For over 30 years, dental practices have been getting reimbursed by medical insurance. Although the policies, trends, and codes have changed, but the fundamental principles and protocols behind cross-coding and dental medical billing have remained the same.
- You need the proper diagnosis codes and procedure codes.
- If it wasn’t documented, it didn’t happen.
- Don’t give up when dealing with the medical insurance company
Dentistry is now seen more as the field of dental medicine and the medical community has embraced this model by incorporating many more dentally related conditions in their coding systems, thereby recognizing the medical nature of certain dental procedures. Many dental surgeons (oral and maxillofacial surgeons) have been successfully filing with their patients’ medical plans, but very few specialty or general practices have taken advantage of this opportunity. To successfully cross code, one must understand what can be filed medically and how it should be done correctly.
There is a general perception that filing cross coded medical claims is too difficult. Granted, medical insurance is more complex than dental insurance. The major difference between the two is that medical carriers always require the use of at least one diagnosis code to explain why a procedure was performed, and therefore more than one coding system is required. By learning how to cross code correctly one can eliminate the difficulty factor in cross coding. You can make use of cross coding manuals, audio sessions, lectures, webinars, and on-site training to excel in medical coding.
In today’s hard economic times, implementing cross coding won’t incur much added cost with regard to the software that will be needed. Most of the practice management software that is available today has a medical cross coding component that is already part of the package or can be obtained as an additional component that must be purchased. Also, those that charge for the extra component bill a nominal fee.
The practices that have learned how to cross code correctly are receiving successfully paid EOB’s. Remember not all procedures are going to be covered by all insurance plans. Call the carrier to determine if benefits are available for the certain procedure and if a pre-authorization is needed. By preparing in this manner and by submitting accurate claims, your chances for successfully paid medical claims is greatly improved.
Getting your dental practice implemented for cross coding is a matter of proper training and education. Check out our session Cross Coding for Dental Sleep Apnea Treatment, to learn the intricacies.
