Who we serve · Dental practices
Dental practices with work the medical plan pays for. Enrolled as a medical provider, billed as one.
Sleep-apnea appliances, much jaw-joint work and oral surgery tied to a medical diagnosis bill to the patient's medical plan. We handle the medical enrollment, coding and claim follow-up. Your dental claims stay where they are.
Summary
What does HRI Med do for a dental practice that bills medical plans?
We enroll the practice with Medicare as a DMEPOS supplier and the dentist with the medical plans your patients carry, then build and follow the medical claims, including the sleep-apnea appliance billed under HCPCS E0486. We read each plan's written policy before the first claim goes out.
The medical plan wants a medical file.
An oral appliance for obstructive sleep apnea goes to the medical plan under HCPCS E0486. For Medicare it is durable medical equipment, and the coverage policy says the device is provided and billed by a licensed dentist. So the dentist enrolls with Medicare as a DMEPOS supplier before the first claim, on an application separate from any practitioner enrollment.
The diagnosis cannot come from the dental chair. The Medicare policy asks for an in-person evaluation by the treating practitioner before the sleep test, an order from a physician or another listed practitioner, and a covered sleep test, and it says a dentist does not count as the treating practitioner. A claim sent without that record in the dentist's file comes back.
Jaw-joint imaging brings a coding problem instead. A cone-beam scan taken to diagnose a TMJ disorder can go to the medical plan under the maxillofacial CT code. That code's description does not mention cone beam, so a payer may question it. Keep the diagnostic reason in the note.
Commercial medical plans set their own rules, and many want approval before the appliance is delivered.
The medical side of the practice, start to finish.
- Supplier and payer enrollment
- The Medicare DMEPOS supplier application, the dentist's enrollment with each medical plan you name, and the CAQH profile those plans read.
- The file before the claim
- A checklist of what each claim needs in hand: the treating practitioner's evaluation, the order, the sleep test report and any approval the plan requires.
- Claims and follow-up
- Medical claims built to each plan's rules and followed until paid. Denials traced to the cause and appealed where the practice is owed.
| Piece of work | Fee |
|---|---|
| A solo dentist, with each medical plan | $450 |
| Medicare supplier enrollment (CMS-855S) for a dental practice. The CMS application fee and any required bond premium are confirmed in your proposal and billed at actual cost. | $1,500per application |
| A written answer on whether one new service can be billed | $2,500 |
| Medical billing | By agreement |
Supplier enrollment also needs a surety bond of at least $50,000. Medicare treats a dentist who fits an appliance another practitioner prescribed as acting only as a supplier, so the bond applies. The full note on dentists and medical plans.
Common questions about billing medical plans from a dental office.
Can a lab or a billing company bill the appliance for us?
Not to Medicare. The practice holds the supplier number, and the appliance is billed under it. No outside firm, including ours, bills it under its own.
Do you touch our dental claims?
No. This work covers the medical plan only. Your dental billing stays as it is.
We have not treated a sleep patient yet. Is it too early?
No. Supplier enrollment and the medical plan applications come before the first appliance, and the review tells you which of them your practice needs.
Tell us which medical work you want to bill.
We check the supplier and payer rules against your practice before anything is filed. The review starts from your report totals.
Say which practice software the office uses today.