Maximizing Revenue: The Critical Role of Cross-Billing and Coding in Oral Surgery Practices

Cross-billing and coding are critical yet often overlooked part of oral surgery practice management. Given the unique nature of oral surgery, where dental and medical procedures frequently overlap, cross-billing allows practices to optimize reimbursements, reduce patient out-of-pocket expenses, and improve cash flow. This article will cover what cross-billing involves, why it’s important for oral surgery practices, and how practices can implement best practices to make the most of cross-billing opportunities.

What is Cross-Billing and Coding?

Cross-billing refers to billing a procedure under both dental and medical insurance. Unlike general dental procedures, many oral surgery treatments—such as extractions, bone grafting, and biopsies—are medically necessary and may be covered by medical insurance as well as dental. Coding is the process of assigning the correct procedural codes for insurance claims, which can differ depending on whether the service is billed to dental or medical insurance.

For example, the extraction of an impacted tooth may be billed as a dental procedure under dental insurance, but if it’s considered medically necessary due to infection or impaction severity, it may also be billable under medical insurance. Proper coding ensures the correct reimbursement amount, and it’s essential for avoiding claim denials, delays, and other billing complications.

The Importance of Cross-Billing in Oral Surgery

1. Maximizes Reimbursements
   Cross-billing allows oral surgery practices to bill medically necessary procedures to medical insurance, often resulting in higher reimbursement rates. By understanding which procedures qualify for medical billing, practices can avoid missing out on significant revenue. This approach is especially important for costly procedures such as biopsies, jaw surgeries, and TMJ disorder treatments.
2. Reduces Patient Financial Burden
   Patients typically have limited dental insurance coverage, which may not cover more extensive or medically necessary procedures. By cross-billing to medical insurance, practices can reduce out-of-pocket expenses for patients, making necessary treatments more affordable. This approach not only helps patients financially but also builds trust and loyalty by demonstrating that the practice is looking out for their best interests.
3. Improves Cash Flow and Reduces Claim Denials
   Accurate cross-billing and coding help prevent delays and denials in claim processing. Since medical insurance carriers often have different requirements from dental insurers, correctly coding claims can expedite payment. This smoother flow of income allows practices to maintain healthy cash flow, meeting operational costs and enabling future growth.
4. Ensures Compliance and Reduces Legal Risks
   Cross-billing and coding come with strict compliance requirements, especially for medical insurance billing. Inaccurate or non-compliant coding can result in audits, penalties, or even allegations of fraud. Practices that cross-bill without proper coding risk serious legal and financial consequences. Staying compliant with coding standards and regulations ensures a smoother billing process and minimizes the risk of legal issues.

Oral Surgery Procedures That Qualify for Cross-Billing

1. Wisdom Tooth Extraction
   Impacted or infected wisdom teeth often require extraction, and if the case meets medical necessity criteria, it can be billed to medical insurance. This is a prime example of a common procedure where cross-billing ensures higher reimbursement for medically indicated cases.
2. Dental Implants for Trauma or Pathology
   In cases where dental implants are placed due to trauma, disease, or pathology, they may qualify for medical insurance coverage. Cross-billing enables practices to bill these procedures under both dental and medical insurance when appropriate.
3. Bone Grafting and Reconstructive Procedures
   Bone grafts required for dental implants or because of trauma are often eligible for medical insurance billing. When these are deemed reconstructive rather than elective, cross-billing helps offset costs for both the practice and the patient.
4. TMJ Disorder Treatments and Corrective Jaw Surgery
   Treatments for TMJ disorders or corrective jaw surgeries are commonly billable to medical insurance because they address functional impairments. Effective cross-billing maximizes reimbursement and covers complex, often costly treatments.
5. Oral Pathology and Biopsies
   When an oral surgeon performs a biopsy to check for oral cancers or other conditions, cross-billing to medical insurance is essential. Medical insurers are more likely to cover diagnostic procedures, allowing patients to benefit from necessary testing without prohibitive costs.

Best Practices for Implementing Cross-Billing

1. Train Staff on Dental and Medical Coding
   Properly coding cross-billed procedures requires understanding both dental and medical coding systems. Training billing staff is essential for ensuring claims are coded correctly the first time, which minimizes claim rejections and avoids the lengthy appeals process. Periodic training on cross-billing and coding can help staff stay updated on code changes and billing best practices.
2. Document Medical Necessity
   Medical insurers often require documentation that proves the medical necessity of a procedure. A detailed medical history, including diagnostics and notes, helps support cross-billing claims and reduces the chance of denial. For example, if a patient’s tooth extraction is necessary to prevent infection, documenting this clearly will support cross-billing efforts with the medical insurer.
3. Leverage Practice Management Software for Cross-Billing
   A comprehensive practice management software solution can simplify cross-billing by automating many aspects of billing and coding. Look for software that offers both dental and medical coding options, with templates or pre-built coding forms. Such tools improve billing efficiency and can significantly reduce the time spent on each claim.
4. Monitor Coding Updates and Changes
   Both dental and medical billing codes frequently change, making it crucial to stay up-to-date on any adjustments. Regularly checking updates from dental and medical coding associations can help prevent errors in coding. Joining industry associations or subscribing to coding update services can make it easier for staff to keep up with changes and stay compliant.
5. Consider Outsourcing Medical Billing
   Many practices find it beneficial to outsource their medical billing to specialists who are experienced in the nuances of cross-billing. A medical billing partner can navigate the complexities of insurance requirements, ensuring compliance and maximizing reimbursements. This can free up in-house staff to focus on patient care and other tasks, while the billing partner handles the intricacies of cross-billing.

How DSN Software Supports Cross-Billing in Oral Surgery Practices

DSN Software is designed to simplify cross-billing between medical and dental insurance for oral surgery practices. With automated coding linked directly to claims, real-time eligibility checks, and compliance tracking, DSN reduces manual data entry and minimizes errors, speeding up claim processing. This enhanced billing accuracy lowers patient costs, decreases claim rejections, and increases revenue potential. DSN’s powerful reporting tools also provide insights into financial trends, allowing practices to boost cash flow and improve overall efficiency.

How Cross-Billing Benefits Patients and the Practice

Cross-billing offers clear benefits not only to the practice but also to patients. By leveraging both dental and medical insurance coverage, oral surgery practices can ensure their patients receive necessary treatments without facing insurmountable costs. For the practice, efficient cross-billing and coding improve revenue, reduce claim denials, and support smoother operational workflows.

For patients with limited dental coverage, cross-billing to medical insurance can be the difference between receiving essential care or forgoing treatment. Building a solid cross-billing strategy demonstrates that the practice values patient care, making treatments more affordable and accessible.

Final Thoughts

Cross-billing and coding are vital for any oral surgery practice that seeks to improve revenue, reduce patient costs, and maintain compliance with insurance policies. As oral surgery procedures increasingly fall under the view of both medical and dental insurance, practices that adopt effective cross-billing strategies can achieve greater financial stability and patient satisfaction.

Investing in training, using robust practice management software, and considering partnerships with medical billing experts are all effective ways to navigate the complexities of cross-billing. With these best practices in place, oral surgery practices can turn cross-billing from a challenging task into a valuable asset that benefits both the business and its patients.