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The Art of Practice Management Dental Pearls


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An insightful and informative newsletter from the Art of Practice Management. A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.

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The Art of Practice Management Dental Pearls

  1. 1. An additional10% OFFthe already discountedprice on ourCross-WalkingManual, LecturePowerPoint andQuick Look-UpCross-Code ListOrder before May 15, 2013Download your FREEHygiene DepartmentAnalysisHave you been frustrated by claims that are denied byinsurance carriers? How do you handle those denials? If youhaven’t been very successful or you haven’t even tried toappeal denied claims, then you are missing the boat. Read onfor the steps to make that boat ride smoother.Claims can deny for many reasons as is evident by the multiple denial codes thatcarriers use. Some claims deny legitimately but there are times when a denial shouldnot be accepted without a fight. Not examining your denied claims to determine if theyare legitimate denials means that you are losing money either by patients not payingthe full balance which can result in bad debt write offs or by delays in patients payingthe balance in full. It is a fact that when a practice takes the time to effectively appeala claim, denials can be overturned and the practice can be more profitable.The following are the steps to successfully appeal a dental or cross coded medicalinsurance claim: Stay timely – Don’t create a problem folder for denied or problem claims andlet the claims sit untouched in that folder for too long. Insurance carriershave time limits set for appeals, so you must be careful not to wait too long.If a problem claim requires multiple contacts with the insurance carrier whichresults in a lengthy time period, be sure to document each contact byrecording the date, time, name of the representative, and notes on what therepresentative told you. The carrier will have a record of thesecommunications also, so they will not be able to use the time factor againstyou. Read EOB’s carefully to look for problems. Not all claim problems are easilyevident, especially when a partial payment is made. If you accept a partialpayment as the final payment without looking for the reasons why the carrieronly paid a partial payment, you will be missing the chance to obtain a higherbenefit for the patient. Become a coding detective with your EOB’s. You can use several different methods to file an appeal – by phone, onpaper, or through the carrier’s website. You will need to investigate which isthe best method for each. State the facts – Review the documentation of the case and glean from it thepertinent details to state your case: Attach copies of attachments. If the denial states that the procedure was non-covered, state why youbelieve that it should have been considered a covered procedure. Problems with bundled services – With medical insurance carriers, theymay not have recognized your modifier that showed that services shouldnot have been bundled, so you will need to either call the carrier andhave them look at their copy of the claim or include a copy of the claimthat shows the modifier and indicate that they did not process the claimcorrectly and need to reprocess it.SPECIAL OFFERTogether we will create a practice MasterpieceArticlesHandling Appeals EffectivelyMarianne Harper
  2. 2. 10% OFF!!"Do-It-Yourself"Dental HygieneDepartmentConsulting KitUse Code APRILMEZuntil May 15th Evaluate problem claims as to whether an appeal or a correction is required.Not all denials require appeals because some of the following situationsmight apply: Incorrect patient data entry – Misspelling names or errors in subscriberID numbers. Date of service was incorrect. Wrong codes were used – either diagnosis, CPT or CDT. Also, withmedical claims, the diagnosis code(s) must always support theprocedure code(s). Incorrect rendering provider is listed on the claim.If you determine that the problem lies with errors made by your staff, you willneed to contact the insurance carrier for their instructions on how to file acorrected claim.Make a difference – take the extra steps – to make your claim filing system runefficiently, effectively and profitably.Bhaskar’s FormulaColleen Rutledge, RDHI recently presented a course on ultrasonics and the last segment discussed pre–procedural rinses and irrigation. Pre-procedural rinsing/irrigating is importantbecause it greatly reduces the bacterial count in oral cavity and thereby aerosolcreated by ultrasonics. Among the medicaments discussed was chlorhexadinegluconate, essential oils, subgingival tetracycline and povidone iodine. The interestand questions from the audience centered on tetracycline subgingival paste,commonly known as “Bhaskar’s Formula”.Bhaskar’s Formula was created by Dr. S.N. Bhaskar, a California periodontist /national speaker. Anyone who has ever attended his courses leaves well-informedand totally entertained! Dr. Bhaskar made a “paste”, with 2 - 3 days substantivity,from 250 mg tetracycline mixed in a gel medium. A homogenous paste is formed bymixing the ingredients with a flexible spatula on a glass slab or oil resistant pad andplaced in a BD 3 ml 22G 1 ½ precision glide syringe. It can be refrigerated for up to 3weeks. One syringe can treat the entire oral cavity.For the exact formula and clinical photos showing how it is used, email me 10% on our "Do-It-Yourself" Dental Hygiene Department Consulting Kituntil May 15th, 2013. Visit and use code APRILMEZat checkout.Dental – According to Michael Uretz, a contributing writer for, thetopic of EHRs (electronic health records) and EDRs (electronic dental records) willbecome more prominent and important this year. He reports that the EHRmandate, the United States’ meaningful use program, is what is fueling the rapidadoption of EHRs in medical practices. He states that the mandate is notapplicable to dental practices at this point but it has gotten the interest of many inthe dental field who see the eventual migration to electronic patient records.This statement should speak to those dental practices that are still filing paperclaims. The time is approaching when all claims will need to be electronic so whynot take the challenge and move to electronic claims? It’s easier than you mightthink and creates a much more efficient and effective insurance system. Contactyour practice management software company to learn how to make the change.Insurance Alert
  3. 3. Medical – When cross coding, make sure that you are using modifiers whennecessary. Modifiers are part of the CPT code set and insurance carriers usethese codes to evaluate whether a normal benefit is applicable to a procedurebecause a treatment was altered by a specific circumstance. Examples of suchcircumstances are: -25 – If you need to report that an exam was separate from an x-ray on thesame date of service and should each be paid individually -26 – If you only provide the professional component of a procedure (e.g.the evaluation only of a scan) -52 – You provide a TMD appliance that was fabricated by an outside labUpdate Time is Past Due –Medical Codes and Dental Codes for 2013And your updated medical coding manual contains the new CDTcodes alsoCPT Code (medical procedure code set) will update as of January 1, 2013.Purchasers of "CrossWalking – A Guide Through the CrossWalk of Dental toMedical Coding" and/or the "Quick Look Up Cross Code List" – you shouldhave received an email that provides information on the way to order the update.Medical insurance carriers will not accept outdated codes and will deny claims forthat reason. I am offering a less expensive update to the paper manual this yearin an electronic format. So take advantage of the savings and keep your codesup to date.Click Here to Update Now!CDT Code Update – Past Due – The ADA has announced that CDT codes willupdate on January 1st of every year. If you havent already purchased your 2013code set, now is the time. I recommend Dr. Charles Blairs "Coding with Confidence."It is the best source for all the detail that you need to understand the CDT codes. Inaddition, consider a subscription to "Insurance Solutions Newsletter." Not only willyou receive a newsletter packed full of great coding information but the subscriptionalso includes a coding support service. You cant go wrong with that kind of help. Toorder either or both of these, please click here.May 1, 2013 -- Medicare PECOS Phase II Activation -- Dentists and others who areeligible to order and refer items or services for Medicare beneficiaries need toestablish their Medicare enrollment record through either a paper form CMS 8550 oronline through Medicare’s PECOS site. Due to the impending date, the onlinemethod is the best. Without this enrollment, denials will occur. Dentists must makesure that they have enrolled in order to be sure that the Medicare claims submittedby pathology labs will be paid. In addition, providers who refer Medicare patients to adentist must be enrolled or the Medicare claim submitted by the dentist will deny.This enrollment is not for claim submission but to ensure that the ordering andreferring provider is a part of Medicare’s enrollment record.September 23, 2013 – HIPAA Omnibus Final Rule – The updates to this rule werepublished on January 25, 2013. The compliance date is September 23, 2013.October 1, 2014 – The new date for ICD-10 implementation.Time Line
  4. 4. My Favorite Quotes:“Efficiency is doing things right; effectiveness is doing the right things.”Peter DruckerTips – For our Patients:Tis the season! No, I’m not crazy, I know that it’s not December. However, it isallergy season and it seems as though a lot of us are fighting allergies. Asuggestion provided on the Dr. Oz blog ( is the following:“To soothe itchy eyes, use a peppermint tea bag as a warm compress for washingyour eyes. Steep the tea bag in hot water for 30 seconds, let it cool to warm andplace it gently over your eyelids. Leave on for 5 to 10 minutes. Mint in general isconsidered to have allergy-reducing properties, so a cup of mint tea might help,too!”Points of Interest:Abraham Lincoln was elected to Congress in 1846.John F. Kennedy was elected to Congress in 1946.Abraham Lincoln was elected President in 1860.John F. Kennedy was elected President in 1960.Both were particularly concerned with civil rights.Both wives lost a child while living in the White House.Both Presidents were shot on a Friday.Both Presidents were shot in the head.Now it gets really weird.Lincolns secretary was named Kennedy.Kennedys Secretary was named Lincoln.Both were assassinated by Southerners.Both were succeeded by Southerners named Johnson.Andrew Johnson, who succeeded Lincoln, was born in 1808.Lyndon Johnson, who succeeded Kennedy, was born in 1908.John Wilkes Booth, who assassinated Lincoln, was born in 1839.Lee Harvey Oswald, who assassinated Kennedy, was born in 1939.Both assassins were known by their three names.Both names are composed of fifteen letters.Now hang on to your seat.Lincoln was shot at the theater named "Ford."Kennedy was shot in a car called "Lincoln" made by "Ford."Booth and Oswald were assassinated before their trials.And heres the "kicker":A week before Lincoln was shot, he was in Monroe, Maryland.A week before Kennedy was shot, he was with Marilyn Monroe.AND...................:Lincoln was shot in a theater and the assassin ran to a warehouse...Kennedy was shot from a warehouse and the assassin ran to a theater...Timeline Photos • Jan 10 at 11:18pmIs there someone you think would be interested in this newsletter?Please feel free to forward this email to them. Thank you!
  5. 5. The Art of Practice Management2217 Fox Horn Road • New Bern, NC 28562 • Phone: • a.p.m.1@suddenlink.netPerio-Therapeutics & Beyond724 Fitzwatertown Road • Glenside, PA 19038 • Phone: • colleen@perioandbeyond.comPlease do not reply to this message.If you have any questions, please contact us by clicking the following link: Contact Us.About us | Privacy policy | © Copyright 2013 - Marianne HarperThe contents of this publication reflect the opinion of the authors only. This publication is for informational purposes only.Any reference to a company or product is done only to provide information about the same and does not reflect any connection betweenthe authors and the company.