Medical billing is definitely the new shiny toy that is getting lots of attention lately. Each week, I receive several e-mails from offices asking if they should or shouldn’t use medical billing in their practices. The answer is … well … it depends. It depends on whether you have medical necessity. You can’t just bill medical for an oral appliance because it is covered under a patient’s medical plan. You must have medical necessity and proper documentation.
There are many considerations when deciding to take on medical billing. The office I worked at for 18 years performed a lot of neuromuscular, head, neck, and facial pain treatment and medical billing was an integral part of our billing process. I think medical billing can be a huge value-added service. However, I want you to go into it with eyes wide open.
- You must have a medical diagnosis – If the patient is being referred to you for an oral appliance from his or her physician for sleep apnea or TMJ, usually the physician can provide you with the diagnosis code and any clinical documentation that will be necessary for the claim. However, if the patient is not being referred, then your doctor will need to provide the diagnosis code for claims processing.
- Medical is billed on a different claim form – If you are going to process the claims for your patients, you will need to send them electronically on a HCFA1500 claim form. Medical insurance plans will no longer accept paper claims from the practice, but you can give patients a paper HCFA1500 claim form to submit to their insurance if you choose.
- Be prepared for denial, denial, and more denials – Medical is worse than dental when it comes to stalling payment. You may want to consider having the patient pre-pay for treatment, then reimbursing him or her when the medical insurance pays.
If I haven’t scared you off yet and want to pursue medical billing in your office, check out an article I wrote last year on getting started with the setup in your Dentrix software by CLICKING HERE. E-mail me directly if you want one-on-one training for your team to learn medical billing in Dentrix.