As documentation linking oral health and overall health of the human body continues to build, more and more dental practices are recognizing the value of filing medical claims for many of their procedures. While this knowledge leads to more opportunities for filing claims with medical carriers, it also requires dental practices to learn how to do it.

Incorporating medical billing in dental practices has turned out to be a win-win situation for everyone. Patients are going forward with treatment, doctors are being paid, and satisfied patients are eagerly referring their friends and family. No doubt, your office will enjoy the rewards that come from happy, patients, profit stability, and a team that will receive compliments on a daily basis.

Here is a current list of dental procedures that can and should be filed with medical carriers:

Trauma procedures Medically necessary oral surgical, laser, and periodontal procedures Medically necessary implant, endodontic, and prosthodontist procedures TMD procedures Appliances to treat sleep apnea Screening to detect oral cancer Medically necessary exams and x-rays, including CT scans, associated with any of the procedures listed above

The following example illustrates how dental practices and their patients can reap the benefits of this billing process: After a nonsurgical periodontal treatment was done on a patient with the medical diagnosis attached, the office that performed the service billed both dental and medical insurance. Not only was the entire cost of treatment covered, but the patient’s only out-of-pocket expense was for home-care products. Staff members were amazed at the number of cases that met the criteria for filing a medical claim. It became quite clear that the increased profits from these cases far surpass the time and expense to learn how to file medical claims correctly.

While some similarities exist between preparing a dental claim and a medical claim, such as patient demographics and insurance demographic sections, there are also some significant differences, such as in coding systems. For instance, medical carriers ask for more than just a procedure code, which is all that is required by dental carriers. Medical carriers also require the reason (which is the patient’s diagnosis) why the particular procedure was done. Therefore, medical necessity is probably the most important element of successful dental-medical cross coding.

Dental practices that choose to implement a dental-medical cross-coding system will undoubtedly experience a positive impact on their day-to-day operation. Patients will certainly appreciate the fact that you are willing to help them obtain medical benefits… and word of mouth is one of the most effective marketing tools that exists in any service business.

By: Heather H Brunson

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