5 Reasons You Do Not Bill Medical for Dentistry

Episode #438 with Laurie Owens

There is a list of dental procedures that medical insurance might pay. So, why do dentists avoid billing medical? Today, Kirk Behrendt brings back Laurie Owens, director of medical billing at Devdent, to share five reasons you don't bill medical, why you should start, and what you can do to increase claim acceptance. And the benefits go beyond reimbursement! To learn how medical billing can add value to your practice, listen to Episode 438 of The Best Practices Show!

Main Takeaways:

Get a complete health history of your patients.

Understand why a procedure needs to be done.

Ask the right questions — not yes or no questions.

Don't give up billing for medical after one try.

If your claim is denied, call and find out why.

Medical billing won't answer all of your problems.

Quotes:

“We sometimes are so rushed in dentistry that we forget that these are people with stories. And literally, medical billing is telling their story. And I think if we [don't] slow down a little bit and realize that there could be a story here, we’re not going to get it. We’re going to just rush, rush, rush, fill the schedule, and not realize there was a story that we missed.” (3:13—3:38)

“My number one [reason you don’t bill medical], you have an incomplete health history. And sometimes, it’s not the practice’s fault. But here’s what the patients think: ‘This doesn't have anything to do with my mouth.’ But are we asking? Are we making sure they understand the importance of — there's actually a video out by Delta Dental that talks about how many diseases the dentist can find. This is not something the medical doctor finds, it’s what the dentist can see. And people see their dentist more than their medical doctor. I've seen my dentist five times more than my doctor. So, if that's the case, and you know that these are all within the scope of your license, why should you not be paid for them?” (8:18—9:11)

“Are you letting your patients know, ‘This complete health history provides us enough information that if we can maximize your benefits through medical, we would have the documentation to do so’?” (10:11—10:22)

“We have to learn how [a health condition] has affected their lives in order to be able to tell the story. If you have a cancer patient, and now you're seeing them, and they can't eat because of the sores in their mouth, and you don't know it, how is that really effective treatment planning for a patient? It’s not. So, we have to ask them how these things have affected their lives, how they're physically feeling — especially if they have to change medications.” (13:04—13:35)

“A lot of people will say, ‘Well, it’s a lot of work.’ But did you know it could help your dental insurance claims too? By being thorough, you are helping your dental claims go through faster when you have all this documentation.” (14:10—14:25)

“In medical, they say, ‘If a patient says it, put it in quotes.’ You don't have to say that that's what you said. If the patient says it, put it in quotes. But asking the right question — quit asking yes or no. Ask them to tell you about it. ‘Tell me about when they found your diabetes. Tell me about when the doctor diagnosed that GERD for you. Tell me what happened. When was that? Were you older, younger? Did you have any other complications, other than what we’re sitting here for today? Tell me about that.’ They're always interested.” (14:27—15:04)

“[Reason] number three [for not billing medical], you're only looking to fill the schedule. Now, I'm all for filling the schedule. Please don't get me wrong. I agree, you should fill the schedule. But my number one is, if I say, ‘The doctor has some open time today,’ then, apparently, he’s not very good at his job. Or you're going to fit this patient in to inconvenience these other patients. And that doesn't make any sense.” (15:12—15:48)

“If it’s an emergency, medical will still pay. So, I get emergencies. And one thing that our practice learned from ACT was to make sure you know where those spaces are that fit best. So, have somebody in the clinical team make a note, ‘This is the best time for an emergency patient.’ Because without that knowledge, and oh my soul, we went years and years without that knowledge. And I can't tell you how much that saved us from chasing an assistant or wanting an assistant to murder us. I mean, it was life-changing for me. And so, that is what a coach helps you with. Finds these little bitty areas that could still fill your schedule, but not impact your current patients.” (17:14—18:05)

“[Reason number four for not billing medical is] because you lack in training. And that's one of the reasons we've kept our training costs low, is because we know coming out of COVID-19 you have so many expenses that were not planned on, were not budgeted for. So, we’ve really kept our costs low. But I've had offices that I said, ‘No. No, you can't do medical billing. You've got to get a coach to get this set first.’ If you think medical billing is going to answer all your problems in the practice, you're wrong. It’s not. It’s going to enhance your practice, absolutely. But don't feel that it’s the answer to your money problems for the practice, because you're going to be only focused on the dollars.” (19:28—20:25)

“How many more new patients could you get because of that one patient who says, ‘Hey, they billed my medical for this’?” (22:43—22:50)

“[Reason] number five [for not billing medical], you tried it once and it didn't work. You tried it once. I always say, ‘Tell me what you coded.’ And I guarantee you they coded it out of sequence and they're not going to pay. Whereas, if you would've looked at what their reason — and sometimes, medical doesn't give you the full reason. I got denied because I didn't have a zero in the ICD code set. Not because of my codes, but because the zero wasn’t there. I also got denied because my X was outside of the box. So, if you don't know — doctors will get a denial and they won't even call. They won't even find out, ‘Why is this denied?’ Because they're always going to say, ‘Denied for medical necessity.’ That's just the standard reply. Until you call, you're never going to know. It could be something little, like my X outside the box.” (24:37—25:46)

“A lot of doctors think, ‘Okay. Well, this worked for the exam, so I'm going to use it for the surgery.’ Well, there are certain requirements, if you would. So, you can't use a symptom for surgery. It doesn't make sense. We talked about that GERD patient that the prosthodontist was working on. If I used that he had GERD, but I didn't tell them what I was fixing, that won't make sense. I need to tell them I'm fixing the erosion because of the GERD. So, the story goes together. And a lot of doctors will say, ‘Well, he’s in pain.’ But that doesn't tell them what you're fixing. You're fixing the abscess that the pain came from.” (26:49—27:42)

“Medical changes every three months. So, that's why I have to constantly be studying what are the changes for this quarter.” (31:08—31:15)

“Most offices have no idea what their dental claim looks like. There is nothing different on the dental claim than the medical claim. This is new. The diagnosis codes, the modifiers — everything. If you print out your dental claim from your practice right now, it will show you ICD-10 codes. It’ll show you where to put units. This is something we don't do in dentistry, right? We put every line, surgical extraction, surgical extraction, surgical extraction. Instead, it’s one line with the amount of teeth that you took out. So, things are changing, even on the dental insurance, to conform more like the medical insurance. But there's nothing different on the medical insurance form than the dental insurance form right now.” (32:31—33:21)

“Whether you think you do or not, you do medical procedures. Most doctors don't realize, we don't get paid for bone grafting because it’s a medical procedure. You don't get paid for membranes because it’s a medical procedure. How about your cone beams? They're medical. There's a reason why dental insurance doesn't pay for it. And it’s not that they're trying to be mean. Those are truly medical procedures. So, why are we writing them off or not charging for them because dental insurance doesn't pay when there's a reason why?” (34:58—35:32)

Snippets:

0:00 Introduction.

2:01 Laurie’s background.

5:57 Why you should learn about medical billing.

8:09 Reason you don't bill medical 1) Incomplete health history.

12:28 Reason you don't bill medical 2) Not asking the right questions.

15:09 Reason you don't bill medical 3) Only looking to fill the schedule.

17:13 Have time set aside for emergencies.

19:23 Reason you don't bill medical 4) Lacking in training.

21:51 Invest in training.

24:34 Reason you don't bill medical 5) You tried it once, and it didn't work.

29:09 Where to go for more information on billing.  

30:52 Stay up to date.

31:44 The future of dental insurance.

36:09 How Laurie can help you, and how to get in touch.

Reach Out to Laurie:

Laurie’s Facebook: https://www.facebook.com/laurie.owens89

Laurie’s social media: @ljowens89

Resources:

Devdent: https://www.devdent.com/

Laurie Owens, CPB, CPC Bio:

Laurie Owens, CPC, CPB, is the Director of Medical Billing Education for Devdent. She brings over a decade of experience educating dental practices on billing medical insurance and the techniques to get claims paid. Laurie believes that patients should be able to utilize their medical insurance for procedures due to oral systemic conditions.

Through on-site training, medical billing courses, Seattle Study Club lectures, and follow-up consulting, Laurie has assisted dental practices in successfully billing medical insurance to collect benefits that would have otherwise been unclaimed. Her training on medical billing has increased practice revenue and patient satisfaction.