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.

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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.

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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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Correct CDT coding of dental insurance claims

2006-02-22T15:16:00.000-11:00

An example that can slow down payment because of improper coding is:

Claims are sometimes submitted for fixed prosthesis retainers (abutments) using single crown codes - 2000 Series - Restorative Category- rather than using the 6000 Series – Prosthodontics-fixed Category.

Besides improper procedure reporting, it can also impact benefit levels.

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MetroJersey.com

2006-02-21T11:37:00.000-11:00

Metrojersey.com

New Jersey's
#1 Website Directory

Correct CDT coding of dental insurance claims

2006-02-20T15:15:00.000-11:00

Every 2 years the American Dental Association makes adjustments to the CDT codes based on recommendations from the Code Revision Committee (representing both ADA and insurance companies) so it’s necessary for your office to stay current. The most up-dated version, CDT-2005, is effective for services provided on or after January 1, 2005 and has been designated by the Federal Government as the national standard for reporting dental services. (Offices submitting claims electronically must use CDT-2005 but some insurance companies will accept prior versions on their paper claims).

Our suggestion is that at least every two years, after the new codes have become effective (CDT-2007 becomes official on January 1, 2007) you and your insurance staff should take a comprehensive course to bring you up to date with any changes.

More details to follow on how to code and code correctly

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Correct CDT coding of dental insurance claims

2006-02-18T15:14:00.000-11:00

Current Dental Terminology, or better known as the CDT, is recognized by most dental insurance companies and other third party carriers. Many of these companies use the CDT code set as one of their criteria to determine which procedures are referred to a dental consultant for review.

In fact, this field will often be used more often by payers than “Description of Procedure” field for identifying a procedure for benefits.

More details to follow on how to code and code correctly

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Dealing with Dental Insurance Consultants

2006-02-17T15:22:00.000-11:00

Know What They Want

Find out what kind of documentation each insurance company actually needs. Why submit information that they won’t even look at?

The trend in some parts of the industry is to request less. It cuts down on cost of internal tracking of this information and return mailings and means there’s less material that can be lost.

Many companies list these requirements on their provider websites. These sites can easily be found by using any of the search engines such as Google, Yahoo, MSN or Altavista

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Dealing with Dental Insurance Consultants

2006-02-15T15:13:00.000-11:00

Be familiar with the most recent CDT (Current Dental Terminology) codes and use them properly.

If you’re not coding correctly, you may not be billing and getting reimbursed correctly. Always use the code that most closely describes the procedure which you performed

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Dealing with Dental Insurance Consultants

2006-02-13T15:10:00.000-11:00

Accuracy and Completeness

If necessity for your treatment is not evident on the x-rays, periodontal charting, or other documentation you submit, always include a narrative. Like the example used to introduce this article, you have examined the patient clinically, the consultant has not and may need that additional information to make a benefit decision.

Stay away from “boiler-plate” narratives. A brief concisely-written narrative describing condition and need will always be considered more appropriate.

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Dealing with Dental Insurance Consultants

2006-02-10T15:09:00.000-11:00

Accuracy and Completeness

Submit current x-rays. Nothing can be more frustrating for a dental consultant than receiving a claim requesting surgical periodontal services and the x-rays are old and reflect the mouth before these procedures were needed. They're not mind readers.

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Dealing with Dental Insurance Consultants

2006-02-08T15:08:00.000-11:00

Accuracy and Completeness

Submit the proper x-rays. It’s easy for the front desk to make a mistake and enclose a film for #3 when you’re filing for a service on #14 but this error can cost you valuable time.

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Dealing with Dental Insurance Consultants

2006-02-06T15:07:00.000-11:00

Accuracy and Completeness

If you’re replacing a prosthesis, indicate that fact on the claim in the proper section along with the date of insertion of the previous appliance and the reason for replacement.

A narrative is necessary here if reasons for replacement are not evident on the x-rays: decay, open margin, etc. (Remember that benefits for replacement are not available just because the prosthesis is “old” or “cosmetically unacceptable”. It must have a loss in functionality). If you didn’t originally place the prosthesis, find out its insertion date.

You’ll want to confirm that it’s eligible for replacement based on the frequency terms of the patient’s contract so there are no financial misunderstandings.

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Dealing with Dental Insurance Consultants

2006-02-02T15:06:00.000-11:00

A common example of inaccuracies or incompleteness that can cause claim delay are:

Not using the correct tooth numbers, dates of service or proper fees. Nothing can be more frustrating to a consultant (and generate delay while an inquiry letter is sent) than a claim where the tooth numbers for the restoration don’t correspond to the need according to the radiographs.

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Dealing with Dental Insurance Consultants

2006-01-31T15:04:00.000-11:00

Accuracy and Completeness

This is a good rule to remember regardless of if the claim is for simple services (exams, prophys, direct restorations, etc.) that are automatically processed or large cases that need consultant review. Not only should the patient/doctor information be complete and up-to-date but the body of the claim, where you explain what treatment you’ve performed or intend to perform, must be accurate. Any omission or inaccuracy can cause that claim to suspend and a “Need More Information” letter sent to you for clarification. And this will delay benefits being paid.

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Dealing with Dental Insurance Consultants – The BIG Secret

2006-01-28T15:02:00.000-11:00

It’s Friday afternoon and the day has not been going well. Mrs. C cancelled her 2 hour 6-veneer appointment at the last minute this morning because her little girl has strep. The occlusion on Mr. S’s full denture wasn’t on the money so you need to do a new occlusal analysis. And to finish up the day, XYZ Insurance Company’s dental consultant denied your request for a crown on your neighbor and gave you an alternate benefit of an amalgam!

“Why do they do this to me!” You scream to the dental gods. “Don’t they know that the lingual cusp on # 20 is fractured subgingivally?”

The truth is that if it’s not obvious on the x-ray (assuming you sent one) and you didn’t tell them, then they probably didn’t know.

So, let’s back up a minute and see what can be done to speed up your claims through the dental consulting review process so the only thing contributing to your increasing baldness is genetics.

We are going to start a series of posts that will assist you in dealing with these perceived converts to the “Dark Side of Dentistry”.

Comments/War Stories are always welcome!

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Free Tour

2006-01-23T06:17:00.000-11:00

Take a free tour.........around your office.......see what your patients' see.

Sit in the treatment chair. Put the chair back and turn your head from side to side to see what the patient sees. Is there dust underneath the edge of your countertop that you wouldn't notice in a million years? If you never look up, is your cleaning crew making sure there are no dead bugs in the florscent lights?

Can the patients in the waiting room see that pile of unfiled charts sitting on top of your filing cabinets?

Perception is reality and your office may be perceived as unclean by these simple observations even though you observe every CDC edit ever issues.

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New CDT code set

2006-01-19T15:25:00.000-11:00

Are you ready for a new set of CDT (Current Dental Terminology)?

CDT-2007 will be released later on in the year with it becoming the required code set, effective 1/1/07, for all offices that must be HIPAA compliant. (If you or a third party submit your claims electronically, you will be required to use it).

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Local Anesthesia - To Bill or Not To Bill

2006-01-14T16:04:00.000-11:00

CDT-4 states that local anesthesia is included in dental procedures. CDT-5 states that it is usually included. Why the change and what are the ramifications?

Certain insurance plans allow for a separate benefit for local anesthesia. Most do not and consider it an inherent part of the primary procedure performed.

Posted by The Huskin Group for JR-NJ. To have your questions posted, CLICK HERE

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International Accreditation

2006-01-10T15:15:00.000-11:00

International accreditation will be the topic on March 20 at ADA headquarters.

Registration forms may be obtained from the AADE.

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NPI - National Provider Identifier

2006-01-02T15:02:00.000-11:00

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.

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

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MedWatch Wants Your Participation

2005-12-20T11:58:00.000-11:00

If a patient has ever had an adverse reaction to a medication, prosthesis, implant, etc., the FDA urges you to report it on their website.

You could save someone from going through the same difficulties.

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Lumineers - A Survey

2005-12-13T11:55:00.000-11:00

For our last survey of the year, we'd like to know what the general feeling is toward Cerinate Lumineers. They've received quite a set if raves from a particular group and its publication, but we'd like to know what the men in the trenches think.

Care to offer your opinion?

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Are you becoming handicapped from dentistry?

2005-12-12T04:18:00.000-11:00

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.

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Bruxism Appliances and Dental Insurance

2005-12-05T04:21:00.000-11:00

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.

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Give Kid's a Smile - 2006

2005-12-02T11:47:00.000-11:00

It's that time again. This year it's Feb 3.

More than 11,800 dentists are registered to treat 493,000 in 1,882 programs nationwide. (Number courtesy of the ADA).

If you haven't registered your program, go online to

It's a wonderful community service.

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Electronic Submission of Periodontal Claims

2005-11-25T11:44:00.000-11:00

The ADA is currently working on a consistent submission format for electronic periodontal claims. Requests for input have gone out and a copy of the proposed spec can be obtained by contacting the American Dental Association.

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Volunteers Needed in New Orleans

2005-11-19T11:42:00.000-11:00

As a result of Hurricane Katrina, dentists, hygienists and assistants are needed to provide free care and treatment to up to 6000 needy patients.

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Dentists and Conference on Aging

2005-11-10T11:33:00.000-11:00

Several members of the ADA were present at the White House's 2005 Conference on the Aging.

More information can be obtained by CLICKING HERE.

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Participating with PPO's

2005-11-01T11:32:00.000-11:00

Have you been participating in a PPO for a while and questioning if you should continue?

One consideration is how much income you’re writing off compared to what you would earn if you charged your usual fees. Remember that no one is twisting your arm to continue participation. It's a business decision and if you feel that financially your practice is losing out, then it might be time to quit.

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Dental Insurance and Cracked Tooth Syndrome

2005-10-30T11:31:00.000-11:00

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

Dentistry and Staying Fit

2005-10-15T11:29:00.000-11:00

We're taking a poll as to how practitioners stay in shape and still maintain their hectic (emotionally and physically) schedules.

Do you take a nap?

How do you deal with stress?

Let us know.

Your exercise plan might be another's salvation.

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The Amazing Disappearing X-rays

2005-10-05T11:26:00.000-11:00

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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Consent Forms

2005-09-30T11:24:00.000-11:00

I'm a GP and was always taught to use consent forms when I'm doing oral surgery. I'm hearing more and more though that they should be used more often. What is the rest of the community doing out there?

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Private practice or residency?

2005-09-20T11:23:00.000-11:00

I'm currently a junior in an east coast dental school and am indecisive as to if I should go look into becoming an associate in a private practice or spend a year in a general practice residency. Would appreciate your feedback.

John W

Technorati Profile

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Updating Your Office Fees

2005-09-07T14:17:00.000-11:00

If you routinely update your office fees the first of every year, now is the time to start the process. Not much preparation is involved if you don't participate in any insurance plans. If you participate in plans that expect you to file your fees with them and they build a personal schedule for you off of that information, then make sure you submit early enough to pass through their evaluation/approval process. They usually won't pay using those fees until they're loaded into their system. Make sure you receive a letter of confirmation before implementing your new office schedule.

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Crown Lengthing - Hard Tissue Only

2005-09-06T11:45:00.000-11:00

Remember that crown lengthing is considered a surgical procedure and benefits for it should be requested and billed only when hard tissue is removed. (Removal of redundent gingival tissue or deepening the sulcur for an impression does not qualify)

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Question: Why are most insurance claim forms rejected?

2005-08-29T02:23:00.000-11:00

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

2005-08-25T11:45:00.000-11:00

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.

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Gingivectomies and restorations

2005-08-24T11:28:00.000-11:00

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.

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

2005-08-23T15:36:00.000-11:00

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.

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Photos - Do I need them?

2005-08-22T15:52:00.000-11:00

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.

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Bruxism vs TMD Appliances

2005-08-17T14:14:00.000-11:00

How often can I replace crowns?

2005-08-16T03:45:00.000-11:00

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

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Where are my x-rays?

2005-08-11T01:07:00.000-11:00

"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

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Maximizing Benefits on Patient Exams

2005-08-09T01:51:00.000-11:00

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.

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Meth Mouth

2005-08-08T04:26:00.000-11:00

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.

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Computer Securty in Your Office

2005-08-05T08:21:00.000-11:00

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.

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My Replacement Bridges Are Being Denied

2005-08-04T04:47:00.000-11:00

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.

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Only Send What They Want

2005-08-03T06:13:00.000-11:00

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.

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ICE - In Case of Emergency

2005-08-02T06:06:00.000-11:00

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.

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ADA Annual Session

2005-07-27T07:36:00.000-11:00

A meeting as large as the ADA’s Annual Session generates very impressive statistics. Here’s a look at projected numbers for this year’s Annual Session in Philadelphia, October 6–9:
2,000,000+ pounds of exhibition freight • 300,000+ net square feet of exhibit space • 42,570 hotel rooms in 37 hotels • 8,000 total dentists in attendance • 600 exhibiting companies • 700 volunteers • 260 continuing education programs • 200 speakers • 6 semi-trailers of equipment and materials shipped from ADA headquarters • 2 years of planning •

ADA - Fluroide - Bone Cancer

2005-07-25T05:48:00.000-11:00

Water Fluoridation and Alleged Risk of Rare Bone Cancer

The Wall Street Journal (July 22, Section B-Market Place, page 1) and other news outlets are reporting that a Harvard University doctor was charged with misrepresenting the findings of a doctoral student's thesis that reportedly found that fluoridated water increases the risk of osteosarcoma (a rare bone cancer). Harvard University is conducting an investigation into the matter. Your local media may report on this story, and your patients may ask you about it. We will post a brief media statement about this issue on ADA.org.

To help you respond to patient inquiries, the ADA provides the following points:

Recent news reports may be alarming people unnecessarily about the safety of water fluoridation.
We're talking about one doctoral student's paper, a paper that has not been published in a scientific journal and therefore has not been available for peer review. Peer review is a process where a group of experts review studies prior to publication to determine if the study is designed well and if the conclusions are valid.
The student notes in her thesis that there are several limitations to her study and recommends that the findings be confirmed using data from other studies. (For example, she notes that the study may not accurately reflect the actual amount of fluoride consumed by study subjects.)
The vast majority of studies by nationally recognized researchers in widely-published, respected and peer-reviewed scientific journals conclude that water fluoridation has not shown any ill effects on health. Studies show that water fluoridation can prevent between 15-40 percent of tooth decay, and that there is no association between cancer rates in humans and optimal levels of fluoride in drinking water.
The Centers for Disease Control and Prevention has proclaimed community water fluoridation one of the 10 greatest public health achievements of the 20th century. According to our current Surgeon General, fluoridation is the single most effective public health measure to prevent tooth decay and to improve oral health for a lifetime, for both children and adults.
Unless and until the weight of scientific evidence shifts to the contrary, the American Dental Association continues to recommend that community water supplies be fluoridated to reduce the risk of tooth decay.
As a dentist, my goal is to help protect and improve your oral health. I believe that water fluoridation is important in preventing tooth decay.
As a member of the American Dental Association, I will be kept up to date on the latest dental research, so if the science on this issue changes, I will certainly let you know immediately.
As the leader of a science-based profession, the ADA is open to new scientific information and welcomes the opportunity to address it according to the standards that prevail in the scientific community.

For more information, go to www.ada.org

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Joining New Dental Insurance Plans

2005-07-21T15:08:00.000-11:00

Are you considering participating in a new FFS dental plan?

Here is another item to consider:

One of our clients asked us about a plan she was considering in which the diagnostic and preventative benefits were extremely low: at about the 50th percentile for that geographic area. However, those were the only services that were covered.

Which meant that every other service: restorative, endodontics, periodontics, prosthetics - you get the picture - were not covered: she could charge her normal fee for those! So for accepting a discount on some of the basic procedures, she was receiving full fee on the other ones.

A perfect example of the plan that covers few services and the dentist benefits.

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Meet you at the ADA Convention

2005-07-21T15:00:00.000-11:00

The Preview for the ADA's 146th Annual Session was recently released and it looks like it's going to be an exciting event. Lots of good speakers, courses and activities. And I'm sure that the dental venders will have some great deals on supplies and equipment. See you there.

More details can be found in the July issue issue of JADA or going to www.ada.org.

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Joining New Dental Insurance Plans

2005-07-20T14:46:00.000-11:00

Are you considering participating in a new FFS dental plan?

Here are some more things to consider:

Are some subscribers of this plan already patients of yours? You have to examine potential fee discounting vs possibility of of losing them to a convenient participating rival.

Are you one of the few dentists in your area that will participate? If you are and fees are low, you may be able to negociate them to a level closer to your normal fees.

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Re-examining antibiotic therapy

2005-07-19T14:54:00.000-11:00

The July issue of JADA has an informative article by the editor, Dr Glick, on the history of antibiotics, the decrease in efficacy against certain strains of bacteria and a charge to the profession to re-examine prescribing patterns.

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Joining New Dental Insurance Plans

2005-07-18T14:42:00.000-11:00

Are you considering participating in a new FFS dental plan?

Here are some things to consider:

What does the fee schedule look like? Are the fees high on the low frequency items and low on the high frequency ones?

How many doctors in your area currently participate?

Is it a new plan in the area and what groups have they contracted with? Or are they building the network prior to offering it to clients?

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Retainers vs Abutments

2005-07-15T08:57:00.000-11:00

Are you aware of the difference between an abutment (no, it's not as many of us were told in dental school, one end of a fixed bridge) and a retainer?

If you don't then you may not be coding your dental claims correctly.

Check your CDT-2005 manual for an explanation. Or, for a complete decription subscribe to The DENTAL TALK NEWSLETTER.

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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Excellent source of office forms

2005-07-14T05:29:00.000-11:00

The Colorado Oral Health Network recently finalized a group of low-literacy oral health patient education materials. They are available online & are copyright free - please copy and distribute them freely.
The materials were written at a third grade level in story format and translated into Spanish, Russian, and French. Material topics include:
* Diabetes and Oral Health
* Pregnancy and Oral Health
* Tooth Removal/ Dry Socket
* Periodontal Disease
* Dental Appointment Etiquette
* Root Canals
* Taking Care of Young Children's Teeth
* Oral Health and Low Birth Weight Babies
* Dentures & Partials
* Oral Cancer
The materials can be found on the CCHN website:
http://www.cchn.org/activities/oral_health-forms.asp (Scroll to Section
IX: Education Materials). Your feedback is welcome!
Terry Hobbs
Oral Health Project Coordinator
Colorado Community Health Network
303-861-5165 x291

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Deadline Filing Date for claims

2005-07-13T14:55:00.000-11:00

Have you read the fine print on your claims, pre-determinations and participating provider contracts you have signed? There are some companies (and some plans within those companies) that place a deadline on how long, after a service is performed, you can file for that service. Sometimes it can vary from 6 months to 2 years.

And what if COB is involved and the reason you're filing the for the secondary insurance late is because the primary paid slowly?

And if you are denied despite the fact that you did file it several times and it went unanswered? Do you have the documentation to prove that to an appeals board?

Claims can fall between the cracks with ven the finest PMS system so make sure you're current on your filings.

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Participating in PPO's

2005-07-12T05:07:00.000-11:00

Have you been participating in a PPO for a while and questioning if you should continue?

A fourth consideration is that if you’re in several plans, evaluate them as a group as to value. Then examine the number of patients from each one. You may want to eliminate them one by one and let your practice catch up.

For example, a plan may have a high benefit for crowns, but a very low one for exams and radiographs. Are you aware of the frequency differential between these services?

An average office statistically performs 7 times the number of recall exams as crowns. What would you like the higher relative benefit for: exams or crowns?

If you have difficulty evaluating this dimensional relationship, The Huskin Group is capable of helping you rank plans according to benefit payments based on procedure frequency. We can be reached at any of the emails listed below.

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Participating in PPO's

2005-07-11T05:05:00.000-11:00

Have you been participating in a PPO for a while and questioning if you should continue?

A third consideration is the role these patients are playing in the overall makeup of your practice. Are they usurping valuable chair time from patients that earn you more? (i.e. taking chair time away from patients in a higher paying plan or entirely FFS?) If so, then it might be time to consider dropping out.

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Participating in PPO's

2005-07-09T05:02:00.000-11:00

Have you been participating in a PPO for a while and questioning if you should continue?

A second consideration is the number of doctors in your area that participate in that same plan. Despite what many practitioners think, economics can be a driving force with patients in selecting and/or staying with a dentist.

In your estimation, how many patients do you think will migrate to another participating provider because of the fee discount if you decide to quit? Unfortunately, many practitioners over-estimate their influence with patients when economics dynamics are involved.

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Participation with PPO's

2005-07-08T04:49:00.000-11:00

Dental Insurance and Your Office

2005-07-07T09:19:00.000-11:00

Many practices are taking a more aggressive stance in evaluating their participation (or intended participation) with dental insurance plans. The next several postings will offer some suggestions both for offices currently participating in plans and those considering joining.

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Low Radiation Report

2005-07-05T09:24:00.000-11:00

There are new studies out that even low level radiation can be hazardous to a patient's health. Read more at this Dental Products Site by CLICKING HERE

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Broken Links

2005-07-03T15:39:00.000-11:00

One of Dental Talk's goals is to provide links to articles that we think may be of interest to our readers. These links are located on other websites and we have no way of knowing how long that article will be on that site at that address. For that reason, if you ever click on a link and it does not take you to the article you're looking for, we apologize and would appreciate it if you notify us via email. We'll try to find shere the article was moved to or remove the posting.

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Continued Difficulty With HIPAA

2005-07-01T02:05:00.000-11:00

The ADA reports that dentists are continuing have difficulty with the new HIPAA security rules, including differentiating between these and the privacy laws.

The ADA has developed a series of training aids assist offices in understanding the process and becoming compliant.

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

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Brush biopsies

2005-06-22T15:51:00.000-11:00

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

2005-06-21T15:44:00.000-11:00

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

2005-06-19T15:07:00.000-11:00

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?

2005-06-18T09:13:00.000-11:00

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...

2005-06-16T15:13:00.000-11:00

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.

2005-06-14T15:05:00.000-11:00

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

2005-06-12T14:58:00.000-11:00

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?

2005-06-10T14:43:00.000-11:00

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. Thatâs 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!

2005-06-08T01:44:00.000-11:00

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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