4 Misguided Myths About Medical Billing in Dentistry

Contrary to common belief, medical billing is a payment option available to dental health care providers.

“Medical benefits can only be accessed by physicians.”

“Oral surgeons are the only dentists that can bill medical plans.”

“It’s illegal for dentists to bill medical insurance.”

“I’ve tried it and it doesn’t work.”

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So many comments, all misguided. So let’s address this issue and lay the misconceptions about medical billing to rest, once and for all.

MYTH #1: “Medical benefits can only be accessed by physicians.”

REALITY: SEC. 2706. NONDISCRIMINATION IN HEALTH CARE. The Federal health care law states the following: “(a) PROVIDERS. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”

MYTH #2: “Oral surgeons are the only dentists that can bill medical plans.”

REALITY: Medical plans determine coverage based on the covered procedure, as it relates to the diagnosis. They do not determine coverage based on degree of provider, as this is illegal. Any dentists that perform the same procedures as oral surgeons (i.e. exams, consults, radiographs, extractions, implants, bone and tissue grafts, etc.) are entitled to the same coverage. There can be no discrimination against providers, as stated in the Federal law.

MYTH #3: “It’s illegal for dentists to bill medical insurance.”

REALITY: Many dentists feel that because medical billing was not addressed in dental school, nor addressed by organized dentistry for decades, then it cannot possibly be legal to do so. If you are trained and licensed to perform a procedure that is covered by a patient’s medical plan, then you can freely bill the plan. You just have to know the rules and follow the steps that medical coding and billing requires.

MYTH #4: “I’ve tried it and it doesn’t work.”

REALITY: Attempting to bill medical plans by reading articles on the Internet or attending half- or one-day course won’t cut it. There are just too many nuances, and learning them involves a steep learning curve. I have repeatedly seen claims sent to me by dentists that have tried it on their own, who have attended a short course or been self-taught, and their claims contain no less than 25 mistakes minimum. I can only imagine the laughter occurring behind the scenes when a Medical Reviewer sees this and the accompanying documentation (dental/periodontal charting and FMX/periapicals). They do not give the claim the time of day. A form letter is generated with a click of the mouse. DENIED.

So how do I get started?

Attending a comprehensive medical billing course is essential to your success. You cannot learn medical billing piecemeal­ — it requires step-by-step learning and progression through the process from A to Z. You cannot accelerate the process, or you will make dozens of mistakes and inevitably be denied payments by medical insurers. You cannot jump into the deep end without learning how to doggy paddle and tread water first. The same is true for medical billing. The coding is different, the documentation requirements are different, and the claim form is different. Start with simple and basic procedures that are easy to bill and result in a quick turnaround and payment: exams, radiographs, TMD and OSA appliances.

In addition, it is critical for the clinical and business teams to work together. The billers cannot do it on their own. They have neither the clinical background, familiarity with the terminology, nor the knowledge of what is or is not medically relevant and how to express it in a letter of medical necessity (LMN). This must be done by the doctor, or knowledgeable clinical team member, so that the Medical Reviewer at the insurance company, who is either an RN or MD, will recognize that the notes and LMN have been dictated and written by a health care professional. Documentation cannot be presented in lay terms. Terminology case in point: Type II Diabetes is referred to by an RN/MD as “T2D,” the word ”cancer” appears in clinical notes as the acronym “CA”, high blood pressure would be stated in the SOAP notes as “hypertension,” etc. Moreover, surgical or operative reports cannot legally be dictated or written by anyone other than the surgeon performing the procedure.

Dr. Olya Zahrebelny (pronounced Zara-bell-knee) graduated from the Faculty of Dentistry at the University of Toronto, Canada, and completed a General Practice Residency, focusing on oral surgery, oral medicine, and oral pathology. She has practiced in both hospital and private practice environments for the past 39 years. Dr. "Z “is a former consultant to commercial and government insurance programs. She has also taught at three dental schools, as well as holding the position of Attending Physician at Swedish Covenant Hospital in Chicago, a Northwestern Memorial Hospital affiliate, for 19 years, and also an Attending Physician in the General Practice Residency program at the University of Illinois, Chicago Medical Center.

Dr. Zahrebelny has lectured extensively throughout the US and abroad at all the major dental meetings. Her book, "Accessing Medical Benefits in the Comprehensive and Surgical Dental Practice" has now been in print for 18 years, with yearly revisions, edits, and updates. Dr. Z is a comprehensive general dentist and a Principal in The Z Group, a practice management consulting company. She provides group and in-house courses on medical billing to general dentists and specialists. She can be reached at thezgroupllc.com.

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