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Category: Delta Dental news (Page 1 of 9)

Stay up to date on the latest news from Delta Dental.

On-site quality assessment review checklist for 2021

The California Department of Managed Health Care mandates on-site quality assessment (QA) reviews for dentists in California. These reviews are helpful in comparing your own practice to the expectations of regulatory agencies and other dental professionals.

Getting acquainted with the aspects of a QA review is a great opportunity to improve your practice’s policies and procedures, while also preparing for future on-site assessments.

QA reviews focus on two aspects: structure and records. Follow the checklist below to get started on your own assessment and make note of what may need correction.

1. Structural review (about 20 minutes)

The structural review involves an assessment of the facility and equipment, as well as sterilization protocols.

Facility and equipment

  • Facility is clean and well maintained.
  • Dentist name and office hours are posted.
  • Procedure manual includes protocols for appointments, complaints, broken appointments and specialty referrals.
  • Accommodations exist for patients with disabilities, such as wheelchair access and a grab bar in the restroom.
  • Waterlines have anti-retraction valves installed and maintained with properly flushed handpieces and waterlines.

Radiology

  • Certificates are current and equipment inspection dates are posted.
  • Lead (or lead-equivalent) apron with thyroid collar is used.

Sterilization and infection control

  • Staff is trained in infection control standards and procedural logs are kept.
  • Gloves, masks, protective attire and eyewear are used appropriately.
  • Weekly biologic monitoring is conducted and records are kept.
  • Instruments and handpieces are properly sterilized, stored and labeled.

Safety and emergency procedures/equipment

  • Drugs, syringes and needles are properly stored and a log is kept of drugs dispensed on site.
  • Required certifications are up to date.
  • A modern evacuation system exists for nitrous oxide.
  • Written office protocol includes staff responsibilities for evacuating patients in emergencies or natural disasters. The evacuation plan with clearly marked exits is displayed.
  • An active contact system can reach the dentist 24/7.
  • A portable emergency oxygen is available, full and there is a positive pressure valve and/or Ambu bag; staff are trained in use.
  • Mercury hygiene and safety requirements are observed.
  • Medical emergency kit is up to date.

2. Records review (about 1 hour and 45 minutes)

This portion involves a review of your patient care documentation.

Medical and dental history

  • Medical history forms include yes/no questions, identify patient’s existing conditions and contain comprehensive health information.
  • Dental history includes baseline information, TMJ/occlusion status, appliances, periodontal condition and results of soft tissue/oral cancer exam.

Treatment notes

  • Progress/treatment notes are legible and in ink.
  • Included, as appropriate, are: 
    • Referrals to specialists
    • Records forwarded or received
    • Anesthetic used (type, amount and concentration of any vasoconstrictor)
    • Medications prescribed
    • Laboratory instructions

Quality of care

  • Professionally acceptable standards of care are observed for: 
    • X-rays — adequate number, appropriate frequency, of diagnostic value, mounted and labeled
    • Treatment plan — in ink, consistent with diagnosis and exam findings, alternative and elective treatment documented with the patient’s choice and reason
    • Treatment sequence — in order of need
    • Informed consent — documentation that treatment plan was reviewed and patient understands risks, benefits, alternatives and costs; any refusal of recommended care is documented

Outcomes of care

  • Patient records demonstrate effectiveness of preventive care
  • Overall comprehensive documentation demonstrates that treatment was provided as appropriate, including: 
    • Good prognosis for appropriate longevity
    • Evidence of need (x-rays, pocket charting etc.)
    • Minimal unplanned treatment or retreatment
    • Referral to a specialist in a timely manner
    • Post-operative instruction given
    • Follow-up (pocket charting, x-rays etc.)

New CDT codes for COVID-19 vaccination

In March 2021, the Code Maintenance Committee of the American Dental Association (ADA) added seven new codes designed to report the delivery of COVID-19 vaccine. These codes have been added to the preventive category of service.

Additionally, a new code for molecular testing has been added to the diagnostic category of service.

These services are covered under medical plans and therefore will not be covered by Delta Dental. If you administer COVID-19 vaccines in your dental office, check with your patients’ medical carriers for more information about coverage.

New CDT codes as of March 29, 2021:

  • D0606 — molecular testing for a public health related pathogen, including coronavirus. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1701 — Pfizer-BioNTech Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1702 — Pfizer-BioNTech Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1703 — Moderna Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1704 — Moderna Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1705 — AstraZeneca Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1706 — AstraZeneca Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1707 — Janssen Covid-19 vaccine administration. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.

Delta Dental’s NCQA Credentialing Accreditation renewed

Delta Dental Insurance Company’s NCQA Credentialing Accreditation has been renewed through March 2024.

“Achieving NCQA Credentialing Accreditation demonstrates that Delta Dental Insurance Company has the systems, process and personnel in place to conduct credentialing in accordance with the strictest quality standards,” said Margaret E. O’Kane, president of the National Committee for Quality Assurance (NCQA).

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA’s Credentialing Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement.

NCQA has reviewed and accredited Delta Dental Insurance Company’s Credentialing functions only. For complete details on the scope of this review, visit www.ncqa.org.

Spotlight: Travis Tramel, RDHAP

Travis Tramel, Ph.D, MA, RDHAP didn’t always know what he wanted to be. What he did know, however, was that whatever he ended up doing would be rooted in service. He’s spent his life serving others, so when he found a career where he could focus on just that, he knew it was his calling.

Becoming a Registered Dental Hygienist in Alternative Practice (RDHAP) requires special training that focuses on prevention. RDHAPs provide services such as cleanings, sealants and screenings to patients in remote locations or limited mobility. Tramel saw this path as an opportunity to educate and enhance health in his community.

As the CEO and founder of GeriSmiles Dental Health Foundation, a mobile dental hygiene practice in Riverside, California, Tramel works with children of all backgrounds to preach the importance of good oral health and ensure that his community is off to the right start. Now 21 years into his career, he says the same things still make him smile: empowering people with the knowledge and tools they need to better their lives.

What made you want to be a Registered Dental Hygienist in Alternative Practice?

My story is different and crazy. Growing up, you don’t know the different levels of health care staff. You just go to the dental office and get your teeth cleaned. It wasn’t until a recruiter came from Loma Linda, California to our undergrad school in Alabama — Oakwood College, at that time. They told us that in dentistry, you could be a dentist or you could be a dental hygienist.

Everybody wanted to be a dentist because they fix root canals and they fix broken teeth. The recruiter got up and said, “I’m a hygienist and I fix the whole body. I’m the bacteria stopper. I stop things in their tracks before they do damage to something else.” That was a different way of looking at things.

I thought that preventive maintenance was neat. I like being at a point where I could keep you from getting into trouble. I realized that if I could help people by being preventive, I can help them in the long run.

How did GeriSmiles Dental Health Foundation come to be?

When you’re a hygienist, you spend a lot of time telling people, “You need to floss more. You’ve got a 4-millimeter pocket over here. Your gums are still bleeding.” You start wondering if you’re being effective.

I was getting to the point where patients were saying, “I don’t want the education on it. Just clean my teeth and let me go.” When you begin to get those answers, you ask yourself if you’re being heard and if your job is still needed. When you hear that day in and day out, you start burning out. 

I talked to a friend of mine about if after 15 years if I should change careers. That’s when she said, “Why don’t we become mobile hygienists?” She had already done the research. We went up to San Francisco to do a program and my eyes were opened to the actual needs of dentistry, especially hygiene, in the public health sector. 

My practice’s name, GeriSmiles, actually came from “geriatric smiles.” When you look at our aging population, no one is there to help them prevent [dental disease]. When they’re in nursing homes and assisted living, they’re usually in that stage where they’re about to lose it all. You’re trying to fix something that’s already broken. So I started looking at how we can prevent issues that can help them going longer. I was going to nursing homes and hospice homes, but you can only see about eight patients a day.

When it comes to being preventive, we realized that we wanted to do more work with kids. Sometimes parents don’t have time to take off of work to take their kids to a 10-minute cleaning. That’s when GeriSmiles went from “geriatric” to “Dr. Geri.”

In 2017, I went into the school system. Now I focus on eight school districts with our mobile dental programs where we work with K-12. Whoever wants a cleaning gets it, because I believe that if we can help the kids and help the parents understand that a five-minute cleaning can save them. We can find issues and still keep kids in school.

What do you love about your career?

I love that I teach the public about oral health care. I get to meet different people every day and it allows me to be community-minded.

As my own boss, I get to educate the public and go to city council and school board meetings. But, I also don’t look at myself like anybody’s boss. We’re equals. I just sign the paychecks. No work is underneath me, from assisting to billing to hygiene work. All my staff will tell you that I’m in the trenches with them. I help them set up, and I help them break down. We are for the public and we’re family.

What does service mean to you?

Service to me is always helping those who need it most. Even though you think you may not need it, take it. If the service is being offered, utilize it. When we give up ourselves to others, we get blessed by just blessing them. My patients are uninsured or on Medi-Cal — those who can’t pay me. To see the smiles on their faces and help them, it means the world to me.

My family volunteered every weekend growing up. My mother ran soup kitchens and would feed anywhere between 200 and 300 people every Sunday morning. If you were hurting, if you needed clothes, she’d take them off her back and give them to you. Service is in my blood.

My mother was in education and my father worked for the State of Georgia. Sometimes you look at your own situation and you know that you don’t have a silver spoon either, but later you realize that you were helping those who really needed help. Give yourself in order to bless someone else. To me, that’s what dentistry is all about. Patients come to you because they need something or are in pain. In my hands, I have the gift of hygiene and the gift of service. I can always use those to help somebody when they’re down low.

How did COVID-19 affect your work?

On March 5, 2020, I got notified that outside providers were no longer needed on school campuses. I got emails saying, “Hey, we don’t know where this is going to go, but at least for the next two months, there will be no dental services on our campus.”

It was like a dagger that just pierced my heart. I’m looking at my staff of 20 and thinking, “What do we do for paychecks? What do we do for bills?” Your head is spinning, as a CEO.

We used our savings and got a loan, because I wanted to make sure my staff’s households were not interrupted. I helped them through the next two months, until unemployment kicked in. We were blessed to not have to suffer, but they’re my family. They’ve been with me since Day One. They never leave me hanging and it wasn’t time for me to leave them hanging — when we needed each other the most.

Luckily, some of the private schools were still meeting, so we were able to serve them. Preschoolers need to be screened within 45 days of starting school, as well. Since they’re virtual, it gave me the idea to use Zoom to do online screenings until the schools reopen and we can return.

Tell us about a time that made you feel especially proud of your work.

I have a special dental cellphone for patients to call and at 9 pm one night, my phone goes off. I don’t normally have it on that late, but I answered it and they said, “Hi, you were at this school today.” I got nervous that something bad had happened, but she said, “I’m calling to thank you. I don’t know what you said to my son today, but when I gave my son his after-school snack, he said, ‘Mom, I no longer want to eat those. The dentist told me they are bad for my teeth and could cause a cavity.’ I gave him a granola bar instead and when we got home, he ran to the bathroom and pulls out the toothbrush packet he got and brushes his teeth. Then he took the toothbrush and ran to his room. When I asked him why, he said, ‘This is my special toothbrush, and I don’t have to share it!’”

For her son to make those changes immediately made her say, “I am impressed with your program. Please keep doing what you’re doing.”

Now when I’m at the schools, I ask if the kids have brothers or sisters and I give them kits for their family members, as well. You never know who’s sharing or who’s suffering. We are 100% self-funded. If they have insurance, we bill. If they don’t, we still treat them. We treat all kids equal.

What do you do in your free time?

I love to travel and see the world. I want my kids, who are 17 and 13, to see things that I didn’t see growing up… We like international travel and seeing different cultures and how they live. We don’t do touristy things. We like to go into the deep country and really learn about the culture.

We love hiking, cycling, scuba diving, touring and educating. It’s all fun to me!

What’s the best thing you watched in recent memory?

The best thing I watched? Well, you can look at COVID two ways: a downfall or a blessing, because it made you cherish life more. Especially your loved ones. It caused us to sit down and talk to our family members, love them and respect the time we have together. It made us cherish the moment we have now. It’s an opportunity to grow and to change. I think that’s the best thing I watched.

Congratulations to Travis Tramel on being our Dental Health Partner of the Month! You can learn more about his mobile practice on the GeriSmiles Dental Health Foundation website.

Access thousands of patients with NY Select

Gain access to over 200,000 NY members with 100% benefits for covered services when you enroll as an NY Select dentist! When you participate in the NY Select network (formerly known as NYPPO), you can help provide your fellow New Yorkers with dependable, quality dental care.

This network is specific to New York state and is the only in-network option for members of two large union health plan/funds:

  • DC37 is the largest public employee union in New York City, with 150,000 members serviced by the District Council 37 Health & Security Plan. DC37 members help make New York run by working in over 1,000 titles — everything from accountants to zookeepers.
  • 32BJ is a branch of Service Employees International Union (SEIU) that is headquartered in New York City. The Building Service 32BJ Health Fund services over 75,000 of New York’s property service workers.

DC 37 and 32BJ’s NY members are benefited 100% for covered services with NY Select participating dentists.

Delta Dental ensures that members are able to find your office by providing special dentist directories especially for DC37 and 32BJ patients.

Everything you’ll need for administration, including how to register for direct deposit, view treatment history and obtain claim status, is available in your Provider Tools account. 

Simply log in or register to access these handy tools:

  • Reference Library: Find your Dentist Handbook and other information.
  • My Patients: Obtain eligibility and benefits for current and new patients.
  • Submit Claims: Transmit free, real-time claims and attachments.
  • My Account: Update your directory profile to ensure patients can find you.

Interested in participating in the NY Select network? Please contact Delta Dental Network Development Representative John Wilson by email at jwilson@delta.org or phone at 628-260-4764.

Not sure if you’re already participating in the NY Select network? Or currently participating and have questions? Please contact our Provider Concierge by email at providerconcierge@delta.org or by phone at 800-592-0156.

Please note: The NY Select dentist network is separate from Delta Dental PPO™ and Delta Dental Premier®. Please review your NY Select contract and fee schedule for additional information.

Connect remotely with your patients using Virtual Consult

There’s a new tool to help you connect with your Delta Dental PPO™ and Delta Dental Premier® patients. Say hello to Delta Dental – Virtual Consult. This new platform lets you check in with and diagnose Delta Dental members remotely, all with an emphasis on simplicity when it comes to scheduling.

Virtual Consult is a video-based platform for conducting limited oral evaluations virtually through a fully secure, HIPAA-compliant platform. It’s ideal for seeing patients remotely for urgent consultations, follow-up exams or general questions. With Virtual Consult, you can:

  • Schedule and have video appointments from anywhere you have an internet connection and a webcam or an iOS device
  • Connect with new patients
  • Safely prescribe e-prescriptions for pain or infection
  • See patients with urgent needs at any time, day or night

Virtual dentistry offers convenience for patients, and it’s a great safe, contact-free access tool for dentists, as well. If you have open time in your schedule or want to see patients after hours, Virtual Consult lets you see patients remotely. Diagnostic exams conducted through Virtual Consult are submitted to Delta Dental the same as in-office claims, so you don’t need to worry about learning a billing new system.

Provider enrollment in Virtual Consult is now open!  To learn more, fill out the Virtual Consult interest form and we’ll reach out to you.

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