In this issue, we will discuss when it’s (in)appropriate to not send a claim on behalf of the patient and their insurance. The ONLY reason to not send a claim is because you are hiding something that brings you shame. There – I said it – now prove me wrong…
How often does your office update radiographs? Is it based upon specific, doctor-diagnosed patient need or their individual benefit plan limitation? Do patients question radiographic frequency to the extent that they only want them if paid for by their insurance? Now here is the kicker — do you write off the fee if the plan doesn’t pay?
Insurance companies and plan administrators usually do not separately reimburse for temporary prosthetics or restorations, particularly if the overall completed procedure is in any way cosmetic in nature or considered to be non-covered. Provisionals and interims are another story. Let’s take a minute and draw a clearer distinction between the use of these terms…
Not so long ago, the claim payment parameter for a crown was pretty simple. The “dump to pay” rate for these claims were rarely if ever questioned. Crowns were easy to treatment plan and they were a vital part of the overall cornerstone to dental office profitability. Those were the good old days of yesteryear and the rules have definitely changed.
It is imperative that we as dental professionals, both clinical and administrative, have a sequential process by which the entire team can follow. All too often I find offices that have slipped out of focus by attempting to hold themselves out as being all-knowing as well as all-doing when it comes to the patient’s benefit plan.
(Yours truly worked on this case for over three years and provided expert testimony on behalf of the Plaintiff.)
A Cook County jury has awarded more than $500,000 to an Oak Park dentist who bought another dentist’s practice, then later learned that dentist defrauded patients and their insurance companies and inflated his revenue.
It is a sad state of affairs when I see procedure coding taken completely out of context for the betterment of one’s own political agenda or simple lack of knowledge. So is the case with the age-old discussion of “When does perio maintenance become a prophylaxis?” Believe me when I say it has nothing to do with simply the calendar or GPS. What’s the solution?
Coming soon to a dental office near you are newly revised procedure codes and definitions for 2018. Will they make more problems or solutions? The management, reimbursement and subsequent coding of non-surgical periodontal care has, for years, been a nightmare for all segments of the dental profession. So what is the real problem and where is the hidden solution? You got it… Where is the dentist?
Monitoring your practice profitability is becoming more and more important as patients’ dollars are squeezed and patients must be savvy by maximizing their plan benefits in the present economy. If you’ve ever participated with an insurance plan or are simply considering the option, it has crossed your mind before… Are you really making money by participating with XYZ plan, or are you losing your shirt? …
No greater dichotomy exists in all the professions of healthcare than that of the love/hate relationship between doctors and the fiduciary responsibilities of today’s Insurance Benefit industry. One provides the loving compassion, while the other coldly enforces contractual financial provisions. How much time and effort do you spend fighting with the patient’s insurance? …