Dental Talk

Sorry for the Lapse

2006-09-02T03:39:00.000-11:00

We've been upgrading our software so we apologize that we haven't posted in a while. But with the changes coming up in dentistry: i.e. CDT-2007 and NPI there's a lot to talk about and consider for both solo and group practitioners.

Say tuned.

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CDT-2007 - Are you ready?

2006-07-19T07:47:00.000-11:00

The new CDT code set becomes effective 1/1/07. Although the changes are not as dramatic as they have been in the past, it does present with:

23 new codes
3 deletions
33 revisions

We'll be discussing these and the impact they will have as the deadline for implementation approaches.

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Reporting loss of controlled substances

2006-07-06T01:10:00.000-11:00

The Drug Enforcement Agency’s form for reporting theft or loss of controlled substances is now online in a secure, electronic format. Form 106 is on the DEA’s Diversion Control Program Web site. Just select the DEA Form 106 On-Line button on the right side of the homepage.

Risky Business

2006-04-25T03:08:00.000-11:00

When is the last time you took a risk management course?

A better question might be, why take a risk management course?

How about
1)Taking an accepted course will often let you save some money on your malpractice premium
2)It let's you examine/tighten up, if necessary, office procedures/policies that need some attention could cause you a liability
3)If you are confronted with a law suit, it's just another positive on your side.

Where can you take RM courses? Contact you malpractice carrier or the state component of the ADA. They can point you in the right direction.

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Credentialing - Why?

2006-04-20T10:26:00.000-11:00

The first question most doctors ask is why does the insurance company make me go through this annoying and timecomsuming process of submitting all this paperwork to be credential/recredentialed?

The answer is that once you're in their network (and published in their directories), they are, in effect, referring patients to you. Although the reason is basically that you agree to accept whatever compensation that network pays, they are also, in effect, endorsing you as a practitioner.

And before they do that, they want to make sure (and in some venues are required) to confirm that you have the necessary licenses and have no type of history that could impact the relationship with you, them and their subscribers.

Next post we'll look at the more commonly requested documents.

Another post will discuss CVO's and the part they play.

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Credentialing - Intro

2006-04-19T06:22:00.000-11:00

Are you joining or being recredentialed by a dental network you participate with?

There are certain guidelines you should know and understand to speed your application through the process.

Remember that if there is any gap in your recredentialing, it could impact your benefits.

Join us as we present "bullets" that will help you with the paper/time intensive process.

Electronic or Paper

2006-04-18T15:58:00.000-11:00

One of my associates thinks that we should computorize the office while the second, and the rest of my staff, wants to stick with the traditional paper records, claims, x-rays, etc. I look at the cost of transitioning over, then I read articles on how it really maxmizes all aspects of your practice... I'm sure I'm not the first who has gone through this soul-searching. I'd appreciate any feedback, positive or negative. Click Here to Manage Your Practice More Effectively

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Athletics and Mouthguards

2006-04-14T02:06:00.000-11:00

Thousands of dollars are spent each year on shin guards, wrist pads,
athletic cups and other sports gear to protect athletes from harm. But with
the weather warming for spring, one of the most important body parts often
remains exposed to traumatic injury: the mouth. In support of National
Facial Protection Month, the American Association of Endodontists (AAE)
urges all athletic directors, coaches and parents to enforce mouth guard
use and facial protection during sports to prevent knocked out, or avulsed,
teeth.

If you would like to post a subject and start a discussion, EMAIL US BY CLICKING HERE

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Dealing with Dental Insurance Consultants-Documentation

2006-04-05T15:38:00.000-11:00

When you're submitting claims/pre-d's for periodontal procedures such as scaling and root planing, osseous, grafts, you will clinically need both charting and raiographs However, you may not have to submit both. Some companies will require either radiographs or charting for periodontal procedures but not both. Check with the various carrriers you submit to to find out what they need. Don't submit more than you have to.

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Dealing with Dental Insurance Consultants

2006-03-27T15:48:00.000-11:00

So, that’s the big secret in dealing with dental consultants. Submit clear concise appropriate documentation with your claims and pre-determinations. And if you do, you shouldn’t have trouble with claims being delayed.

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Increased periodontal awareness among patients in general practices

2006-03-26T16:04:00.000-11:00

According to a recent article in Dental Products Report, 71% of GP’s report an increased awareness among their patients about periodontal disease with 50% attributing this to education by the dentist and/or office staff. 57% have increased the number of periodontal soft-tissue management procedures in their office with 99% performing pocket probing with a manual probe. Go to dentalproducts.net for the complete article.

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Dealing with Dental Insurance Consultants-Documentation

2006-03-22T15:41:00.000-11:00

There are times when the diagnostic quality of the radiograph is questionable. A good rule is to never submit any radiographs that you would not be hesitant to present to your study group.

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Why Your Dental Insurance Claims May Be Denied

2006-03-20T15:56:00.000-11:00

Is your patient eligible for benefits?

Many claims are submitted for patients who are not eligible for any payments(their benefits have run out or coverage is terminated). Rather than file a claim or predetermination and wait weeks to find out that they have no coverage you’ll be billing the patient for all costs, check a patient’s eligibility before-hand. Depending on the insurance company you can often check either by phone, using their IVR or even going online.

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Emdeon and the ADA

2006-03-17T14:58:00.000-11:00

The ADA and Emdeon (formally WebMD) are teaming up to improve relations with dentists, insurance companies (payers) and demonstrate the data that can be obtained electronically including:

Eligibility
Benefit determination
Claims information
Claims’ status
Electronic remittance
Electronic fund transfer

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FDA approves Decapinol

2006-03-16T16:03:00.000-11:00

The FDA recently approved Decapinol as a treatment for gingivitis but as a device, not as a mouth rinse. Other rinses kill the plaque bacteria or interfere with bacterial metabolism while Decapinol forms a physical barrier.

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Are Some Of Your Patients Smokers?

2006-03-13T16:02:00.000-11:00

A recent survey indicated that more than half of all smokers visit the dentist regularly. Are you doing your part to identify these patients and educate them as to the risks they are exposing themselves and others around them to?

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Dealing with Dental Insurance Consultants-Documentation

2006-03-11T15:39:00.000-11:00

Many companies will require a pathology report before allowing benefits for a biopsy.

And they frown on paying for cystectomies for every 3rd molar that's extracted or apicoectomy

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Dealing with Dental Insurance Consultants

2006-03-10T15:37:00.000-11:00

Most insurance companies will need to see recent full arch films for implants and removable/fixed prosthesis to determine if an alternate benefit is appropriate. But some will accept a "toothmap" in lieu of radiographs. To avoid submitting unneccessary documentation, check with a patient's carrier.

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#1 Reason Dental Insurance Claims Are Denied

2006-03-08T15:50:00.000-11:00

Did you know that the Number One reason claims are rejected by insurance companies is that the wrong group number is placed on the claim?

If you’re filing electronically, always make sure that all information is accurate in your software.

If you’re using paper claims, be accurate and legible. More insurance companies are using optical scanning (OCR) to input claims into their system and a smudged entry can be mis-read.

Whenever a patient is starting a new series of visits, confirm that their correct insurance information. They might have switched jobs or benefit levels in the interim and your old information might not be accurate.

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Correct CDT coding of dental insurance claims

2006-03-06T15:21:00.000-11:00

If you use a code that has been discontinued, that service will usually be denied by most payers. (For example, it has been discontinued, some offices continue to submit the procedure code D4220 – gingival curettage)

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Correct CDT coding of dental insurance claims

2006-03-03T15:19:00.000-11:00

A mistake we see is in their haste, some offices will mis-code retainer (abutment) teeth as pontics and visa versa. This can lead to denial of the claims and return to the office for correcte coding. A lot of time can be wasted as a result of this simple avoidable mistake.

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Correct CDT coding of dental insurance claims

2006-03-01T15:18:00.000-11:00

Use as specific a code as you can find. If your procedure is not listed, you can use the last code (unspecified procedure, by report) in each grouping, DX999, but include a narrative to explain what you did.

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NPI - National Provider Identifier

2006-02-27T07:18:00.000-11:00

This post deserves a repeat since many practitioners are not giving this the attention it needs. Like it or not, it will be here soon.

By May of 2007 (or sooner) if you submit your claims electronically, you will have to obtain a ten digit NPI from the government.

The application can be made over the web and usually takes only short time to process and receive. Or you can download and commplete a paper form and mail it in,

Data you will need when you apply is any tax ID's you use, state license number, home and practice address.

More information can be obtained by going to the ADA website www.ada.org.

You can apply at http://nppes.cms.hhs.gov or by calling 800-465-3203.

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What fees do you use when filing dental insurance claims?

2006-02-26T02:50:00.000-11:00

There is a tendency, especially if an office has PMS (practice management software) and participates in various dental insurance plans, to use those fee schedule allowances as the charge when filing a claims.

You might be doing both you and your colleques a disservice.

Why?

A number of dental insurance companies use the charge data from their dental population to determine fees. If you submit lower fees, that could drive down their maximum allowance and give an unrealistic impression of what practitioners are using as their normal fees.

Always submit your regular fees. The insurance company will make the adjustment.

If you would like to post a subject and start a discussion, EMAIL US BY CLICKING HERE

Visit us at The Huskin Group about our dental insurance and practice management services.

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ADA and Alaska

2006-02-24T03:48:00.000-11:00

The American Dental Association (ADA) is currently suing based on their feelings that properly licensed persons are not providing adequete healthcare.

What are your thoughts?

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