Medical Case Submission

Medical Billing Academy     

division of Dental Claims Cleanup           

1810 Erie Blvd.,  Syracuse, NY  13210   

(800) 652-3431

https://dentalclaimscleanup.com/dental-medical-billing

Medical Billing Academy- Medical Billing Training Course ($4000 virtual 8 hr training)

1. one day online training for team (up to 12 attendees, $200 each additional attendee)

2. digital patient intake form 

3. medical claim work flow and coding template for the team

4. medical billing clinical digital intake form for the team

5. medical billing support subscription $50/month 5 cases, then $15/per case AFTER training

6. templates for letters of medical necessity 

7. medical claim submission & follow-up fee after training

8. templated clinical notes

9. individualized case work flow up to 5

Do It Yourself AFTER training  ($375/month/provider)

1. medical billing software access $150/month

2. eclaims provider enrollment $75/month

3. clinical medical billing module $150/month 

4. medical billing support subscription $50/month 5 cases, then $15/per case

B. Outsource to Dental Claims Cleanup

1. medical billing service $2250/month for each provider 

2. prorated fee for larger office (we use the dental claim volume for the office)

3. base of up to 50 claims, $20 per claim above the base of 50

4. Includes follow up on the claims and accounting of the EOB into dental software and send a statement

C. Pay Per Claim Medical Billing

1. service includes initial claim submission only @ $25/claim 

2. follow up on claims by the office team

3. medical billing software subscription $375/month/provider

      a. medical billing software access $150/month

      b. e-claims provider enrollment $75/month

      c. clinical medical billing module $150/month 

      d. medical billing support subscription $50/month/up to 5 cases, then $15/per case

What I personally discovered is that utilizing an actual medical billing software with e-claim submission and attachments dedicated to medical billing is the most efficient way of deling with the medical b illing claims for dental services.  However, the stand alone medical billing software for a typical dental office is cost prohibitive.  Dental Claims Cleanup was able to obtain a group price specifically for our providers allowing use of the software at a reasonable price ot the Dentists.  The office can do it themselves or can outsource the medical billing to Dental Claims Cleanup.  Regardless, I recommend training as the first step to make that final decision.

Medical Billing for Dental services include options of training, then can be an add-on service to our dental billing services, or is set up as a stand alone program. Your team or the DCC's team will remotely utilize cloud medical software and their e-claims submission service. The client is responsible for the license, electronic claim submission fees, and we will facilitate the setup for the Client to. Software utilization fees will be billed directly to the Client.

1. DCC will provide Medical billing worksheets that serve as treatment planning and routing slip of performed/treatment planned procedures to be billed to medical. 

2. The Medical billing digital forms and templates will contain cross coding ADA/CDT and associated list of ICD-10 diagnostic choices for those procedure codes. 

3. Providing Doctors will be responsible to check off diagnostic ICD-10 codes, and CPT codes that have been performed or are treatment planned. This worksheet will be part of the patient’s record and will be scanned to the patient’s chart as well as provided to DCC for medical billing purposes. 

4. Medical Billing worksheets will be developed for each Client to cater to the services provided by the practice. Medically billable dental procedures that are eligible for medical billing will be submitted ONLY based on the following:

• Traumatic injury
• Inflammation or infection
• Surgery required
• Diagnosing/diagnosed medical condition
• Suffering from loss of function

5. Procedures will not be submitted to medical insurance if they are related to routine dental care or the medical necessity is based on neglect of oral care ex: caries resulting in need for fillings and other restorative procedures. 

Interesting information that I have learned from Dr. Nikhil Saha, a colleague, regarding his experience with medical claims for dental services. If you feel that your practice could benefit from medical billing services, please contact us to discuss this further.

1. ANY traumatic injury to the mouth- all associated oral and dental procedures

2. Exams and consultations when oral cancer screening done, and in preparation for any other medically billable procedure

3. Emergency treatment of oral inflammation and oral infections

4. Diagnostic, radiographic, and surgical or healing stents

5. Radiographs for screening and diagnostic purposes (orthopantograms, occlusals, lateral jaw X-rays, Water's views, cephalograms, CT scans, tomograms, etc.). PA's and FMX are ONLY billable in conjunction with traumatic injuries.

6. Biopsies and excisions, including smears and brush biopsies

7. Extraction of all impacted teeth, also any extractions recommended by an MD prior to surgery, transplant, chemo/radiation, or due to a medical condition

8. Surgical procedures not associated with traumatic injury, including periodontal, reconstructive (implant), augmentation, soft and hard tissue grafts, etc. This includes the associated anesthesia.

9. Prosthetics- interim prostheses when surgery is involved, both interim and final prostheses if a traumatic injury or any medical condition necessitates their fabrication

10. Appliances fabricated for the treatment of bruxism, temporo-mandibular dysfunction, sleep apnea, snoring, palatal expansion, habit-breaking. Etc