Oral surgery A/R recovery
Oral surgery A/R ages because the same case can be billed to a dental plan, a medical plan, or both, with different code sets (CDT versus CPT and ICD-10), different documentation rules, and different deadlines. Third-molar extractions, anesthesia, TMJ treatment, trauma, pathology, and implant cases each fall into the gap between the two systems. MARR Partners works these aged claims for oral and maxillofacial surgery practices on a contingency fee.
Why oral surgery A/R ages
An oral surgery practice is a dental office and a medical practice at once. Dental plans want CDT codes, radiographs, and narratives; medical plans want CPT and ICD-10 codes, medical-necessity documentation, and often a prior authorization. Coordination of benefits between the two is frequently wrong: the medical plan denies as "dental," the dental plan denies as "medical," and the claim sits. Anesthesia adds its own unit and time rules. Medicare covers only a narrow set of dental services, so Medicare-age patients generate denials that are legitimate on one side and appealable on the other.
Common oral surgery denials and the recovery path for each
| Denial | Typical cause | Recovery path |
|---|---|---|
| Medical vs. dental determination | Medical plan denies as a dental service; dental plan denies as medical; neither has the other's EOB | Determine the correct primary; bill with the other plan's denial attached; appeal citing the plan's oral-surgery benefit |
| Third-molar extractions | Medical necessity not documented (impaction type, pathology, symptoms); radiograph missing | Resubmit with panoramic image and narrative; appeal with clinical findings |
| Anesthesia | Time units missing; deep sedation billed without the required documentation or provider credential on the claim | Corrected claim with time and provider; appeal with the anesthesia record |
| TMJ and trauma | Plan exclusion asserted incorrectly; trauma billed without the accident date and cause | Appeal citing the plan's medical benefit; corrected claim with accident details and liability information |
| Pathology and biopsy | Biopsy billed to the dental plan without a pathology report; medical plan requires ICD-10 diagnosis | Rebill the correct plan with the report |
| Implants and bone grafts | Predetermination not obtained; plan requires documentation of the missing-tooth date; medical necessity for reconstruction not shown | Appeal with dates and clinical rationale; bill the patient portion correctly where excluded |
| Medicare dental exclusion | Service is excluded unless it meets Medicare's limited dental coverage rules | Appeal only where the service is inextricably linked to a covered medical procedure; otherwise close with reason |
What we look for in your aging report
- Claims denied by a medical plan as dental with no dental claim ever filed (and the reverse)
- Third-molar claims denied for medical necessity with imaging on file
- Anesthesia lines paid at zero
- Trauma and TMJ claims without accident information
- Medicare-age patients with dental-plan balances that belong to a medical benefit
Who it is for
Oral and maxillofacial surgery practices with 1–15 surgeons, including groups affiliated with hospitals or dental service organizations, and dental groups with an in-house surgeon.
Fee: 12–18% of recovered revenue by claim age, invoiced after the payer pays the practice. No setup fee, no minimum, no long-term contract. Start with the MARR 90+ Day Recovery Audit.
How it works
Send aging report
Your 90+ day aging report through a secure link under a BAA.
MARR analyzes recoverability
Every claim is checked against deadlines, payer rules, and the denial reason.
We work approved claims
Corrections, documentation, appeals, and disputes, claim by claim.
You pay on recovered revenue
Payers remit to you. Our fee is invoiced on remittances actually received.
Related articles
Sources
- CMS, Medicare dental coverage (limited coverage of dental services)
- American Dental Association, CDT code set and claim resources
- CMS, Medicare timely filing requirements
- CMS, Original Medicare appeals process and deadlines
Figures attributed to a source are that source's; commonly used benchmarks are labeled as such. Verify deadlines against your own payer contracts.