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In reply to the crucial changes in healthcare reimbursement plans, billing medical insurance for dental insurance verification service is so essential.

Presently, the dental industry might not be prepared for billing medical insurances for dental insurance verification service. Dental Claims Cleanup has been establishing cross over protocols and systems to help Dentists in the job of medical insurance billing for dental procedures. This article will check differences and commonalities in dental and medical billing, and also, offer pointers in the dental procedures for the medical billing process.

Dental and medical billing shares the following:

Patient and insurance details have to beget, confirmed, and properly set-up in the practice management system

Procedures should be coded and fees established

A form of claim is submitted

Payment is accepted with and clarification of benefits (EOB) that requires to be broken down in the practice management system

Claims require to be pursued until payment is accepted and re-submission and appeals are done until payment is reached

Patient’s portion should be collected after the insurance claim fixes or should be gathered prior to the procedure (if an evaluation of the patient’s portion is viable)

Differences between dental billing and medical billing:

Medical billing needs diagnostic codes to assist medical fundamental of procedure codes to be submitted along with the claim; there is no need yet for diagnostic codes in dental billing, however, diagnostic causes for dental procedures are offered upon demand by the dental insurance, during narrative submission with claims, and during process of claim appeal, and should be documented in the patient’s chart.

Insurance coverage based on an actual resemblance of diagnostic codes and plan coverage for procedure codes. Claim rejection is more likely with medical claims, because of the needs essential for a “clean” submission of a claim, therefore, it is crucial to discover out information needs for particular procedures before the claim is submitted during the coverage confirmation process (re-authorization and pre-certification)

Sending “clean” claims in medical billing is important to get payment and coverage. All details should be correct comprising provider, insurance demographics, diagnostic codes, procedure codes, modifiers, narrative submission, and patient, etc.

Pre-certifications (“pre-certs”) for treatment are hospitalized prior to starting the treatment. Decisions are created, once pre-certs or rejections are obtained, to submit to dental insurance instead. The patient can make a decision whether or not to go with the treatment, depend on the details accepted from the pre-certs. Another pertinent detail is found during the pre-cert instruction that helps in claim submission and claim coverage depends on the information mentioned in the pre-cert. The insurance company will decide whether the procedure required is pre-authorized or pre-certified. Pre-certifications authorize that the procedure “might be” medically essential and requires a review prior to payment. Pre-authorizations authorize that the procedure will be covered, but the insurance company does not mention any fees. Contact DentalRCM for dental insurance verification service.

ADA codes for dental hospitalization enclose various procedures that are not coded but are component of the fee (i.e. lab fee, lab materials, temporary crown fabrication, visit for adding the crown, x-ray when the crown was seated, etc.) Those components of the treatment are comprised of one crown fee. In medical billing, there is a CPT Service (reports surgical, medical & diagnostic procedures and services) or HCPCS code (supplies, products & services not comprised in the CPT codes) for all the components of treatment or a procedure which would insert up to the analogous one fee in dental coding. The fee for medical treatment is accepted from coding all components of the treatment. Dental billing bills for a “product” offered and this product has one fee that is coded. In medical billing, we bill for treatment of a “condition” provided (comprises services done depend on complexity and time, products/devices, materials used and amounts, and diagnostics procedures, the procedure can be dismantled into professional service and technical services provided).

dental insurance verification service

Medical claim submission has 3 months from the day of service prior to expiration, while dental insurances permit up to six months, or even up to 12 months, for claim submission from service date. Therefore, if medical insurance does not make payment for the dental procedure, there is time to submit the claim to dental insurance. The claim cannot ethically be simultaneously submitted to medical and dental insurance. If you submit $600 to medical for a procedure, that gets rejected, you need to submit $600 to dental insurance for a similar procedure.

This is why, the cost for the procedure, billed to medical or dental, has to be similar. Various medical codes (which will comprise products/devices, services, submitted materials, and diagnostic procedures) might require to be deployed for the analogous ADA code, but the price for the hospitalization must be similar. Many ADA codes contain procedures that in medical coding are separately billed. Ex: x-rays in dental billing comprise the reporting and diagnosis while x-rays in medical can be billed as the fee of service (technical part) and the fee of reporting (professional component) with a modifier 26.

Letters/Narratives to help medical necessity are important to get medical claim coverage; in dental billing, medical necessity letters are only essential for ADA codes that inquire for narratives during the appeal process or by the report, or as a follow-up to provider referring.

Medical reimbursement for office visits/consultations/exams based on time spent with the patient encounters, the severity of the encounter/exam, and reimburses for every encounter for a previously diagnosed condition, in dental follow-up visits and visits for the previously diagnosed condition are treated component of the dental procedure.

Medical insurance does not offer fees for hospitalization during the gains confirmation process, or pre-certification process, but rather, details if treatment is qualified for medical billing after reviewing of claim examiner. Pre-authorization will inform you it will be covered by the plan but the insurance company will not mention the fees. The reimbursement is based on the reimbursement schedule of the medical plan, covered benefit, and if it is a billable medically procedure.

 It is not viable to perform a sound pre-estimate and figure out the patient’s accountability for the hospitalization, therefore, the provider should decide what will be gathered at the time of service. If the medical insurance addresses that the services will be covered (pre-authorized) and can be submitted, a minimum of one-third must be gathered from the patient, as a down payment, at the service time. Some medical insurance is known to take a longer time to payout. Providers might acknowledge gathering the total amount, from the patient, at service time, and the insurance payment is sent directly to the patient.

Most of the time, medical insurance has a greater reimbursement for dental services rather than dental insurance verification service resulting in a low balance of patients. This is because various components of one dental code are billable to medical. Payment for various more codes outcomes in a total higher insurance reimbursement. Apart from that, there is no clear history or provisions for payments on dental procedures therefore many times the medical insurance pays better on those codes. More click on Dental Insurance Verification or free contact us at +1 888-315-2050.


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DentalRCM is completely dedicated to delivering excellent quality of service to the whole dental fraternity. Our comprehensive innovative and process refinement strategies assist us to fulfill your supplies in a very cost-effective manner and flawlessly, while you look after your patients. We trust that a methodical and structured approach to service delivery removes potential gaps and pitfalls in the service. Our whole team is exclusively concentrated on delivering you with credentialing, insurance verification, insurance billing, and other services that are personalized to your valuable requirements and are offered with full regard to your community of the patients. For more information, contact toll-free number (888) 315-2050.

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