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• Prior to starting any procedure it is imperative to obtain pre-authorization or pre-certification from the dental carrier or at times the medical carrier
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• Ascertaining if coordination of benefits clause has been included. This usually states if the dental carrier makes the payment then the medical carrier will not be liable and vice versa
• In a case of no coordination of benefits clause the dentist can maximize payments and minimize the patient's expenses by- billing both the medical and dental carrier
• While billing both carriers normally the dental carrier is billed first; however the medical carrier is billed first when the biller is confident that the medical carrier will make the payment
Commonly for procedures like impacted wisdom teeth, gingivectomy/gingivoplasty, subepithelial tissue grafts, alveoloplasty, and osseous surgery the medical carrier makes the payment.
Billing the medical carrier for dental procedures - MBC experts generally cross reference a CPT code to determine if the dental code to be used has a compatible medical code. In case no compatible medical code (CPT) exists, the CDT "D" codes are used for submission.
Additionally during submission the CMS-1500 form (formerly HCFA-1500) is used instead of the commonly used dental ADA form, along with a copy of the denied EOB (explanation of benefits) or request for primary carrier denial from the dental carrier.
The most common billing and coding problem that dental practices face is determining how to bill a procedure which involves both the dental and medical carrier.
Other problem areas that currently plague dental billing include- appeals process, coding surgical procedures, understanding an EOB, credentialing with medical carriers, and so on.
MBC experts are of the opinion that - "by outsourcing their billing requirements; numerous US dental practitioners have been able to counteract challenges and increase their savings significantly."
How MBC experts ensure maximum savings for dental practices?
MBC helps reduce payment delays, claim resubmissions and avoid under or non payments by-
- Ensuring accurate payment settlement with - suitable depiction of dental services under their various categories and subheads in the billing system
- Avoiding unnecessary denials by - providing accurate details of the surgery and the treatment devised by the physician
- Attaining the right level of detailing- as in certain cases detailing can be directly proportional to the rate of payment reimbursed
- Accurate verification of patient's insurance eligibility through calls or online checks
- Constant checks done of preauthorization number, deductibles, plan exclusions, claim mailing address, policy status, etc
- When required obtaining additional information by contacting the patient
About Medicalbillersandcoders.com
Medicalbillersandcoders.com is the largest 'Consortium of Medical Billers and Coders,' across the US. (California Medical Billing, Florida Medical Billing, New York Medical Billing, Ohio Medical Billing ).The portal brings together hundreds of billers, with experience in different specialties ( Internal Medicine Billing, Cardiology Billing, Podiatry Billing, Family Practice Billing, Radiology Billing, Gastroenterology Medical Billing, Orthopedic Medical Billing, OB-Gyn Medical Billing ), on the same platform to service physicians in their local areas. This network of coders and billers is growing rapidly and is currently servicing over 50 specialty physicians, across the US.
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http://www.medicalbillersandcoders.com/ Medical Billing Blog
SOURCE MedicalBillersandCoders.com
