For oral surgery specialists, billing can be especially daunting as the process demands skilled medical and dental insurance collection. And rules are a bit different when it comes to oral surgery billing versus just regular dental billing.
Dental ClaimSupport’s oral surgery billing service provides a team of trusted billing experts for OMS claims processing. Our experts provide fast, accurate insurance billing you can depend on so that you can deliver a stress-free oral surgery experience for patients.
Our oral surgery experts have seen a few rules that teams seem to struggle with. In this article, we will share 5 oral surgery billing rules that are crucial to remember for the success of your oral surgery practice. When you keep these rules in mind, you’re sure to get quick, reliable claim reimbursement.
1. Avoid overbilling sedation times on oral surgery insurance claims
Overbilling in dental insurance means that you’re billing insurance for more than what they actually owe. This is a very common mistake made in oral surgery billing. Let us explain.
Let’s say a patient needed their wisdom teeth removed, and your dentist decided to take out all four wisdom teeth. Typical sedation for this procedure is normally three units which are billed in fifteen-minute increments.
Billing an insurance company for nitrous oxide in addition to IV sedation is not allowed per OMS billing guidelines.
If nitrous oxide is used during moderate or general anesthesia it should be included in the total anesthesia time, starting at the administration of the nitrous oxide.
Nitrous oxide is included in the anesthesia. And in scenarios like these, we see overbilling pretty frequently.
Another aspect of overbilling is the actual units of sedation. It’s very specific to the time the sedation begins and ends. So, the patient may be in the office for an hour and a half, but can't bill that entire hour and a half.
And insurers will notice this, which can increase the likelihood of an audit by the insurance company. As stated earlier, anesthesia billing for wisdom teeth removal is typically forty-five minutes.
So don't overbill an hour for most procedures, because insurance companies will know that it doesn't add up.
2. Always bill medical insurance first for any pathology-related procedures
Coordination of benefits is a huge factor in oral surgery. Understanding the order in which a patient’s insurance coverage should be billed is crucial for correct claim reimbursement.
Medical should always be filed as primary insurance when the procedure is pathology related. Once the medical EOB is received, you will then cross-code it over from a medical CPT to a dental CDT code. Then the office should bill the dental carrier with a copy of the medical EOB and the pathology report.
Helping your patients maximize their dental and medical benefits is an excellent way to build a relationship with your patients and build trust in your office team as well as your clinical team. If your administrative team is not familiar with cross-code billing the medical and dental insurance, you may want to look at outsourcing insurance billing for support.
If the medical insurance pays, and the secondary dental insurance pays, the patient may have less out of pocket and it doesn’t reduce their dental insurance maximum.
If you bill the medical carrier and they pay, the dental carrier’s remaining dental benefits for that year may be used for other treatments, thus increasing the revenues for the practice.
3. Use the appropriate medical and dental codes and provide all necessary documentation
On the medical insurance side, there are specific criteria and rules you have to look out for.
In order to accurately bill the medical and dental carrier, you must include the proper CPT codes and the ICD-10-CM diagnosis codes on the procedure correctly.
If your practice uses the “SOAP Notes'' (The subjective, objective, assessment, and plan) method for clinical notes, it will be easy to properly bill the appropriate CPT and ICD-10-CM codes. Submitting all of the details and supporting documentation ups your chances for quick reimbursement. It also helps you remain legal and compliant.
Related: 3 illegal dental billing practices that can hurt your dentistry
4. If oral surgery is needed due to an accident, the insurance related to that accident will be primary
(auto and home insurance)
Did you know that if a patient comes in with oral surgery needs due to an accident, the primary insurance would actually be related to how the accident happened?
For example, if a patient was in a car accident, and needed a tooth replaced, you would file their auto insurance first. In fact, most auto policies have medical benefits on them.
It is also important to note that assignment of benefits for accidents is NOT always followed. Contact the carrier for details on the coverage, requirements for prior authorizations, and assignment of benefits for in or out-of-network benefits.
Let's say you have a visitor in your home and they fall off a porch and break their jaw. They can file the homeowners’ policy. The key here is, you always want to know how the injury occurred and where. The patient can receive a higher reimbursement when the office files the correct insurance policy.
5. Make sure your consultation is coded correctly for the work performed in your oral surgery practice
D9310 is a common code that is improperly used because of similar codes for providing an oral examination.
If a general dentist refers a patient to you, an oral surgeon, for a second opinion, you can use the D9310 code as a diagnostic or therapeutic code, to see that patient for a consultation. But in order to do that, you must have a referral from the patient’s general dentist.
You also have to send a letter back to that dentist explaining what your recommended treatment is. But according to D9310, you cannot be the practitioner who also provides the treatment.
So if you are referring the patient back to their general dentists for, let's just say a root canal, then as an oral surgeon, you could bill out the D9310 consultation code. But if you say “No, the tooth just needs to be removed, and we're going to go ahead and do that today,” you can't bill out that code because you're the one providing the treatment.
Ready to take your oral surgery billing to the next level with expert help?
Oral surgery billing is complicated, but if you take advantage of resources and tips, you can lead a more efficient claims process, leading to a healthy cash flow at your oral surgery practice.
Avoiding overbilling, remembering rules of pathology and COB, how to handle accidents, and remembering coding details are all big rules to remember to ensure consistent claims income.
No OMS practice should struggle because the billing process drains time and money you and your team want to devote to your patients. Deliver an excellent patient experience and get expert support for your claims with Dental ClaimSupport’s oral surgery billing service. Collect more, worry less, shrink your aging report, and grow your practice.
Our billers specialize in oral and maxillofacial surgery and are trained in the latest coding updates. Schedule a call to learn more today.
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