FYI

Dentist blog from Delta Dental

Category: Reminders (Page 1 of 3)

Stay up to date about annual updates and TIN, NPI, fraud prevention and ID card tips.

It’s time to complete your annual General Compliance and FWA training

It’s that time again. If you’re a Medicare Advantage contracted dentist, you must complete your annual General Compliance and Fraud, Waste and Abuse (FWA) training by November 30, 2020.

In addition to the training, you’re also required to have a written ethics guide and code of business conduct in place for your practice. To meet this requirement, you can incorporate Delta Dental’s Ethics Guide at your practice.

Are you recertified? If you haven’t complete this year’s training or want to incorporate our guide, visit Delta Dental’s Medicare Advantage Compliance and Training site for more information. (No login is required.)

If you’ve met this year’s training and ethics guide requirements, please check your email for an attestation survey and complete it by November 30, 2020.

If you have any questions, email us at fwacoc@delta.org.

This applies to Medicare Advantage contracted dentists in the following states:

Delta Dental of California – CA, Delta Dental of the District of Columbia – DC, Delta Dental of Pennsylvania – PA & MD, Delta Dental of West Virginia, Inc. – WV, Delta Dental of Delaware, Inc. – DE, Delta Dental of New York, Inc. – NY, Delta Dental Insurance Company – AL, DC, FL, GA, LA, MS, MT, NV, TX and UT.

Note: The original version of this post addressed all Delta Dental dentists. This training is a requirement only for Medicare Advantage contracted dentists. We apologize for any confusion.

Use Provider Tools to submit claims, get answers to your questions

Necessary changes in Delta Dental’s operating practices are directly impacting our processing of paper claims and paper checks, as well as answering customer calls. Using Provider Tools is the quickest, easiest way to get your claims processed, checks paid and questions answered.

  • Submit real-time claims electronically for faster processing and payment, for free.
  • Sign up for direct deposit.
  • Check patient eligibility and benefits.
  • Check claim status and treatment history.
  • Find answers to your questions about fees, benefits, eligibility and pre-treatment estimates.

If you don’t already have a Provider Tools account, it’s free and easy to register.

Need help with registration? Read our handy registration guide. Additionally, we have Provider Tools tutorials (see “Resources” tab), including videos and articles with step-by-step instructions on claims submission, eligibility, benefits, direct deposit and more.

How to improve communication with non-English-speaking patients

Do you have patients who best understand a language other than English? Being able to communicate with your patients is essential, and the Language Assistance Program can help. You’ll help increase your patients’ comfort level, engage them in the treatment process and improve the quality of the health care you provide.

Be supportive. You can direct non-English-speaking patients to our Language Assistance Program. They’ll get the support they need with forms and get access to important written materials in their language of choice. They can also get help understanding health and wellness materials.

Get to know your patients. Take steps to accommodate your patients’ cultural differences:

  • Advise your Delta Dental patients with limited proficiency in English about their right to language assistance services free of charge through our Language Assistance Program (LAP).
  • Document your practice’s protocol for working with cultural differences in your office manual. Make sure all staff are familiar with it.
  • Do your best to actively respect patients’ cultural differences. When you make a conscious effort to create an inclusive in-office experience, it shows.
  • Ask patients (or an accompanying relative or friend) what their preferred language is and how you can create a comfortable environment. Note and highlight the answers in the patient’s chart.
  • Be sensitive to how well each patient understands you and always take time to answer questions.

Call for language assistance. You or your patient may call Customer Service and we will arrange for a qualified interpreter to help via telephone.

For on-site interpretation services, call at least 72 hours in advance of the appointment time. (Dentists and office staff are not prohibited from speaking with patients in languages other than English; however, use of interpretive services is recommended.)

Did you know? Spanish is the most commonly reported non-English language spoken among our enrollees in the U.S., according to Delta Dental of California and its affiliates’ latest population assessment. Next in line are Chinese, Tagalog and Vietnamese.

Additional resources:

On-site quality assessment review checklist for 2019

On-site quality assessment (QA) reviews are part of our quality assessment program for dentists in California, mandated by the California Department of Managed Health Care.

A QA review gives you a look at how the many components of your practice compare to the expectations of dental professionals, regulatory agencies, dental educators and Delta Dental.

QA reviews are conducted in two parts:

  1. Structural (about 20 minutes): Review of your facility and equipment, as well as emergency, sterilization and infection control protocols.
  2. Records (about 1 hour and 45 minutes): Review of patient treatment documentation for relevance and acceptability under current standards of patient care.

The following list highlights just some of the aspects of a QA review. It can serve as a useful tool to help you review your practice through the eyes of the QA examiner. Together with your staff, you can evaluate your office policies and procedures and be even better prepared for a future on-site QA review.

Structural review

Facility and equipment

  • Facility is clean and well maintained, dentist name and office hours are posted.
  • Procedure manual includes written protocols for new and recall appointments, documenting complaints, broken appointments, specialty referral.
  • Accessibility/reasonable 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, handpieces and waterlines are properly flushed.

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 logs are kept of procedures followed.
  • 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; 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 assisting/evacuating patients in emergencies or natural disasters, evacuation plan is posted and exits marked.
  • An active contact system can reach the dentist 24/7.
  • Portable emergency oxygen is available, tank is 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.

Records review

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.)

On-site Quality Assessment review checklist

On-site Quality Assessment (QA) reviews are part of our Quality Assessment program for dentists in California, mandated by the California Department of Managed Health Care.

A QA review gives you a look at how the many components of your practice compare to the expectations of dental professionals, regulatory agencies, dental educators and Delta Dental.

QA reviews are conducted in two parts:

  1. Structural (about 20 minutes): Review of your facility and equipment, as well as emergency, sterilization and infection control protocols.
  2. Records (about 1 hour and 45 minutes): Review of patient treatment documentation for relevance and acceptability under current standards of patient care.

The following list highlights just some of the aspects of a QA review, and is a useful tool to help you review your practice through the eyes of the QA examiner. Together with your staff, you can evaluate your office policies and procedures and be even better prepared for a future on-site QA review.

Structural review

Facility and equipment

  • Facility is clean and well-maintained, dentist name and office hours are posted
  • Procedure manual includes written protocols for new and recall appointments, documenting complaints, broken appointments, specialty referral
  • Accessibility/reasonable 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, handpieces and waterlines are properly flushed

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 logs are kept of procedures followed
  • 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; 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 assisting/evacuating patients in emergencies or natural disasters, evacuation plan is posted and exits marked
  • An active contact system can reach the dentist 24/7
  • Portable emergency oxygen is available, tank is 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

Records review

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; documentation of any refusal of recommended care

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/retreatment
    • Referral to a specialist in a timely manner
    • Post-operative instruction given
    • Follow-up (pocket charting, x‑rays, etc.)

 

Important reminders for 2018

Verify your TIN: Double-check that we’re using the correct taxpayer identification number (TIN) to report your Delta Dental earnings to the IRS. Check the last four digits of the TIN on page 1 of the claim payment document you receive from us. If they don’t match exactly with your TIN on file with the IRS for your name/business name, notify us right away. Use the TIN Enrollment Form under Administrative Forms on our website. Check out more TIN tips, too.

Use CDT 2018: Use the new codes on claims for treatment provided on and after January 1, 2018. Review the summary of new codes and other changes.

Report fraud: We work diligently to uncover fraudulent behaviors and prevent fraud from driving up the cost of our plans. If you suspect fraud has occurred, please contact us. You may remain anonymous.

  • Fraud hotline: 800–526-1852
  • Online fraud report form
  • Medicare fraud, waste and abuse hotline: 800–511-0831

Learn ways to protect your practice from fraud. 

Respond promptly to a re-credentialing letter: Re-credentialing is required by state and federal regulations and Delta Dental, and occurs once every three years. When you receive a re-credentialing letter from us, please be sure to reply by the due date indicated in the letter. If we don’t hear from you, we’re required to take action, which may include contract termination. Learn more about re-credentialing.

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