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The Biggest Missed Opportunity in Dentistry

By admin July 8, 2014

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 havedental insurance.  So let me ask you avery simple question – why doesn’t your dental office learn to bill medicalinsurance?

This is by far the biggest missed opportunity in dentistry.This has been available to dental professionals for quite some time and I wouldsay that most of you reading this column have never realized what this canpositively do for your practice.  By theway, this opportunity is by far the most effective and quickest driver of newpatients into your office.  It doesn’tcost you a penny – in fact, it pays you.

Most of you probably are thinking medical insurance andMedicare doesn’t pay dentists, does it? Besides, your physician friendsconsider medical insurance a real hassle. In fact, there are a number of dental services that do qualify formedical insurance benefits.  You areright – while medical insurance can be a challenge for physicians, they wouldnot live without it because it drives the healthcare system. Medical insurancereimburses dental professionals on specific areas of treatment which aretypically very well-defined. There are certain diagnosis and treatmentprotocols 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 withmedical insurance providers in your area as well as a technique for knowingwhat to bill medical insurance first in order to gain the recognition needed asa dental provider.  Let me give you anexample that perfectly demonstrates this. Right now, nearly every medicalinsurance and Medicare will pay dentists for oral appliances that treat bruxismand obstructive sleep apnea.  Theprotocol for these oral appliances are very well defined in terms of thespecific diagnostic criteria needed for a patient to be able to qualify for reimbursement.  In addition, there is a credentialing andenrollment process that you need to go through with the medical insurances inyour 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 canonly bill for certain treatments, it is not worth it.  In my opinion, that is incrediblyshortsighted.  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. Nearlyevery patient over 65 has Medicare, many are already in your office and I wouldbet that a number of them have TMJ/orofacial pain, bruxism and obstructivesleep apnea issues. If you know the process of billing Medicare, that wouldresult in instant production just by finding out who these patients are in youroffice and learning how to make oral appliances that treat TMJ/orofacial pain, bruxismand obstructive sleep apnea together. Medicare patients that are new to youroffice 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 toget paid for one service, it is about getting millions of patients to yourdental offices who need a lot of dentistry.

In every AAFE course we teach, there are dentists who nowbill medical insurance.   Learn theprocess of medical insurance which includes enrolling with the major medicalinsurances, knowing how to document like a physician, what medical insurancedoes and does not pay for, and the right strategy of how to start billingmedical insurance so that you are recognized as a trusted provider of theseservices.  Because dental sleep medicineand bruxism is the number one dental service recognized by major medical andMedicare, 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 dentistand an internationally known lecturer and author.  Dr. Malcmacher is president of the AmericanAcademy of Facial Esthetics (AAFE).  You can contact him at 800 952-0521 or email

Go to  www.FacialEsthetics.orgwhere you can find information about live patient Frontline Myofascial Paintraining, Frontline Dental Sleep Medicine, Bruxism and Medical Insurance, Botoxand dermal fillers training, download his resource list, and sign up for a freemonthly e-newsletter.


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