Oral surgery is complex and requires specialized knowledge, skills, and equipment. Therefore, it is essential to ensure that the billing process for oral surgery is carried out accurately, efficiently, and in compliance with applicable laws and regulations. Proper billing for oral surgery ensures that healthcare providers receive fair compensation for their services and plays a vital role in maintaining patient satisfaction and trust. For this purpose, dental organizations need professionals and experts to lead every step flawlessly. This article will share some essential tips for successful oral surgery billing, including navigating the complex coding and documentation requirements. With these tips, healthcare providers can optimize billing processes, streamline operations, and provide exceptional patient care.
Insurance verification confirms the details of a patient’s insurance coverage, including eligibility, benefits, and co-payments. It is a vital step in the billing process as it ensures that the surgeon is reimbursed for their services and that the patient is not burdened with unnecessary financial strain.
Verifying insurance is particularly important in oral surgery, where procedures can be expensive and often require multiple appointments. Failure to verify insurance can lead to denied claims, delayed payments, and unexpected costs for the patient and the surgeon.
To ensure successful insurance verification, oral surgeons must follow a series of steps:
Collect patient Information: Collecting the patient’s insurance information is the first step in the verification process. This information includes:
Contact Insurance Carrier: Once the patient’s information is collected, the surgeon or billing team must contact the insurance carrier to verify coverage. This can be done over the phone, through an online portal, or via email.
Verify Eligibility: The next step is verifying the patient’s coverage eligibility which includes confirming the policy is active, the patient’s coverage start date, and any exclusions or limitations.
Check Benefits: After verifying eligibility, the surgeon must check the patient’s benefits to determine the level of coverage for the procedure. This includes understanding the deductible, co-payments, and any out-of-pocket expenses.
Confirm Prior Authorization: Certain procedures require prior authorization from the insurance carrier before the surgeon can perform them. It is essential to confirm whether the procedure requires prior authorization and, if so, to obtain it before the surgery.
Document Everything: It is essential to document all interactions with the insurance carrier, including the date, time, and name of the representative spoken to, as well as the conversation’s outcome.
Using the correct codes for oral surgery billing is critical for several reasons.
When it comes to oral surgery billing, there are several codes that dental practitioners need to be familiar with. The most commonly used codes are the CPT codes and the ICD codes.
For oral surgery billing, some of the most common CPT codes include:
For oral surgery billing, some of the most common ICD codes include:
In addition to CPT and ICD codes, dental practitioners should also be familiar with CDT codes, some of which are:
To ensure successful billing, supporting documentation must be provided to the insurance company or payer. This documentation should include the following:
Over-coding occurs when a dentist submits a claim for a service that is more expensive or complex than the service performed.
If you over-code or over-bill any service, it would be considered fraud, and you must face a penalty.
Assisting your patients in optimizing their dental and medical benefits can serve as a valuable means of establishing a strong rapport between them and your dental practice. It can also cultivate a sense of confidence in the abilities of your clinical and administrative teams. For this purpose, pathology-related services are the first bill to medical insurance.
Pathology-related procedures refer to any oral surgery related to a medical condition. This could include surgery to remove a tumor, repair a cleft palate, or treat a sleep disorder. There are several reasons why this is a best practice.
Upon receipt of the Explanation of Benefits (EOB) from the medical insurer, it is incumbent upon your practice to cross-code the medical Current Procedural Terminology code to a corresponding dental Current Dental Terminology code. This requires understanding the nuances of both coding systems and a deft touch in navigating the intricacies of the medical and dental insurance realms.
Oral surgery billing involves submitting claims to insurance companies, which can be complex and ever-changing. It is vital to keep up with the latest changes in insurance policies, billing codes, and regulations to ensure accurate and timely reimbursement for services rendered.
To stay up to date:
Looking for a reliable partner to handle your oral surgery billing needs? Look no further than MedsDental Billing Company! Our team of experienced professionals is dedicated to helping you maximize revenue and streamline your billing process. With our advanced technology and in-depth industry knowledge, we can help you easily navigate the complex world of dental billing and increase your reimbursement. From verifying insurance coverage to submitting claims and following up on payments, we’ve covered you at every step. With MedsDental on your side, you can focus on providing the best possible care to your patients while we take care of the rest.