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Aug 7 2014
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]
Jul 2 2014
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]
Apr 28 2014
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]
Apr 4 2014
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]
Feb 26 2014
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]
Jan 28 2014
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]
Jan 3 2014
“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]
Dec 2 2013
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]
Nov 4 2013
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]
Oct 2 2013
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]
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