We’ve seen it many times in our medical billing department with claims sent to us for submission of procedures. Chart notes document several visits with exams before the procedures are performed but this is the first claim we’ve ever seen for this patient. Where are the billings for previous exams, evaluations, and consultations?
We have a list of restorative procedures to submit that seemingly come out of the blue. Even worse is the knowledge that many of our providers are giving away their valuable time for free when patients come for consultation but do not move forward with treatment.
Dental insurance and exams
It is a familiar problem with dental insurance. Two exams a year are covered and if the doctor is lucky they get to bill an extra problem-focused exam when they see the patient. Doctors are reluctant to bill patients for exams because they don’t want to lose the patient over what they see as “frivolous over-billing”. They simply code these additional visits as zero-charge exams or observational visits and move on with their days.
Medical insurance and exams
Medical carriers have no such limits. You will rarely see a specialist office visit denied because the patient has “met their maximum” for office visits. Doctors lose valuable revenue, time, and credibility when they don’t bill for consultations.
A prime example is the sleep apnea appliance. Providers will see the patient for an initial consultation which can include impressions, pharyngometer/rhinometer testing, radiographs (pano or CBCT), and easily 30 minutes of face-to-face conversation between the provider and the patient.
TMJ appliances can take the same course for an initial consultation. Full mouth reconstruction due to disease or illness requires a 30-minute consult, x-rays, and impressions for study models. You can see the trend here. Hour after hour of unreimbursed chair time. However, it doesn’t have to be unreimbursed.
Billing exams, evaluations and consultations
Any encounter with a patient should be billed as an appropriately coded office visit. Other services such as study models, x-rays, and testing should also be billed in conjunction with the office visit. Bill for what you do.
Important documentation and considerations for coding an office visit include whether the patient was new or established, how much time was spent face-to-face with them, and what was discussed (follow-up, reviewing records, establishing a future treatment plan, etc.). The office should also collect the patient’s specialist visit copay at this time. For medically billed care the dental provider is a specialist and should assert and bill as such.
Your time as a provider is valuable. We strive every day in this industry to assert our value to our patients and place worth on the amazing services performed. If you are filing medical claims for reimbursement make sure you are filing for ALL of your time and not just the time spent performing procedures.
To ensure your evaluations, exams, and consultations are properly billed consider partnering with eAssist. Our Success Consultants will ensure you collect all that is owed you. To learn more schedule a consultation today.
