Question: Why are most insurance claim forms rejected?

Answer: Incorrect Group ID number.

So make sure your staff are paying attention to this field (and, come to think of it) all fields.

And remember that if you're electronic, you only have to do it once.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newsletter. For more information, send us an email at DENTAL TALK

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Blood Pressure Monitoring in the Dental Office

Are you or your staff routinely taking blood pressures on your patients? The ADA and local components recommend making it a regular part of your patient's exam. And besides being a practice builder, it's the right thing to do.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newsletter. For more information, send us an email at DENTAL TALK

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Gingivectomies and restorations

It's not an uncommon occurance: you've just finished preparing a tooth for a direct restoration or a crown and there's some gingiva in the way. Or maybe there is some inflamed tissue around your temporary.

You hook up your handy laser or electrosurgery unit and that tissue is history.

Can you charge for a single tooth GV?

Most companies consider removal of gingiva during preparation or placement of a restoration to be inclusive in the restorative procedure and not subject to a separate benefit. And since they consider it an inherent part, you can not charge the patient for this.

Does this mean that if the patient has a valid periodontal condition and needs a GV that it will not be covered? Of course not.

But make sure you have the clinical documentation of necessity to back up your diagnosis and treatment: i.e. for a GV, charting.

And our suggestion is to perform it on a different date of service to eliminate confusion. Remember that narratives can also be helpful.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newsletter. For more information, send us an email at DENTAL TALK

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What do you charge when the patient is over their max - and you're in their network?

There are two opinions, even within our group. Of course, if this situation is addressed in your provider contract, ignore the rest of this post. You're obligated to follow that path.

However, the first thought is that even if the patient goes over their max, you're still obligated to stick to the fee schedule.

The second thought is that once the patient has exceeded his/her max, the office can charge their normal fees.

What should you do? Check with the plans to participate with to find how they deal with these situations.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newsletter. For more information, send us an email at DENTAL TALK

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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Photos - Do I need them?

Photos can assist in established necessity by revealing to consulants what is not visible on an x-ray: i.e. a restoration with an extraordinary B-L width, the extent of a cuspal fracture.

Where they really prove their worth is when filing claims for soft tissue grafts where x-rays are useless and narratives and charting might need some assistance.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newsletter. For more information, send us an email at DENTAL TALK

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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Bruxism vs TMD Appliances

Some practitioners think they can enhance both the chance of acceptance and the insurance benefit they will receive by claiming a patient has TMD and are inserting the appropriate orthotic (or NTI)when in actuality the patient is a bruxer and their treatment is a mouthguard.

Nothing could be further from the truth.

First, if a pratitioner is upgrading a diagnosis to receive a larger benefit, then that could be considered fraud.

Second, most dental insurance plans do not cover TMD although they will allow for a habit (bruxing) appliance so the doctor himself is eliminating any chance of a benefit.

Of course, if a patient has a legitimate TMD condition and dental does not cover it, the practitioner should attempt to acquire benefits from the medical carrier.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newsletter. For more information, send us an email at DENTAL TALK

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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How often can I replace crowns?

Most insurance companies have a 5 year frequency on crowns. Why? Because insurance underwriters/actuaries have built in this factor into their premiums. Is is clinically sound? Probably not. Most dentists would not be very proud to state that their fixed prosthetics have a life of only 5 years.

Understanding the original reason for selecting this time period, some insurance companies are increasing their frequency to 7 years, some up to 10 years.

How does this impact dental offices?

First, don't replace a crown just because it has exceeded its "contractual" life. Replacement should be because of necessity and this should be noted in a narrative if x-rays don't show the need.

Secondly, if a crown does need replacement, determine if benefits are available, if any, so there are no surprizes.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newsletter. For more information, send us an email at DENTAL TALK

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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Where are my x-rays?

"Some dental insurance companies are not returning my x-rays. What can I do about it?

First of all, you should never - we're going to repeat that -

YOU SHOULD NEVER EVER EVER SEND IN YOUR ORIGINAL X-RAYS!!!

(Why? We'll go into at another time)Think we got the point across?

Back to the question.

Some dental insurance companies, in analyzing internal processes and costs(it takes people to address envelopes and postage for mailing), have realized that they're spending money returning x-rays where the doctor should have retained the original in the first place.

Some are not returning any. Some are not returning obvious duplicates and others are discarding films for services that have been paid for. As digital x-rays become more of the norm and an office can conjure up a film with a mere press of the "print" button, there will be less of a tendency to return films.

So, what do you do?

To be on the safe side and make sure you always have a complete record for you patients: YOU SHOULD NEVER EVER EVER SEND IN YOUR ORIGINAL X-RAYS!!!

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newsletter. For more information, send us an email at DENTAL TALK

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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Maximizing Benefits on Patient Exams

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

What most offices do not know is that most insurance companies do not distinguish between the types of exams for which they impose frequency limitations and who performs them.

For example, you perform a comprehensive exam for a patient and then refer them to a specialist, who performs an emergency exam 2 weeks later. Under many plans, you will receive benefits for the first and benefits will be denied for the second because it was performed within the 6 month limitation. Although the patient is responsible for the fee for the second exam, (it is considered a non-covered benefit), it can cause confusion between the practitioners and the patient.

And then there is the scenario: a patient calls your office and, from his/her description, you determine that the patient should see an endodontist. You perform a comprehensive exam 2 weeks later. Many plans will reimburse the endodontist for the focused exam but your comprehensive exam (which would receive more benefits from the insurance company) will be ineligible for benefits because of frequency.

Learn and understand your patients' benefits.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newletter. For more information, send us an email at DENTAL TALK



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Meth Mouth

The following has been extracted from the ADA's site because of the topic's impact on today's practitioner and our patients.

Meth mouth is getting a lot of media attention lately as one of the sequelae of methamphetamine use. To help you recognize this oral health condition and address it with your patients, we've created a new professional topic on ADA.org that summarizes the literature and links to more detailed information. We've also prepared a new topic in the “Your Oral Health” public area on ADA.org to alert your patients to the oral health risks of methamphetamine use. You also can contact the ADA Library for more information on this topic. We hope you find this timely information helpful and welcome your feedback on how we can better serve you and your patients.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newletter. For more information, send us an email at DENTAL TALK



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Computer Securty in Your Office

You protect your patients with rubber dam, eye shields and sterilize anything that doesn’t move too fast. But did you know that that without another type of proper protection, there are other viruses and infections that can be just as devastating?

I’m talking about computer viruses that you can unknowingly pick up while online and can compromise both your business and personal life.

Many experts feel that if you go online your office computer should be protected at a minimum with a firewall, anti-virus software, ad ware and spyware that are updated and run regularly.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newletter. For more information, send us an email at DENTAL TALK



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My Replacement Bridges Are Being Denied

One of the main reasons replacement bridges are denied and/or there is so much hassle with insurance companies is the failure to indicate that it is a replacement bridge on the claims.

Remember, when you are replacing an existing fixed bridge:

Replacement is not automatic just because it has met frequency requirements. There must be a structural reason: decay around a margin, etc. Fx porcelain, discoloration does not qualify for a new prosthesis.

If it has met frequency requirements and there is a valid reason for replacement, make sure you check the appropriate box on the dental claim (pre-d), indicate date of original placement if known and reason for replacement. A separate narrative may be included if more space is needed. Include radiographs if appropriate.

Note that some insurance companies (because of their internal policy and if there are other teeth missing and unreplaced in the arch), may allow benefits for crowns on the retainer teeth and a removable partial denture for all missing teeth despite that it is a replacement.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newletter. For more information, send us an email at DENTAL TALK



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Only Send What They Want

Practices are always complaining about the amount of documentation that they need to send to insurance companies but is your office sending too much?

As insurance companies re-direct their focus and attitude toward documentation, the need for some is decreasing.

We suggest that on a yearly basis your office contact the insurance carriers you regularly submit claims to to find out if there has been any change in documentation requirements for crowns, perio, C&B, prosthetics, etc.

You might be pleasantly surprised.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newletter. For more information, send us an email at DENTAL TALK



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ICE - In Case of Emergency

More and more emergency response technicians (police, EMT, firefighters) are being trained to consultant the cell phone directory of an unidentified person to look for an ICE entry, standing for In Case of Emergency that has a phone number to contact if that person has, guess what, an emergency.

Who would you want called if you were incapacitated? Enter that number on your phone and give it the name designation of "ICE".

We urge all readers of DT to email this message to all friends and relatives to set up an ICE contact on their cell phone.

For a more comprehensive discussion of this and other practice management and insurance topics, subscribe to the Dental Talk Newletter. For more information, send us an email at DENTAL TALK

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