Category: Dental Insurance & Medicaid

There is no way a dentist can prevent a third-party payer from auditing or "red flagging" his/her claims. A dentist’s actions, however, can impact the likelihood of unwanted insurance company scrutiny. For example, providing significantly more crowns or core buildups or doing more than two quadrants of scaling and root planing on the same ... [continue reading]

Every month the Ohio Dental Association receives calls from member dentists concerning how to properly coordinate benefits (or issue refunds) for patients who are fortunate enough to be covered by multiple dental benefit plans. While the patient may benefit by having a lesser out-of-pocket expense, their multiple coverages can present ... [continue reading]

Like almost everything else associated with Medicare’s prescription drug rule, the most recent actions by the Centers for Medicare and Medicaid Services (CMS) have sparked a flurry of calls to the Ohio Dental Association from member dentists. Late last year, CMS announced its plans to rescind certain Medicare Part C and D requirements for ... [continue reading]

The Ohio Dental Association at times receives calls from member dentists concerned about insurance company claim denials because the carrier determined the work the dentist provided was not medically necessary. If appealing the denial does not provide a satisfactory resolution to the matter, then the dentist and patient may want to consider ... [continue reading]

Late this summer the Ohio Dental Association began receiving second-hand reports of isolated cases of dentists being "required" to accept as payment in full the allowed reimbursement amount from Blue Cross Blue Shield of Michigan even though the dentists had no contractual relationship with BCBSM. These reports also indicated the dentists were ... [continue reading]

Earlier this year a small number of Ohio Dental Association members reported receiving what they believed were incorrect payments from a handful of out-of-state Delta Dental plans. The payment amounts were significantly less than what the dentists expected them to be. Those who contacted the ODA happened to be Delta Dental Premier contracted ... [continue reading]

The ODA regularly gets calls from our member dentists seeking guidance on how to handle specific scenarios in an ethical manner. One of the most common questions we get is how to terminate the dentist-patient relationship in a proper way. Terminating the dentist-patient relationship requires the dentist to exercise care to minimize the risk of ... [continue reading]

To say the Center for Medicare and Medicaid Services (CMS) prescription drug rule has caused a lot of confusion and angst within Ohio dental practices is an understatement. Enforcement date changes, third-party payer responses to the rule and the basic premise of the rule itself have left many dentists unsure of the best action to take to address ... [continue reading]

Over the past year the Ohio Dental Association has received an increased number of calls from dentists who are the subject of some form of elevated third-party payer scrutiny relative to their use of the periodontal scaling and root planing procedure codes (D4341 and D4342). While this scrutiny goes by different names, e.g., audit, focused review, ... [continue reading]

The Ohio Dental Association continues to receive calls from Ohio dentists who are the subject of some form of elevated third-party payer scrutiny. While this scrutiny goes by different names, e.g., audit, focused review, utilization review, it typically causes a degree of angst and extra work for the involved dentist. One common area of ... [continue reading]