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Medical Insurance in Dentistry

You Can Bill Medical Insurance!  Perhaps the biggest missed opportunity in dentistry is going to surprise you. 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.

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?
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 would not live without it because it drives the healthcare system.

Truthfully, and as ironic as this is, it is much easier to be a dentist when it comes to getting paid by medical insurance. There is some work involved initially but once you are in the system, it is well worth it.

Let me explain – 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 as a 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. Let’s take Medicare as an example. The primary service Medicare pays for is oral appliances for bruxism and obstructive sleep apnea. It is hard to get Medicare to pay a dental provider for any other services. Medicare also has an established fee schedule which is the total amount that you will be paid for these appliances which ranges from approximately $1200 to $2200. Some dentists look at this and say if that is all I can bill for, 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 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 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.

Beware those medical insurance “experts” in dentistry who will tell you that you can bill medical insurance for many dental procedures because there are medical diagnostic and treatment codes available. I remember spending a hundreds of dollars taking a course that came with a book of the special medical codes that supposedly dentists could use and get paid for. Just because there is a code, that doesn’t mean you’re going to get paid. If you as a dental office just send a claim to medical insurance, and they don’t recognize you as a provider, you are going to get rejection after rejection and being very frustrated. 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. This is exactly why the AAFE developed the course titled Dental Sleep Medicine, Bruxism Therapy, and Medical Insurance Billing for Every Dental Practice. You can save $1600 off tuition until April 15 – for dates and registration, click here. I will personally be there teaching these courses so hope to see you at an AAFE course!

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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