Cross coding for medical claims

by Ann-Marie C. DePalma, RDH, MeD, FAADH
[email protected]

How many times have you heard, “My insurance doesn’t cover that,” after you’ve recommended treatment for a patient? But what if the recommended procedures were covered by the patient’s medical insurance? Does your office know the importance of dental-medical insurance cross coding in the practice of dentistry?

Marianne Harper has designed a course to address these issues called Abra-Code-Dabra. Abra-Code-Dabra is designed to enlighten dental practices in transforming dental insurance codes into medical codes for any appropriate and medically necessary dental procedures.

Objectives of the course include:

• Introduction of the medical coding process and medical insurance plans
• Discussion of medical coding sets
• Demonstration of medical insurance claim processing as it relates to dental procedures

The program can be presented in either a full or half day format. The full day offers more in-depth information into each area, and includes hands-on application of the medical claims form process. In addition to the medical coding program, Marianne’s other programs are “Too Little Too Late,” “What’s a Sandwich Without the Bread?” and “Is Good Good Enough?” Each program offers unique insight into accounts receivable control, insurance claims processes, and business office systems and procedures.

Marianne developed the Abra-Code-Dabra program to assist dental professionals in handling the ever-increasing need to file medical claims. With increased documentation and research studies implicating the systemic/dental connection, many dental insurance carriers are suspending or denying dental claims by saying there is a medical nature to the dental procedure and the claim must be filed with the medical carrier as the primary carrier.

When dental professionals know how to submit medical insurance claims, they help patients achieve optimum insurance benefits. Additionally, the practice increases revenue stream and patients become believers in future dental procedures that are recommended. The understanding of the medical claims process is a great marketing tool for any practice. The patients who are recipients of additional medical insurance benefits will become champions of that dental practice.

In order to effectively use the medical claims process, all members of the dental team need to understand its complexities. Hygienists play a key role in this process because they are the ones who spend the most time with patients, and they can determine who are candidates for medical insurance claims processing. Hygienists who attend Marianne’s programs are taught the full scope of cross coding for medical claims.

Hygienists who understand the medical necessities of treatment become advocates for patient benefits and treatment. Managing the medical claims process, however, is a full practice process. All team members must understand the purposes and objectives of instituting medical cross coding. Once implemented, the front desk staff needs to understand the codes and forms, the hygienists and assistants must be observant as to potential candidates, and the dentist needs to understand the complete process and become familiar with the procedure and diagnosis codes. The use of diagnosis codes is the major difference between medical and dental insurance.

Marianne began her journey into medical insurance claims when a patient in a pediatric practice was injured, and Marianne filed the claim under the patient’s dental insurance. The dental insurance carrier denied the claim, stating it must be filed with the medical carrier first. Marianne had no idea how to file medical insurance claims but wanted to help the patient’s family receive their maximum benefits. Luckily, she found someone who was instrumental in assisting her in the medical claims process.

Knowing that she would face similar situations in the future, Marianne devoted herself to learning all she could about medical claims — taking classes, buying books, and working part-time in a medical practice learning the coding system. Five years ago she took a leap of faith and began her dental practice management firm called The Art of Practice Management, which specializes in front desk systems and accounts receivable controls, including dental-medical cross coding.

Marianne presents the program in PowerPoint with all the necessary information in handouts. It is impossible to retain all of the information presented without a take-away. Coding classes are not very exciting, so Marianne spices up the program with quizzes and audience participation. Teamwork is essential in her presentations. As a former dental assistant and office manager, she understands the role that teams play in practice management and growth.

When not on the job, Marianne enjoys spending time with her husband, children, and grandchildren. She has developed a love of watercolors and she wishes she could spend more time on her painting. Her love of guiding practices and patients to achieve optimum health and insurance benefits is “painting” its way to a brighter future.

For information on Marianne’s programs, contact [email protected].

Ann–Marie C. DePalma, RDH, MEd, FAADH, is a fellow of the American Academy of Dental Hygiene and a member of ADHA and other professional associations. Ann–Marie presents continuing–education programs for hygienists and dental team members and has written numerous articles on a variety of topics. She can be reached at [email protected].