Category: Dental Insurance & Medicaid

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]

The state's largest dental benefits program, Ohio Medicaid, is implementing new rules effective Jan. 1, 2016. The wide-ranging rules impact coverage and payment policies for dental services and related oral health services. More than 2.6 million Ohioans are covered by Medicaid, the state and federally funded health insurance program that covers ... [continue reading]

With the end of the year fast approaching, dentists should ensure their practice has acted on two third-party payer related issues before the New Year rings in. One, the “Current Dental Terminology” (CDT), is very straight forward, but the other, Medicare, is not as straight forward and has been wrapped in confusion for many. CDT 2016 now ... [continue reading]

More than 2.6 million Ohioans are covered by Medicaid, the state and federally funded health insurance program that covers low-income adults, children, pregnant women, senior citizens and individuals with disabilities. About 70 percent of those covered are enrolled in Medicaid’s managed care program, and the remainder are in its ... [continue reading]

Another third-party payer has been identified as paying dentists with a modality that many dentists find objectionable. It involves a nationwide insurance company that the American Dental Association has identified as requiring contracting dentists to choose between electronic funds transfer (EFT) and virtual credit cards as their preferred ... [continue reading]