The Huskin Group - Insurance and Practice Management Tips

WE'VE MOVED TO DENTALTALK

2005-07-18T16:12:00.000-04:00

We're pleased to announce that we have moved our blog to DENTAL TALK at http://dentaltalkblogspot.com.

We look forward your visiting us at our new site for new ideas on dealing with dental insurance and other practice management issues.

The Huskin Group

Negociating Higher Fees

2005-03-28T23:09:00.000-05:00

Is it possible to get a higher fee schedule from an insurance company than their standard PPO fees? If so how do I go about it?

Usually not. Why? PPO schedules are published to both doctors and patients. If a patient were to receive say, a crown, from Dr X who had negociated a higher benefit, that additional money would have to come from either A - the patient, who could perceive this plan as a bait and switch or B - the insurance company, who base their premiums on anticipated payment based on the fee schedule. In addition, if area doctors were aware that another was receiving a higher benefit, they would also want an increase.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE. or EMAIL US BY CLICKING HERE

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

Get paid by insurance companies faster.

2005-03-07T21:50:00.000-05:00

Wherever we lecture throughout the country, offices are constantly asking us how they can get paid faster by insurance companies. The best answer for all situations is : File your claims electronically.

What are some advantages:

1) The claims are checked for mistakes along the submission process and you are notifed usually within 48 hours when you can immediately correct and refile. Not 3-4 weeks later.

2) Some companies can notify you of a patient's eligibility in real time.

3) You are notified when the insurance company receives the claims. The clearing house will give you a tracking number for your claim as soon as it arrives (Usually 24-48 hours after submission).

4) You actually save money in mailing and manual claim preparation costs.

5) Companies will accept electronic attachments: no more sending in hard copy x-rays or periodontal charting.

For more information, including a calculator that lets you determine how much you'll save, based on the number of claims you submit, contact NDEDIC (National Dental EDI Council) by CLICKING HERE.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE. or EMAIL US BY CLICKING HERE

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

Are you coding your dental claims correctly?

2005-03-03T22:16:00.000-05:00

Probably one of the most frustrating things we find when assisting dentists with their dental insurance problems is the fact that many offices do not code their procedures correctly. And because of this, they are sometimes missing out on potential benefits and possibly mis-reporting work performed. Are you aware of the difference between a multi-surface restoration and a crown-buildup and when each should be used? How about the difference between types of exams? Were you aware that CDT-2005 has a procedure code that can be used for Valplast partials?

Make sure the insurance coordinator (and the doctor) understand the nuances of the different codes. Take courses (or contact us) for information on correct coding.

Because if you're not coding correctly, you may not be getting paid correctly.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE. or EMAIL US BY CLICKING HERE

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

ADA Speaks Out About Insurance Plans

2005-02-26T23:17:00.000-05:00

The latest issue of the Journal of the American Dental Association has an interesting article that discusses the different types of dental insurance plans/networks with questions practitioners should ask before "signing up".

For more information on practice management and dealing with dental insurance in your office, CLICK HERE. or EMAIL US BY CLICKING HERE

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

New JADA editor

2005-02-22T22:31:00.000-05:00

Members of The Huskin Group are pleased to welcome Dr Michael Glick as the new editor of the Journal of the American Dental Association. Dr Glick is a well known lecturer and faculty member of University of Medicine and Dentistry of New Jersey.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE. or EMAIL US BY CLICKING HERE

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

Why are my crown claims being rejected?

2005-02-20T22:18:00.000-05:00

The Huskin Group's consultants routinely receive the following question from our clients: "Why was my crown rejected by the insurance company? The lingual cusp was sheared off to the free gingiva!"

Our first questions is usually: "Did it look like the tooth needed a crown in the radiograph?"

The answer is often "Well, no but ...".

Our second question is then: "Did you include a narrative explaining the extent of the fracture and that it is not evident on the x-ray?"

Consultants are dentists too and are limited to evaluating what you send in. And if the fracture isn't evident on the x-rays, please tell them so so they have all necessary information to perform an intelligent claims review.

And finally, if the answer is "Yes", we ask, where did you write the narrative? Was it legible? Was it written in the notes section of the claim or scrawled some other place on the claim? And did you use red, black or blue ink? Companies are moving more and more toward OCR or optical scanning equipment to input their paper claims. These scanners are programmed to look in definite areas for additional information and some are color sensitive with regard to what writing they can detect. Red does not scan well.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE. or EMAIL US BY CLICKING HERE

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

Understanding Insurance Benefits for Dental Exams

2005-02-17T22:40:00.000-05:00

Most offices are aware of patient initial and recall exam frequencies that are found in different insurance contracts and their differences; i.e. two exams per year vs. two exams per year with a frequency limitation of one every six months.

What most offices do not know is that some insurance companies do not distinguish between the types of exams for which they provide benefits.

They will pay for only a certain number, usually two, of any type of exam. And although the benefit levels may vary for eligibility, a time consuming initial and emergency exam is, frequency-wise, equal to a usually routine recall exam.

Therefore, it is important to understand the requirements of an exam as defined by an insurance company and the needs of your patient so that their visits can be planned to maximize their covered benefits.

For example, you perform an emergency exam on a new patient that requires you to place a sedative temporary. A claim is then filed and you receive benefits for both services. This person returns a week later for a new patient comprehensive exam and associated services. A claim is filed for that visit also.

In certain instances, you may find that the less expensive emergency exam satisfied the patient's contractual frequency which will not entitle you to receive the benefits for the more expensive comprehensive exam. Although the patient can be billed directly for the service, they have potentially lost benefits if they don't reach their yearly maximum.

Therefore, proper planning of patient care and their visits is important, especially if specialties are involved. If you refer an emergency patient out to a specialist for, say, endodontics or periodontics, unfortunately it is often the first one to file a claim that receives the exam’s benefits.

To avoid this, clearly understand your patient's plan. This will allow you determine how to file a claim and for what visit frequency may be important.

File your claims for the more comprehensive services first and make the patient aware that they will be responsible for the less expensive visits.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE.

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

Evaluating Dental Insurance Plans

2005-02-13T22:01:00.000-05:00

When you're approached by a carrier to become a member of their dental network and accept their benefit schedule, what factors do you evaluate when making a decision? Do you consider how many subscribers in their area and do they quote contracts or actual potential patients? Do you ask how many other doctors are participating in your area to size up the competition? How about the number of your current patients that are in the program? If the fee schedule is less than your actual charges, if you join, you will probably be limited to those fees rather than your regular ones. Of course, if you decide not to participate, you run the risk of losing those patients to a neighboring dentist who does.

The procedures on the fee schedule are important too. If only basic, preventive, diagnostic and simple restorative are covered, you might be able to continue to charge your regular fees for the higher end procedures such as fixed/removable prosthetics or implants. And do you have ability to compare fee schedules for various plans based on benefits and frequency? You might be better off participating with a plan that has a high preventative benefit than one that is high on the low frequency procedures but low on the treatment you render often. Contact The Huskin Group to properly evaluate your present and future dental insurance participation.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE.

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

Is Dentistry a pain in your.......neck? back? wrist?

2005-02-10T22:18:00.000-05:00

The number of dentists and office personnel suffering from back,neck and carpel tunnel conditions is increasing. Many professionals have had to give up their practice, or at least cut back, because of these disabiities. An interesting discussion on this topic can be found by CLICKING HERE.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE.

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

X-ray submission

2005-02-07T21:50:00.000-05:00

Are you submitting your original x-rays for documentation to insurance companies? If so, you are making a big mistake. First of all, the films can be lost. either by the insurance company or in the mail. Which leaves you in a bind if you need to submit again, either for a re-submission to the same insurance company or a 2nd (if COB is involved). A larger problem rears its ugly head if you are audited, a law suit develops or the State Board wants this patient's records.

The solution: 1) use double film packets 2) only send out duplicates or 3) implement a digital x-ray system in your office where a duplicate set of films are only a mouse-click away.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE.

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

Commercial for The Huskin Group

2005-02-03T22:27:00.000-05:00

Search Engine Optimization and Free Submission

For more information on practice management and dealing with dental insurance in your office, CLICK HERE.

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

American Dental Assocation releases new criteria for x-rays

2005-02-01T09:00:00.000-05:00

The American Dental Association, in conjunction with the FDA, have developed new radiograph criteria. These new guidelines can be found by

CLICKING HERE

For more information on practice management and dealing with dental insurance in your office, CLICK HERE.

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

Give Kid's a Smile

2005-01-29T21:54:00.000-05:00

On Friday, February 4, 2005, the nation's dentists will provide free oral health care services to thousands of low-income children across the country. If you participated in Give Kids A Smile® in 2004, you were part of an effort that resulted in the delivery of some $100 million in dental education, screening, treatment and products to a million children around the country by 38,000 dental professionals.

For more information on the event and how to participate, CLICK HERE

For more information on practice management and dealing with dental insurance in your office, CLICK HERE.

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

Cracked Tooth Syndrome

2005-01-26T22:36:00.000-05:00

Rarely a day goes by without a consultant receiving at least one claim requesting a crown or onlay for a tooth described as having "cracked tooth syndrome". Accompanying the claim is usually an x-ray showing a tooth (usually posterior) with an moderately-sized existing restoration (composite or amalgam) and a intra-oral photo showing a tooth with craze lines.. There appears to be no reason to place an indirect restoration outside of the fact that the tooth has "cracked tooth syndrome". So how can you demonstrate to the consultant that that tooth indeed requires that restoration? Show that you used due diligence to arrive at this diagnosis. Send in a copy of the patient's chart demonstrating that you followed the usual course which usually includes the results of stick biting tests, removing the existing restoration to look for internal fractures, placing a temporary restoration for a period of time to see if the restoration was the problem, etc.

For more information on practice management and dealing with dental insurance in your office, CLICK HERE.

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

How Do I Become A Dental Consultant?

2005-01-24T07:44:00.000-05:00

I'm in my mid-fifties (yes, a baby boomer) and am considering retiring from practice (I have an associate-in-training) , but don't want to remove myself entirely from the dental field. I've been thinking about going into dental consulting but really don't know where to start. Can anyone give me some assistance?

For more information on practice management and dealing with dental insurance in your office, CLICK HERE. If you would like to post a subject and start a discussion, EMAIL US BY CLICKING HERE

Malpractice Insurance Slush Fund?

2005-01-22T22:29:00.000-05:00

The cost of malpractice insurance is always a concern, more so with physicians than with dentists (except for oral surgeons). New Jersey recently collected $75 from every licensed professional including dentists, physicians, chiropractors, etc., to provide a fund for practitioners who can not afford their own dental insurance. What is your opinion?

For more information on practice management and dealing with dental insurance in your office, CLICK HERE. If you would like to post a subject and start a discussion, EMAIL US BY CLICKING HERE

CDT-2005 Are You Ready?

2005-01-20T22:51:00.000-05:00

Effective 1/1/05, any practice that submits electronic claims or has a billing service submit claims for them using EDI must use this new coding system. Explanations of the new codes are forthcoming in this posting. Specific questions will be answered in this forum and can be sent to us by CLICKING HERE.

2004-11-04T22:44:00.000-05:00

Blog Search Engine

2004-11-03T16:00:00.000-05:00

Always send readable x-rays in with your cases. If you're unable to read a film, a consultant who is unfamiliar with the patient's mouth certainly won't be able to. A good rule of thumb is to use a critical eye and only submit x-rays to insurance carriers with the same quality and clarity as you would for a presentation to your study club. If you feel uncomfortable projecting an x-ray onto a screen for your peers, you should feel equally uncomfortable submitting that x-ray for any other purpose, including attempting to claim insurance benefits.

2004-10-23T16:00:00.000-04:00

Misunderstandings concerning treatment and fees can be reduced dramatically between office and patient by notating and having the patient sign the agreed-upon treatment plan in that patient's record.

CDT-2005

2004-10-17T09:04:00.000-04:00

There's a new codeset due to become effective 1/1/05. We will update this site as new information comes out including impact on the individual dental office.

2004-10-16T16:00:00.000-04:00

Are you on the same page as the specialists you refer to? An interesting situation was presented by one of our subscribers and they wanted to share it with the entire Group. A patient had had a 3 unit bridge (28-29-30) inserted ~ 15 years previously. The patient had disappeared for several years and when he returned, presented with loose bridge caused by a severely broken down unsalvageable #30. The patient was in his late 70's, had average periodontal health and a history of "putting off definitive treatment until it was really necessary". In addition, the patient had subgingival decay around another crowned tooth, #12. It was decided that the tooth requiring the crown lengthening would be addressed first, and then attention would be directed to the the molar abutment and its options. The patient was referred to a periodontist. Two months later the patient returned with a healed crown lengthening on #12 and an implant where #30 had been! The only fee the periodontist had discussed with the patient had been the implant. When the patient found out the cost for a replacement bridge, he hit the ceiling.
The lesson from this is that make sure your specialists understand that they should be co-treatment planning with you. They should not be taking the initiative and possibly misleading the patient. They should discuss treatment options with you before presenting to the patient.

2004-10-09T16:00:00.000-04:00

Take a free all-expense-paid tour.... around your own office. Pretend you're a patient and have a seat in the reception room. Can you inadvertently overhear confidential phone or financial conversations that are taking place in the reception area between your front desk personnel and patients. Remember HIPAA? Recline in your treatment chairs. Remember that dead fly in the overhead lighting assembly that your patient mentioned to you a month ago but, since you never look up, forgot to confirm that the cleaning crew removed? Does your staff un bag your instruments in front of the patient (so the patient actually sees that you follow the proper sterilization techniques) or is that done before they are seated, so they're ready for you to use. Remember that perception is reality. Every once in a while, look at your practice from the same perspective as your patient. You'd be surprised at what you see.

2004-10-02T16:00:00.000-04:00

This tip can not be repeated enough: Never ever send your original x-rays in to an insurance carrier. They are integral parts of the patient's permanent record, legal documents for your office and are necessary if your treatment is ever challenged by the state board, other insurance companies, etc. Always send duplicates or, better yet, use double film packets..