A recent NEA webinar presented by Colleen Huff, FAADOM, a dental field veteran with more than 20 years’ experience, focused on what to do when you have a patient who has been in an accident – and the steps to take to ensure you get paid.
Many dental practices shy away from seeing a patient who has been in an accident, afraid of dealing with a medical claim, or that the claim won’t be accepted or paid. In our webinar, Colleen talked about how to handle these situations, so everyone wins. Here are the highlights:
What are accidental dental services?
Accidental dental services are medically necessary services to restore a natural tooth to the most closely approximate pre-accident form and function. The damage must be the result of an accidental injury to a sound and healthy, natural tooth struck from outside the mouth.
If you want to get paid, ask questions
From the initial phone call with the patient, ask questions. A lot of questions – and take detailed notes. What you uncover in this phone call will help your outcome in the end.
Here’s what to ask:
- When did the accident happen?
- Where did the accident happen? This determines what type of insurance you’ll be dealing with.
- Did the patient go to the hospital?
- Did the patient go to their doctor?
- Has the patient been to another dentist?
- Are there any existing records?
Types of accidents
At work – Worker’s compensation is typically one of the easiest types of accident cases to deal with as long as you follow procedure. The patient’s employer has a limited window to report the accident to their insurer, typically about 10 days. You must obtain the name and number of the accident carrier along with a specific worker’s compensation number. Verify the accident with the employer and have the patient bring a typed copy of all details to their appointment.
At home – If your patient is hurt at their home or someone else’s house, it may not necessarily go through medical insurance first. It may go through homeowners, which pays well, but it will increase the insurance rate for the insured party. The patient is not obligated to use homeowners’ insurance and may elect to use medical insurance.
At school – Many sports teams or schools carry a policy that will cover accidents. If they don’t, the claim will go through medical, and if they do, you will still have to go through medical first, then dental, and then through the sports team or school, which allows more time for treatment.
In a car – Before you schedule a patient from a car accident, make sure you have their medical insurance information and find out who the responsible party is and whether it’s the same as the dental insurance provider. Not knowing can delay or cause problems for claim approval and payment.
Contacting insurance providers
Now the fun begins, but the advice remains the same. Ask questions and keep detailed records of who you spoke to and their phone numbers, along with all claim information:
- Who am I billing?
- Are the required services covered?
- Is there a filing limitation to when work must be completed?
- Do you need a pre-authorization? Ask every time as this can change daily.
- Can I bill on a dental claim? For most accidents, you will be able to charge on a dental claim.
Follow up is critical, and sometimes you must be persistent in getting paid.
Colleen’s key recommendations
- Gather all insurance information before you move forward with treatment.
- Bill dental codes if you can. If you must, you can enter medical codes on your dental claim form and bill it that way.
- A pre-authorization is highly recommended. When you submit a pre-authorization, you may submit your dental codes and the information you have. In the future, Medicaid and medical may not allow the use of D-codes.
The final payoff
In addition to being paid on accident claims, you may end up gaining lifelong customers. By being willing to do some additional legwork to see patients who have been in an accident and providing excellent care, they may stick around – and bring many referrals with them.