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If you’ve ever had a surgical claim denied and couldn’t figure out why—this one’s for you. Medical cross coding is one of the trickiest parts of oral surgery billing, and unfortunately, it’s also one of the most expensive when done wrong.

Here are three common mistakes we see every week that cost practices time, money, and trust.

1. Using the Wrong Code Set Dental codes (CDT) don’t always apply to surgical cases. If the claim should go to medical first, CPT® codes are often required—and using the wrong one almost guarantees a denial. You also need the correct modifiers, diagnosis codes, and place-of-service. Every detail matters.
2. Missing or Weak Documentation Even when the codes are correct, missing or incomplete documentation can tank your claim. That means clinical notes, imaging, referrals, and a clear explanation of medical necessity. If the insurance reviewer can’t find a reason to pay, they won’t.
3. Not Knowing When to Bill Medical First Some procedures must be billed to medical before dental. Many practices get caught in the cycle of billing dental first, getting denied, and then restarting the entire process. That delay can mean months of lost revenue and frustrated patients.

How to Avoid These Mistakes This isn’t something most in-house billing teams are trained for. That’s why working with a team that understands surgical billing—and medical cross coding specifically—makes all the difference.

At Insurance Billing Experts, we’ve been handling complex OMFS claims for years. We know the code sets, documentation requirements, and payer quirks. And as part of the DNTEL community, we have access to real-time insights from other billing leaders.

If you’re spending too much time chasing down unpaid surgical claims, we’re here to help get it right the first time.

All-on-4, full-arch, and full-mouth implant cases are some of the most transformative treatments in dentistry—but they’re also some of the most financially intimidating for patients.

While these procedures are often seen as “cash-only,” there are real opportunities for partial insurance reimbursement. The key is knowing when—and how—to use medical billing correctly.

Let’s Start with the Truth: Most dental insurance plans don’t cover full-arch implants outright. Even if there’s some coverage, annual maximums are usually too low to make a real dent.

But here’s what many practices don’t realize: medical insurance may offer partial reimbursement for certain parts of the treatment—if you know how to submit it.

When Medical Billing Might Apply Here are some common situations where medical billing could be considered:

• Trauma-related tooth loss
• Medical conditions that impact oral function (e.g., bone loss due to cancer treatment or autoimmune disease)
• Severe functional impairment (like inability to chew or speak properly)
• Congenital defects like Anodontia

In these cases, the procedure must be considered medically necessary. That means documentation is everything.

What You Need to Bill Medical for Implants. If your team wants to attempt medical crossover, you’ll need:

• A clear narrative of medical necessity
• Diagnosis codes (ICD-10-CM)
• CPT® codes, not just CDT
• Referrals or supporting documentation from physicians, if applicable
• Imaging and clinical notes

Most in-house dental teams don’t have time to learn this process—let alone stay updated as requirements change.

How a Billing Partner Can Help. At Insurance Billing Experts, we’ve seen firsthand how a well-documented, correctly submitted claim can give patients access to support they didn’t know they had. Our team:

• Identifies which cases qualify for medical review
• Handles coding and documentation from start to finish
• Submits and follows up on both dental and medical claims
• Provides clear guidance so your treatment coordinators can focus on the patient—not the paperwork

It’s Not About Promising Magic. It’s About Knowing What’s Possible. Not every case will qualify. But when they do, the impact is huge. Even a few thousand dollars of coverage can be the difference between “I want this” and “I can’t afford this.”

Let us help you give your patients the clarity—and support—they deserve.

If you manage or own an oral surgery practice, you already know billing isn’t just one more task—it’s an entirely different world. Between medical-dental cross coding, high-dollar claims, and pre-auth puzzles, OMFS billing is one of the most complex areas of the dental revenue cycle.

And if you’re relying on a general dental biller or trying to keep it all in-house, you’ve probably already felt the pressure.

Why Surgical Claims Get Rejected More Often

Surgical billing isn’t just harder—it’s different. You’re often working across two systems: dental and medical. That creates extra layers of complexity, like:

• Mixing CPT® and CDT codes in the same case
• Multi-visit surgical treatment plans
• Detailed documentation requirements
• Frequent pre-authorization hurdles
• Coordination between referring providers and surgical teams

One small error in this process can lead to weeks—or months—of payment delays.

You Can’t Wing It With OMFS Billing

We’ve seen it happen too often. A practice’s in-house team is strong on preventive and restorative billing but struggles with surgical coding and cross coding. The result:

• Denied or delayed claims
• Stressed-out staff
• Revenue stuck in AR

Why It Pays to Work With a Surgical Billing Expert

At Insurance Billing Experts, OMFS billing is what we do. Our team knows the codes, the documentation requirements, and the nuances of both dental and medical payers. We don’t just submit claims—we build them correctly from the start.

And we’re not alone. As part of the DNTEL network, we have a community of billing experts sharing knowledge, payer insights, and real-time support. That means your claims get the benefit of decades of shared experience.

Bottom Line: Your surgeries deserve more than trial-and-error billing. You need a team that understands the full scope of surgical revenue management—and knows how to get claims paid the first time.

Let’s be honest: once your AR backlog reaches a certain point, it’s no longer just a billing problem—it becomes a leadership problem. It affects your patients, your team, and your ability to run a healthy practice.

In oral surgery, a few missed steps can create a pile of unresolved claims faster than most teams can keep up with.

What Causes the Backup in the First Place?

We hear these common issues from specialty practices all the time:

• Documentation that’s incomplete or doesn’t support medical necessity
• Claims submitted without the correct codes or required pre-authorization
• Lack of structured follow-up (especially with medical payers)
• Front office teams stretched too thin to keep up with complex billing

If any of that sounds familiar, you’re not alone—and it’s fixable.

Where to Start When You’re Buried in AR

1. Audit your AR – Sort claims by age, denial reason, and insurance type. You need clarity before you can fix anything.
2. Assess your claim workflows – Are you building each claim correctly from the beginning? Are your pre-auth processes consistent and trackable?
3. Decide if it’s time to get outside help – If your team is too overwhelmed to recover the backlog, bringing in specialists can save you more than time—it can protect your revenue.

How Insurance Billing Experts Can Help

We’re not here to patch holes. We help rebuild your billing systems. At Insurance Billing Experts, we specialize in surgical claims—and our community of OMFS billing professionals knows how to:

• Recover and reduce aging AR
• Identify where claims are getting stuck
• Rework internal processes to prevent the same problems from coming back

We’ve supported practices dealing with $100k+ in outstanding claims, and we know how to get the work done without overloading your staff. We chase the claims, track the progress, and help you get back in control.

You deserve billing that works. Your patients deserve answers. Your team deserves support.

As the landscape of dental insurance billing continues to evolve, staying ahead of regulatory changes is critical for maintaining a smooth revenue cycle. One significant shift on the horizon is the potential requirement for ICD-10-CM diagnosis codes on dental claims submitted to Medicare and Medicaid programs. While traditionally a staple in medical billing, these diagnosis codes are becoming increasingly relevant in dental claims processing.
Understanding this change and how it impacts your practice can save time, reduce claim rejections, and ensure proper reimbursement. Here’s what you need to know and how our team at Insurance Billing Outsourcing can help you prepare.

What Are ICD-10-CM Diagnosis Codes?

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), is a coding system used to classify and document diagnoses and health conditions. These codes are critical for providing payers with detailed information about the medical necessity of treatments, including dental procedures that intersect with broader healthcare concerns.
Historically, dental claims have relied primarily on CDT codes, which describe procedures. However, Medicare and Medicaid’s integration of ICD-10-CM codes signals a move towards aligning dental billing more closely with medical billing standards.

Why Are ICD-10-CM Codes Becoming Necessary for Dental Claims?

Medicare and Medicaid programs are increasingly focusing on comprehensive patient care and cost transparency. By requiring ICD-10-CM codes, these programs aim to:
• Enhance Data Accuracy: These codes offer more detailed descriptions of a patient’s condition, supporting claims with robust documentation.
• Streamline Interoperability: Aligning dental and medical billing practices enables better communication across healthcare providers.
• Ensure Compliance: The integration of ICD-10-CM codes may become a standard to meet federal and state guidelines for claims processing.

The Challenges of Adopting ICD-10-CM Codes

While the inclusion of diagnosis codes offers benefits, it can also pose challenges for dental practices:
• Knowledge Gap: Dental teams may not be familiar with ICD-10-CM coding conventions and applications.
• Increased Complexity: Identifying the correct diagnosis code to support a claim requires careful attention to detail.
• Risk of Denials: Incorrect or incomplete coding can lead to claim rejections and delayed reimbursements.
These challenges underscore the importance of proactive preparation to ensure a seamless transition.

How We Can Help Your Practice

At Insurance Billing Outsourcing, we specialize in simplifying the complexities of dental billing. Our expertise in both dental and medical billing allows us to support your practice as you adapt to this new requirement. Here’s how we can help:
1. Training and Education: We provide comprehensive training for your team on ICD-10-CM coding, ensuring they feel confident and prepared.
2. Coding Support: Our experienced team can assist with identifying and applying the appropriate diagnosis codes to your claims.

3. Compliance Assurance: We stay up to date on Medicare and Medicaid billing requirements, ensuring your claims meet current standards.
4. Streamlined Processes: By outsourcing your billing to us, you can focus on patient care while we handle the intricacies of coding and claims submission.

Why Act Now?
Waiting until ICD-10-CM requirements are fully implemented can put your practice at risk of non-compliance, delayed reimbursements, and frustrated patients. By acting now, you can:
• Avoid disruption to your revenue cycle.
• Minimize the learning curve for your team.
• Ensure your practice is positioned as a leader in compliance and efficiency.

Ready to Make the Transition?
ICD-10-CM diagnosis codes may feel daunting, but with the right partner, the transition can be smooth and beneficial for your practice. At Insurance Billing Outsourcing, we’re here to guide you every step of the way.
Contact us today to learn more about how we can help you navigate these changes with confidence and ease.
Together, we’ll ensure your dental practice is prepared for the future of billing. Schedule a consultation with our team and take the first step toward mastering ICD-10-CM coding requirements today!

3. Establish Credibility and Trust
Building credibility and trust with patients is crucial for the success of a dental practice. Establishing a solid reputation within the community ensures that your practice is known for reliability and professionalism.
          • Consistency in Quality Care: Delivering exceptional dental care consistently helps in building trust. Employ evidence-based practices and stay updated with the latest advancements in dental technology and procedures to ensure your patients receive the best treatment options available.
          • Transparent Communication: Open and honest communication is vital. Discuss treatment plans, potential outcomes, and financial arrangements with your patients thoroughly and listen to their concerns. This transparency fosters a trusting relationship and demonstrates your commitment to their health and well-being.
          • Professional Development: Continually enhance your professional skills by attending workshops, conferences, and courses. Being actively engaged in learning demonstrates dedication to your profession and reassures patients that they are in the hands of a skilled and knowledgeable practitioner.
          • Patient Testimonials and Reviews: Encourage satisfied patients to share their experiences by leaving reviews on platforms like Google or Yelp. Testimonies from happy patients not only validate your credibility but also attract new patients who value others’ opinions before choosing a healthcare provider.
          • Participate in Accreditation Programs: Engaging in voluntary accreditation programs or certifications shows your commitment to maintaining high standards in dental practice. Accreditation from reputable organizations can significantly boost your credibility.
By focusing on these aspects, young dentists can build a strong foundation of trust with their patients, enhancing patient retention and fostering long-term  success for their practice.

4. Focus on Patient Experience
A dental practice’s success is heavily reliant on the experience it provides to its patients. Creating a welcoming and supportive environment encourages patient loyalty and positive word-of-mouth marketing.
          • Personalize Patient Interactions: Tailor your communication and treatments to each patient’s specific needs and preferences. Remember important    details about their lives and be prompt in responding to inquiries.
          • Maintain a Comforting Ambiance: The design and feel of your practice should reduce anxiety and promote comfort. Consider soothing colors, comfortable seating, and calming music to enhance the patient experience.
          • Efficient Appointment Scheduling: Use technology to minimize waiting times and streamline scheduling processes. Offering online booking options and reminders can improve patient satisfaction and reduce no-show rates.
          • Ongoing Communication: Regular follow-ups post-treatment can enhance patient relationships and ensure any concerns are addressed promptly.
          • Solicit and Act on Feedback: Actively seek patient feedback to understand their experiences and make necessary improvements. Implement changes based on this valuable input to constantly evolve your practice.
          • Affordable Pricing Options: Offer flexible payment plans and accept various insurance plans to make dental care accessible to a wider audience. Highlight these options in your marketing materials to attract cost-conscious patients.

Starting a dental practice is both exciting and challenging, especially for young dentists stepping into the entrepreneurial world. Here are six strategies to ensure your practice thrives:

1. Build a Strong Patient Base

Network Effectively: Engage with your community by hosting free oral health workshops and attending local events to introduce yourself and your practice. Partnering with local businesses for cross-promotion can also enhance visibility.

Develop a Marketing Strategy: For a dental practice to flourish, effective marketing strategies are crucial in attracting and retaining patients. Here are some strategies to consider:

• Optimize Your Online Presence: Ensure your website is user-friendly, mobile-compatible, and optimized for search engines. Regularly update your site with valuable content like blogs about dental health tips and practice updates to keep your audience engaged.

• Leverage Social Media: Platforms such as Instagram and Facebook are excellent for reaching a wider audience. Share informative posts, patient testimonials, and behind-the-scenes glimpses of your practice to build a personable brand.

• Email Marketing Campaigns: Develop an email list to communicate with existing and potential patients. Share newsletters with special offers, seasonal greetings, and reminders for regular check-ups or upcoming events at your clinic.

• Utilize Google My Business: Claim and optimize your Google My Business profile to increase your visibility on local search results. Encourage satisfied patients to leave positive reviews, enhancing your online reputation.

• Engage in Community Involvement: Sponsoring or participating in community events positions you as a committed member of the community and can drive word-of-mouth referrals. Host or participate in health fairs or local charity events to showcase your expertise and commitment to community health.

By combining these marketing strategies, young dentists can effectively broaden their reach, enhance their reputation, and ensure the growth of their practice.

2. Manage Finances Wisely

Revenue Cycle Management: Implement efficient billing processes to ensure timely payments. Use dental practice management software to track revenue and expenses, helping you stay on top of financial health. Consider hiring a billing specialist or outsourcing to a dental billing service for added efficiency.

Outsourcing dental billing can significantly enhance the efficiency and profitability of your practice. By delegating billing tasks to a professional service, dentists can focus more on patient care rather than administrative burdens. Here are some key benefits:

• Improve Accuracy and Speed: Dental billing services specialize in processing claims quickly and accurately, reducing the likelihood of errors that can lead to denials or delays in payment.

• Decrease Overhead Costs: By outsourcing billing, practices can save on costs associated with hiring, training, and maintaining an in-house billing staff, including expenses related to salaries, benefits, and ongoing training.

• Enhance Cash Flow: Professional billing services work diligently to ensure claims are processed and reimbursed swiftly, minimizing disruptions in cash flow. This allows practices to maintain steady financial health.

• Navigate Complex Insurance Networks: As experts in the field, billing services understand the nuances of various insurance requirements, ensuring compliance and increasing the rate of successful claims submissions.

• Access to Advanced Technology: Many billing services use state-of-the-art software to manage accounts, track claim statuses, and generate detailed financial reports. This results in increased transparency and better financial oversight for your practice.

• Free Up Time for Patient Care: With billing tasks handled externally, staff can devote more time to patient-facing roles, improving the overall patient experience and satisfaction.

By considering these advantages, young dentists can make informed decisions about incorporating outsourcing strategies that align with their practice goals, ultimately leading to sustainable growth and operational excellence.

Here are 4 more strategies to be implemented by a young to ensure their success.  We will discuss these strategies in more detail in our next blog.

3. Establish Credibility and Trust
4. Focus on Patient Experience
5. Balance Clinical and Business Skills
6. Engage in Community Outreach

 

Navigating the complexities of dental insurance can be challenging, particularly when it comes to understanding rental networks. As dental professionals, it is essential to comprehend these networks to better assist our patients and ensure smooth operations within our practices. This article aims to clarify what rental networks are, how they function, and how they might impact our practices and patient care.
What Are Rental Networks?
Rental networks, also known as leased networks, are third-party networks that dental insurance companies utilize to broaden their network of dental care providers. Essentially, an insurance company “rents” access to a larger network of dentists from another organization. This arrangement allows insurers to offer an extensive range of in-network providers without directly contracting with each dentist.
How Rental Networks Work

Here’s a simplified breakdown of how rental networks operate:

1)  Contracting: A dental insurance company contracts with a rental network provider. This provider already has a network of dentists under contract.
2 ) Access: The insurance company gains access to the rental network’s pool of dentists. This means patients can visit any dentist within this expanded network and receive in-network benefits.
3)  Claims Processing: When a patient visits a dentist within the rental network, the claim is processed as if the dentist were directly contracted with the insurance company. Patients typically benefit from lower out-of-pocket costs due to negotiated rates between the rental network and the dentists.

Advantages of Rental Networks
1)  Increased Provider Access: One of the primary benefits of rental networks is the increased access to dental care providers. This can be particularly important in areas with fewer dentists or for patients who prefer a specific dentist not originally in their insurance company’s network.
2)  Cost Savings: By utilizing a rental network, patients can often access lower rates for dental procedures. These negotiated rates help reduce out-of-pocket expenses, making dental care more affordable.
3)  Convenience: Rental networks simplify the process for insurance companies to offer a broad network of dentists, providing patients with more choices and potentially reducing travel time to find an in-network provider.

Potential Drawbacks of Rental Networks
1)  Confusion and Miscommunication: One downside is the potential for confusion. Patients may not realize they are using a rental network, leading to misunderstandings about coverage and benefits. Clear communication from the insurance company and your office is essential to avoid these issues.
2)  Variability in Quality: While rental networks expand access, the quality of care can vary. It’s important to ensure that dentists within the network meet our standards for quality and care.
3)  Billing Issues: Sometimes, billing issues can arise if there’s a disconnect between the insurance company and the rental network. Ensuring that your office is aware of and properly processes the insurance claim can help mitigate these issues.

How to Navigate Rental Networks
To effectively navigate rental networks and maximize the benefits for both your practice and your patients, consider the following tips:
1)  Review Plans Thoroughly: Understand the specifics of the dental insurance plans you accept, including whether they utilize a rental network. Check the list of in-network providers and identify if any are part of a rental network.
2)  Clear Communication: When scheduling appointments, confirm with patients that our office accepts their insurance plan and is part of any rental network associated with their coverage. This can help avoid surprises when it comes time for payment.
3)  Verify Coverage: Before performing any dental procedure, verify with the patient’s insurance company and ensure that the treatment will be covered under their plan and that they will receive in-network benefits.
4)  Maintain Detailed Records: Keep thorough records of interactions with both insurance companies and patients. This includes pre-authorization letters, treatment plans, and explanations of benefits (EOBs).
Conclusion
Rental networks play a crucial role in dental insurance, offering expanded access to dental care providers and potential cost savings for patients. However, understanding how they work and being proactive in managing your practice can help navigate potential pitfalls. By staying informed and maintaining clear communication with your patients and insurance companies, you can ensure smooth operations and provide the best possible care to your patients.
If you have any questions about rental networks or need further assistance, please feel free to reach out. Together, we can navigate the complexities of dental insurance and continue to provide exceptional care.

In the ever-evolving field of orthopedic dentistry, balancing patient care with administrative duties can be challenging. One area that often demands significant time and expertise is dealing with insurance tasks. For dental practices focused on orthopedic remodeling, outsourcing these tasks can offer several key benefits.
This article aims to shed light on the advantages of outsourcing insurance tasks and provides compelling case studies to illustrate these points effectively.

Key Benefits of Outsourcing Insurance Tasks

1. Efficient Prior Authorizations
Prior authorizations can be a cumbersome process, requiring detailed information and precise documentation. By outsourcing this task, dental practices can ensure that all necessary authorizations are obtained promptly, reducing delays in patient care and optimizing treatment timelines.

2. Proper Filing of Claims with Attachments
Accurate claim submissions are crucial for timely reimbursements. Outsourcing ensures that claims are filed correctly, complete with the necessary attachments such as x-rays, treatment plans, and medical necessity documentation. This reduces the likelihood of errors and subsequent claim rejections.

3. Effective Claim Follow-Up
Constant follow-up is required to ensure claims are processed without delay. Specialized outsourcing services are adept at tracking the status of claims, addressing any issues that arise, and ensuring that payments are received on time.

4. Processing of Explanation of Benefits (EOBs)
Understanding and processing EOBs can be complex and time-consuming. Outsourcing this task allows for a meticulous review and reconciliation of EOBs, ensuring that any discrepancies are identified and resolved swiftly.

5. Appealing Rejected Claims
Rejected claims are a common issue in the dental industry. An outsourcing partner can handle the appeals process efficiently, ensuring that all necessary corrections and additional information are provided to secure payment.

Conclusion
For dentists and dental office managers focusing on orthopedic remodeling, the benefits of outsourcing insurance tasks are immense. From enhancing efficiency and reducing administrative burdens to improving revenue cycle management and patient care, outsourcing offers a strategic advantage that can propel your practice forward.
If you’re considering outsourcing for your practice, take inspiration from the success stories and consider how these services can be tailored to meet your specific needs. Partnering with Insurance Billing Outsourcing can be the key to unlocking greater efficiency, profitability, and overall practice success.

Orthopedic remodeling in the realm of dentistry stands as a testament to the advanced strides dental care has made. This specialized approach not only reflects the skill of a practitioner but also emphasizes the edge a dental practice holds in offering comprehensive care. Primarily beneficial for patients requiring jaw correction and alignment, orthopedic remodeling plays a pivotal role in the improvement of oral health and overall well-being.

Who Should Be Engaged in Orthopedic Remodeling?

Orthopedic remodeling in dentistry is a field that requires expertise and precise implementation. The key players include:

• Dentists: Specially trained in orthodontic and orthopedic procedures.
• Dental Office Managers: Key individuals responsible for coordinating remodeling services, overseeing insurance matters, and ensuring the practice offers the latest in orthopedic options.

Key Benefits of Orthopedic Remodeling in Dental Practices

Insurance Coverage

One of the most significant aspects of orthopedic remodeling is the potential insurance coverage it affords. Procedures that were once considered elective or purely cosmetic are now recognized for their health benefits and may be covered under patient’s dental insurance plans. This provides a widened access to essential services and ensures that patients can receive the care they need without undue financial stress. Practices adept at navigating insurance complexities will find they can offer their patients more options and better care.

Procedures Involved

The range of procedures within orthopedic remodeling is vast and is designed to address various skeletal and dental anomalies. Among these, common interventions include:

• Palatal expanders
• Jaw repositioning appliances
• Modified retainers

For adults, surgical orthodontics, also known as orthognathic surgery, comes into play when correction is needed beyond braces. These procedures aim to align the jaw, resulting in improved function, aesthetic appearance, and long-term oral health.

Invasive vs. Non-Invasive

Modern advances in dentistry have paved the way for minimally invasive techniques that reduce discomfort and speed up recovery times. Traditional reconstructive surgeries are gradually being supplemented or even replaced by non-invasive methods, attracting patients to practices that can offer the latest technologies with a less intimidating approach.

Non-invasive techniques might include:

• Clear aligner technology
• Orthodontic headgear
• Removable appliances for gradual bone remodeling

Each of these options caters to the convenience and comfort of the patient while ensuring effective results.

Conclusion

Orthopedic remodeling in dentistry is a sophisticated field that offers enormous potential for practices willing to invest in the required training and technology. Catering to this demand demonstrates a practice’s commitment to state-of-the-art care, providing patients with choices that meet their health, aesthetic, and lifestyle needs.

For dentists and dental office managers, understanding and communicating the benefits of insurance coverage, the breadth of available procedures, and the choice between invasive and non-invasive options will position a practice as a leader in comprehensive dental care.

By integrating orthopedic remodeling into your practice portfolio, you reassure your clients of your dedication to their oral health and your capability to deliver cutting-edge, personalized dental solutions.

For a deeper insight into how to incorporate orthopedic remodeling into your dental practice, stay tuned to our upcoming series of articles where we will explore each aspect in detail, offering practical guidance and professional tips to help your practice thrive.