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The Biggest Missed Opportunity in Dentistry

By Dr. Louis Malcmacher Wednesday, May 07, 2014 9:00 AM

There are over 49 million people with Medicare in this country. There are approximately 249 million people with medical insurance. Through the Affordable Care Act, millions more are signing up for medical insurance. This represents many more patients than have dental insurance.  So let me ask you a very simple question – why doesn’t your dental office learn to bill medical insurance?

This is by far the biggest missed opportunity in dentistry.This has been available to dental professionals for quite some time and I would say that most of you reading this column have never realized what this can positively do for your practice. By the way, this opportunity is by far the most effective and quickest driver of new patients into your office.  It doesn’t cost you a penny – in fact, it pays you.

Most of you probably are thinking medical insurance and Medicare doesn’t pay dentists, does it? Besides, your physician friends consider medical insurance a real hassle. In fact, there are a number of dental services that do qualify for medical insurance benefits. You are right – while medical insurance can be a challenge for physicians, they wouldn’t live without it because it drives the healthcare system. Medical insurance reimburses dental professionals on specific areas of treatment which are typically very well-defined. There are certain diagnosis and treatment protocols that serve as the basis for claim submission and reimbursement.  Once you are trained in what those are, develop the proper documentation procedures and a streamlined system for billing medical insurance, the entire process can be easier than billing dental insurance.

There is a strategy for developing a relationship with medical insurance providers in your area as well as a technique for knowing what to bill medical insurance first in order to gain the recognition needed asa dental provider.  Let me give you an example that perfectly demonstrates this. Right now, nearly every medical insurance and Medicare will pay dentists for oral appliances that treat bruxism and obstructive sleep apnea.  The Protocol for these oral appliances are very well defined in terms of the specific diagnostic criteria needed for a patient to be able to qualify for reimbursement.  In addition, there is a credentialing and enrollment process that you need to go through with the medical insurances in your area to be recognized as an established dental provider.

Most dentists have the typical “tunnel vision” that is common when evaluating whether or not to accept medical insurance and Medicare.  Some dentists look at this and say if I can only bill for certain treatments, it is not worth it.  In my opinion, that is incredibly short sighted.  Here is how I look at it -patients are coming to your office because they know that you accept Medicare.They have no idea what dental services are or are not covered by Medicare. Nearly Every patient over 65 has Medicare, many are already in your office and I would bet that a number of them have TMJ/orofacial pain, bruxism and obstructive sleep apnea issues. If you know the process of billing Medicare, that would result in instant production just by finding out who these patients are in your office and learning how to make oral appliances that treat TMJ/orofacial pain, bruxism and obstructive sleep apnea together. Medicare patients that are new to your office also need many other dental services whether they are implants, crowns,bridges, restorative, and dentures. Accepting Medicare and medical insurance is not about just being able to get paid for one service, it is about getting millions of patients to your dental offices who need a lot of dentistry.

In every AAFE course we teach, there are dentists who now bill medical insurance.   Learn the process of medical insurance which includes enrolling with the major medical insurances, knowing how to document like a physician, what medical insurance does and does not pay for, and the right strategy of how to start billing medical insurance so that you are recognized as a trusted provider of these services.  Because dental sleep medicine and bruxism is the number one dental service recognized by major medical and Medicare, get trained in this area first and begin billing medical insurance.

You can get start your training right now with the AAFE online medical insurance billing course to bill the procedures the AAFE teaches in its dental sleep medicine, bruxism therapy and frontline TMJ/orofacial pain treatment and onsite and online live patient training courses – call 800952-0521 and add this to your practice today!

Louis Malcmacher DDS MAGD is a practicing general dentist and an internationally known lecturer and author.  Dr. Malcmacher is president of the American Academy of Facial Esthetics (AAFE).  You can contact him at 800 952-0521 or email

Go to where you can find information about live patient Frontline Myofascial Pain Training, Frontline Dental Sleep Medicine, Bruxism and Medical Insurance, Botox® And dermal fillers training, download his resource list, and sign up for a free monthly e-newsletter.

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