Billing medical plans for dental treatment

There is an ongoing trend within health care toward integration and consolidation of health care delivery systems. This trend is reflected in provisions of the federal Affordable Care Act, such as the envisioned coordination of care provided by a single entity, the "Accountable Care Organization." The objective of such integration and consolidation is to provide better management of care, create greater efficiencies in the provision of care and improve patient outcomes.

How this trend will affect dentistry largely remains to be seen. But one area that is apparent is an overlap between medical and dental services and how care is paid. What this means is that, increasingly, dental offices are being required to bill a patient's medical plan for treatment that is essentially dental in nature. These types of treatment situations can include trauma from an accident, sleep apnea, oral or periodontal surgery procedures, or dental disease that is secondary to cancer treatment. In those cases, an option exists for billing a patient's medical insurance. These are procedures that medical plans not only pay for, but increasingly dental plans are deferring to as the primary payers. 

There are advantages to billing patients' medical benefits plan, including easing the financial burden on patients and conserving their annual dental insurance benefits. The disadvantage is the dental office must have the knowledge and business systems in place to file and manage medical claims. The learning curve can be considerable. It makes sense for practices that treat a reasonable volume of medically related issues to create and implement such systems.

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