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
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
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
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.
- Exams and Consultations
- Infection that goes beyond the tooth apex
and is not treatable by entry through the tooth
- Procedures related to dysfunction
- Trauma procedures
- 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
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
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.