Making Medical Insurance Work for Your Practice
Dental practices increasingly encounter opportunities to bill medical insurance for eligible procedures. Integrating medical insurance requires structured workflows, accurate coding, and proper documentation. Research shows dental practices billing medical claims appropriately can capture significant additional revenue (ADA, 2021).
Eligible Procedures
- Sleep Apnea Appliances: Medical necessity documentation can allow coverage.
- Trauma Care & Oral Surgery: Accidents and pathology-linked procedures are frequently covered.
- Chronic Disease Management: Linking periodontal therapy to systemic conditions like diabetes can support reimbursement.
Workflow & Staff Training
- Pre-Verification of Benefits: Confirm patient eligibility before procedures.
- Documentation: Clearly tie procedures to systemic health needs, including medical notes if available.
- Coding: Use appropriate CPT, ICD-10, and dental codes; consider dual coding when eligible.
- Front-Office Training: Educate staff on insurance verification, pre-authorizations, and patient communication.
- Denial Management: Track claim denials and develop a process for corrections and resubmission.
Case Example:
A 45-year-old patient required a surgical extraction due to an infection exacerbated by heart disease. Proper documentation and coding led to full reimbursement through the patient’s medical insurance, reducing out-of-pocket costs and ensuring the practice was fully compensated
A structured approach to medical insurance in dentistry improves patient access to care while optimizing practice revenue. Contact us to learn how to maximize your billing.