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Is Medical Billing for Dental Procedures Legal?

is medical billing for dental procedures legal

Short answer: Yes.

Long answer: Yes. But it is a complicated process. 

So let’s talk about the elephant in the room. “I’m sure that medical billing for dental procedures is not legal. Dentists can only bill dental insurance”. 

That is a very common answer that we encounter from our partnered dentists. There has always been a popular myth among the dental industry that dental procedures are illegal to bill medically. However, even though it sounds sensible, this myth couldn’t be further from the truth.

Let us debunk the myth.

Medical billing is a payment practice within the U.S. health system. The process involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures.

So why do many dentists believe that they cannot bill medically?

First of all, many dentists believe that since this procedure is not taught in dental school, it is not possible to do so. Additionally, the process hasn’t been addressed by professional dentistry for decades. Therefore, dentists keep spreading the false myth to one another. 

Secondly, there is a misconception that medical benefits are only available to physicians and oral surgeons. This misconception is not true. It is stated by medical insurance carriers that their coverage is determined by the procedures performed, not title or capacity of the service provider. In reality, a large number of procedures that dentists are performing nowadays are considered to be medical, procedures such as exams, Pano’s, SRP’s, implants, bone grafting, and extractions.

Implant is one of the dental procedures that could be bill to medical insurance carriers

Legal Support: SEC.2706. NONDISCRIMINATION IN HEALTH CARE. The Federal health care law states the following: “(a) PROVIDERS. A group of health plan an 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.”

Finally, the myth may come from the fact that the idea to bill medically for dental practices just seems wrong. There is already dental insurance for dental procedures. So obviously medical insurance is not. 

However, if you look at the myth from another perspective, it also doesn’t make much sense. There is clearly a “medical” part of dental practice, as your teeth could severely affect other parts of your body and vice versa. Let’s consider an example of a patient who has diabetes which could cause him oral problems such as teeth loss. On the other hand, a patient with missing teeth may not be able to eat normally, which severely affects his overall health. Dentists solving this patient’s condition can clearly bill the procedures to medical insurance carriers. 

ph_dental_dentists
Dentists are also “Physicians of the mouth”

Medical billing for dental procedures is 100% legal.

So take everything into account, medical billing for dental procedures is in fact legal, as long as the procedures performed are proven to be medical necessity. Because after all, oral health and overall health have a really tight connection.

The California Dental Association has listed the procedures that could qualify for medical billing. Dentists just need to know the rules and follow the steps that medical coding and billing requires. These procedures include:

  • CT scans & exams
  • Consults for medically necessary procedures
  • Sleep Apnea Appliances
  • Oral Surgery
  • TMJ Disorder Treatment and appliances
  • Sinus Lifts and Bone Grafts
  • Mucositis
  • Tooth Loss due to trauma or systemic conditions
  • Oral Systemic Infection
  • Botox injections for painful bruxism
  • Excisions
  • Biopsies
  • Reconstruction due to trauma or conditions
  • Endodontics due to trauma or medical conditions
  • Oral Cancer Screening
  • Bone Atrophy that results in ill-fitting dentures
  • Denture Pressure ulcers
  • Many More Procedures
CT scan is also one of the procedures billable for medical

Doing medical billing for dental procedures brought numerous benefits to dentists, such as a large increase in revenue, patient base, and case acceptance. In terms of income, offices doing both dental and medical billing could make 30-40% more revenue than traditional practices billing dental only. Through medical billing, dentist A in Glendale, CA, managed to get an extra $3,000 for a bone grafting surgery.

Moreover, by tapping into the patient’s medical plan you can reduce the patients’ cost for treatment. Even in some cases, you can help eliminate the cost entirely.

So, why not start doing medical billing right away?

At pH Dental, we have developed a medical billing for dental procedures service called New Era Consulting. Since medical billing is a complicated process, our goal is to offer consulting, guidance, and support dental offices in this whole process. Visit our page to learn more.

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