From the very beginning, we make sure that all of your credentials are accurate. Credentialing is an important part of medical billing. We credential out of network or in network.
Medical Insurance Billing
If you are not staffed to implement medical billing, don’t worry. With our billing services, we can process the medical claims for you.
We will teach you how to implement the process of medical billing into your practice. You will learn how to incorporate efficiencies with your existing practice management software.
Learn From The Best!
Medical billing for dentists is a hot topic and an amazing source of additional revenue! Most importantly, it will help patients pay for needed dental treatment that otherwise may be unaffordable. However, a practice cannot afford to learn by theory or errors…you must learn to do it correctly to avoid getting into trouble with payers.
Not only do we provide the billing services for you, we can teach your practice how to implement medical billing from the initial contact with the patient to posting the medical insurance payment and everything in between.
Basics of Medical Insurance
Dentists provide medical treatment every day and in most cases they never realize it. Medical insurance will pay for procedures performed in a dental office if it is a diagnosed medical treatment.
Some treatment is just dental…like routine preventative care. However, some procedures like an abscessed tooth would be classed as both a dental and medical condition. Heart disease or diabetes are medical conditions that have oral health implications.
Here are 4 basic types of dental procedures that are billable to medical insurance.
Services Billed to Medical Insurance
A few procedures that often qualify for medical billing:
CT Scans, diagnostic casts, apicoectomy, gingivectomy, bone grafts, tissue regenerations, biopsies, fluoride trays for cancer patients undergoing chemo, alveoloplasty, excision of bone, and a frenulectomy.
Description of Services
Our credentialing services provide an all inclusive package for medical billing credentialing, medial billing portal setup, enrollment for electronic processing of medical claims, payer setup based on practice needs, and on-going payer management setup during contract.
Some procedures will require a pre-certification (aka pre-authorization) for the treatment to be done. Transition Acceleration Group, LLC can do all pre-certifications and update the practice to discuss with the patient the payers decision.
When a claim is denied, it is imperative to appeal the decision of the payer. In many cases, insurance companies use denials to manager cash flow and hope that most providers will not appeal the initial denial. We will exhaust all appeal opportunities to get claims paid.
Out of Network Acknowledgement
This service will provide the payers with practice and provider information to allow the doctor/ group to be recognized as an out of network provider.
In Network Application
The in-network application fee covers all applications for payers, the payer web-portal registration and follow up until an effective date has been issued.
3rd Party Portal Setup
Often with medical billing there are third party portals that are needed to upload additional information, view claim status, view detailed ERA’s and appeal claims. This process is more in depth that just registering for the access to a portal.
Provider More Information Request
This service will provider payers ore information such as a LMN (letter of medical necessity), surgical notes, x-rays etc, as requested.
Medicare, DME or Tricare Applications
Government applications can take a considerable about of time and effort. Transition Acceleration Group will complete and submit the applications for Medicare Part B, DME or Tricare for either participating or non-participating providers.
Credentialing Management will prevent delays in medical insurance payments as well as keeping provider directories current and speed claim processing and adjudication. In addition, it will help alleviate administrative burdens. All in-network payers re-credentialing is included in the monthly fee.
Connection Series Training
The Connection Series Training will keep your patient ledger in line with medical billing. During this series, we will help the practice benchmark their fees to ensure there are no issues when billing both medical and dental insurances. We will help you understand the medical codes to add to the practice management software, how to track and post your medical insurance payments.
With any new process, there’s training. With our clinical training, the dentist and assistants will learn the proper way to document the patient visit. You will learn how to select the correct diagnosis codes and record the surgical notes to get your claims paid.
Gaining hospital privileges is a long and tedious process that can take up to 120 days. Our services will gather all the needed information, complete required forms, submit verification forms, and follow up until privileges are granted.
There will be occasions where the dentist will need to have a case consult on picking diagnosis codes, or writing the LMN’s. Our consultants will be available to assist the dentist in making sure the correct medical “story” is told.