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Billing medical insurance in dentistry

Medical Billing in Dentistry: Coding – Speaking Their Language

Last Updated: 01/07/20 ICD-10 Codes International Classification of Disease 10th Edition DIAGNOSIS CODE Learn More CPT Codes Current Procedure Terminology PROCEDURE CODE Learn More Modifiers & Qualifiers Additional Information to Explain the Procedure ADDITIONAL INFO Learn More Medical coding is made up of 3 categories. These universal coding categories are intended to explain both what and why for any medical procedure or encounter.  If done correctly, the codes themselves replace the need for a narrative. I like to look at the Why, before the What. Why do I believe this procedure has Medical Necessity?  If the patient is suffering from certain health conditions i.e., Diabetes, Heart Failure, Pregnancy, Sleep Apnea, Acid Reflux or Infection or certain symptoms i.e., Dry Mouth,

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Jaw Pain Sleep Test Paid Successfully

Amount Billed: $3800 Amount Paid:$1,140 Insurance Carrier: Aetna This patient was seen by their dentist with a chief complaint of jaw pain, migraines, and tension headaches. They underwent a sleep screening and their provider billed medical insurance $3,800 and was paid $2,660, leaving the patient with less to pay out of pocket! Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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Patient Accident Emergency Surgery Successfully Paid Within a Week  

Amount Billed:$4,500 Amount Paid: $3,541.91 Insurance Carrier: Empire This patient fell and broke a tooth, causing an infection, swelling, pain and difficulty when eating. Emergency surgery was performed by their dentist to include bone grafting and bone stabilizers to restore full function. Medical insurance was billed: $4500.00. The claim was processed within a week of submission and paid: $3541.91 to the provider! Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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Wisdom Tooth Extraction Success Story Paid Within 8 Days!

Amount Billed: $3,262.23 Amount Paid: $2,706.14 Insurance Carrier: Highmark Western The patient received services for wisdom teeth extraction. After the dental provider submitted the claim to medical insurance, the claim was processed 8 days from submission and paid $2,706.14 of the $3,262.23 billed!  Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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Custom OSA Night Guard Medical Billing for Dental Sleep Success Story

Amount Billed: $3,800 Amount Paid: $1,137 Insurance Carrier:Aetna The provider created a custom night guard for their patient who suffered with OSA and was able to bill medical insurance, not only saving their patient on out of pocket costs, but allowed them to get paid $1,137! Billing medical insurance for custom night guards for sleep patients has many benefits, including saving patients in out of pocket costs, and reducing treatment hesitancy!  Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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Infant Laser Frenectomy Medical Billing Success Story

Amount Billed: $750 Amount Paid: $631.14 Insurance Carrier: Anthem A newborn patient had difficulty nursing and wasn’t gaining enough weight during their first few weeks after birth. Upon examination, the healthcare provider discovered that the connective tissue in the patient’s tongue was limiting its mobility. To address this issue, the provider performed a laser frenectomy procedure to enable the patient’s tongue to move freely.  The cost of this procedure was $750.00, after processing the insurance claim to bill medical insurance, the provider received $631.14. The patient’s deductible was only $100.00, and the total amount allowed for this procedure is $731.14.Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance

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OSA Device Modifier Corrections Success Story

Amount Billed:  $4,000 Amount Paid: $1,825.23 Insurance Carrier: Empire Though this case for an OSA device required modifier corrections, the claim was processed within 5 days of the corrected claim and paid the provider $1,825.23 out of the $4,000 billed. This left the patient with just a coinsurance of $206.94 after the total allowed amount of $2,032.17! Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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Oral Cyst Excision Success Story

Amount Billed: $2,138.23 Amount Paid: $850.40 Insurance Carrier: Aetna This patient was seen for the excision of a benign cyst. After a medical review, the claim was processed within two months. The dentist billed $2,138.23 to medical insurance and was paid $850.40, leaving the patient with just $364.46 out of pocket toward their deductible.  Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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OSA Billed to Medical Insurance Saving Patient’s Dental Benefits!

Amount Billed: $7,500 Amount Paid: $142.66 Insurance Carrier: Aetna This provider billed medical insurance for the patient’s OSA device. The claim was processed within 1 month of submission and paid $142.66 on the allowed amount of $1,590.22, leaving the patient with just their deductible of $1,400 and $47.56 in coinsurance! Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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$0 Out of Pocket Custom Fabricated Orthotic Device Success Story!

Amount Billed: $7,600 Amount Paid:$4,940 Insurance Carrier:Empire HealthChoice Assurance This patient was suffering with headaches and jaw pain. Their dentist custom fabricated two orthotic devices to help resolve the patient’s symptoms and billed medical insurance.  Medical insurance was billed $7,600 and the claim was processed within 3 weeks of submission, allowing $4,940 which was paid in full to the provider! Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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Custom Airvata Device Success Story

Amount Billed: $3,800 Amount Paid: $2,470 Insurance Carrier: Empire HealthChoice Assurance This patient suffered with headaches and TMJ issues, their dentist custom fabricated an Airvata device to help relieve the symptoms. Medical insurance was billed $3,800 and the claim was processed within a week of submission, paying $2,470 to the member! Contact us at (855)-534-1433 or take our assessment to see how we can help you get more success in billing medical insurance for Dental procedures! 

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