How billing to medical can protect your practice from inflation and decreased dental reimbursements

Did you know we can bill to both dental and medical insurance, and be reimbursed by both—up to the full fee that was charged? Billing to medical helps offset inflation and decreased dental reimbursements.

The overhead of a dental practice is approximately 60%–70% and rising, while dental reimbursements have decreased. Dentistry is paid poorly compared to other medical specialties, while the overhead for other medical providers is lower. When you visit your MD, typically they have minimal supplies in their offices: a table for you to lie on, a chair for you to sit on, and a computer with very few additional supplies. Following the COVID-19 pandemic, I was hoping that dental practices would finally be seen as surgery centers and closer to being viewed and reimbursed as a medical specialty. But the opposite has happened.

Dental insurance carriers have decreased reimbursements for claims. Our operatories are called that for a reason; we are performing invasive procedures every day, all day, even if that procedure is “cutting into a tooth.”

Overall, this should be an exciting time in dentistry with all the additional surgical procedures and treatments we can provide, as well as all the amazing technology we have to offer outstanding care to our patients. But with all the education and technology come significant costs that diminish our excitement. What options do we have to help combat the rising costs so our industry can be profitable? Medical billing can help.

Are you aware that our specialty can bill to both dental and medical insurance, and be reimbursed by both—up to the full fee that was charged? Patients have medical benefits for many procedures that we provide in a dental setting. Billing to both dental and medical will decrease patients’ out-of-pocket costs, increase case acceptance, and make a significant impact on practice collections. In fact, medical allowances are far higher than anything you’ll see on a dental fee schedule. Billing to medical allows you to be paid as you should: as a medical specialist.

What can be billed to medical insurance?

Any of these procedures can be billed to medical: evaluations, panorex, CT, repeat and limited CT, lateral ceph, periapicals with trauma, bone grafts (including sinus lifts), dental implants, implant removal, surgical stents, interim/final prosthesis, cyst/abscess removal, sinus repair, alveoloplasty, wisdom teeth extraction, biopsies, frenectomies, sleep apnea appliances, TMD appliances, Botox, restorative treatment when needed due to a systemic condition as a root cause, and more.

When you shift your mindset and start to look beyond teeth, you’ll see a lot of medically necessary treatment. Medical typically does not pay for tooth-related procedures unless the teeth are impacted or there is a systemic condition causing destruction to the dentition. With the advanced services we provide to our patients, dentistry is far beyond treating just teeth.

Taking a new view of dental benefits

We also need to shift our mindset about dental benefits. Dental benefits have brainwashed us in so many ways. We allow those fee schedules to dictate the fees we charge for our services. A great example is a clinical exam. Is an exam on a 10-year-old the same as one on a 60-year-old? Absolutely not, yet the fee is often the same. The only time the fee should be the same is for a service like a panorex; then, it would be logical to charge the same fee for all patients.