Oral and Maxillofacial Surgery - Articles

Should I Bill Dental or Medical?
June 16th, 2020 - Christine Taxin
While you likely find yourself focusing on fewer patients and more on emergency care, it’s a good time to understand how medical billing can allow patients with active infection in the oral cavity to seek the treatment they need. Forms need to be filled out correctly, and you must carefully follow ...
Medical Necessity using Soap can prevent a future audit!
June 15th, 2020 - Christine Taxin
Medical Necessity using Soap can prevent a future audit! How Do I Correctly Document all my notes on every patient regardless of the insurance I am billing? Medically necessary care is the reasonable and essential diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow-up care as determined by qualified ...
Documenting telephone calls at your dental practice is just as important as documenting patient visits.
February 4th, 2020 - Christine Taxin
Documenting telephone calls at your dental practice is just as important as documenting patient visits. Similar to other documentation, the common rule when it comes to call documentation is that if it is not documented, it did not happen. Therefore, every clinically relevant telephone call should be documented. Clinically relevant calls ...
Non-Surgical Periodontal Treatment
January 14th, 2020 - Christine Taxin
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.SCALING AND ROOT PLANINGScaling ...

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American Dental Association (ADA) and Delta Dental Plans Association (DDPA) Class Action Lawsuit
December 10th, 2019 - Christine Taxin
The American Dental Association and two individual dentists filed a class-action lawsuit Nov. 26 against the Delta Dental Plans Association, its affiliated national entities, and 39 independent Delta Dental companies, alleging the provider network has engaged in anticompetitive conduct and violated federal antitrust laws. The complaint alleges Delta Dental allocated territories ...
Regence: Dental Procedures Under The BlueCard Program?
December 9th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
This information can be found on Regence/Blue Cross Dental procedures explaining additional benefits for dental procedures. Regence currently does not offer dental benefits, however, there are times a patient can receive treatment with a Blue Cross provider and qualify under their medical benefits. In addition, Regence informs the providers to file these claims ...
Hypertension ICD-10-CM Code Reporting Table
November 25th, 2019 - Wyn Staheli, Director of Research
In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.
Medical Insurance Coverage for TMJ Disorders (TMD)
November 19th, 2019 - Christine Taxin
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...
Documentation Tips
November 18th, 2019 - Christine Taxin
Documenting Medical NecessityTo receive reimbursement from medical insurers, you need to make a case that proves that dental surgery is necessary for the patient. To make your case, you need to explain your decision process in terms that a medical insurer can understand, using ICD-10 codes and CPT codes. These ...
Are you providing TMD treatment and having a hard time receiving payment from Medical? Take a look at the law for your state!
November 3rd, 2019 - Christine Taxin
TM TREATMENT AND THIRD PARTY INSURANCE COVERAGEMinnesota, in 1987, became the first state to adopt legislation requiring health insurance policies issued within the state to include coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders on the same basis as other joint disorders. At ...
Wellness In the Dental Practice
September 25th, 2019 - Christine Taxin
This course is the beginning of change. Understanding that patients have additional benefits under their dental plans will provide you with the changes taking place in the world of billing. Objectives PROFESSIONAL GROWTH Professionally your team members will be pushed and stretched as you develop your new system. They will require advanced training ...
Help is on the way!
September 17th, 2019 - Christine Taxin
Dental carriers are starting to deny coverage for treatment considered a medical necessity! Dental offices are just charging the patient for those services or patients are refusing the treatment. Have you considered why that service should be full fee for the patient when they have coverage under their medical insurance? ...
A Step by Step Guide to Medical Billing
August 20th, 2019 - Christine Taxin
The next 4 weeks we will be providing you with a step by step guide to why medical billing is now part of our Dental future. Dental surgery is performed to treat various conditions of the teeth, jaws, and gums. Surgical procedures that dentists perform include dental implants, treatment for temporomandibular ...
Medical ID Theft
August 16th, 2019 - Namas
Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019 - Namas
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
Tips to Preventing Audits
July 23rd, 2019 - Christine Taxin
There is an ever-increasing number of dental claims that have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and billing practices. When payers identify the activities they deem ...
Are you Treating & Billing Medical Patients Tooth Infections
July 16th, 2019 - Christine Taxin
A tooth infection, or an abscessed tooth, generally occurs as a result of tooth decay and poor oral hygiene. However, it can also develop due to previous dental work or traumatic injury. When an infection occurs, it causes a pocket of pus to form in the mouth as a result ...
5 Ways to Minimize HIPAA Liabilities
July 12th, 2019 - BC Advantage
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...
The Oral Connection
June 24th, 2019 - Christine Taxin
The mouth is, was, and forever will be part of the body. The old model in traditional medicine of treating symptoms and body parts in isolation is flawed. Pioneers in functional medicine like Dr. Mark Hyman, Dr. Mike Roisen, Dr. Axe, Dr. Fuhrman, Dr. Amy Doneen, Dr. Brad Bale, and ...
Auditing Hospitalist Services
May 31st, 2019 - Namas
Auditing Hospitalist Services The inpatient side of coding and auditing can be enormously complex, with many more moving parts than are typically found in the outpatient setting. In this audit tip, we will discuss a few of the challenges that come with auditing one of the most important players in the ...
Antiresorptive Osteonecrosis of the Jaws
January 9th, 2018 - Find-A-Code
Osteonecrosis is a serious bone disease caused when the bone is starved of its normal blood supply. Because bone is living tissue, without a good supply of oxygenated blood, it becomes weakened and then dies. Scientists have not been able to identify the exact cause of osteonecrosis of the jaws, but they have ...
Sleep Apnea Terminology
January 3rd, 2018 - Find-A-Code
Apnea-Hypopnea Index (AHI): The average number of episodes of apnea and hypopnea per hour of sleep without the use of a positive airway pressure device. Respiratory effort related arousals (RERAs) are not included in the calculation of the AHI. Sleep time can only be measured in a Type I or (facility based polysomnogram) Type II sleep study. BiPAP: Bilevel positive airway ...
Sleep Testing
July 26th, 2017 - Chris Woolstenhulme, CPC, CMRS
Once a patient has been evaluated for symptoms associated with sleep apnea, testing is ordered to identify severity and determine treatment. There are several types of sleep tests, but coverage is based on meeting the criteria for Type I (inpatient facility based) or Type II-IV and Other (home-based sleep tests). All ...
Treating TMJ
April 4th, 2017 - Chris Woolstenhulme, CPC, CMRS
Temporomandibular Joint (TMJ) Syndrome can include a wide variety of conditions that may be characterized as TMJ. Also there are a wide variety of methods for treating these conditions. Many of the procedures are excluded from coverage in the Medicare program for services or devices. There are other services and appliances ...
Devices Used for Treatment with TMJ
March 27th, 2017 - Chris Woolstenhulme, CPC, CMRS
Dynamic splinting systems or devices are used to assist in restoring physical function and are commonly used for treating TMJ. Injury or joint stiffness are diagnoses that may qualify for medically necessity. If physical therapy has proven ineffective to restore or improve range of motion, mechanical devices are often a next step. This ...
Reporting Unilateral Procedures
March 13th, 2017 - Chris Woolstenhulme, CPC, CMRS
Some procedures are unilateral such as D7840-Condylectomy. It is important to consult with your payer on reporting requirements. Some payers require two separate line items with a LT or RT HCPCS Modifier, while others require only one modifier to be appended to the claim. When billing a medical code for a Condylectomy, ...

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