Dental Billing Basics
Physicians and dentists are different in many ways. They attend different schools for their degrees, perform different procedures on their patients, and use different sets of data and codes for billing. However, medical and dental billing are actually very similar. Successful billing for both physicians and dentists requires an understanding of billing and coding principles and of how insurance companies process claims. In either case, there needs to be knowledge of how to communicate with health insurance companies and which forms and codes to use.
Different Sets of Billing Codes
Coding for medical billing comes from three sources: ICD-10, which includes diagnostic codes; Current Procedural Terminology (CPT) which includes codes for procedures physicians perform; Healthcare Common Procedure Coding System (HCPCS) which includes codes for supplies and drugs used in treating patients.
Dental billing, on the other hand, relies on a single text. Current Dental Terminology (CDT) is published by the American Dental Association (ADA). Unlike The medical billing data, the CDT combines diagnosis codes with corresponding dental procedures. Each code includes the diagnosis and the procedure to treat it. There is no need for separate diagnosis and procedure codes.
Different Claim Form
J400 is the name of the dental insurance claim form. It has many similarities to the forms used by physicians and hospitals. The patient’s personal information, insurance information, dates of service and procedure codes are all included. The J400 requires other information not used by physicians and hospitals such as the area of the mouth worked on, specific tooth numbers, procedure descriptions and information about missing teeth. Like medical claim forms, dental claim forms are available in electronic form. More than half of dental claim forms are submitted on paper because they often require other documents to be attached. Although, many electronic systems now include the capability to scan and include documents along with the claim.
Outsourcing of billing is less common among dentists than physicians. This may be related to the number of documents that must be attached to many claims. There are companies prepared to handle billing and coding for dental practices. ProMD Practice Management offers a full range dental billing and coding services, including complete management of your entire billing operation. Our billing customers enjoy collection rates of 90% to 98%. Our proven processes and infrastructure lead to low error rates, higher claim payments and shorter waits. Our billing experts keep up to date on all industry changes through continual training. Call us today to find out how ProMD can help with your dental practice billing needs.