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. That side needs medical enrollment, medical codes and a medical biller's habits. We run all three, and leave your dental claims where they are.
A medical plan pays on medical terms.
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 in so many words that 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, whose description does not mention cone beam, and a trade article warns that some payers audit it for that reason.
Commercial medical plans write their own policies. One vendor guide names approval before delivery as the usual first step with them. We read each plan's policy on the practice's list rather than assume one answer covers them all.
The medical side only. Dental claims stay with you.
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.
- What we check first
- The supplier rules against your practice, in the free review, before you pay anything.
| Piece of work | Fee |
|---|---|
| A solo dentist, with each medical plan | $350 |
| A written answer on whether one new service can be billed | $2,500 |
| Medical billing | By agreement |
Supplier enrollment carries a federal application fee of its own, and a surety bond unless one of the rule's exceptions fits the practice, apart from any fee of ours. The full note on dentists and medical plans.
What dentists ask us about medical billing.
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?
It is the right time. 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 any fee. The review needs no patient records.
We get back to you as quickly as possible.