So exactly WHAT procedure code number do we use? One would think that this would be the easiest part of the equation. However, this is not always the case if the first two parts of the previously discussed equation are not followed. The application of Rule #5 is always to be paramount. You have to act accordingly, and code for exactly the specific procedure that is completed…
So WHEN does the actual coding of a clinical procedure take place in your office? Pretreatment is an issue unto itself for a later discussion. However, at this time, I want to address the actual delivery of dental services. That’s right, I’m talking about the patient in the chair…
So WHO does the actual coding of clinical procedures in your office? Is it your administrative team? Is it your practice management software? Of utmost importance is the question as to who is responsible for monitoring, as well as measuring the coding accuracy in your office? Let’s start with the end and work our way forward….
It is a professional travesty to see and read from so-called “experts” on various blind social media platforms who teach the manipulative dishonesty of tricking a patient into signing a nondisclosure HIPAA form saying they don’t want selective “upgraded” services billed to their benefit plan..…
There are more than a dozen different ways to successfully, as well as profitably, provide the necessary compassionate services to the Medicaid population. Ask yourself: Is it worth another look?.…
Each and every facet of the American healthcare system has been stretched beyond any previous conceptual limitation. Never in modern history has such upheaval touched (now go wash your hands) every individual, community, and industry…
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.