ADA Speaks Out About Insurance Plans

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

The staff at Dental Talk 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?

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

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 Plans

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?

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

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 Dental Talk

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

New x-ray criteria from American Dental Association

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