Dentaltown January 2018 - 83

for You?
There has been an upsurge in interest in
medical billing by dentists and many have
eagerly jumped on the bandwagon, only
to find it's nothing like they imagined and
they're receiving only denials and rejections,
with maybe a bone thrown to them once in
a while by the medical insurance companies,
just as a tease. This article is meant to share
the pros and cons-unfiltered, as Dr. Howard
Farran would say-of commercial medical
billing, so you can decide if it's a service
that you'd like to incorporate into your
practice's business armamentarium. (This
advice refers to commercial plans only,
not Medicare; the covered procedures and
"medical necessity" criteria are markedly
different between the two.)
For starters, let's address the misconceptions.

Myth #1: The codes and claim
forms for medical billing are
different, but otherwise it's
just like dental billing.
Nothing could be further from the
truth! Medical billing is nothing like dental
billing. Not only are the codes different, so
also are the documentation requirements
and the format in which information is
presented. The language used must also
be one that a registered nurse or medical
doctor can understand.
There are two code "sets"-one for
the diagnoses, another for procedures and
treatment. There is no "cross-coding" (a

term I'm opposed to using, because there is
no one-to-one coding relationship between
medical and dental codes). Rarely are dental
codes acceptable on a medical claim form.
If they are used, the claims will routinely be
denied, despite what you may have heard.
The medical claim form also is different
and it's critical that it be completed correctly
for claims to be processed quickly and
payments made promptly. How hard can it
be to complete? Check out the CMS website:
There are more than 60 pages of instructions
and they change yearly, every July.

Myth #2: A biller who is good at
dental billing will automatically
be good at medical billing.
Not necessarily. To be successful at
medical billing, the biller must be aggressive,
assertive, focused, and religious about
following up with precertification and claim
submissions. The biller must also be familiar
with the procedures being billed, and not
just have the terms and/or codes memorized.
Visual learning is the best-it then makes
sense to them as to which procedure precedes
or follows another, and why certain codes
are selected and appropriate for a given
procedure or surgery.
The biller cannot back down when
dealing with medical insurance company
representatives and must not take "no" for
an answer from them, especially those in
customer service. The more you push back,
the more successful you will be.

by Dr. Olya Zahrebelny
Dr. Olya Zahrebelny (pronounced
"zara-BELL-knee") graduated
from the Faculty of Dentistry
at the University of Toronto,
then completed a GPR, focusing
on oral surgery, oral medicine
and oral pathology. She has
practiced in both hospital and
private practice environments
for the past 40 years. "Dr. Z" is a
former consultant to commercial and government insurance
programs. She has also taught at three dental schools,
as well as holding the position of attending physician at
two Chicago-area hospitals. Zahrebelny has lectured at all
the major dental meetings. Her book, Accessing Medical
Benefits in the Comprehensive and Surgical Dental Practice,
has been in print for 21 years, with yearly updates. She is
a comprehensive general dentist and a principal in The Z
Group, a practice management consulting company.

dentaltown.com \\ JANUARY 2018

83
http://www.dentaltown.com
Table of Contents for the Digital Edition of Dentaltown January 2018
