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Wiki Oral Health and Pathology

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charmaine1980

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HELP!!! :confused: I am a coder/transcriptionist at a Dental School that also includes Oral Health and Pathology services. This subspeciality is not recognized (or paid) by a lot of different insurance companies based on classification of our doctors (as either oral surgeons or pathologist - not oral pathologist or oral medicine as they should be). Procedures such as trigger point injections and biopsies are not being paid due to not being a covered service recognized by our specialty! Has anyone else ran into this problem? If so, how can I correct it to maximize reimbursement for our group?
 
Hi charmaine1980,
I am going to reach out because this REALLY almost sounds like a credentialing issue based on working claim denials.
If your providers have more than one specialty "each specialty" needs to be credentialed with the merits (proof to perform) and to provide those services. I would call each different insurance company with the denial received to "review the claim together". You will be able to quickly identify what your provider is able to bill and whether or not you need to have them credentialed for another specialty.
Be sure to be specific with your questions. Dr. ZZZ did this and we billed it out with NPI and they did this procedure(s) on this DOS and they are qualified/certified to do this. Why are we not getting paid? It's ok to reiterate your question and ask it again ~ so you didn't pay on this claim because of ...... reason. It's ok to ask - "so I need Dr. SSSS to have this credential to be able to bill this procedure code."
Great news on this - if you reviewed the denial early and have to credential for a new/different specialty there really is time. Fill/submit the paperwork as quickly as possible and follow up they have received & updated their records so you may "resubmit" those claims.

Hoping you will be able to receive reimbursement,

Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB
Anesthesia, Pathology, and Laboratory Coder
 
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