Proper dental coding is necessary to facilitate accurate reimbursement from insurance plans. Navigating the mysterious world of dental PPO and HMO plans can be very confusing to dentists and their staff. Insurance plans are constantly evolving and creating new policies to reduce their liability when it comes to making payments to dental practices for procedures that are performed on their plan’s members.
Dental practices that sign a contract with dental plans are considered in-network and enter into a contracted fee schedule. A dental practice that enters such a contract agrees to abide by the rules of the plan. The rules set forth may not always be in the favor of the dentist or patient. Regardless, a dentist signs the contract in the hopes of growing his or her practice with a constant flow of new patients, and of achieving success by providing quality care to those patients, only to be let down by the insurance companies.
The barriers that arise with becoming contracted with these insurance plans include a wide variety of exclusions, limitations, and frequencies that are not realistic. These barriers can become permanent inhibitors from patients obtaining necessary treatments. This results in the insurance companies dictating what treatment they find necessary and what can and cannot be rendered at their costs. What may not be clear is whether these companies are acting in their member’s best interests or in the best interests of their shareholders.
Almost every corporation is asked to give a quarterly earnings report that beats expectations. As a common business model, it may seem like the only way to realistically meet those goals is to grow membership and minimize company expenses. This model yields high profits by allowing the company to hold on to their members’ insurance premiums by curbing payments made to dental practices. The policies of these dental plans tend to ultimately result in denied claims and a lack of quality care by being cost prohibitive to their members and in-network dentists.
This is why proper dental coding is imperative. For every miscoded claim and misguided staff member, the insurance company wins. This is why I will be one of the lecturers on October 23 at the Perio-Implant Advisory Symposium, and I’ll be addressing the importance of dental coding.
My goal is to provide you with accurate coding for procedures related to saving teeth. In addition, I will be sharing tips on increasing case acceptance and winning over the insurance companies. Believe it or not, you may already be submitting for these procedures. The question is, are you submitting correctly and receiving the full reimbursement? You can find out on October 23. Learn more about the PIA Symposium, called “Saving compromised teeth,” here.
Kyle L. Summerford is a nationally recognized practice management guru, author, and lecturer. He is founder and president of Summerford Solutions Inc., and cofounder of Elitedentalclaims.com. Summerford also serves as editorial director of Dental Office Manager Digest enewsletter. He lectures extensively to dentists and their staffs on topics such as insurance coding and billing and useful practice management tips. Contact him at [email protected].
