Brush biopsies

Since the American Dental Association has assigned it an exclusive CDT code and insurance carriers recognize the relationship between oral and systemic diseases and the potential to identify life-threatening lesions in their infancy, more and more are beginning to provide benefits for brush biopsies.

The taking of the biopsy, which includes the materials, will usually be covered by the dental plan while the actual cost for the analysis and pathology report is often the responsibility of the patient's medical carrier.

Be cautious here. Many medical carriers have agreements with certain pathology labs that include discounts and prohibit or reduce benefits to labs not in this "network". Physicians are more familiar with these agreements and what labs participate. Before preforming a biopsy, check with the patient's medical carrier to make sure that benefits are available for the lab you will have to use to avoid benefit problems.

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Choosing a dentist

The latest ADA survey indicates that when choosing a dentist: 64.8% are likely to choose a dentist who is an association member, 34.5% don't care while 0.7% are less likely to choose a dentist who does not belong.

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National Practioner Identifier

Are you ready for another number to use to identify yourself for electronic claims? The NPI is intended for use in electronic transactions (although some carriers may opt to require it before it's effective date of May 23, 2007). You can request an application or apply online at http://nppes.cms.hhs.gov.

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How do I get paid for a crown buildup?

Crown buildups required when a tooth does not have enough structure, after decay is removed, to physically retain a crown on its own and the anatomic crown must be "embelished". It is not a payable procedure to report replacing a filling, removing decay, placing a base or liner, etc. if the tooth could retain the crown without this additional restorative material.

Crown buildups are an abused procedure and these claims are often scrutinized more critically. If the tooth you are restoring does need this structuraly enhancement, make sure it is evident on the x-ray(s) you submit. And if necessity isn't evident, include a narrative for the consultant.

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The coolest piece of equipment I use is...

A national dental supply company recently conducted a poll asking dentist "What is the coolest piece of equipment (or instrument) you own and use?"

While we're waiting for their results, we're going to conduct our own survey.

What is the coolest (greatest) instrument (piece of equipment) do you own and use in the office?

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I filed a dental claim too late and they denied benefits.

Many insurance companies have a time limit after which a claim will not be paid. This can be anywhere from 1 year to 18 months after date of service (DOS).

A problem can arise when their are two insurances involved (COB)and payment from the primary is slow (for whatever reason) and causes you to file a claim with the secondary after the time period has elapsed.

Our suggestion is that if the secondary filing is denied because of lateness, write an appeal letter and offer a comprehensive narrative, including dates of submission to the primary carrier and the problems you had.

If you can demonstrate that the delay wasn't your fault, many carriers will overturn the benefit denial. If they continue to refuse, you may want to contact the state dental society or insurance commission.

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ADA and electronic claims

The latest issue of the ADA newsletter features the first of a series of articles on submitting claims electronically. (Never mind that various aspects of the dental community have been promoting it for over 15 years).

The lead off article is a good intro to the series and we'll see what comes next.

There are some misleading information involved. One being that they intimate that pre-determinations can not be filed using paper. The other is that by submitting pre-determinations electronically, you will automatically receive real-time benefit estimates. Some insurance companies can provide this but make sure it is a real number and not an estimate based on the patient's plan and total year benefits, not taking into account benefits that have already been used.

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Alternate Benefit - What does it mean?

Have you ever had a fixed bridge alternately treated to a partial denture? Maddening,isn't it?

You were probably the victim of the dreaded alternate benefit, a provision
that is found in most dental plans.

Basically, the alternate benefits states that if there are multiple modalities of
treating a particular oral condition, the insurance company will allow benefits
for the least expensive one. That’s why fixed bridges become removaable ones.

The positive side is that that benefit can be applied to your treatment actually
performed.

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Dentists - We Need Your Help!

At the weekly consultant phone-in our cross-payor team discusses issues they see on a regular basis. This week the topic was: Please! If a patient's dental plan has an alternate benefit (which a large majority do) and you are replacing a missing tooth with a fixed bridge, PLEASE submit full arch radiographs!

Consultants need to review the entire arch to determine if other teeth are missing and the alternate benefit applies. Some dentists try to hide the fact that there are other teeth missing by only submitting the side being treated. Consultants require both sides and holding back will usually just delay your claim or pre-determination while this information is requested.

More on the alternate benefit provision on a later post.

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Not Just Teeth....How To Detect Fake Emails

If you're reading this blog, then you're a potential for fake emails. Here's an article we thought would be interesting to the readership.




10 ways to recognize fake (spoof) emails

Generic greetings. Many spoof emails begin with a general greeting, such as: "Dear PayPal member." If you do not see your first and last name, be suspicious and do not click on any links or button.

A fake sender's address. A spoof email may include a forged email address in the "From" field. This field is easily altered.

A false sense of urgency. Many spoof emails try to deceive you with the threat that your account is in jeopardy if you don't update it ASAP. They may also state that an unauthorized transaction has recently occurred on your account, or claim PayPal is updating its accounts and needs information fast.

Fake links. Always check where a link is going before you click. Move your mouse over it and look at the URL in your browser or email status bar. A fraudulent link is dangerous. If you click on one, it could:
Direct you to a spoof website that tries to collect your personal data.
Install spyware on your system. Spyware is an application that can enable a hacker to monitor your actions and steal any passwords or credit card numbers you type online.
Cause you to download a virus that could disable your computer.

Emails that appear to be websites. Some emails will look like a website in order to get you to enter personal information.

Deceptive URLs. If you see an @ sign in the middle of a URL, there's a good chance this is a spoof. Legitimate companies use a domain name (e.g. https://www.company.com).

Misspellings and bad grammar. Spoof emails often contain misspellings, incorrect grammar, missing words, and gaps in logic. Mistakes also help fraudsters avoid spam filters.

Unsafe sites. The term "https" should always precede any website address where you enter personal information. The "s" stands for secure. If you don't see "https," you're not in a secure web session, and you should not enter data.

Attachments. Like fake links, attachments are frequently used in spoof emails and are dangerous. Never click on an attachment. It could cause you to download spyware or a virus.

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Forensic Dental Course at UMDNJ

This week we attended 2 day forensic course at the University of Medicine and Dentistry of New Jersey that was taught by forensic dentists of the New York City and Philadelphia Medical Examiners Offices, faculty at UMDNJ, and New Jersey Dental Association’s Disaster Response Team and other dentists who assisted following the attach on the US on 9/11. Kudos to all.

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Why do insurance companies lose x-rays?

Believe it or not, insurance companies do not try to lose or misplace radiographs. Their intent is to get them back to the submitting doctors as quickly as possible after they’ve reviewed what information they need. But large carriers may receive thousands of films in a week. Despite their best efforts, films will be lost or returned to the wrong doctor.

So how do you prevent insurance companies from losing or misplacing your films?

1) Only send the films they require. The trend in the industry is to decrease the procedures that they request films for. Certain requirements will probably remain the same (i.e. FMX for fixed prosthetics and implants) but check with the carriers you submit to to see what procedures they require films for.

2) Never ever submit your original films. Use double film packs or send duplicates. The advantage of digital films is that you can always print another copy if any are lost.

3) Use electronic attachments wherever possible. Either scan or take digital x-rays and use a web-based attachment service such as NEA. That way your films will always be available.


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