The Importance of this Insurance System in Dental Practices
By: Marianne Harper
Has it happened in your practice yet? You open an envelope from a dental insurance plan expecting that it contains a claim payment but instead you read the EOB and it states that you must file this claim with the patient’s medical plan prior to the dental plan considering coverage. Is your first reaction – “we are dental, not medical, and we don’t know anything about completing medical claims?” If this has happened to you, you’re not alone.
Dentistry is gradually adopting the medical model which is resulting in much improved overall body health for our patients and better collaboration with physicians. Dental-medical cross coding is a consequence of this shift. Both dental and medical insurance plans are recognizing this and that is why we are having dental claims suspended till filed with medical.
There are numerous instances when a dental procedure can be medically necessary and can then be filed with a patient’s medical insurance plan. Examples of medically necessary dental procedures are the following:
- Trauma procedures
- Medically necessary oral surgical, laser, and periodontal (and this should only continue to grow with continuing research into the oral systemic link),
- Medically necessary implant procedures
- Medically necessary endodontic procedures
- Medically necessary Prosthodontics
- Management of atypical facial pain
- TMD procedures
- Sleep apnea appliances
- Screenings for oral cancer and salivary abnormality
- Medical request for minor salivary gland biopsy in cases of suspected Sjogren’s disease
- Physician or surgeon requested dental clearance prior to surgery
- Any medically necessary exams and X-rays that are associated with the above procedures
- Screenings and tests such as oral cancer screening, HgA1c, C-reactive protein, BANA, DNA testing, TOPAS, oral HPV, diabetes testing, saliva testing
Dental practices need to make a decision as to how to handle this aspect of the paradigm shift in dentistry. Part of the decision will be whether to implement a cross coding system in the practice or whether to outsource these claims. There are advantages and disadvantages to both. Cross coding is definitely more difficult than dental coding but, with proper training, can be successful.
In considering implementing cross coding internally, you will need to discover if your practice management software has a medical coding component. If so, insurance staff will need to learn how to handle cross coding and can then implement this system. Not all practice management software systems can handle cross coding but there are software programs available that can be used for claim completion independent of the dental software. For practices that choose to handle the claims internally, it will take time and effort to learn but should not be a costly implementation. You should weigh the amount of cross coding that you predict will occur in your practice as one of the factors in your decision.
Outsourcing is an option for those practices that either don’t choose to learn cross coding or don’t have the manpower to implement it. One company that handles these outsourced claims is Dental Medical Coding, L.L.C. The companies that handle the outsourcing usually charge a percentage of the benefit payment. However, practices that outsource claims will still have to be involved with providing information to the coding company.
Advantages to implementing cross coding are significant. In addition to being able to handle requests by dental insurance plans as was described above, there is a huge financial benefit. If a patient’s medically necessary dental procedure is covered by his or her medical insurance plan that probably does not have an annual maximum, case acceptance and the resulting increased practice revenue will result. There is also a marketing benefit because those patients who you help financially by obtaining extra insurance benefits will be very thankful and will spread the word that your practice goes the extra mile for its patients.
Whatever your choice, you will need to know at least the basics of cross coding. I provide many tools to help dental practices implement this important coding system. Please check my website, www.artofpracticemanagement.com for services and products that can make the process much easier.
You will discover that helping your patients through cross coding will result in helping your practice financially.
Contact Information:
Marianne Harper
The Art of Practice Management
2217 Fox Horn Rd.
New Bern, NC 28562
252-637-6259
[email protected]
