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Stay ahead of insurance reimbursement trends with Limoli & Associates.
Do Any of These Scenarios Hit Home?
In Our Practice…
- We take way too many plans.
- We take no plans.
- Patients don’t stay with us if their plan changes.
- We have available chair time.
Our Existing Patients…
- Accept only the treatment that is covered by their plan.
- Expect us to know exactly what their plan is going to pay.
- Hold us accountable when something goes not as planned.
- Come in only once or maybe twice then disappear.
Our New Patients…
- Want to know if we are part of their insurance.
- Expect to have their teeth cleaned on the first visit.
- Only want x-rays if the insurance pays for them.
- Are emotionally driven by their insurance benefits.
Our Administrative Support Team…
- Spends hours on the phone chasing down benefit information.
- Feels the need to tell patients everything about their plan.
- Wants stock narratives to satisfy requests for additional information.
- Keeps the doctor owners away from the daily EOBs.
- Has and wants nothing to do with the clinical team.
Our Clinical Support Team…
- Thinks auto-notes are the solution to everything.
- Wants the doctor to stop talking and simply run on time.
- Tells the patient that insurance is not part of what they do.
- Has and wants nothing to do with the administrative team.
- Want to do more dentistry.
- Want to get paid for what they do.
- Want to get paid now.
- Want the insurance to not be such a big deal.
And As The Owners…
- Have to keep everybody happy.
- Hear that the administrative team wants another employee.
- Knows that the clinical team wants another employee.
- Fears that the hygienists want more time with new patients.
- Realizes the actual cost of doing business.
- Frustrated that dentistry is not the team’s top priority.
Here's Your Solution...
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Tom Limoli is the prevailing expert on proper coding and administration of dental insurance benefit claims, with over 30 years of experience. Limoli & Associates has, over the past quarter century, assisted dental offices in streamlining the insurance reimbursement process and ahead of reimbursement trends.
Tom’s no-nonsense approach to the management of third-party reimbursement has been implemented in thousands of dental practices across the United States and Puerto Rico.
Let Tom help you in simplifying and streamlining the challenges associated with all the various forms and formats of dental reimbursement.
Limoli’s Original Dental Insurance Today – Blog
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. This is not an orthodontic case, as that too is another discussion. Let’s address at what point in the treatment you encounter the use of a procedure code…
So exactly WHAT procedure code number do we use? One would think 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. Completed when? Completed today. In other words, the patient walked out the door with (having received) WHAT procedural treatment?
The laser has continually evolved into becoming one of the most powerful operative tools available to dentistry. Its many variations and flexibilities allow for today’s clinician to not only simplify, but also streamline most facets of specialty and general dentistry. It’s a hot topic of late as more dentists are considering the purchasing of lasers but yet are wondering, “Where do I go from here?” This is a broad question that when broken down really asks, “What is the best way to bill and see a return on my investment, AKA the laser?”
How is changing a bunch of definitions going to simplify and streamline the overall reimbursement process? Answer – it won’t. We have got to understand that insurance companies and third party administrators pay, by contract, toward the overall costs for completed procedures.
Now why is the reincarnation of D4346 merely a symptom of a greater problem? Let’s look at the actual sub components of its ancestors and see if the solution does not automatically appear…
On May 17th of this year, the American Dental Association (ADA) released a 10-page publication entitled “A Guide to Reporting D4346 – A resource guide from the ADA developed to educate dentists and others in the dental community on the newly approved scaling code for CDT-2017 that will be effective Jan 1, 2017.”
Although well intended, the document lacks specificity if, in fact, its intent was to guide the reader in the anticipated appropriate use of this newly re-resurrected procedure code. Its failure is as simple as the definition of insanity whereby again doing the same action in anticipation of a different result.