1. Who is able to bill medical insurance?
Medical insurance provides reimbursement to physicians, physician specialists, dentists, dental specialists, chiropractors, and acupuncturists just to name a few.
2. Is it possible to bill both medical and dental insurance?
The answer to this question really depends on the scenario at hand for the patient. The answer therefore could be yes or no. We will provide a couple examples for both answers.
For yes- It is possible to send a claim to medical insurance first to receive initial reimbursement. Most of the time coverage for a service is not reimbursed at a 100%, therefore, when the medical EOB is received by your office it will show the amount paid to your office and remaining co-pay owed by the patient. At this point, your office may make a copy of this medical EOB and attach it to a dental claim for secondary payment.
For no- If medical insurance or dental insurance pays the claim at 100% then it is not necessary to send any additional claims as a secondary as this would be double billing.
What if I have charged a patient and later I receive a medical claim paying for these services?
If the patient has made any payment for services that are later reimbursed by medical insurance or dental insurance that patient is entitled to refund for their personal funds. For example, if an office charges a patient for a CT scan and later the claim is paid by the medical insurance carrier in full the patient is entitled to their personal funds. Please note the patient is not entitled to all funds received by the practitioner just their own personal funds used for services rendered.
How I do incorporate medical billing into my treatment plans?
There are a variety of ways to incorporate medical billing into your practice. Each practice is unique and part of our training after your initial sign up is to train your office on suitable billing protocols and account ledger coding. Also, our team provides you with same day eligibility checks that assist you in working with your patient to notify them of covered services.
It is strongly recommended by the team at CODE, to not promise the patient their medical benefits or to guarantee anything from medical insurance. Dental insurance behaves like a benefit plan, in that it has built-in guarantees, such as 2 cleanings per year. Medical insurance does not have such guarantees and is highly based on final review of information for payment determination. Therefore, if you can still collect from the patient beforehand, like a fee for service office, this is the best scenario for patient and practice.
What is the average time for our office to receive reimbursement?
The very first claim you submit to any medical insurance carrier will always be the longest. From the first submitted claim, the insurance company will look at two items to verify the practice. First, the insurance company will use the NPI number on the claim to run a background check for good standing. Second, the insurance company will use the Tax ID number on the claim to check with the Internal Revenue Service to make sure no back taxes are owed. This process could take 6 to 8 weeks. After this initial check typically the insurance carrier will not perform it again.
If it is a standard claim that does not require a medical review, such as exams and imaging, typical reimbursement time is about 20 to 30 days on average. If a claim requires medical review, such as an extraction or soft tissue graft, then reimbursement could take from 30 to 40 days on average. Some of the larger medical insurance carriers are extremely systematic in processing of claims and issuing payment, especially when submitted electronically. These types of companies issue payment much more swiftly and thus usually provide some kind of response in 30 days or less. In contrast, smaller medical insurance carriers do not have the processing ability of larger companies and may take more than 30 days to issue a response.
For how far back can our office try to submit a medical claim?
According to most states rules and regulations the typical time frame is one year going backwards in time to submit a medical or dental claim. It is important to note that some medical insurance carriers have their own internal rules of claims submission that may be 180 days or less for initial submission.