwhile, medical billing for dental surgery is more suitable for patients who can’t afford the expenses of dental treatment. Not only for the patient but a dental practice can get maximum reimbursement from the insurance company.
Tips to Get Medical Insurance For Dental Surgeries
To get medical insurance for dental surgeries you need to make a very strong case that the patient’s dental health is associated with his overall health condition. For this purpose, you will require proper documentation like;
- The initial condition of the patient represents the complications.
- A secondary note with supportive diagnosis
- An appropriate diagnostic code as these codes are used to get reimbursement so the appropriate diagnostic code is essential for the treatment you plan for the patient.
- A surgical preauthorization is also essential for the treatment.
- A letter termed as a medical necessity this letter recognizes that the surgery is necessary to treat the patient for his underlying health condition.
- A support letter from the patient’s primary care physician has also required. A support letter to make sure that the patient needs dental surgery to avoid a serious health condition.
- Lastly, the documentation of the procedure that is performed at each surgery location should be given as this documentation is critical for the coding purpose which eventually gives your dental practice reimbursement from the insurance company.
This will give a clear picture to the insurance service provider that the dental treatment or surgery is performed to treat a medical condition.
Dental Procedures That Are Covered By Medical Insurance Payers
Below are some of the dental treatments and procedures that will be covered by the health insurance provider. This coverage is according to the plan of the patient and the coverage of the procedure and treatment by the insurance payer. Let’s have a look!
- Any accidental injury which required dental restorations.
- Any kind of oral infection can impact the body function of the patient.
- The treatment that is related to cancer complications.
- The cone-beam computed tomography (CBCT) is used to get the data by using a cone shape X-ray that is used to create a 3D image of the teeth.
- Frenectomy, a procedure that is used to remove the connective tissue from the upper and the lower side of the mouth or specifically under the tongue and it is usually recommended for newborns suffering from speech eating or other oral disorders.
- Treating sleep apnea which is a serious sleep disorder in which a patient suffers from interrupted breathing during sleep, dental appliances are used to treat sleep apnea for patients who suffers from moderate to obstructive sleep apnea these instruments will prevent the tongue to block the throat and lower jaw region and that eventually leads to help in passing the air during the sleep.
- Gentle biopsies are usually used to get tissue from the patient’s oral cavity.
- The treatment that is used to treat congenital malformation.
These were some of the treatments that are covered by the insurance service provider.
Step By Step Guide To Get The Reimbursement
There are some steps that you need to consider to get reimbursement from the medical insurance payer for the dental surgery.
A pre-authorization Process:
A pre-authorization is an initial step to getting a reimbursement. As you are providing dental services to the patient or treating any other underlying health complication. When a patient visits to get treatment the first step you do is to verify the insurance eligibility and insurance coverage.
Many times patients are not familiar with their insurance coverage. Complete information related to copays and deductibles helps you to guide the patient to pay their liability so a pre-authorization can save your practice revenues.
The letter for medical necessity is a type of statement which is written by a doctor that clarifies the services or instruments which are used to treat the patient from a medical condition.
Through the letter of medical necessity, a dental service provider can get reimbursement from the insurance company by highlighting the case for surgery.
You can get the reimbursement by giving appropriate reasoning for the surgery. In that case, you need to use the proper ICD-10 coding procedure; an insurance company only approves those claims that are properly managed under ICD-10 coding.
For the claim approval, list down the most essential part of the procedure to the least essential part.
The appropriate cording is the key to getting reimbursement your dental practice has to explain to the insurance provider about the need to have the dental surgery like if a patient loses his tooth and has other medical complications like cancer or diabetes then it becomes essential to get a tooth surgery to prevent the further complication.
Filling and submitting the claim:
The last step is to properly check, fill and submit the claim. In the earlier section, we have discussed that we should list the procedure and treatment for the surgery from the most appropriate or most expensive to the least appropriate or the least expensive procedure.
Before submitting the claim make sure that your claim is appropriate, all the essential information is embedded and there is no coding error in your claim.
To make your case stronger always include some supporting documentation with your claim like you can add Lab reports for dog diagnostic imaging.
If you are facing any denied claim due to some kind of error in your claim then your practice should find out those errors and resubmit the claim and consistently follow up with the insurance companies to get reimbursement.
Get desired results and maximize your revenues with Med miles. Med-Miles LLC provides the best solutions to get maximum reimbursement. Call us at (888) 598-9181 for more information.