Think you know OMS billing? Here are 3 myths that are draining your profits

Whether you’re an oral surgery professional or work at a general dental practice, you probably have assumptions about how oral surgery (OMS) billing should work, and how it impacts revenue and workflows. With the complex nature of oral surgery billing — and its high stakes — it’s important that you know the truth about it.

Oral and maxillofacial surgery (OMS) practices face unique challenges when it comes to billing. Unlike general dental practices, oral surgery billing involves a complex mix of medical and dental coding, payer-specific requirements, and patient communication.

But some OMS practices operate under processes that hurt their workflows and slow their cash flow. That’s why we’re here to clear up 3 big myths about OMS billing. 

DCS is a full-service revenue cycle management (RCM) provider with a department dedicated to — and with decades of experience in — oral surgery billing. Our team knows all the ins and outs of how to help oral surgery practices collect more from medical and dental claims.

With their knowledge and experience on our side and yours, we can bust 3 big myths on OMS billing so you can avoid the errors and inefficiencies that lead to lost revenue.

Key takeaways about oral surgery billing: 

• OMS billing requires even more specialized insurance knowledge than general dental billing, as all OMS claims require both medical and dental insurance coding.
• Because OMS practices collect larger sums from payers and patients, it’s crucial you have proven game plans for handling both.
• Outsourced oral surgery billing will simplify your internal processes, collect from insurance faster, and make collecting from patients easier.

Myth #1. OMS billing is the same as general dental billing

Oral surgery billing is not the same as general dental billing, but it is similar: You meet with the patient, give them a breakdown of what their insurance will and will not cover, bill them, then send their claim off for reimbursement. 

But that’s an oversimplification of the process. If you’re an oral surgery professional, you know there’s more nuance to these steps when it comes to OMS billing. 

Here’s this myth’s impact: Treating OMS billing like dental billing can lead to undercoding, when codes used on the claim don’t capture all the work performed, or don’t capture the level of work performed.

Undercoding leads to claim denials and reduced reimbursements, which hurts your cash flow and your bottom line. Also, in reducing the amount paid by the insurer, an undue burden is put on the patient for higher out-of-pocket costs. This opens the door to higher write-offs — another hurt on your bottom line.

Read more: What makes OMS billing special? An expert explains the top 3 differences

Here’s the truth: Filing insurance claims at an oral surgery practice is twofold: You’re always filing both medical and dental insurance claims, which general dental billing rarely requires.

The combined coverage can be much more complicated, particularly because the procedures are more intricate, and also because filing both dental and medical claims requires mastery of Coordination of Benefits rules. Therefore, your team requires expertise on both insurance and medical claims for accurate and compliant claim submissions.

Our Oral Surgery Billing Business Unit Manager, Angela Rakestraw, explains: 

“OMS procedures span a very wide range, from simple removal of a baby tooth to orthognathic surgery and/or facial reconstruction. Coverages not only fall under dental plans, but in most instances, also medical plans. It is very important that benefits are reviewed for all active plans.”

Oral surgery treatment sometimes begins at a general dental practice, who then refers the patient to an oral surgeon. This transfer of information from one place of business to another can be delayed or miscommunicated, adding another layer of complexity.

So, no — OMS billing and general dental billing are not the same, and they need to be treated differently to ensure you’re collecting all you’re owed promptly for healthy streams of revenue.

Myth #2. Traditional patient billing methods will be sufficient to collect from patients

We understand every oral surgery practice has their own way of doing things: Some collect from patients up front, file the claim, accept reimbursement from insurance, then bill the patient for any remaining balance. 

Some offices wait to bill the patient until insurance pays their portion of the claim, then the patient is sent a bill for any remainder.

Either process is compliant, so it’s up to you — the only bad plan is having no plan at all.

Even with insurance coverage from medical and dental, oral surgery is typically far more costly than general dental treatments. Because of this, collecting from patients can be more precarious. You want to be sensitive to the high cost, but you’re also running a business — you need to collect all you’re owed.

Here’s this myth’s impact: You’re less likely to collect your complete fee from patients when your only plan is to mail them a final bill for the full amount after insurance pays their part. That’s a lot to ask with no conversation, no documentation, and no payment options.

If the patient is resistant to paying or slow to pay, it can stall your cash flow, damage overall revenue, and even harm the relationship with your patient.

Here’s the truth: When you prepare your patient at the start, you’re setting yourself up for easier collections at the end.

First, calculate an accurate estimate that details: the cost of the procedure, what the patient’s plan will cover, and how much the patient can expect to pay. This needs to be presented before treatment and approved by the patient. It must be clear that regardless of the estimate, the patient will be responsible for paying any amount that their insurance does not.

The final steps to get payments from patients become easy when you use patient collection software like ZeroBalance from DCS.

Not only will patients be sent their first bill automatically as soon as their balance is known, they can pay easily online using the phone, tablet, or laptop — no bills lost in the mail or forgotten on the kitchen counter!

ZeroBalance uses automated technology to send patients payment reminders via text and/or email with a direct link to their payment portal, so they can pay you from anywhere at anytime using their credit card or a digital wallet, such as Google Pay or Apple Pay.

To make payment even easier, you can split their bill into recurring installments — an options patients will welcome because, as mentioned earlier, oral surgery is typically more expensive than general dentistry.

You can collect more efficiently from patients when you offer payment plans which ensure you collect all of your revenue, even if that takes extra time.

Learn more about ZeroBalance and automated patient collections here.

Myth #3. Outsourced OMS billing is too expensive

Outsourcing administrative tasks has become a more common solution for all dental businesses, including oral surgery practices — and it’s more affordable than many think.

As mentioned in Myth #1, OMS billing requires coding expertise for both dental and medical insurance. This work is complicated and time-consuming, and it’s getting harder to find qualified, experienced billers who can handle it.

So, wise business leaders are turning to experts who will handle insurance while their in-house teams focus on patients. However, it’s a common myth that outsourcing for this expertise is too expensive, and that hiring someone in-house is more cost-effective.

Here’s this myth’s impact: You hire an experienced insurance coordinator, but discover that when you consider salary and benefits, in-house staffing is actually more expensive than outsourcing to an insurance billing service like DCS.

If you try to save on overhead costs by hiring a less experienced insurance coordinator, you’ll see more claim errors followed by more claim denials as your novice coordinator learns on the job You also a risk a higher A/R, and lost revenue due to undercoding and timely filing. As in all areas of dentistry, claim mistakes take a toll on your bottom line.

You can read more about the impact of costly claim mistakes in this case study about your colleagues at Aspire Oral Surgery: 

Here’s the truth: You can avoid pricey mistakes and the headache of hiring, training, and retaining a new team member when you outsource your insurance billing to our oral surgery experts at DCS. You’ll have their decades of experience and the competitive advantage of our DCS Knowledge Network managing your insurance and medical claims without raising your overhead costs.

Compare costs here: The cost of revenue cycle management services vs. in-house dental billing: 5 questions answered

Denied claims are dollars you’ve earned that are left in limbo or never collected And in the case of OMS? That’s a significant amount that you’re leaving on the table. Outsourced insurance billing isn’t too expensive, it’s just a cost of doing business — and the key to having consistent cash flow and increasing your overall revenue without adding personnel problems.

Now that the myths are busted, how will you improve your oral surgery profits?

To recap, here are 3 OMS billing myths we busted:

• Myth #1. OMS billing is the same as general dental billing
  • The Truth: Oral surgery billing is more complex because both medical and dental claims are required
• Myth #2. Traditional patient billing methods will be sufficient to collect from patients
  • The Truth: When you prepare your patient at the start, you’re setting yourself up for easier collections at the end. Discuss costs and payment options in the treatment presentation for transparency and trust.
• Myth #3. Outsourced OMS billing is too expensive
  • The Truth: Hiring an experienced insurance coordinator usually costs more than outsourcing, and due to the staffing shortage, this expertise will be increasingly hard to find.

Now that you understand the larger nuances of OMS billing, you can address these misconceptions. We hope that this knowledge put into action helps you recover lost revenue, improve cash flow, and focus on delivering exceptional patient care. 

As you evaluate your current billing practices, consider outsourcing to a dental revenue solution provider to ensure your practice stays financially healthy, and your patients have a great experience. The paired power of DCS Insurance Billing and ZeroBalance is a winning choice for many successful OMS practices.

Join us, and you’ll collect seamlessly from insurance and patients with the help of our OMS billing experts and automated software.

"Since beginning DCS our AR has greatly improved. Not to mention the timeliness of our claims. The entire process is far superior to what was being done before. I would and have recommended DCS to other oral surgeons as well as other dentists. It is game changing for a well run office." --Idaho Oral Surgery

Ready to increase your oral surgery profits with ease? Book a free 30-minute consultation today.