Considering the nature of treatment and for the purpose of improving patient care, your practice can integrate both dental and medical care as stated in the Affordable Care Act at your dental practice. However, that will require you to utilize medical billing for dental practices and get several dental services reimbursed by the patient’s medical insurance to avoid their financial strain due to coordination of care. For example, some essential dental work will ultimately be billed to dental insurance companies, whereas more extensive operations like biopsies, Botox injections, dental implants, and bone transplants can be bullied through medical insurance. A well-organized medical billing procedure is highly beneficial to dental clinics as it aids in getting optimal reimbursements from the payers. However, many dentists are unaware that medical coverage plans frequently reimburse surgical operations performed in the mouth, such as biopsies, pathology excisions, and repairing traumatic injuries as medically necessary in dentistry. Hence, this comprehensive guide offers an explanation of certain conditions in dentistry when medical billing becomes essential for dentists and dental procedures billable to medical insurance.
Compared to other healthcare services, dental treatment is far more expensive, putting a financial
burden on patients hesitant to seek frequent care. Moreover, a considerable number of Americans,
including older adults, lack dental insurance. Even those having one or the other type of dental
insurance end up paying out-of-pocket costs for dental treatment as the care is cost-prohibitive because
of annual maximums, co-pays, and procedure exclusions.
More than 90% Medicare advantage plans on the other hand offer some type of dental benefit over
traditional Medicare–an alternative for many dentists to compensate lower dental reimbursement through
medical billing and for patients to search Medical insurance for dental treatments.
Evidence from February 2023 indicates that one in five dental practices plan to drop out of some
insurance plan. 26% of dentists reported in July 2023 that they offer an in-office dental plan, and 22%
reported that they were thinking of offering one.
Considering the limited benefit of dental insurance plans and dental insurance providers’ progress
toward constant reduction in reimbursement rates, delivering dental care with medically necessary
treatment is more than a challenge for dentists commanding reimbursement in tens of thousands of
dollars. However, billing patients medically amidst these scenarios is a win-win solution serving both
dental care providers and patients alike. Patients can get the needed and timely care while providers
can stabilize reimbursement for their practice in the best possible way.
Dental practices frequently encounter patients with underlying medical conditions that contribute to their oral health issues. However, the average dental patient doesn't have $60,000 on their hands to get a full-mouth reconstruction. Despite the difference between medical billing and dental billing, dentists need to bill their patient's medical insurance when dental procedures intersect with medical conditions. This integration between dental and medical billing involves directly invoicing medical insurance for dental procedures that include medical necessity due to their connection with underlying health conditions. Billing dental services to medical insurance can assist patients facing complicated conditions in receiving the adequate treatment they require cost-effectively, while dental practices can enhance their practice's bottom line. Moreover, acquiring medical billing facilitates effective mechanisms for generating referrals and ensures the participation of multiple insurance providers in a patient's dental plan. Here is a breakdown of what medical and dental procedures can be billed to a patient's medical insurance.
Dental procedures are categorized as billable or can be billed to a patient's medical insurance. Before offering treatment to the patients, the dentist must ensure the procedure or service falls under one of these categories:
| Categories | Procedures |
| Diagnostic Procedures | Examination, consultations, medical imagings, models, stents, bacterial testing |
| Non-surgical Medical Treatments |
|
| Surgical Treatments |
|
| Treatment For Traumatic Injuries |
|
D7210 - Surgical extractions
D6010 - Implants with abutment
D4263 - Bone graft
D4266 - Membrane
D7880 - TMJ Treatment
D7953 - Maxillary/ Mandible bone grafts
D7951 - Lateral sinus augmentation
D7240 - Removal of impacted tooth
D7310 - Alveoloplasty
D9223 - Sedation
Example dental procedures used with CDT to the cross code of CPT for billing medical insurance:
| CDT Code | Fee | CPT Code | Fee |
| D0150 | $124 | 99204 | $463 |
| D6010 | $2,058 | 21248 | $2,498 |
| D7953 | $709 | 21210/ 21215 | $1,988 |
| D4341 | $324 | 41805 | $878 |
Some of the other significant advantages of medical reimbursement for dental treatment involve:
Accessing successful medical billing for dentists not only provides patients with the satisfaction of receiving essential care but also enhances your practice’s productivity. Your practice may have hesitated to connect confidently with patients just because of the lack of tens of thousands of dollars to treat patients. However, medical billing and insurance bridge the gap for you to handle patients’ affordability crises and connect with them confidently.
By including medical billing for dental practices, you expand the scope of your dental business and draw in new clients. Your clinic will benefit if you offer people an alternate method of paying for their medical care. It will not take long for a natural referral system to start growing your present patients, bringing in new ones and making it challenging for rival dental offices to compete.
Generally, dental insurance pays for routine operations like cleanings and fillings. Dental insurance plans offer savings for more complex procedures, cover standard procedures, and have low annual cost caps. Hence, patients are responsible for the total cost of procedures that fall outside that range, such as crowns and root canals. In contrast to dental insurance, medical insurance typically has no yearly maximum and frequently offers more coverage for expensive operations. By providing a service that few dental practices perform, medical billing in your dental practice not only lets you keep innovative but also allows your patients to save thousands of dollars.
Receiving necessary dental services improves overall dental health for individuals, regardless of payment methods. Preventive care procedures, often covered by PPO plans at 100%, enable early disease detection and treatment. Research indicates that 45% of patients visit dentists only after experiencing pain. Regular visits facilitate early problem identification and cost-effective solutions. Patients with dual insurance coverage can utilize medical plans for necessary surgeries, preserving dental plan benefits for other procedures. Overcoming cost concerns through medical billing assistance fosters higher case acceptance rates, leading to increased practice revenue and patient satisfaction.
The dentists may submit a claim to the patient’s medical insurance when treating a person with interconnected medical and dental problems. Dental services considered medically necessary are cost-effective. Hence, patient’s financial strain will be lessened, and their yearly dental insurance benefits will remain available.
Patients will be highly appreciative and will become fantastic marketing assets for your clinic if they know that you are prepared to assist them in obtaining medical benefits. Your dental practice will function more effectively due to our medical billing services in numerous ways; you should spend your maximum time in your patient’s care to make your practice fully comply with the regulatory regulations, while our practice revenue experts will manage your financial responsibilities in a modernized way.
Integrating medical and dental procedures often requires more effort to have difficulty cross-coding and billing the services accurately. MedsDental Dental Billing Company is an expert in medical billing for dental practices to get you reimbursed from the patient’s insurer. The professionals perform every step of medical and dental billing accurately. Our specialized and certified coders know which codes will be applied for specific services using coding rules. Along with performing streamlined billing, we aim to enhance your practice’s revenue by up to 30%. By filing a proper claim to insurance companies and collecting payment quickly, MedsDental is providing many customers with its beneficial medical, dental billing, and coding services. Now is your turn to gain the benefits of HIPAA-compliant services. Because we do not ask for any onboarding charges and implement HIPAA-compliant services using innovative technology, we are the right approach for you. Establish a partnership with our company to gain confidential assistance without any threat of data breach because we do every service by keeping the factor of data protection into consideration.
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