Medical Billing in the Dental Office

The Michigan Medical Billers Association is providing a special presentation with Christine Taxin, of Links2Success, who is well known for guiding dental providers on what and how to bill dental procedures medically.

Sometimes one of the most difficult parts of performing dental surgery is helping your patients figure out how they are going to pay for it. You see a deteriorating oral health situation that can impact their whole-body health, but they’re focused on the cost of the procedure. Unless you can find a way to help them pay, you are not going to be able to solve their problems.

Christine Taxin is going to educate us billers on how medical billing for dental surgery can make it easier for the patients to afford treatment. Dental insurance often has low benefit caps. Meanwhile, if a surgery is medically necessary, medical insurance may reimburse up to 70 percent of the cost. When you add medical billing capabilities to your office, life gets easier for your patients. However, making the switch means changing how you think about medical necessity and how you document it.

To receive reimbursement from medical insurers, you need to make a case that proves that dental surgery is necessary for the patient. To make your case, you need to explain your decision process in terms a medical insurer can understand using ICD-10 codes and CPT codes. These codes may appear like the CDT codes that you are familiar with, but they are more detailed and take time to learn.
To succeed in your medical billing claims, you need to document correctly, update your Medical History Forms, learn what the top 10 procedures are that need pre-authorization, and the proper way to fill out the claim. If done correctly, this can result in a higher payment to the provider.

You will need to learn how to use a SOAP form to have each part of the team help explain their role:
Subjective: Administration
Objective: Assistant, Hygiene, and Doctor
Assessment: Doctor will review all tests, CBCT and/or x-rays to confirm type of procedure
Plan: Administrator

The objective of this presentation includes determining the primary and secondary (supportive) diagnoses, surgical pre-authorization, medical necessity letter writing, the process of choosing the best codes and the tricks of the trade to fill out the claim form. All these plus other helpful tips to help your office bill for the highest reimbursement through medical insurance. Biopsies, TMJ, sleep apnea, implants and DME products are just a few of the other procedures provided by dental professionals that should also be billed through medical insurance as well.

Finally, remember that medical billing is both an art and science. Forms need to be filled out correctly and you must carefully follow each insurer’s rules and processes. On the other hand, within those rules, you need to learn how to paint a compelling picture of medical necessity.

Date of presentation: Wednesday, April 27, 2022
Time: 12pm to 1pm
To register for the event, please visit:

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If you are a dental provider, this is one presentation you cannot afford to miss!

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MMBA EAST CHAPTER SPOTLIGHT!!!

Michelle Pierson, CMRS, CMCS                

Michelle has worked for Oral and Maxillofacial surgeon D Gary Wolford DDS since 1996. She started in the office as his receptionist and through the years has worked to become the surgical scheduler, referral specialist and insurance credentialing liaison. In 2014, she became the office insurance biller/coder and one year later the office manager as well. Michelle has been a part of the Michigan Medical Billers Association for over 8 years! In 2017, she completed the CMRS course and during the 2020 COVID shutdown completed the CMCS course. Michelle looks forward to serving the members of MMBA as the East Michigan Co-Chair!

 

                 Lisa Jacobson, CPC-A

I would like to introduce myself, My name is Lisa! 

I am a mother to three grown children all with children of their own. I have been employed by Genesys for 22 years now. I started my career as a Medical Assistant, then worked my way into billing and credentialing within our revenue cycle department. I decided I needed more of a challenge and decided coding would be the challenge I was looking for. Boy, I was not wrong! I love the learning aspect that this field offers me!  My hobbies include powerlifting which helps keep me active not only my body but allows my mind time to rest.  I am so glad to become a part of the MMBA, and be able to assist, learn, and grow with those around me. 

Unintended Consequence  

By Jill Young, CPC, CEDC, CIMC

As a member of the WPS Medicare Provider Outreach and Education and Education Advisory Group (POE AG) I was made aware of some disturbing information during a recent meeting.  The concern has been a known issue in the past.  However, now with increased numbers of claims are being submitted by Nurse Practitioners or Physician Assistants, there is now a more widespread problem of rejections for these types of claims with no payments being made.  The problem occurs in large groups or hospital systems where there are multiple specialties under the same tax ID, and Nurse Practitioners and Physician Assistants that work for those specialties are involved in the care of the patients (predominantly in the hospital).

Previously when multiple services by multiple physicians of differing specialties were performed on the same date, the claims submitted were paid by Medicare.  They did not show as concurrent care because the specialty denotation of each physician Medicare had on file showed that the services were performed by differing specialties.   Looking at that same scenario where perhaps two of the specialties had billings under their Nurse Practitioners (NP) is now a problem because the specialty denotation for the NP is simply Nurse Practitioner (50).  There is no medical specialty associated with their number.  The first claim submitted in this example is paid, but the second one is not.  Medicare sees the second claim by the same provider type is concurrent care and rejects that claim.  To Medicare, providers of the same specialty under the same Tax ID are seen as one provider.  The same is true when looking at this  scenario for Physician Assistants (PA) whose specialty denotation is Physician Assistant (97).

In a large system that utilizes Non-Physician Practitioners (NPP) of this type, rejections for a particular patient’s claims submitted for a date of service can be significant, depending on the number of NP or PA provider specialties that are submitting claims on a particular date.

WPS Medicare has indicated that they cannot change policy, only CMS/Medicare can.  On the POE AG call several members indicated they had received multiple rejections on patients for dates of service when one of these two provider types (NPs and PAs) submitted multiple claims.  Again, this is one of these provider types submitting claims on the same patient on the same date of service (i.e. several NP’s of differing specialties) 

This type of rejection for overlapping services by Nurse Practitioners or Physician Assistants can happen anytime in a large system including office New Patients (when an NP or PA has seen the patient at another location and the patient goes to a different specialty practice in the system and is seen by the same provider type (NP or PA).  If the NP from the first practice bills a new patient visit when the NP from the second practice in the same system under the same tax ID bills a new patient visit, the Medicare claim will reject.  Again, this is because there is no specialty associated with the NP’s specialty number.  The same is true if both providers were PA’s as well.

Unfortunately, this is not to offer any solution, but rather bring to your attention a problem that already existed but is now exacerbated by CMS/Medicare’s redefinition of their Split or Shared Policy.  It is, perhaps an unintended consequence of the policy change that should be addressed.