Maximizing your Dental Fee Schedule

Boosting Practice Revenue with Dental Cross-Billing
The number of Americans with dental insurance coverage declined notably in the period following the economic woes of 2007.  According to the National Association of Dental Plans, dental benefits enrollment had declined 5.7% by 2009 due to economic contraction.  With 56% of the U.S. population reporting some type of benefit plan in 2012, coverage levels appear to have rebounded to pre-crisis levels.  If so, then why are dental practices still feeling the pinch?  A commonly cited reason is declining reimbursement rates.

Getting Out of the Rut
Dentists in many markets are experiencing declining reimbursement rates from dental carriers across the board.  This trend can be prohibitive to the delivery of needed services to patients, especially those procedures of medical necessity which may involve higher dollar claims.  In this climate practice owners are seeking new and innovative ways to enhance practice performance.  Staying abreast of the dizzying number of changes in the industry can be exhausting.  With demanding clinical schedules and limited time available for practice management, the most efficient strategies often are those which can be implemented with the existing procedure mix.  One of these strategies is cross-billing to medical insurance.  Many dentists leave money on the table by failing to maximize reimbursement for the procedures they are already providing. Properly coding and billing to medical insurance for appropriate procedures can increase practice cashflow while adding value to your patient base.

What is Dental Cross-Billing?
Historically, dentistry was viewed distinctly from the field of medicine.  Today there is a large body of research documenting the connection between oral health and body systems and a greater acceptance of the holistic approach to dentistry. As insurance payors embrace the medical nature of dentistry, it is prudent for dentists to re-tool their billing practices in order to be fully reimbursed for their work.  Dental cross-billing involves coding and billing dental procedures to medical insurance payors.  Many doctors are put off by this idea because they are not sure what can be billed to medical insurance and how to follow through with a sustainable course of action.  The level to which medical necessity and documentation is required varies widely by the specific procedure.  Naturally, specialists will encounter more such cases but general practitioners are commonly treating an array of conditions which can be billed medically.  There are a growing number of dentists who provide diagnostics, therapy, surgery, and oral appliances to treat conditions which may have been referred out in the past.

Benefits of Billing Medical Insurance
One major benefit of medical insurance billing is increased revenue. Reimbursement rates from medical carriers commonly are higher than those of dental carriers. For the same procedure dentists can receive significantly greater payment and may also get paid for procedures which are not covered under dental plans.  Patients can also reap the benefits by avoiding out-of-pocket payment for procedures which are billed medically.  Moreover, they will be able to preserve their annual dental plan maximums to use with other services which may previously have been unaffordable.  With this comes greater patient compliance with treatment plans and improved oral health outcomes.  Patients may be more inclined to refer friends and family when they are able to fully leverage their existing coverage and receive additional needed services.  They will also appreciate your medically-oriented approach to dentistry. 

How to Implement Cross-Billing

  • Assess your practice and take an inventory of the services and procedures which can benefit.
  • Generate reports based on procedure code. It is important to analyze actual data. You cannot improve what you cannot measure.
  • Evaluate the effectiveness of cross-billing with the existing procedure mix before adding new procedures.  This will give you some room to work out potential difficulties.
  • Invest in staff training or engage a dental billing company that specializes in dental cross-billing.  Some billing agencies will offer a complimentary assessment.
  • If your efforts have been fruitful, consider a marketing program designed specifically for those services.  Use the competitive advantage to grow your market share.

The Impact on Your Practice
The role of insurance plans in the dental industry continues to grow and change.  On a national level the market is divided as follows: Private Insurance (48.6%), Patient Pay (39.9%), Medicaid (8.5%) and Medicare (0.3%) (US Census).  This is expected to progress even further in light of looming changes on the horizon as the result of health reform.  While insurance reimbursement can be one of the most financially frustrating aspects of practicing dentistry, dental cross-billing is one of many strategies which can help.  If implemented properly, practices can generate greater revenue with minimal hassle or added cost.  This can yield dividends for your practice today and tomorrow: 1) A noticeable rise in revenue and earnings in the interim, and 2) Increased practice value when it comes time to sell.  Practice value is largely determined by the financial characteristics of your business and boosting short term and long term financial strength can allow you to reap the benefits twice.

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