DAY 1: Basic Medical Billing — Accessing Benefits for Exams, X-rays, Wisdom Teeth and TMD/OSA Appliances

presented by Dr. Olya Zahrebelny, Chief Education Officer


“Medical billing by dentists is illegal.”

“I’ve tried it and it doesn’t work.”

“I’m told only oral surgeons can bill medical plans.”

Many dentists are under the misconception, for various reasons, that medical plan benefits can only be accessed in cases involving trauma, but this cannot be further from the truth. Current medical plans on the market cover a wide variety of procedures ranging from simple examinations and consultations, such as oral cancer screenings and exams for minor issues like herpetic lesions, aphthous lesions, tori, Candidiasis and dry mouth, to the more complex, such as atrophy of the alveolar bone and pneumatization (enlargement) of the sinus as a result of tooth loss. In addition, both surgical and nonsurgical treatments for these and a myriad of other infectious, inflammatory and pathological problems are medically covered, including therapeutic (topical) treatments; periodontal surgical services; Stage I and II implant treatment; TMD, orthodontic and sleep apnea appliances; and oral and dental procedures related to traumatic injury.

There is NOTHING illegal about billing medical plans by ANY dentist, and there are NO tricks involved. You just have to approach things the right way. This one-day presentation is an introduction to the basics of medical billing and will discuss the different medical plans on the market, the basics of medical diagnosis and procedure coding, as well as medical documentation requirements.


Part I: Lecture

(a) Medical Insurance Overview:

  • Medical plans and what they cover, including nuances for billing to each type

  • Documentation: Patient history and clinical notes for medical billing

(b) Medical Coding and Guidelines:

  • ICD-10 (Diagnosis) Coding

  • CPT (Procedure) Coding

  • Documentation and correct formatting for medical billing- the LATEST requirements

Procedures covered include:

  • Examinations, diagnostics

  • Radiographs

  • Therapeutic (non-surgical) treatments, including Sleep apnea, Nightguards, and TMD appliances)

  • Wisdom teeth extractions

  • Nitrous oxide analgesia, oral and moderate conscious (IV) sedation

Part II: Medical Billing –IMPORTANT parts of the CMS-1500 (02/12) Medical Claim Form for e-filing

Part III: Discussion of Basic Claim Examples

Additional Course information: It is strongly suggested that the Doctor attend the program with the Team member(s). Successfully leveraging medical plan benefits for payment requires very close cooperation between the clinical and business teams. This is what differentiates the offices that are ultimately wildly successful with medical billing from those that achieve only mediocre results, or none at all.

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