Dental Claims Cleanup®, LLC
Dental Claims Cleanup®, LLC experience, expertise, excellence
Dental Claims Cleanup®, LLC experience, expertise, excellence
for Dental Procedures Service
-$3,000 training/sign-on fee
1. one day online training for team (up to 12 attendees, $200 each additional attendee)
2. digital forms
-provider sign-up for Apex electronic medical claims submission service $50/monthly/provider
-templates for medical necessity letters
-medical claim submission & follow-up fee after training: $1400/month (gives you base of up to 50 claims) & $15 per claim above the base
Medical Billing for Dental is an add-on service or stand alone program starting at $1400 per month. DCC's team will remotely utilize Speedy Claims Software and their Apex e-claims submission service on behalf of the Client. Speedy Soft license and electronic claim submission fees will be setup for the Client to have their own account and 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. 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. 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. 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:
1. traumatic injury
2. inflammation or infection
3. surgery required
4. diagnosing/diagnosed medical condition
5. suffering from loss of function
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. DCC will evaluate and advise on claims which are not eligible for medical billing. In the event that a claim is not approved and denied due to plan specific clauses, DCC will immediately submit to patient’s dental insurance.
2. Client's team will be responsible to enter all transactions (diagnosed, performed, and approved by the providing Doctor). The transactions are Dental ADA codes, for the analogous medical CPT codes, to be entered into the Client’s practice management software which were performed or planned.
3. Client's team will fax or scan into a dedicated folder patient’s information to submit claims: DCC will provide appropriate Medical Patient’s Demographics worksheets for the client to fill out
4. Doctors will be responsible to provide a letter of medical necessity with ALL claims to be submitted to medical insurance. DCC will provide templates for these letters
5. DCC will setup patients in Speedy Claims Software and their accounts
6. DCC will call medical insurance to obtain a pre-certification for ALL procedures to be billed to medical. Procedures no certified for medical billing will be immediately billed to dental insurance and the Client will be notified of the denial by e-mail if patient is not in the office and by phone if the patient is in the office within 20 minutes.
7. Diagnostic exams and consultations will be billed to medical as treatment rendered, and DCC will attempt to obtain a pre-certification.
8. Client will decide the down payment to be collected from patients at time of service because medical insurances DO NOT provide any fees or payment information. Medical insurance will only provide “coverage approval” or “no coverage”. The payment is based on individual plans. DCC recommends that the Client decides what is minimally necessary to collect at time of service and what amount can be waited on for up to 4 months, or the client may choose to collect the entire amount from patients and send insurance payments to the patient’s home.
9. DCC will follow the medical claims and manage the EOB entry for payments in Speedy Claims Software and in dental software if EOB entry service is contracted. EOBs will be scanned to a dedicated DCC folder on the Client's workstation.
10. DCC will manage the patient’s balance after medical claims resolve and appeal any claims as necessary (if the claim denial is NOT based on plan specific exclusions)
11. DCC will keep track of claims submitted and billing reports will be provided upon request.
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.
Here is Dr. "Saha's" TOP TEN LIST OF MEDICALLY BILLABLE PROCEDURES
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