Dentistry has access to a revenue stream that medicine does not: a separate medical billing channel in addition to dental insurance. Most practices are not using the medical billing channel. Kandra Sellers, RDH, a dental hygienist-turned-medical billing consultant with more than 35 years in the profession, has spent years educating practices about this dual billing structure and how their billing methods are leaving money on the table.
In this episode of The DrBicuspid.com podcast, Editor-in-Chief Kevin Henry sits down with Sellers, the founder of TIPS Medical Billing, to walk through the biggest gaps holding dental practices back from successfully implementing medical billing and what the second half of the year looks like for practices that are ready to start.
Kandra Sellers, RDH.
The core problem, Sellers says, is not complexity, it is education. Medical diagnostic codes are not taught in dental or hygiene programs, and most practices are unaware that four diagnostic code fields already exist on the standard dental claim form.
The result is that dental claims go out with no documented medical necessity, carriers deny or downcode those claims without providing an explanation, and practices conclude that medical billing does not work. What actually did not work, Sellers says, was the implementation, not the system.
The list of billable procedures is longer than most dentists realize. Surgical extractions, bone grafts, implants, computed tomography (CT) scans, frenectomies, temporomandibular joint orthotics and Botox, sleep appliances, oral cancer screenings, and restorative care for patients undergoing chemotherapy or radiation can all move through medical. A CT scan, for example, can be billed on the day of diagnosis, the day of surgery, and 91 days postoperatively.
Dental benefits cap at roughly $1,000 to $1,500 annually. Medical benefits, when medically necessary procedures are documented correctly, have no such ceiling.
For practices that are concerned about where to start, Sellers is direct: Documentation is the single biggest gap. A clinical note should make it clear not only what was done but why -- most practices do not document the rationale for treatment. Improving your documentation practices not only bodes well for medical billing, but it strengthens your position if your practice is audited, and it can reduce your legal exposure.
Sellers can be reached via her website, where she also maintains a library of articles, podcasts, and continuing education resources covering medical billing topics in depth.
Listen to the full conversation below.
