#AskT-Bone – How to dive in with medical insurance


Hello and welcome to another episode of ask T-bone.


Today we’ve been sent a question regarding medical billing. It seems like we got a lot of questions regarding medical bill and we can see that medical billing is a Hot Topic within dentistry, and we can also see that medical billing is a very unknown topic within dentistry.  So well so the question that we received this time is:
To build on your recent podcast on medical billing how can an office dive in and get started? I’m starting medical billing and coding class but that is obviously much more than dental-related. So, how can I start teaching the staff to write this SOAP notes and to start billing medical? Does the SOAP notes always have to be written in order to bill medical? Also with just billing x-rays exams to Medical, do you always have to provide that element letter of medical necessity?


So that’s kind of get started so I could go to you not familiar, in season 1 episode 7 we did an entire episode dedicated to talking about medical billing with Mr. Hootan Sahidi. So, I encourage you to go back into the archives and visit www.tbonespeaks.com and look up 3episode 7 medical billing what you’re missing if you’re not doing it.

Now back to the specific question how can an office dive in and get started. You know, I would like to direct your attention for this one to another podcast episode and that was episode number 5 “integrating new procedures into a practice”. While it’s not specific medical billing it does address many of the concerns that practices have in terms of not being able to properly Implement many things that they’re learning. So, how does an office dive in and get started? I can tell you we’ve been trying to do medical billing for the last four years and we’ve been successful for the last two years. But two years we absolutely struggled with this and I will tell you that the biggest looking back the biggest struggle we had was that we would not consistent with medical billing. In other words we only consider doing medical billing when a patient didn’t have money, when we didn’t get paid, when we felt bad for patients, or in fancy procedures that some lectures has talked about how well medical billing pay for these things, and then we got very discouraged because it wasn’t very consistent in getting paid. So, to me the number one step to being diving in is number one: Being consistent and number two: Having a plan of action of what you want a medical bill. Do not start by trying to build everything, or things that you’re not comfortable with, or things that you’re not doing on a regular basis.

So I would say that the first a number of things that I would start billing, and diving in with would be my exams and my cone beam Imaging. If you’re a cone beam office, and my appliances.


Those three things: exams, 3D X-rays and appliances.

By appliances I mean a TMD appliances, Sleep appliances and things along those lines would be the things that I would dive in, and I would slowly bill getting my my process in place, and then move forward from there.


So, the next part is I’m starting medical billing and a coding class, but that is obviously much more than dental-related.

I would encourage you to absolutely stop. Do not take that class.


There is, in my opinion, no reason to take a true medical billing and medical coding class. There are so many diagnosis, there’s so many things that apply to a medical office that simply do not apply to a dental office. And my opinion is that you going to get confused, and I have been to a true medical billing and coding class, because my wife is a position and we manage her practice, as well. So I would encourage you that that is probably not the best area to get going.


So, how can I start teaching the staff to write this SOAP notes and start billing medical? So, I would like to back up here. To be truly honest with you, you want to be writing your own SOAP notes. And the reason I say that is, you need to write them in the beginning in a way that incorporates for diagnosis and builds the story to justified medical necessity. Now, you can certainly turn it over to a team member, but my firm belief is that the dentist has to be the leader, and the dentist have to be the one leading the ship in the right direction. So if you yourself do not understand how to write SOAP notes or how to build medical yourself, then I in my opinion it’s a recipe for failure. So I firmly believe that you’ve got to do it yourself. Now how do you teach them write the SOAP notes? Just write them. Quite honestly I think we make too much of this SOAP, a SOAP notes certainly is required, it’s necessary, it’s important, but it doesn’t have to be in a quote on quote SOAP format, it just needs to be a note that gets the story across, that builds the story and gives, if we were ever required or requested to send the information in, that tells the medical insurance company exactly what we did, why we did it, and the how that note will support the codes and diagnosis codes that you used.


Does the SOAP note always have to be written in order to bill medical?


Now that’s a really a two-sided question.

Number one does a SOAP note always have to be written? yes. Do you have a SOAP note to build medical? No. And why do I say that because technically you can build medical without a SOAP note. It’s just that you need documentation if they would request documentation on behalf of the claim. And besides, quite honestly, it’s absolutely unethical probably bordering on malpractice to not have notes. So you need to be writing notes for everything that you do whether it is dental insurance or medical insurance. You need to get in the habit of writing notes that support the claim that you’re billing whether that is dental or medical. Also, with just billing X-rays and exam to Medical, do you always have to provide a LMN (letter of medical necessity) and that will vary from plan to plan. I will tell you that in my experience, in the last two-and-a-half years, we have not had a single medical insurance company request a letter of medical necessity for an exam. now I will tell you that we do so often get requested for a letter of medical necessity for an exam. Now, I would tell you that we do so often get request for a letter of medical necessity for the the X-ray, for this 3D CBCT x-ray. So I would certainly be prepared with a letter of medical necessity for the 3D x-ray.


So again, they are many ways to dive in and get started. Selfishly I must certainly mention our wonderful 2 day implementation program we require the doctor to come, we require a team member to come and then why we do that is because we have success. 95% of the people that leave our program go back to the office, they easily recoup their money that they spent on travel and coming to the class and the class itself, and most, 95% of them go well beyond that. And we give you a implementable way to do it. You bring your own patients cases, you bring your old patient’s insurance cards, would do benefit checks, eligibility checks on your patient, we will create claims and submit the claim on your patients, so that way you can get paid on your actual patient and not just some random fake cases that we make up. So, and then what we also do is we provide three months of follow-up through webinars and phone support to allow you do us help on those claims that submit on your behalf. So I do believe that there are other wonderful courses up there, I don’t believe in my opinion that there’s anything more practical and better than what we’re providing in Raleigh North Carolina.


To get more information on our courses please visit www.3d-dentist.com test.com or if you text T-Bone speaks to the number for 4222 you’ll be inserted into her email sequence and you will receive all of this information directly.


Again thank you for the question and we look forward to meeting you in person soon.


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