EP 143 Medical Billing for Dental Procedures: Your Newest RCM Tool

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Leslie Icenogle, CPC, a leading medical-dental billing expert, shared her strategies to maximize your dental revenue through proper medical coding. From documenting procedures correctly to navigating Medicare's maze, she breaks it down for me. She also shared how a chance encounter at a post office led to significant patient benefits - it’s a great story! It demonstrates how proper medical billing can dramatically impact patients. Most importantly, she revealed why many dental offices are leaving money on the table by not exploring medical billing options. You know I perked up about that topic! 

FROM LESLIE, A CLARIFICATION ON ONE POINT:

Medicare Part B, DME-covered appliances (with an actual sleep apnea diagnosis, MD referral, an appliance that meets their criteria, etc.):

• Non-participating DMEPOS suppliers can accept assignment on a case-by-case basis: If you do NOT accept assignment: There is a Medicare stipulation for DME providers only, which says if you are enrolled as a non-participating DME provider and assign benefits to the patient, you may collect your fees in full from the patient. In this case, and this case only, you are not limited to the Medicare allowable.
• If you DO accept assignment: Medicare will pay 95% of the limiting fee, and you can collect/charge up to 15% above that fee. (Take the limiting fee (say $3,000) times 95% ($2,850), then times 115% ($3,277.50). In this example, you would charge the patient $3,277.50 and no more—since you accepted the assignment on this case.) The EOMB would tell you that (what the deductible and co-insurance amount is)--as I am sure you know.  

Participating suppliers that accept assignment are limited to Medicare's approved amount for that appliance.

Connect with Leslie

Dental Classroom Online: https://www.dentalclassroomonline.com/

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Email: [email protected]

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I created Dental Revenue Network to foster collaboration and networking amongst RCM professionals. Billing company owners and billing professionals will have access to skill building sessions, current carrier news and insurance discussions beyond “what's the code?" Check it out - I hope you'll join! https://dentalrevenuenetwork.mn.co/

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