Listed below are the bi-monthly issues of Insurance Solutions Newsletter for the past three years in chronological order. Continue to scroll down the page to display the various issues.
MARCH/APRIL 2012
- Additional Tips For Crown & Onlay Narratives
- Bulleted list of additional tips for crown and onlay narratives.
- Back to Basics...Survey Crowns, Maryland Bridges
- Reviewing the fundamentals of coding and dental plan design is essential for newer staff members. Our support department fields calls daily from staff members who are asked to submit dental claims and field patients' insurance questions without adequate training or support. Learning from the "school of hard knocks" can be very costly for a dental practice and its patients, which is why we believe it is important that we continue offering our subscribers personalized code support, even as most businesses strive for complete automation.
- Dentists Five Options Under Medicare
- Chart outlining dentists five options under Medicare.
- Enrolling in Medicare as an Ordering/Referring Provider Only
- Enrolling as an ordering/referring provider does not give a dentist the same protection as opting out of Medicare and entering into private contracts. If a dentist performs services that may be covered by Medicare (such as biopsies, sleep apnea appliances, extractions to prepare the jaw for radiation treatment, etc.) and does not want to be required to submit claims to Medicare and accept its fees, the dentist must formally opt out of Medicare and enter into private contracts with Medicare patients. Opt-out dentists are still allowed to order/refer services for Medicare patients.
- Establishing A Dental Reimbursement Plan for Your Dental Team
- This question and answer addresses establishing a dental reimbursement plan for your dental team.
- Medicare Advantage Plans
- The creation of Medicare Advantage plans by private insurance carriers was authorized by the federal government in 2003 to give Medicare-eligible beneficiaries an alternative to the traditional Medicare program. Although routine dental services are not covered under the traditional Medicare program, some are covered by certain Medicare Advantage (Part C) plans.
- Medicare Patient Reimbursement Form CMS-1490S
- Contact the Medicare DMEPOS contractor for your area and ask if it will reimburse your Medicare patients directly if they submit Medicare form CMS-1490S (Patient's Request For Medical Payment) along with an itemized bill of your charges.
- Medicare Reimbursement For Oral Sleep Apnea Appliances
- The January/February 2012 edition of Insurance Solutions states that Medicare will pay for oral sleep apnea appliances if the dentist has enrolled in Medicare as a DMEPOS supplier. We are questioning this because the medical code for a custom oral sleep apnea appliance (E0486) appears to be a non-covered service on the Noridian fee schedule for Jurisdiction B, which is where our office is located. Is it possible that Medicare does not cover oral sleep apnea appliances in all jurisdictions?
- Medicare Resources
- Medicare resourse links found here.
- Reporting Supernumerary Teeth
- Supernumerary teeth in permanent dentition are identified by the numbers 51 through 82 beginning with the area of the upper right third molar. A quick way to determine the supernumerary tooth number is to add the number 50 to the number of the closest permanent tooth.
- Tips For Successful Crown Reimbursement
- Dental plans vary in their documentation requirements for crown claims. Some require a periapical x-ray with every crown claim to verify that the correct tooth number is being reported, that there is significant tooth structure missing due to fracture or caries, and that the tooth is periodontally and endodontically sound. Some only require an x-ray and narrative if multiple crowns are performed on the same date of service. Other plans will pay for a crown if the documentation sent with the claim shows that at least one cusp required replacement. Here are some tips to successful crown reimbursement
- Tired of Denials Due To Attrition, Abraision, or Erosion?
- Patients often erroneously assume that necessary procedures are covered by their dental plans. They fail to realize that certain procedures are excluded from dental plans simply as a means to control costs - a way to draw a line in the sand. This is often the case with restorations associated with excess wear due to attrition, abrasion, or erosion.
- VPAY® Shifting Costs to Dentists
- There's a new game in town, and it is costing dentists plenty to play. VPay® is marketed to dental benefit payers as an electronic payment solution that will reduce claim payment costs. Unfortunately, the costs are passed on to dentists who receive VPay® payments. According to VPay's website (http://www.vpayusa.com/pages/healthcare.html), less than ten percent of health care providers accept electronic funds transfer (EFT). VPay® guarantees dental benefit payers that it can save them money by cutting in half the number of checks and EOBs that they send providers.
- What Dental Services Does Medicare Cover?
- Most dentists are aware that the traditional Medicare program (Part B) does not cover routine dental services, which is why the majority have tried to avoid Medicare altogether.
- What Every Dentist Needs To Know About Medicare
- It is understandable why so many dental practices have intentionally ignored information about enrolling in Medicare until now. Unfortunately, there can be significant consequences for continuing to do so. Recent Medicare changes under the Affordable Care Act make it imperative for all dentists to understand their current options and responsibilities under Medicare.
- When Are Dental Practices Required To Use Electronic Health Records?
- Our support department has experienced a significant uptick in calls during the first quarter of 2012 from dental staff wanting to know when dental practices are required to become "paperless" and when diagnosis codes will be required on dental claims. The questions likely stem from misinformation about the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which authorized Medicare and Medicaid to offer incentive payments for the "meaningful use" of certified electronic health records (EHR). The truth is that there is no deadline for dentists to switch to certified electronic records if they do not submit claims to Medicare or Medicaid, and there is no requirement for dentists to start reporting diagnostic codes.
- When to Report Oral Cancer Screening
- Oral cancer screening exams, even at the most basic level, should be performed regularly on patients of record. Especially when performing the traditional visualization-palpation exam, patients should be made aware of what you are doing on their behalf. It is a tremendous practice builder, and on those occasions that the doctor may feel rushed during an exam/evaluation, the patient will likely remind him/her to do the cancer screening. Oral cancer screenings may only reveal a suspicious area one time in a thousand, but as the old saying goes - you cannot see what you are not looking for.
- The Icon Coding Controversy Continues
- Icon is a caries infiltrant that is being used in many dental offices to treat early carious lesions and carious white spot lesions with a minimally invasive procedure. Icon is manufactured by DMG America, which relies upon research showing that effective treatment of an early carious lesion does not always rely on removal of decay. The concept is that if caries can be stopped in its tracks, the decay becomes inactive and is no longer a threat to healthy tooth structure. At the February 2012 Code Advisory Committee (CAC) meeting two code requests for variations of this procedure were discussed. One request was for "resin infiltration of facial non-cavitated white spot lesions." The other request was for "resin infiltration of proximal incipient lesions."
JANUARY/FEBRUARY 2012
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- ADA Cautions Dentists About Using Groupon and Offering Referral Incentives
- Before implementing any marketing plan, dentists need to ensure that their marketing programs do not violate state and federal anti-kickback laws, third party payer contracts, and the ADA Code of Ethics.
- Ask the Expert...Medical Billing Basics - Part II
- All too often, medical claims are denied simply because the fundamentals of medical billing are not understood. Medical Billing Basics - Part I in our December 2011 edition addressed common questions such as which dental procedures are most often covered by medical plans, how to research medical benefits, how to obtain medical preauthorization/predeterminaion, how to request a network gap exception, where to obtain medical forms, etc. Medical Billing Basics - Part II highlights many of the additional questions that are frequently asked by dental teams who are interested in learning how to bill certain dental procedures to medical plans.
- CDT 2011-2012 Expands Use of D2940: Protective Restoration Vs. Sedative Filling
- Prior to the latest dental code set, D2940 was only used to report a sedative filling. However, D2940 was revised in CDT 2011-2012 and can now be used to report a protective restoration, which expands its use considerably.
- Is It Legal to Waive Deductibles and Copayments?
- Every dental practice should check its state laws and participating provider contracts to understand its obligation for collecting deductibles and copayments. If questions still exist, contact your malpractice carrier directly. It is in its best interest to provide you with accurate guidance so you are never accused of overbilling or fraudulent billing practices.
- Should We Report A Consultation Or An Evaluation?
- We are trying to fine-tune our billing efforts and are getting conflicting answers about when to report the consultation code (D9310). A recent issue of AAOMS Today discusses evaluations and consultations, but I am still not confident that I know when to report a consultation.
- The ABCs Of Records Retention
- With the beginning of every new year, when file cabinets and storage rooms are bulging and begging to be decluttered, dental teams often have questions about the retention and release of patient records and business tax records. It is imperative that you review your state laws before discarding patient records and consult with your accountant regarding retention of business records.
- D9110 - Palliative Treatment Examples
- D9110 is a grab-bag code for any "minor" procedure performed to relieve pain in which there is no other procedure code available. Think of it as a "999" code for pain-relief procedures. This is important to understand because a key purpose of CDT codes going forward will be for electronic health records. The government is not going to want narratives on claims once electronic health records are fully implemented.
- Delta Dental of California Changes Enrollment Options
- On the heels of Washington Dental Service and Delta Dental of Idaho making big cuts to the fees they pay providers, Delta Dental of California recently announced its new policy for dentists enrolling in Delta Dental for the first time.
- HIPAA & Hitech Staff Training
- Given staff turnover, security changes, computer updates within a practice, and the pending publication of the final HITECH rules, providing annual training for all dental teams ultimately serves their best interest.
- HIPAA 5010 Enforcement Begins March 31, 2012
- What is the consequence if your current software system is not 5010 compliant? Failure to update your electronic transactions to 5010 standards will disrupt your ability to communicate electronically with insurance companies and other third party payers, which may result in unpaid claims.
- Internet Addresses for State Dental Laws
- List of web addresses for dental laws by state
- Patient's Right to Restrict Disclosures to Health Plans
- Does the HITECH provision take precedence over our provider contract?
NOVEMBER/DECEMBER 2011
- Ask the Expert...Medical Billing Basics - Part I
- This article contains a list of frequently asked questions to assist dental teams in understanding some of the fundamentals of medical billing. The purpose of this article is to focus on and answer questions about which dental procedures are sometimes covered by medical plans, how to research medical benefits and obtain preauthorization/predetermination, how to request a network gap exception, and where to obtain medical claim forms.
- Billing Tips for D9110
- Billing Tips for D9110
- Coding CAD/CAM Dental Restorations
- Even the most modern digital office must still provide exceptional personalized service to patients, and it is often excellent communication between business staff and patients that brings patients back. Having the ability to explain to patients the specific CAD/CAM services provided in your office will improve your value to the dental team and improve patient flow.
- Learning From Denied Code Requests
- As the dental industry anxiously waits to hear how the code revision process will be structured now that the CRC has been disbanded, some CRC observers are wondering if code requests that were denied in the past will be resubmitted and if past decisions by the CRC may be reversed. Only time will tell. In the meantime, much can be learned by reviewing the CRC's rationale for rejecting past code requests.
- No More Code Revision Committee - How Will THis Affect Dental Practices?
- For the past ten years, the Code Revision Committee (CRC) has been in charge of maintaining the American Dental Association's Code on Dental Procedures and Nomenclature, also referred to as The Code, or the CDT Codes. These are the dental codes we use every day to submit insurance claims, record those procedures for our own individual use, and communicate to other members of the dental community the procedures that have been performed. Today, the CRC no longer exists. The insurance industry was notified by the ADA of this change in late September 2011, and everyone in the coding community is still reeling from the news.
- Palliative Care - What Is It? When Do We Code For It?
- The palliative treatment code may be one of the least understood and least used procedure codes in dentistry. Palliative treatment is not aimed at treating the root of the problem - palliative treatment is only intended to relieve the pain the problem causes. As we move further into the realm of electronic health records, dental teams must get into the habit of recording everything they do. Coding for palliative care supports the doctor's written narrative in the patient's chart of the treatment that was rendered.
