We recently hosted Laurie Owens, the Director of Medical Billing at Devdent for an online webinar. Her discussion about how dentists can utilize medical billing was so impressive that we decided to revisit the topic with her for our blog. Laurie says, “Medical billing for dental procedures isn’t just about maximizing reimbursement for patients; it’s about creating more value for your practice by treating the patient’s whole health.”
Laurie has extensive experience in the dental industry. She worked as a treatment coordinator for a dental clinic for many years. What set her apart was her expertise as a medical biller. Laurie is a Certified Professional Biller (CPB) and holds certification as a Certified Professional Coder (CPC). After the owners of the clinic retired, she joined Devdent, where she now educates dental practices on medical billing while also continuing to bill medical for 6 dental practices.
Laurie says there are several compelling reasons why your practice can benefit from medical billing:
- You decrease the amount the patient owes
- You increase case acceptance
- You create more value for procedures
- You’re treating the whole patient
It’s Not About What Procedure You Do, It’s About Why It Needs to Be Done!
Instead of focusing on what you can bill for, Laurie encourages dental practices to find out “why” the procedure needs to be done. “If you can document medical necessity, even veneers can be a covered service,” explains Laurie.
So, the next question becomes, “how do you prove a medical necessity?” Here, Laurie again encourages practices to focus on the “why?” question. “If a patient comes in and they have one cavity over the last 6 months, that is not medically necessary. But the patient that comes in and in 6 months they have developed six areas of caries and need a crown, there is something going on because that’s not normal,” she explains. “This shouldn’t be happening over a three-to-six-month period. You need to ask them more questions about their health history. Does the patient’s oral condition or dental diagnosis affect their health, like periodontal disease, abscess, or infection? Does it affect their ability to chew and digest properly? Does your patient’s health or their medical affect their oral health? For instance, diabetes, periodontal disease, and oral caries are so directly linked that there is only one diagnosis code.”
For things like third molar extractions and implant placement, Laurie again says, ask why to find medical necessity. Examples to look for include a medication that caused tooth loss. “When you have medication that causes xerostomia and that xerostomia causes caries and the tooth becomes unsalvageable, then that’s a medical condition that caused the tooth loss. There are four reasons a patient will lose a tooth: caries, perio, trauma, or other.” She says, “By asking why, you can get to the bottom of which one applies and increase your chance of acceptance.”
Two Top Conditions to Bill Under Medical
Two of the top major medical conditions that you can bill medical include diabetes and