FYI

Dentist blog from Delta Dental

Category: Reminders (Page 1 of 5)

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

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.)

Is your office listing up to date in the directory?

With more and more people receiving COVID-19 vaccines, you may be adjusting scheduling availability for your office to handle in-person visits.  Be prepared for a busier spring and summer for your practice, as patients return for care and open enrollment season begins.

Take a moment to ensure your office information is correct in the Delta Dental directory. Please check your listing and provide any updates, such as office hours, languages spoken by staff, and more.

You can easily revise listing information in Provider Tools. Or you can update it via a form and return it by email or by fax.

For current and potential patients, the directory is a trusted resource. They can use the Find a Dentist search tool to easily locate your office and plan visits.

Quality dental care is essential for people to stay healthy as they return to normal lifestyles. Make it easy for them to connect to your office, whether it is through the online Delta Dental directory or popular websites. 

Here are links to update your information on heavily searched sites:

Yelp

Facebook

Google

Apple

Re-credentialing reminder

Delta Dental is required to confirm at least once every three years that our network dentists are professionally qualified based on the standards of national, federal and state accrediting and regulatory agencies.

We will send you a letter and form approximately 90 to 180 days before the end of the three-year period. When you receive this notice from us, please:

  • Complete and return the re-credentialing form (including any required document copies) promptly. The process should take no longer than 60 days to complete.
  • Let us know right away if you received a letter for a dentist who is no longer at your practice location.

We are obligated to terminate your contract as a network dentist if your credential expires. You’ll be able to re-apply to join under the terms of our most current dentist agreement, as long as you meet the credentialing criteria. Your contract might not be the same as before, so don’t wait!

For questions, please contact Provider Concierge at 800-592-0156, Monday through Friday, 7 am to 5 pm PT. You can also email us at providerconcierge@delta.org.

SmileWay Wellness Benefits help patients stay healthy

More patients are becoming aware of the way that health issues can manifest in the mouth and oral health issues can exacerbate other medical conditions. With serious issues like heart disease being responsible for so many deaths in the U.S., your patients may be interested in learning how good dental health can improve their overall health. For patients who have medical conditions that affect their oral health, SmileWay® Wellness Benefits may be available to help meet their needs.

Who’s eligible for SmileWay Wellness Benefits?

Not all patients are eligible for SmileWay Wellness benefits. To claim these benefits, patients must:

  • Have a Delta Dental PPO™ plan
  • Belong to a group that offers SmileWay Wellness Benefits
  • Have chosen to opt in to the program

Members who have been diagnosed with any of the following are eligible for expanded coverage:

  • Diabetes
  • Heart disease
  • HIV/AIDS
  • Rheumatoid arthritis
  • Stroke

What are the benefits?

Members whose plans offer SmileWay Wellness Benefits are eligible for these added benefits each calendar or contract year:

  • 100% coverage for one scaling and root planning procedure per quadrant (D4341 or D4342)
  • and 100% coverage for four of the following in any combination:
    • Prophylaxis (D1110 or D1120)
    • Periodontal maintenance procedure (D4910)
    • Scaling in the presence of moderate or severe gingival inflammation (D4346)

If you have patients with medical issues that necessitate extra dental care, find out if they’re eligible for SmileWay Wellness Benefits. These benefits can help keep them both smiling and healthy!

Reminder: CDT 2021 updates have arrived

The American Dental Association’s CDT procedure codes and nomenclature* have been updated for 2021. The CDT updates for 2021 include 28 new codes, four code deletions and 11 nomenclature and description revisions.

Please review our summary of changes and claims processing policies (PDF) and begin using CDT 2021 codes on claims for procedures provided on and after Jan. 1, 2021.

*CDT coding and nomenclature are the copyright and a trademark of the American Dental Association, all rights reserved.

Don’t miss out: Earn your gifts cards by Nov. 30

There’s still time to earn gift cards for using Provider Tools. You can earn up to $60 in gift cards for Amazon, Target or Starbucks when you use Provider Tools to submit claims.

The Learn, Practice, Earn campaign ends Nov. 30.

To get your gift cards, complete the steps in Option 1 or Option 2 below.

Option 1: Earn $40

  1. Submit 20 claims, including two with an attachment. Keep the claim numbers handy — you’ll need to email them to us to claim your gift cards.
  2. Sign up for paperless claim payments. (If you need assistance, call 800-589-4712 to change your delivery option.)
  3. Email us the claim numbers. at providertools@delta.org.
  4. Receive $40 in gift cards to the merchant of your choice.

Option 2: Earn $60

  1. Submit 20 claims, including two with an attachment. Hang onto the claim numbers so you can email us them to us once you’re done.
  2. Sign up for EFT. Select the EFT/ERA icon after signing in to your account.
  3. Email us with your claim numbers.
  4. Receive $60 in gift cards to the merchant of your choice.

Get started today by logging in to Provider Tools.

« Older posts

Theme by Anders NorenUp ↑