Dentaltown June 2015 - (Page 54)

finance feature How to SUCCESSFULLY ADMINISTER Insurance in Your Practice E ach day dental practices must file dental claims for the procedures performed there. Selecting the proper dental code is important when filing any dental claim, and proper insurance administration is just as vital. Proper administration may differ depending on the type of plan and whether the practice is in- or out-of-network with the payer. However, there are some areas of dental administration that apply to all claims. Listed below are three categories where dental teams are often in need of additional information and support. the dentist and business team members fully understand the language of both the PPO contract and the manual. However, many practices do not realize that these documents exist until the practice is presented with a challenge, which may result in hefty, unexpected write offs. Therefore, a practice should always maintain a current copy of the manual. Many payers provide a copy on their website. To obtain the manual, contact the dental benefit plan's provider relations department. PPO contracts and provider processing policy manuals Summary plan description vs. plan document The decision to join a PPO is frequently based solely on the contracted fee schedule, without any consideration of the obligations that come with participation. These obligations are detailed in the PPO contract and the associated Provider Processing Policy Manual (the manual). The PPO contract mandates that the dentist adhere to all of the payer's processing policies. The manual is a separate document that details all of the provider's obligations. This manual often requires that all services be submitted to the payer, even non-covered services (such as teeth whitening, veneers, or multiple crowns). Also within the manual is the PPO's optional services policy which may allow balance billing for non-covered services. As an in-network, contracted provider, it is imperative that 54 JUNE 2015 // dentaltown.com Another challenge that practices face is understanding the coverage of dental benefit plans available to their patients. Unfortunately, practices typically have very limited information about patients' plans. It is recommended that the practice verify benefits for each patient. When benefits are verified, the practice may only obtain a booklet (the summary plan description) from the payer. In many cases, the patient receives only the summary plan description. Each dental benefit plan has its own unique plan document. The plan document is a long, detailed document that contains the dental plan's established criteria. In some cases, it may be up to 200 pages long. The payer uses the plan document as a guide when administering the plan. The subscriber-or patient-is the only person http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown June 2015

On Dentaltown.com
Howard Speaks: Dentists: Let's Band Together to Improve Public Health
Professional Courtesy: The Appointment is Broken and You Can't Fix It
Continuing Education Update
Poll
Forensic Odontology: Solving Crimes One Tooth at a Time
Routine Equipment Maintenance and Checklist
Minimally Invasive Approach: Implant Prosthetics and Aesthetics of a Lateral Incisor
Electric Toothbrushes: The Benefits of Tech
OFFICE VISIT: The Ninja Dentist Reveals Her Training Ground
The Best 401(k) Plan: Pooled or Participant-Directed?
The State of Little Teeth: Answers About the ACA and Access to Care for Children
How to Successfully Administer Insurance in Your Practice
Continuing Education: Slow-Growing Nodule of the Hard Palat: Differential Diagnosis and Management
Corporate Profile: DentalMarketing.net: Maximizing the ROI of Your Practice
Products in Practice: Ivoclar Vivadent
Disney for Dentists: How Walt’s Principles Can Improve Your Cash Flow
Burnout: The Dental Pain No One Mentions
New Products
Ad Index
Improve Care, Increase Revenue: The Case for Midlevel Providers
How to Calculate Maximum Dosages of Lidocaine and Articaine Anesthetic
Not Your Everyday Oral Pathology Lesion
Overcoming the Entrepreneurial Conundrum
Dentally Incorrect

Dentaltown June 2015