FYI

Dentist blog from Delta Dental

Tag: tips (Page 1 of 5)

6 things to do before the year ends

As the year comes to a close, there are some things you’ll want to take care of before a well-deserved holiday break. Make sure you’ve taken action on the following items to set yourself up for success in the new year!

1. Get ready for 2022 CDT codes

Be sure to use the new codes on claims for treatment provided after January 1, 2022. A summary of the changes introduced by CDT 2022 will be available in the Reference Library in Provider Tools in mid-December. Copies of CDT 2022 may be purchased at adacatalog.org. For more info, check out this summary of changes and claims processing policies.

2. Complete your fraud, waste and abuse training by December 31

If you’re a Medicare Advantage dentist, you’re required to complete annual General Compliance and Fraud, Waste and Abuse (FWA) certification. A big part of this is completing FWA training, but you also need to have a written ethics guide and code of business conduct for your practice. Fortunately, the steps needed to take care of this requirement are available online.

3. Take care of re-credentialing

Based on the standards of national, federal and state accrediting and regulatory agencies, we’re obligated to confirm at least once every three years that dentists in our networks are professionally qualified. If you’ve received a letter from us about re-credentialing recently, that means your re-credentialing may be due in as little as three months from the postmarked date. Make sure to complete and return your re-credentialing form and to let us know right away if the letter you received is for a dentist who’s no longer at your practice location. We’re obligated to terminate your contract if your credential expires, so don’t wait!

4. Encourage your patients to use their benefits before the end of the year

Many studies and surveys have found that most people don’t understand how insurance works. Because of this, your patients may not realize that their annual maximum has not been met and more care can be covered by their insurance. It can be helpful for your patients if you contact them while there’s still time for them to make the most of their benefits. All Delta Dental plans cover diagnostic and preventive services at low cost or no cost, so remind your patients to get their cleanings and exams before their plans reset with the new calendar year. For patients who have hit their annual maximum but still need non-urgent care, encourage them to make appointments for early in the new year.

5. Verify your taxpayer identification number (TIN)

Do we have your correct TIN in our files? Make sure that we do in order to ensure that your Delta Dental earnings are properly reported to the IRS. You can check the last four digits of your TIN on page 1 of the claim payment documents you receive from us. If those digits don’t match exactly with your TIN on file with the IRS for your name/business, notify us right away with the TIN enrollment form on our website.

6. Report any suspicions of fraud

We work diligently with all of our partners to uncover and prevent fraud. If you suspect fraud has occurred, please contact us. You can reach us through:

  • Our fraud hotline: 800-526-1852
  • Our fraud report form
  • Medicare’s fraud, waste and abuse hotline (if Medicare fraud is suspected): 800-511-0831

Have a great rest of 2021!

5 common reasons for QA non-compliance

California practices, do you have a quality assessment (QA) review coming up? Are you just interested in making sure your practice is up to standards? Keep your eye out for these common QA violations to stay on track for great review results.

1. Instruments and handpieces not properly cleaned, sterilized or stored.

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Tip: If you have two or more sterilizers in the office, indicate on bag labels which sterilizer was used in case you receive a positive spore test result.

2. Medical emergency drug kit not on-site.

Violated guideline: All dental offices must be equipped with an emergency drug kit. Dentists must know when and how to use each drug.

Tip: Include a log in the kit that lists all emergency drugs on hand and their expiration dates. Do not include any drugs that have expired. A basic emergency kit should include:

  • injectable epinephrine
  • injectable diphenhydramine
  • nitroglycerin tablets
  • bronchodilator (albuterol)
  • chewable aspirin
  • a sugar source

3. Biological (spore) testing of sterilizers not done weekly.

Violated guideline: Each sterilizer in the office must be spore tested at least weekly.

Tip: Document in a log the spore testing process for all sterilizers, including the pass/fail results of each test. Maintain the results for at least 12 months and be sure they are on site and available for inspection during your QA review.

4. Handpieces and waterlines not flushed appropriately.

Violated guideline: Operatory unit waterlines must be flushed for two minutes in the morning before use and for 20 seconds between patients, according to the California Code of Regulations, section 1005 of Division 10 Title 16.

Tip: All staff should be able to demonstrate this task before your QA examiner.

5. Cold-sterilization log not kept.

Violated guideline: Disinfection solutions must be changed regularly, according to the manufacturer’s recommendations. When establishing change schedules also consider usage.

Tip: Keep a log of every sterilization solution change. In your log, include the brand name, date changed, name of person changing the solution and the calendar date of expiration. Make sure the log is available during your QA review.

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

How to talk with your patients about smoking and vaping

November is the perfect time to think about how you engage with your patients who smoke or vape. On the third Thursday of each November, which falls on November 18 this year, the American Cancer Society sponsors the Great American Smokeout, a day to inspire people to make a plan to quit.

As a dentist, you have a unique opportunity to help your patients quit smoking. The adverse effects of smoking often appear first in the mouth, so you are often the first to see the damage that smoking can cause. Research shows that your intervention can be effective in helping patients decide to quit. Intervention in conjunction with appropriate medications from you is even more effective in promoting successful cessation.

Clearly, you can reach and affect a large number of smokers. But how exactly to talk with your patients about smoking isn’t always so clear.

The 5 A’s of speaking with patients who smoke or vape

If you’re not sure how to speak with patients who smoke, why not start with the 5 A’s? The 5 A’s are an evidence-based smoking intervention approach developed by the U.S. Public Health Service. They’re built on the idea that successful intervention begins with identifying users and then applying appropriate actions based on the patient’s willingness to quit. The Surgeon General has labeled the 5 A’s the gold standard of brief smoking intervention for clinicians.

  • Ask. Ask each patient if he or she uses tobacco. Do so in a routine, friendly way, without judgment or accusation. Keep it simple: “Do you smoke or use any other form of tobacco?” Make it a goal to identify and document tobacco use for all of your patients.
  • Advise. Advise the patient that they should quit. Advice should be clear and strong. As a dental professional, you’re uniquely positioned to give this advice and make it relevant. Motivational information has the greatest impact if you give it in a personalized manner that places it in the context of the patient’s specific diagnosis and health history. You may feel awkward at first or have concerns about sounding too preachy or offending the patient, but smokers often expect their health care providers to discuss smoking with them, and research shows that smokers are more satisfied with providers who bring up the subject. An office visit represents a unique opportunity during which patients may be especially receptive to cessation advice and assistance.
  • Assess. Assess whether or not the smoker is ready and willing to quit. Ask “Do you want to stop smoking?” or “Are you interested in quitting?” If the patient doesn’t seem ready or interested, try helping the patient to identify some relevant risks of smoking and the potential rewards of quitting.
  • Assist. Assist the patient if they indicate they want to quit. Express caring and concern without setting unrealistic expectations. Make sure you have a list of existing tobacco cessation services (such as quit lines and tobacco cessation clinics) on hand. Sometimes your role can be as simple as encouraging the patient to quit and connecting the patient with outside resources. If possible, don’t just recommend services, but help patients enroll while they’re at your practice. Many of your patients may be unaware that you can prescribe cessation medication, so remind them and offer your help where appropriate.
  • Arrange. Arrange to help the patient through their quit attempt by setting up follow-up contact, either by telephone, through your office staff or in person. During subsequent contact, ask the patient how cessation is going. Quitting tobacco is a long-term process. Offer further assistance if needed, reminding patients who are unsuccessful that relapse is common and can be a learning experience on the road to success. Renew your support and consider more intensive treatment where appropriate.

It only takes a few minutes, but when you talk to your patients about quitting, it can make a huge difference in their health.

Join the Medicare Advantage network this open enrollment season

Have you become a Medicare Advantage (MA) network dentist yet? If not, you may be missing out on a great opportunity to add more patients to your practice. Regular Medicare patients don’t have dental care, but Medicare Advantage plans are different.

What are Medicare Advantage plans?

Medicare Advantage plans (also known as Part C or MA plans) are plans offered by Medicare-approved private companies that follow the rules set by Medicare. These plans are still considered to be Medicare, but they offer coverage for services that standard Medicare doesn’t cover, such as vision, hearing and, most importantly for you, dental.

Why join the Medicare Advantage network?

Joining the Medicare Advantage network can be a great choice for your practice. Nearly 20% of the United States’ population will be 65 or older by 2030, according to Census projections. That will mean about 65 million eligible Medicare Advantage patients.

By joining our Medicare Advantage dentist network, you’ll enjoy the following benefits:

  • Your practice will be listed in our Medicare Advantage network directory
  • You’ll retain current patients who join the Medicare Advantage network and are required to visit an MA network dentist
  • You’ll gain access to new patients who are looking for an MA network dentist

Open enrollment starts October 15 and runs through December 7. After the open enrollment period ends, coverage will begin January 1, 2022. Don’t wait until it’s too late!

How can I join?

In order to apply for participation in the Delta Dental Medicare Advantage provider network, please send an email to medadv@delta.org, and we will reply with an application and contract.

Dental fraud — what it is and how you can help fight it

An estimated 3% of the United States’ total spending on health care is caused by fraud, according to the National Health Care Anti-Fraud Association. That may sound like a small percentage, but with dental spending projected to reach $203 billion by 2027, that means we can expect to face over $6 billion in dental fraud.

Dental fraud is “any crime where an individual receives insurance money for filing a false claim, inflating a claim or billing for services not rendered,” according to the American Dental Association (ADA). Fraud can take many forms, but it requires intent, deception and unlawful gain.

Fraud harms everyone in the dental industry. It not only drives up the cost of coverage for patients and employers, but it can also directly affect your practice. Being found guilty of perpetrating fraud can result in fines, loss of professional licenses and even jail time!

Educate yourself and your staff on how to stay on the right side of the law. The ADA (PDF) and Delta Dental can help you, and your state’s dental board may have resources as well.

Common signs of fraud to watch out for

Because fraud requires intent and deception, there are signs that you and your staff can watch out for from patients who commit dental fraud. Stay alert for:

  • Patients who use another person’s ID or multiple IDs to obtain benefits
  • Patients who request that you misreport dates to circumvent calendar year maximums or limitations
  • Patients who misrepresent their available coverage or ask you to misrepresent care to their insurance (including concealing dual coverage)

Because fraud can be perpetrated by both patients and care providers, having clear policies can help prevent fraud before it begins. Make sure your practice prohibits the following:

  • Regular failure to collect a patient’s payment without notifying the carrier
  • Claims for covered services when non-covered services are provided
  • Recommendation of unnecessary services

Although fraud requires intent, it’s possible to commit mistakes that could unknowingly get you into trouble. It’s entirely possible to unknowingly commit fraud in an attempt to help patients who might be seeking help with their coverage. For example, waiving coinsurance costs is one example of this. In other cases, it might be a simple oversight. Common mistakes considered fraud include:

  • Listing the incorrect treating dentist on a claim
  • Coding the wrong treatment (for example, prophylaxis vs. periodontal maintenance)
  • Altering dates of service

What you can do to help protect your practice

Fraud can happen at any point in the process of providing care, accepting payment and submitting claims, but having clear, consistently applied policies for your practice can help everyone play their part in fighting fraud. Here are some general steps your practice can take.

  • Make arrangements for payment with patients prior to providing services. This includes discussing coverage and fees, especially for optional and non-covered services, so that patients fully understand what their financial obligations are.
  • Discontinue relationships with patients who don’t make reasonable efforts to pay.
  • Write out a fraud policy, including examples. Make sure that your office staff has read and signed this policy.
  • Divide the tasks related to processing payments among multiple staff members. For example, have one person accept payments and another make the adjustments in patient records.
  • As a dentist or practice owner, review the claims your practice submits. Claims are considered to be legal documents submitted with your authorization. The dentist listed is legally responsible for the accuracy and honesty of a claim, even if an office manager or other staff member submits the claim.

Here are some things you can do every month to help fight fraud.

  • Mail monthly reminders to patients of their balances and minimums due.
  • Forward large uncollectable balances to a professional collections agency.
  • Review collection and production reports each month. Make sure your bank statement and your office records agree.
  • Check the percentages on your monthly profit and loss records, as well as any year-over-year changes. For example, if supplies cost about 8% of your income a year ago and you’re spending 10% this year, find out why.

What Delta Dental does to help prevent fraud

You don’t have to combat fraud on your own. We’re proud to be your partners in working to eliminate fraud at all levels and steps of the dental care process. What we do includes:

  • Educate our clients, members, dentists and employees about fraud detection and prevention
  • Conduct clinical patient examinations to ensure that provided services meet professional standards and were correctly submitted
  • Review financial and treatment records to ensure contracts are followed
  • Report potential cases to state and federal law enforcement and cooperate with fraud investigations
  • Pursue the recovery of funds when fraud is suspected
  • Terminate contracts when fraud is confirmed

If you suspect someone is committing fraud, report it. Call Delta Dental’s Anti-Fraud Hotline at 800-526-1852. You may remain anonymous during this call.

By making sure that you and your staff stay on top of the law, having understandable and consistent policies and maintaining good relationships with paying patients, you can help keep your practice in the green and trouble-free.

DentaQual ratings update

This spring, DentaQual ratings were added to dentist directory listings. The program introduction was positively received and we are sharing a national announcement to broaden the understanding of the system as it is rolled out to more listings. In preparation for these changes, you can learn more about how DentaQual works, how it can help your practice and how ratings are developed.

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