Dental procedures are expensive and mostly not covered by Medicare. For outpatient procedures, Medicare will not be responsible for the excluded services. Part A of Medicare covers the costs of inpatient hospital dental treatments given in conjunction with dental operations that need hospitalization owing to a medical condition or clinical state underlying the dental procedures, or their severity.
Knowing what Medicare covers and what it doesn’t, along with ensuring appropriate billing and coding is crucial.
This helps satisfy payer criteria and is critical if you want to get the most payment possible. A medical billing service provider that deals with Dental billing can help with this.
- Understand Your Medicare Dental Coverage: In general, Original Medicare (Parts A and B) does not cover routine dental services associated with the treatment, removal, filling, or replacement of teeth, dental devices such as dentures or plates, or structures directly supporting the teeth. Medicare will cover the following:
- Dental treatments that are a necessary component of a covered service
- Extractions, performed in preparation for radiotherapy treatment of neoplastic disorders of the jaw!
- Oral exams, but not treatment, are permitted in some situations before kidney transplantation or heart valve replacement.
- Dental sleep apnea devices are covered for specific geographic regions, provided the criteria are fulfilled!
- Medicare Advantage (Part C) plans are private health insurance plans that include some dental benefits. They may cover routine preventive care such as cleanings, X-rays, and regular exams in part or entirely. It may also cover procedures such as extractions, root canals, dentures, crowns, and fillings.
- Should you Enrol in Medicare? : Dentists who offer covered goods and services under Medicare Part B must either enroll in Medicare or officially opt-out. Even if they do not offer Medicare Part B covered goods and services, businesses must enroll or opt-out, in case they order covered clinical laboratory tests, imaging services, or durable medical equipment and supplies (DMEPOS) for Medicare beneficiaries.
- The patient must sign ABN if Medicare doesn’t cover the treatment: Patients must sign the ABN form (Advanced Beneficiary Notification) if they desire treatment or an item that Medicare does not cover. This demonstrates that the patient is aware that the treatment or item is not covered by Medicare and is willing to pay for it out of pocket. ABN documents aren’t required for things like regular dental treatment like cleanings and root canals, which Medicare usually doesn’t pay.
- Dental Eligibility Verification: Patients and the provider both benefit from verifying coverage and perks. While regular dental treatment would be considered an extra benefit under Medicare, the benefits provided by Medicare Advantage dental plans may vary widely. Every important aspect of insurance eligibility should be included in the verification process for dentistry, such as identifying information like your name and date of birth as well as the percentage of coverage you have for different services like teeth-whitening and crowns as well as out-of-pocket expenses for procedures like dental implants and tooth grafting. If prior approval is required, it should be sought.
- Accurate Medicare Billing – Dentists must submit correct insurance claims. Medicare considers the codes used to identify the health care services, very carefully before making a coverage determination. For claims processing and payment accuracy, billing dental services properly is essential.
- Medicare Part B Deductibles – Before Medicare will reimburse extra expenses for Part B enrollees, they must first pay a deductible. An accurate record of all deductibles must be kept, and incorrect deductibles must be reimbursed!
To guarantee accurate invoicing, service providers must keep abreast of changes in industry laws and standards. We are well aware that not everyone can stay up-to-date with the latest changes. So, the best approach to maximize Medicare billing, collect appropriate compensation, and improve patient satisfaction is to work with the best medical billing company in New Jersey, Tall RCM. We will do the heavy lifting for you, so you can focus on your core responsibilities.