Medical Billing Forum
General Category => New! => : Alfreda8590 March 05, 2013, 04:39:51 PM
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Question: I work for a dental office. I need to know if I can bill dental procedures and medical procedures. ADA form for dental and 1500 for medical.
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Most policies will only consider the portion of charges under "bony impacted" as major medical. You will need to break out charges for both dental and major medical. I would first verify benefits with carrier to make sure.
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Yes, you can bill certain dental procedures to the medical carrier; when completing the CMS 1500, ensure you have the cross codes and diagnosis on the claim so that it will process properly.
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Check this out! Please be detail it helps. I just called and insurance company and found out that i have to get pre-auth for service in the office that is medical in a dental office. Everything that i have sent up to now has to have an appeal letter to pre-auth to get auth for servicedone in office. Help!!!!!!
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Alfreda, I'm not sure exactly what you are asking but YES if you are billing a service that will be filed to medical that requires authorization, then you must obtain authorization regardless of if it's if done in a dental office or not.
Please be more specific and I will try my best to help you.
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Thanks! But this is a lot of help. 1st let me be a little more detail. I work for a pediatric dentist. He does work in hospital and the same work in his office. He is trying to bill for a CRNA in his office. I was told that the medical side you use CMS1500 form.
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Alfreda, it seems that you know this much so far: When anesthesia is done for dental work, it must be billed to medical insurance, not dental insurance. It is billed to medical insurance using Form CMS 1500. In many instances, medical insurance requires pre-authorization before they will pay for anesthesia. You have sent multiple CMS 1500 forms requesting payment for anesthesia services that need to have pre-authorization.
Given all of that, what do you need help with?
a. Help filling out the CMS 1500 form?
b. Help with the appeal letter to the insurance carrier(s)?
Totally different point: did the dentist pay the CRNA? If he did, then dentist must bill for the anesthesia services in order to get reimbursed. If he did not, then the CRNA should bill using his own NPI Number.