It may be helpful for Ohio dentists to review some of the major dental benefits issues that confronted the profession during 2016 in order to prepare for the coming year.
Medicare prescription drug rule
The Centers for Medicare and Medicaid Services (CMS) has again delayed its enforcement of its new Medicare prescription drug rule until Jan. 1, ... [continue reading]
The Ohio Dental Association has expressed its concerns to MetLife Dental regarding its decision to require dentists to enroll in electronic funds transfer (EFT) and utilize EFT as the only payment method for provider reimbursement.
Many dentists have contacted the ODA regarding MetLife’s decision. All indicated that they did not want to be ... [continue reading]
There are many positives associated with dental insurance. Third-party payment has been shown to increase the likelihood that patients will access dental care. This can lead to better oral health outcomes for the patient and increased numbers of new patients, higher levels of treatment place acceptance and improved cash flow for the dental ... [continue reading]
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]
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