April 21, 2023 • 10 mins read

Team Roles for Medical Billing in Dentistry

The importance of knowing how each team member contributes to medical billing for dentistry. It provides a list of the top 4 roles and what they can produce to complete your medical billing.



Laurie Owens

CPC | CPB | COC | Director Of Medical Billing Education for Devdent

Team Roles for Medical Billing

Everyone loves a great performance. But imagine if the cast does not know where to be when their part in the play begins? As you can imagine, it would be a fiasco. We can laugh about the prospect, and yet we throw our teams to the wolves without knowing how their piece of the medical billing for dentistry puzzle fits into the picture. But it doesn’t have to be that way, let’s take a deeper look at how each team member contributes to medical billing in your practice.

Here are the top 4 roles and what they can produce to complete your medical billing for dentistry:

Team Role #1: Doctors

You may be thinking to yourself, “Well, of course, the doctor has to do things right!” That is true, but do you know what their role is? Here are the items that are needed from the doctor to prove medical necessity:

  • A very defined head and neck exam
  • Medical conditions and medications clearly reviewed – do NOT put HH reviewed without clarification of what was reviewed
  • Diagnostics – PH test, HbA1c, radiographs, periochart, etc.
  • Diagnosis each radiograph taken or reviewed
  • Synopsis of the periochart results (as in 4-6mm pockets with slight exudate maxilla posterior)
  • During an exam, we should prompt the doctor for clarification.  What that means is the following:

Doctor Says: 

  1. Patient has bone loss.
  2. Patient has perio.
  3. Patient needs all on X.
  4. Patient has diabetes.
  5. Patient has cavities.

What we ask: 

  1. Is that minimal, moderate, or severe? 
  2. Chronic or aggressive? Localized or generalized? Minimal, moderate, or severe? 
  3. Would that be from caries, trauma, perio, or other? 
  4. Type I or II; do we have a glucose or HbA1c number? 
  5. Smooth surface or pit & fissure? Does it go to dentin or pulp? 

There are many questions, not just the ones above, that could be prompted to the doctor. Our recommendation is to have a team meeting to review what your team would like to do.

The doctor is to give a diagnosis. #5 has a class III caries lesion likely caused from her medication induced xerostomia from anti-anxiety medication.

We need a treatment plan. Beware of giving options, this will not be a good situation because of LEAT – Least Expensive Alternative Treatment.  

We all know that when a patient has options, they will, most of the time, opt for the cheapest, and not the best option. Our practice success came from giving the patient the best treatment option, they see your doctor for a reason, they are professionals of the oral cavity.

The more options you give, the harder it will be to obtain medical preauthorization AND your notes will read as being wishy-washy, instead of confident. 

Team Role #2: Assistants

Assistants are an extremely vital part of the dental office, and the medical billing process. They are the ears of the office, and listen to everything, from the review of health history, medications before the doctor comes in, to handing off to the doctor what was discussed in his/her absence.  We cannot stress enough how important the role of the assistant is.  

Tips for Dental Assistants: 

  • Practice the hand off.  Make sure the doctor knows all that you discussed and reviewed with the patient before they came into the treatment room.
  • Work on verbiage in your chart notes and make sure to prompt the doctor when more information is needed.
Team Role #3: Hygienist

In general practice, a hygienist wears many hats. Starting with a new patient, assisting the team to facilitate a surgery, to helping answer the phones or contacting patients when needed.  

When a hygienist sees a new patient, they step into the assistant role and need to help clinically correlate what is going on in their oral cavity to the treatment needed in the oral cavity.  

A hygienist knows clinical information that others must study hard to understand. They are an asset for medical billing with their concise notes and care for their patients.

A tip for hygienists: Make sure you note the patients’ health history and medications in your chart note for the exam.

Team Role #4: Admin Team

The admin team, any first contact in the practice goes through them. Because our dental practices can be extremely fast paced, when a new patient calls to schedule, are you giving them the time they need to make sure all information is gathered?  

Many offices fall short and rush the call to get the patient scheduled or put them on hold because another patient is coming to their desk. Taking a little more time makes a difference.

Information that your admin team should be obtaining:

  • Demographics
  • Chief complaint
  • Insurance information
  • Details about what is going on
  • Past dental treatment
  • Personal information

Gathering that information will help your team and will set them up for success in billing medical insurance for dental treatments!

Remember, if you are focused on the teeth, and only teeth, not the whole body health that stems from the oral cavity, medical billing for dentistry may not be for you. If you still aren’t sure about implementing medical billing, education on medical billing for dentistry should be your first stop.  

Without this vital knowledge, it can seem like you are grasping for straws. Remember, building your case to submit to medical insurance is like a puzzle. If one part of the puzzle fails to provide information, your medical necessity will not be proven. 

Patients are looking for dental providers that are thinking outside the box, are you ready to take the next step in expanding your care beyond teeth and into medical billing to help your patients lessen their burden? 

Take our free assessment to see how medical billing for dentistry will look in your practice!

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