Category: Dental Insurance & Medicaid

Can an insurance company withhold payment for one patient because it made an overpayment for a different patient? Or, can an insurer withhold payment for one dentist's patient because it made an overpayment to a different dentist? And, if they can do these things, how far back can they go, six months, nine months, a year, longer? “The Ohio ... [continue reading]

While the Health Insurance Portability and Accountability Act has been in effect for over a decade, the evolving nature of the law seems to have created as many questions about it now as when it first took effect. The lynchpin tying dentists as health care practitioners into HIPAA is dental insurance. Only dentists or other health care providers ... [continue reading]

A recent re-credentialing letter that was mailed to Ohio dentists has sparked a flurry of calls to the Ohio Dental Association.  It is unclear who actually sent the letter, though it was printed with numerous corporate logos on it, including a major preferred provider organization (PPO), credentialing organization and credentialing data ... [continue reading]

The Ohio Dental Association is again receiving calls from dental offices concerning the Ohio law that governs the submission and payment of electronic claims. The calls have been prompted by language used in various third-party payers’ explanations of benefits. In 2010, the Ohio General Assembly adopted a state operating budget containing a ... [continue reading]

“Dentists need to realize that third-party payers are closely watching their claim submission patterns and should consider taking steps to minimize their risks should they ever be the subject of an audit. Large insurance companies receive so many dental claims that they are able to develop individual and collective profiles of dentists. In ... [continue reading]

The Ohio Dental Association has recently fielded questions related to dentists offering their own in-office dental plans. These in-office dental plans have many different permutations off of the same general principle:  for a fee, the consumer gets a membership in a plan that affords him or her access to various free and/or discounted dental ... [continue reading]

The Ohio Dental Association is again receiving calls from member dentists on issues that have arisen within the past five years and continue to generate concern and confusion. They include the payment method of a small number of third party administrators (TPAs) and the use of electronic health records. TPA credit card payments This ... [continue reading]

Dealing with the subject of fees can be a tricky and at times an uncomfortable but necessary part of the patient-dentist relationship. The subject can become even more difficult when third party payers become involved in the discussion. One of the most antagonizing things a dentist can encounter involves an assertion that his/her fees are ... [continue reading]

The Ohio Dental Association occasionally receives calls from patients complaining about dentists who assess separate fees or charges for services, activities or functions that would not typically be considered distinct dental procedures such as infection control, missed appointments and filing insurance claim forms. The complaints range from the ... [continue reading]

Recent letters to dentists from dental-related entities concerning regulatory changes to Medicare have generated many questions in dental offices across the state. The questions typically involve whether the letter actually pertains to the dental office and what, if any, action the office needs to take in response to it. Payment issues Medicare ... [continue reading]