Category: Dental Insurance & Medicaid

In late August, Dr. Manny Chopra, chairman of Ohio Dental Association Council on Dental Care Programs and Dental Practice, canceled a day's worth of patient appointments to travel with me to Okemos, Michigan to meet with the upper management of Delta Dental of Michigan, Ohio, and Indiana regarding Delta's response to the Center for Medicare and ... [continue reading]

In 2008, the Ohio General Assembly passed the Healthcare Simplification Act. One provision of this law, Ohio Revised Code 3963.05, required the Ohio Department of Insurance (ODI) to prescribe the Council for Affordable Quality Healthcare (CAQH) credentialing application form in electronic or paper format for physicians. It also required ODI to ... [continue reading]

Many dentists have contacted the Ohio Dental Association with questions and concerns about recent mailings from some dental insurance companies concerning the insurers' response to the Center for Medicare and Medicaid Services (CMS) prescription drug rule. Their questions involve the validity of the information in the carriers’ letters while ... [continue reading]

It is not uncommon for dental insurance companies to audit and/or subject contracting and, at times, non-contracting dentists to audit and/or utilization review procedures. These activities are conducted by both publicly and privately funded third-party payers. Dentists who have gone through these audit/review procedures have reported a wide range ... [continue reading]

The Ohio Dental Association has received a number of calls recently from dental practices asking if they could submit claims to third-party payers for an exam when the dentist is not physically present in the office at the time of the patient's visit. The callers reported they had either been told it was acceptable to bill for an exam in this type ... [continue reading]

The Centers for Medicare and Medicaid Services (CMS) has again delayed enforcement of its new prescription drug rule to Feb. 1, 2017. The previous deadline was June 1, 2016. This change and outreach efforts to dentists by numerous organizations, including CMS, drug companies and dental suppliers, have sparked many calls to the ODA from member ... [continue reading]

The Ohio Dental Association has received a number calls recently from dental practices asking about the appropriate use of the adult prophylaxis (D1110), child prophylaxis (D1120) and periodontal maintenance (D4910) codes. In a nutshell, the answer to the questions is the dental practice must utilize the code that most accurately reflects the ... [continue reading]

In early February the Centers for Medicare and Medicaid Services (CMS) published its final rule addressing the reporting and returning of overpayments by Medicare providers and suppliers. The rule will likely have a somewhat limited impact on most Ohio dentists, but its existence may inadvertently cause some confusion relative to it and other laws ... [continue reading]

The Ohio Dental Association has recently received a number of calls from ODA member dentists who received a fax from a nationwide information management company requesting information specific to their practice (e.g., provider name, appointment phone number, practice address, practice fax, NPI, TIN, email and business/practice name). The form also ... [continue reading]

The Ohio Dental Association Council on Dental Care Programs and Dental Practice monitors and addresses third-party payer issues on the profession's behalf. One issue of particular note that the council has been monitoring involves silent preferred provider organizations (PPOs). In its 2010 Silent PPO White Paper, the American Association of ... [continue reading]