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Dental-Medical Cross Coding
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A Cure For That Nagging Stomach Ache
How A Dental-Medical Cross Coding System Can Decrease Your Costly Accounts Receivable
By Marianne Harper

Your scheduling coordinator tells you that a trauma patient is coming in. You immediately get that familiar feeling in the pit of your stomach. Yes, you are concerned about the patient and how you will care for him but you also know that you there is a really good chance that you may never get paid for your services. Because you are a health care provider, you treat the patient.

This fee, along with so many others, may sit in Accounts Receivable for months or years to come. The cost to you is higher than you realize because of the time value of money and other costs.

There are four common factors that affect the time value of money. The effect of interest rates is the most well known. If rates decrease, a dollar in your hand today will have more value than a dollar at a later date. Less known is the opportunity lost. If you had that same dollar in your hand today, you could purchase what you want or what you might need. In addition, you could invest it and earn interest on it. If you didn’t have that dollar, you could not have earned anything more. The third risk is the collection factor. You may receive your fees later than what you were promised or you may never receive them at all. Keep in mind that this risk increases with the time that the fees are outstanding. Lastly, inflation plays a role. If prices are rising, you will be able to buy less with that dollar at a later date than you could today. Let us assume in this article that the time value of money today is six percent. The cost of a $50,000.00 Accounts Receivable is $3000.00.

Those costs listed above are the more obvious ones associated with maintaining an Accounts Receivable. There are hidden costs involved that are rarely considered. Let’s assume that your accounts receivable is $50,000.00. Over the course of one year the hidden costs of maintaining the accounts receivable can total almost half of the total A.R.

If this $50,000.00 is unavailable to you, then you are denied the ability to use those funds to service the debt of the practice. You can estimate that this can cost you at least $1,000.00 in interest in a year’s time. Then there are the patients who will never pay you. You can count on about two percent who fall into that category. Two percent of $50,000.00 is $1000.00.

You must consider the cost of the supplies that service the billing system. It is estimated that the cost of each statement sent is $5.00, not including the labor involved but including the cost of the statements, envelopes, printing, and postage, or your fees for electronic billing. If your practice sends out one hundred fifty statements per month, that in turn totals one thousand eight hundred statements for the year. You will have incurred an additional $9,000.00 in costs.

Payroll must also be considered. If your financial coordinator spends one hour per week (and this is a very conservative estimate) working on collection activity and the per hour wage for this staff member is $18.00, you will have paid an estimate of $936.00 over the course of the year.

There are two additional dilemmas associated with the cost of maintaining Accounts Receivable. It is known that many patients who owe money that is past due will not return to your practice. Two Recare appointments that might total a conservative fee of $90.00 each for an estimate of five lost patients will result in a loss of $900.00 per year. Broken appointments are most often caused by patients who owe money and can easily cost you another $900.00 per year. In addition, these patients will rarely refer patients to you and this can cost an estimate of at least $1000.00 in lost fees.

As we calculate the total of all of these estimated hidden costs, we can see that having an Accounts Receivable balance of $50,000.00 can be quite expensive. The estimated costs total $17,736.00 for the year.

One solution to lowering accounts receivable involves filing dental procedures with medical third party carriers. Filing a significant number of dental procedures with medical insurance plans can increase practice revenue and reduce the costs associated with handling the Accounts Receivable. Dental-medical cross coding may be part of your answer!

The question then arises as to when is it appropriate to file dental procedures with a patient’s medical plan. There are five categories under which procedures must fall.

  1. Exams and Consultations

  2. Infection that goes beyond the tooth apex and is not treatable by entry through the tooth

  3. Procedures related to dysfunction

  4. Trauma procedures

  5. Pathology that involves hard or soft tissue

There are several advantages for dental practices when they implement a dental-medical cross coding system. Dental plans have yearly maximums that medical plans do not have. When you are able to file procedures under both plans, you can significantly lower the patient’s out of pocket expense. In addition, while most dental plans provide an allowance for a full mouth series, the American Medical Association approves this benefit every two years. Let us also consider that receiving benefits from a patient’s dental and medical plan can reduce their out of pocket expenses.

Cutting edge dental practices of the twenty-first century should especially embrace this coding system. This past decade, dental professionals have been learning of the link between oral infection and systemic conditions, thereby influencing the therapies that they provide. A carefully developed patient medical history section that includes entries

for cardiovascular disease, high blood pressure, diabetes, and respiratory disease is a must on new patient registration forms and Recare update forms. Periodontal pathogens have been proven to have a direct effect upon these conditions. The information provided on these forms in addition to your clinical findings will provide the diagnoses that are needed to file medical claims.

Medical insurance is diagnosis driven. The first item listed on a medical claim following patient demographics is the diagnosis and no benefits will be paid without it. Providers use ICD codes (International Classification of Diseases) to report their diagnoses. In addition, they must use V and E codes that give additional information about the diagnosis. The procedures are reported with CPT codes (Current Procedural Terminology) in addition to modifiers that clarify certain types of procedures.

The biggest obstacle in filing medical claims will be learning how to choose the correct codes, both CPT and Diagnostic (ICD-9). Keep in mind that incorrect coding will cause the greatest delay in payment. I encourage the preparation of a list of the most common procedures that your practice will use for medical claims and assign the CPT and Diagnostic codes to each procedure. This can be a handy reference tool for the actual preparation of the claims. Dental-Medical cross coding manuals can be of great assistance with this. Always proof read the claim prior to submission to check for accuracy. Another very important step will be to promptly track these claims, just as dental claims should be tracked.

Implementing a medical-dental cross coding system in your practice will involve several steps. You will need to obtain the patient’s medical insurance information either by re-designing your registration form or by using a separate medical information form. You will then need to become familiar with the ICD and CPT codes and how to use them. Staff training by a dental-medical cross coding specialist will be the best way to learn the system and successfully file claims. You will need to purchase either a dental-medical cross coding manual or the ICD and CPT code books. The forms that you will use are the HCFA 1500 forms and they can be purchased from medical or office supply companies. These forms are red and cannot be duplicated. Duplicated claim forms will not scan correctly and will cause denials. Some practice management software systems have a medical component that will prove to be very helpful.

Written pre-authorizations are discouraged. You will rarely receive a reply. Should you wish to determine if certain procedures will be covered by a patient’s medical plan, it is best to do so by phone.

Trauma claims require special handling. These patients will need to provide you with a copy of the emergency room report or the police report if either apply to their situation and it will need to be filed with the claim. You will also need to file a narrative report along with the claim. The narrative will need to include the pertinent details of the accident. In addition, the ICD codes will be chosen from this information. The following accident form will prove helpful to your practice.

Narratives will be required for other classifications of medical claims. Never write notes directly on a claim form. These notes must always be included in the narrative. By the very nature of these claims, it would never hurt to include a narrative on most claims. You can create a narrative template that would simplify this process.

Medical claims must be tracked just as dental claims are. When benefits are received, it is very important to carefully review the calculation of benefits. Payers may reduce payment levels, or they may combine procedures. Denials may occur for no apparent reason or they may deny because they state that it is a dental claim. You must appeal and advise them that it is a medical claim. When submitting an appeal, it is crucial that you insist that they provide you with the plan rules that their decision was based upon. Encourage your patients to handle their own appeals, especially if they believe that the appeal failed unjustly and the patient’s insurance commissioner needs to be contacted. The patient is the one with the authority to deal with the insurance company, as the contract is between them alone.

Most important of all, I encourage practices to collect payment in full at the time of service. Patients should be told that the medical claims are being processed as a courtesy to them and that any benefits received will promptly be refunded to the patient

The benefits of implementing a dental-medical cross coding system are numerous. You should find an increased case acceptance for those procedures that fall under the guidelines for filing, especially from patients who do not have any dental insurance. You should then see increased practice revenue, not only from the increased case acceptance but also because your patients will have less out of pocket expense and more benefits paid by insurance plans. Lastly, implementing a dental-medical cross coding system can be a great marketing tool for your practice.

As a practice management revenue systems consultant, I have processed many successful dental-medical cross coded claims. There will, of course, be a learning curve for novice coders but this is not much more difficult than when coders learned how to file dental claims.

With time and experience, medical-dental cross coding will become much easier. It is certainly worth the time and effort to implement a dental-medical cross coding system in your practice for many Periodontal, Surgical, Endodontic and emergency trauma procedures. You will be able to add a valued service for your patients that should reap financial rewards for you.

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