Category: Dental Insurance & Medicaid

There has been an increasing amount of talk around the country concerning dentists being audited by third-party payers. While some of the situations that have prompted this talk are applicable in Ohio, many are not. For example, much attention has been focused on Medicaid Recovery Audit Contractors (RACs) in other states, and particularly ... [continue reading]

Dentists are becoming increasingly aware that they must take some type of action with respect to Medicare if they treat Medicare covered patients. So are those who would like to sell dentists products or services. The Ohio Dental Association has received numerous calls from member dentists who have been solicited to attend seminars and/or purchase ... [continue reading]

How can an insurance company or even its dental consultant make treatment decisions about the care a dentist provides without ever seeing the patient? How can they make treatment decisions based on X-rays alone? The Ohio Dental Association receives many calls throughout the year from member dentists expressing these or similar concerns. Many times ... [continue reading]

A national PPO has stopped its efforts to institute a dentist star rating system. The PPO is withdrawing its current program to rate the cost effectiveness of dentists in its network of participating providers but may develop an alternative plan at some point in the future. The PPO’s actions appear to have affected many more dentists in ... [continue reading]

The newest version of the American Dental Association's "CDT 2015: Dental Procedure Codes" book takes effect Jan. 1, 2015, and is available to be ordered now. It contains 16 new and 52 revised procedure codes including new codes for post-operative visits, sealant repair, evaluation for deep sedation or general anesthesia and missed appointments. ... [continue reading]

A small number of dentists have contacted the Ohio Dental Association concerning a letter they received from a major national preferred provider organization (PPO). The letter described the PPO’s new program to rate the “cost effectiveness” of dentists within the PPO’s lines of participating provider networks. The PPO is ... [continue reading]

“The ODA’s Dental Insurance Working Group often hears complaints from dentists concerning hassles in dealing with dental insurance companies,” said Dr. Manny Chopra, chairman of the Ohio Dental Association’s Council on Dental Care Programs and Dental Practice. “Pre-treatment estimates, inferences that a fee is too ... [continue reading]

Recent actions by the federal government will again impact dentists treating patients who have health care benefits through Medicare. This time it involves prescriptions for medication for Medicare Part D drug plan covered patients. As reported in the June 16, 2014 “ADA News,” “the Centers for Medicare and Medicaid Services [CMS] published ... [continue reading]

Patients fortunate enough to be covered by multiple plans typically benefit by having a lesser out-of-pocket expense. Their multiple coverages, however, present administrative issues for the dental office. Under the traditional form of coordination of benefits (COB), a patient can receive up to 100 percent reimbursement of their expenses from a ... [continue reading]

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]