Tips for Dental PPO Fee Negotiation & Credentialing

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Special Message For The Dental Community

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COVID-19 and Your Dental Practice

If your dental practice is located in the United States, there is a high probability that “business as usual” is anything but “usual” right now. We wanted to share with you how APEX Reimbursement Specialists is working tirelessly to help support all of our dentist clients and ensure that revenue is maximized and uninterrupted during this difficult time. 

COVID-19 and Your Dental Practice 

Most recently, the American Dental Association suggested that dentists postpone all elective procedures for three weeks and instead leave schedules open for emergency dental care. This will allow dentists to see emergency patients that otherwise might go to the hospital emergency departments and provide the most pressing care. This will also help to limit the spread of COVID-19 in your community and in your dental practice. The ADA also created an informative FAQ guide for dental providers struggling to determine the best way to serve patients while staying healthy for the duration of the pandemic. 

Additionally, the American Academy of Periodontology has created COVID-19 resources that can be utilized by general dentists and specialists alike. Their tips include ways to protect your workforce, including screening patients for symptoms of acute respiratory illness before entering your practice, using the proper personal protection equipment (PPE), encouraging sick employees to remain at home and adjusting your hours to include telephone triage and follow-up with patients before and after they visit.

How We Are Helping

As always, APEX Reimbursement Specialists is working hard to generate as much revenue as possible for your dental practice. From optimizing your coding, negotiating with insurance providers on your behalf, completing credentialing paperwork, and addressing accounts receivables to make sure all insurance revenue is collected during this time, we want to ensure you get the revenue that you rely on to keep your bottom line healthy. 

We know that you are probably dealing with numerous complex patient situations now, as some offices are moving to only work with emergency and complicated dental patients. Let us communicate with insurance carriers on your behalf to keep all contact as seamless as possible so that you can focus on your patients. From following up on your credentialing paperwork to negotiating reimbursement rates, our team can support yours as we all work together during this trying time. 

APEX Reimbursement Specialists Can Help Your Dental Practice During COVID-19

Whether you’re preparing for the recredentialing process or looking for assistance credentialing with a new provider, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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How to Optimize Your Dental Insurance Credentialing Process

The credentialing process is never enjoyable for dentists, and unfortunately, it’s something that needs to be completed for every insurance company (and again when it is time to complete the recredentialing process). Thankfully, there are ways to make the process easier, including working with APEX Reimbursement Specialists.

Dental Credentialing 101

Dental credentialing is the process of verifying a dentist, their licensing and professional record before allowing them to be part of an insurance network. The credentialing process includes things like verifying career history, training history, education, malpractice history and licensing. The credentialing process will need to be completed for every insurance company that you become an in-network provider for.

Why Is Credentialing Important?

Credentialing is no longer optional for many dentists, as many patients will start planning the dental treatment process by first checking which dentists are in network. When you credential, you will increase the chances that patients in your area will become patients of your practice. The insurance companies that you are in network for will also give you publicity as a result through listing you in their guides online and in print. When you attract more patients, it can increase your revenue and help your practice to grow exponentially.

How Can You Make It Easier?

While the credentialing process is critical to the success of many practices, it is not easy or straightforward. Because it is so complex and time-consuming, many dental practices choose to work with a partner like APEX Reimbursement Specialists. We can take all of the necessary documents, like your malpractice insurance, licensing, certifications and other information, and ensure that your application is completed correctly. Then, we will complete the hardest part of the process for you—follow up. Many insurance companies will leave you completely in the dark during the process and you will not know if something was missing or not received. That’s why someone following up on a regular basis to ensure the application was received and processed is so important. We will work with you through every part of the credentialing process to save you time.

APEX Reimbursement Specialists Can Help With Your Credentialing

Whether you’re preparing for the recredentialing process or looking for assistance credentialing with a new provider, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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Could Your Practice Benefit from a Third-Party Audit?

Every year, your dental practice faces the threat of an audit from an insurance provider. Do you think that you would pass? Many dental practices fail to adequately self-audit their businesses, which can lead to serious consequences if a formal audit occurs. Whether you think you have nothing to worry about or have concerns about the accuracy of your coding, here are some of the signs that your dental practice could benefit from a third-party audit.

What Is a Third-Party Audit?

During a third-party audit, a professional company can complete a review of your office’s practices and procedures, from your charting methods to your insurance claims. When you work with an insurance carrier, your dental practice is always at risk for an audit. These audits are designed to ensure that providers are properly documenting treatment and that the treatment paid for was appropriate for the situation. During an audit, the insurance carrier will request copies of patient records from your dental practice to confirm the necessity of the treatment. A third-party audit can ensure you are maintaining compliance and, in the process, you may even find out that there is revenue opportunity! 

Could Your Dental Practice Benefit from a Third-Party Audit?

1. Medicaid Compliance: Any dental practice that participates in Medicaid should schedule an annual third-party audit to ensure compliance. Medicaid standards are very strict, complex and change from year to year. Dentists can face civil or criminal charges in the aftermath of a Medicaid audit under the False Claims Act, so what seems like a small error could turn into a big deal.
2. Chart Irregularities: Are all of your dentists and coders doing a consistent job writing down what procedures were completed and supplying documentation? A third-party audit can complete a random charting review to check for everything that an insurance company would when completing an audit and identify any necessary areas for improvement.
3. Changes to Your Processes: If you recently made significant changes to how your practice workflow operates, switched coding software or had other alterations to your practice that could affect the accuracy of your claims, a third-party audit can ensure everything is going according to plan.

Benefit from a Third-Party Audit from APEX Reimbursement Specialists

Whether you’re concerned about the potential for receiving an insurance provider audit in the new year or looking for assistance in raising your overall revenue with skilled PPO fee negotiation, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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What to Look for in a PPO Fee Negotiator

As you close out your books for 2019, are you leaving money on the table? Every year, dental practices leave behind thousands of dollars in potential reimbursement fees due to not negotiating with their insurance provider partners. If you are ready to take charge of your revenue in 2020 and not leave any money behind, you need to work with a PPO fee negotiator. They work on your behalf to increase reimbursement rates for every insurance provider and boost your bottom line. What should you look for in a PPO fee negotiator?

4 Characteristics of a High-Quality Negotiator

1. Knowledge: Working with insurance providers requires a great deal of knowledge, and there’s a reason why reimbursement negotiation is so difficult for a dentist to complete on their own—it’s hard! A PPO fee negotiator has all of the background knowledge necessary to identify your areas for improvement and work with insurance providers to get more beneficial rates.
2. Persistence: Many dental practices struggle with PPO fee negotiation because they get told “no” one time and give up. Negotiation takes hard work and persistence. A professional PPO fee negotiator knows the effort required to follow up with each provider, ensure that all paperwork was processed, update your fee schedules and re-negotiate again the next time that credentialing takes place.
3. Reputation: Reputation matters when negotiating with insurers and when choosing a negotiator. You want your practice to be professionally represented when speaking and working with insurance providers, so you should choose a highly professional PPO fee negotiator that understands it represents both itself and you. Reputation also stems from experience, and an experienced negotiator understands how to package alterations to reimbursement in a way that benefits your practice without isolating the insurance provider.
4. Strategy: Do you think that PPO fee negotiation is just a matter of asking every code to be increased? Nope! There is a great deal of strategy and data computation behind the best way to get results, and that is what quality PPO fee negotiators specialize in.

Partner with the PPO Fee Negotiator Specialists at APEX Reimbursement Specialists

Whether you’re preparing for the recredentialing process or looking for assistance in raising your overall revenue with skilled PPO fee negotiation, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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3 Common Coding Mistakes for Dental Practices in 2019

Your dental practice relies on accurate coding to quickly and efficiently bill insurance providers and receive reimbursement for the services you perform. Common coding mistakes can lead to denied claims or issues with receiving your reimbursement as quickly as possible. What were some of the most common coding mistakes for dental practices in 2019?

3 Common Coding Mistakes

1. Using the Wrong Codes: It probably goes without saying that the most common code mistakes are using the wrong code. This often occurs when the new year begins and codes that were valid last year have been replaced or refined with something else. This can also happen when there is a new, more specific code for the procedure that you performed. Always make sure that your staff and all of those who participate in the coding and billing processes take relevant trainings to prevent errors.
2. Not Running Your Reports: What is one of the best ways to catch common coding mistakes? Running your practice analysis reports on a regular basis. If your practice does not offer certain services, you can also proactively deactivate the codes associated with them to prevent them from being accidentally used. When you update your charting and coding systems with the new codes for 2020, only add the codes that are for procedures that your practice provides. In many cases, having too many codes makes it easy to mistype or misidentify a procedure. By eliminating codes that you do not offer or that are no longer acceptable to insurance providers, you can increase accuracy without asking your dentists or billing professionals to do anything at all!
3. Improper Communication: One of the other causes of using the wrong code is not charting and communicating correctly. If the person who is completing procedures is not the person who is doing the billing, it is up to them to clearly communicate and chart what procedures were performed and provide back-up documentation. Make sure that you have a defined system for charting, coding and billing that everyone in your practice understands.

Avoid Common Coding Mistakes with APEX Reimbursement Specialists

Whether you’re preparing for the recredentialing process or looking for assistance making sure that your office coding practices are up to snuff, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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3 Common Recredentialing Mistakes

When many offices finish the credentialing process with a new insurance provider, they breathe a sigh of relief. After all, they never need to worry about completing the process again, right? Wrong! After the credentialing process has been completed, the recredentialing process immediately appears on the horizon. Depending on your provider, you might need to complete recredentialing every 2-3 years. What are the most common recredentialing mistakes that many dental practices make?

 

The Recredentialing Process

 

Recredentialing is a process enacted by insurance providers to ensure that all of their in-network dental providers are meeting the same standards that they were the last time they were credentialed or recredentialed. Just like the initial credentialing process, it can be quite lengthy, require a great deal of paperwork and need tremendous attention to detail to be successful. However, recredentialing can also be a great thing for your dental practice. It gives you an opportunity to renegotiate your reimbursement rates and improve your bottom line. APEX Reimbursement Specialists can assist both with the recredentialing process and your fee negotiation needs.

 

3 Common Recredentialing Mistakes

 

1. Waiting Too Long to Start: Did you know that the recredentialing process timer starts the day that your dental practice becomes an in-network provider for an insurance company? If you get your provider status before your office is open or before you see your first patient, that does not have an effect on when your recredentialing will need to be completed. Make sure that you give yourself plenty of time to complete the recredentialing process, as it requires paperwork and documentation on top of time for the company to process your submission.
2. Not Following Up: Insurance providers will never contact you proactively to let you know that something is missing or incomplete. Instead, you (or a trusted recredentialing assistant like APEX Reimbursement Specialists) will need to reach out for any updates. We can take care of touching base with all insurance providers to confirm the receipt of the application, review any missing materials and ensure it was accepted.
3. Not Paying Close Attention: Recredentialing is just as detailed and intensive as the initial credentialing process in some cases, so you must pay attention to detail. Make sure that you have all necessary documents and paperwork gathered before submitting your materials to the insurance provider.

 

Avoid Recredentialing Mistakes with APEX Reimbursement Specialists

 

Whether you’re preparing for the recredentialing process or looking for assistance credentialing with a new provider, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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Code Changes Every Dental Practice Should Know About for CDT 2020

While the new year isn’t here yet, it’s never too early to start preparing for the CDT 2020 additions, deletions and alterations at your dental practice. The Code Maintenance Committee reviewed existing codes and developed 37 new codes, 5 revised codes and 6 deleted codes that every practice should update. Remember that while insurance providers are required to recognize the CDT 2020 codes and utilize them, but you are not required to provide benefits they may not extend coverage for new or revised codes. The CDT 2020 codes will be going into effect on January 1, 2020.

 

Added Codes

 

As with the code additions last year, many of the new and revised codes are designed to emphasize the connection between overall health and oral health. The mouth plays a vital role in the physical health of every individual, and more codes will allow dentists to assert their role as important physicians for every patient. One such code is 0419- assessment of salivary flow by measurement. This code allows dentists to bill for the assessment of a patient’s health through measuring salivary flow. Other notable additions were made to assist with case management for patients with special or more complex healthcare needs.

 

All of the notable additions include:

 

• 0419 – assessment of salivary flow by measurement
• D1551 – re-cement or re-bond bilateral space maintainer – maxillary
• D1552 – re-cement or re-bond bilateral space maintainer – mandibular
• D1553 – re-cement or re-bond unilateral space maintainer – per quadrant
• D1556 – removal of fixed unilateral space maintainer – per quadrant
• D1557 – removal of fixed bilateral space maintainer – maxillary
• D1558 – removal of fixed bilateral space maintainer – mandibular
• D2753 – crown – porcelain fused to titanium and titanium alloys
• D5284 – removable unilateral partial denture – one piece flexible base (including clasps and teeth) – per quadrant
• D5286 – removable unilateral partial denture – one piece resin (including clasps and teeth) – per quadrant
• D6082 – implant supported crown – porcelain fused to predominantly base alloys
• D6083 – implant supported crown – porcelain fused to noble alloys
• D6084 – implant supported crown – porcelain fused to titanium and titanium alloys
• D6086 – implant supported crown – predominantly base alloys
• D6087 – implant supported crown – noble alloys
• D6088 – implant supported crown – titanium and titanium alloys
• D6097 – abutment supported crown – porcelain fused to titanium and titanium alloys
• D6098 – implant supported retainer – porcelain fused to predominantly base alloys
• D6099 – implant supported retainer for FPD – porcelain fused to noble alloys
• D6120 – implant supported retainer – porcelain fused to titanium and titanium alloys
• D6121 – implant supported retainer for metal FPD – predominantly base alloys
• D6122 – implant supported retainer for metal FPD – noble alloys
• D6123 – implant supported retainer for metal FPD – titanium and titanium alloys
• D6195 – abutment supported retainer – porcelain fused to titanium and titanium alloys
• D6243 – pontic – porcelain fused to titanium and titanium alloys
• D6753 – retainer crown – porcelain fused to titanium and titanium alloys
• D6784 – retainer crown ¾ – titanium and titanium alloys
• D7922 – placement of intra-socket biological dressing to aid in hemostasis or clot stabilization, per site
• D8696 – repair of orthodontic appliance – maxillary
• D8697 – repair of orthodontic appliance – mandibular
• D8698 – re-cement or re-bond fixed retainer – maxillary
• D8699 – re-cement or re-bond fixed retainer – mandibular
• D8701 – repair of fixed retainer, includes reattachment – maxillary
• D8702 – repair of fixed retainer, includes reattachment – mandibular
• D8703 – replacement of lost or broken retainer – maxillary
• D8704 – replacement of lost or broken retainer – mandibular
• D9997 – dental case management – patients with special health care needs

 

Deleted Codes

 

Many of the deleted codes were removed to allow for greater specificity with new CDT 2020 codes. For example, D8693- re-cement or re-bond of fixed retainerhas been broken into two new codes, D8698- re-recent or re-bond of fixed retainer—maxillaryand D8699- re-cement or re-bond of fixed retainer—mandibular.

 

The deleted codes include:

 

• D1550 – re-cement or re-bond space maintainer
• D1555 – removal of fixed space maintainer
• D8691 – repair of orthodontic appliance
• D8692 – replacement of lost or broken retainer
• D8693 – re-cement or re-bond fixed retainer
• D8694 – repair of fixed retainers, includes reattachment

 

Updated Codes

 

There are only three code revisions this year, all of which are intended to allow dentists more clarity and specificity when coding.

 

• D1510 space maintainer – fixed, unilateral – per quadrant. Excludes a distal shoe space maintainer.
• D1520 space maintainer – removable, – unilateral – per quadrant
• D1575 distal shoe space maintainer – fixed – unilateral – per quadrant fabrication and delivery of fixed appliance extending subgingivally and distally to guide the eruption of the first permanent molar. Does not include ongoing follow-up or adjustments, or replacement appliances, once the tooth has erupted.

 

The Latest CDT 2020 Information from APEX Reimbursement Specialists

 

The experts at APEX Reimbursement Specialists can help you to explore the best options for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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Dental Industry Growth Part One: The Boom and Decline of PPO Insurance Carriers

The dental industry continues to grow, and many dental practices are reaping the benefits. Alongside the growth of DSOs and third-party networks, PPO insurance carriers blossomed, but now appear to be on the decline.  

How Many People Are Covered?

According to the National Association of Dental Plans, 77% of Americans currently have dental benefits. Of those 249.1 million people with benefits, approximately 164.2 million have a form of commercial insurance, and 90% of those individuals get those dental benefits through an employer or group program like AARP. Dental Preferred Provider Organizations (DPPOs or PPOs) make up a whopping 82% of dental policies today.

PPO Insurance Carriers

In the PPO model, the insurer will create a network of dental providers that their patients can choose from. Dentists who are enrolled in that network often experience an uptick in patients as a result, but they do so at the cost of a reduced payment rate for the services that they perform. Most PPO insurance carriers cover all in-network preventative care, like cleanings, but require the patient to pay a co-pay for restorative work, like a root canal or filling.

How Many PPO Insurance Carriers Are There?

PPO insurance carriers have been on the rise for decades now, as articles dating back to 1985 proclaim that “the number of operating PPOs has increased” and “their enrollment has risen dramatically.” However, recent reports suggest that the PPO plan count is on the decline. For the fifth straight year in 2015, the total number of PPOs operating nationally declined from 454 to 451. Over the period from 2003 to 2015, the total PPO count fell by 33.7%. Insurance company-owned PPOs are experiencing the most growth, and in 2015 they accounted for 72% of all PPO enrollment. It’s important to note that while the total number of PPO insurance carriers may be declining, enrollment continues to increase, which points to steady and growing consumer interest in enrollment.

Thrive in an Era of PPO Insurance Carriers with APEX Reimbursement Specialists

The experts at APEX Reimbursement Specialists can help you to explore the best options for your continued growth and sustained success, including PPO insurance carriers. We can assist you with ensuring that your dental practice continues to grow and thrive whether you are located in Maryland or across the country. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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What Your Practice Needs to Know About the Amalgam-Free Era Starting Soon

Reducing Accounts Receivable Is Essential to Your Practice’s Success

5 Common Credentialing Mistakes

What Is Insurance Negotiation?

Could the DSO Market Be a Good Thing for Your Dental Practice?

The Importance of Clinical Due Diligence

Whether you’re drilling in a patient’s mouth or making notations in their chart, accuracy matters a great deal. When editing patient records, it is vital that dentists always accurately record what was done, even if the results were not notable. Clinical due diligence is essential to maintain a dental practice that is protected from any insurance provider or third-party audit, or when evaluating a new practice for purchase.

In Your Personal Practice

A patient records review is an effective way to determine whether or not your practice is meeting clinical due diligence benchmarks. When insurance companies deny claims, and it’s time to resubmit, do you have all of the necessary paperwork to prove that the work you did was appropriate? A third-party audit, like those offered by APEX Reimbursement Specialists, can look through both front-office paperwork and patient records.

A patient record review is a thorough look at the files of several patients, chosen at random. We will look at all components of the chart, including:

• Patient health history
• Baseline charting of examination findings
• Diagnosis
• Treatment plan (caries examination, periodontal evaluation, etc.)
• Radiographs and X-rays
• Progress notes
• Patient financial ledgers

The charts will then be examined to see if they include all critical legal and healthcare insurance paperwork documents, including:

• A signed informed consent form
• Office privacy notice
• Financial agreement
• Signed HIPAA paperwork, including who can be granted access to PHI

The absence of one of these documents could lead to difficulty being recredentialed, trouble during an audit or even legal trouble if a patient brings a complaint and you lack proper supplementary evidence.

When Evaluating a New Practice

Clinical due diligence is also essential when evaluating a new practice for purchase. Just like a third-party audit can assist in making sure that your practice is operating with all proper procedures in place, a third-party audit can do the same for a practice you are looking at purchasing or partnering with. Patient chart examinations are an illuminating glimpse at how the practice operates. Does the seller’s treatment philosophy mesh with yours? Were the procedures billed for actually performed? When looking at radiographs, do they coincide with what is noted on the chart? A discrepancy here and there doesn’t always point to a bigger problem, but consistent lack of attention to detail is a big red flag.

APEX Reimbursement Specialists Can Assist with Your Clinical Due Diligence

If you want to learn more about how APEX can help your practice improve your numbers and gain more insight into how you’re doing, contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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Insurance Companies Can Benefit from Working with a Dental Consultant

While many dental practices hire dental consultants to maximize their reimbursement potential, boost their bottom line and protect themselves from audits, every insurance provider is not enthusiastic about cooperating. In reality, the relationship between dental consultants and insurance companies can be mutually beneficial.

Greater Accuracy

Insurance companies rely on accuracy from dental practices when credentialing, recredentialing and submitting claims. Companies devote time, effort, auditing departments and plenty of employees to ensure accuracy and make sure that the company is paying for services rendered. When dental practices are correctly billing procedures, submitting paperwork and completing claims, it makes the entire process simpler for insurance companies. The accuracy that a dental consultant works to improve helps everyone involved in each transaction. How much lower could an insurance provider’s bottom line be with a more moderate amount of practice oversight and an increased reliance on high-quality, skilled dental consultants?

Partner with High-Quality Practices

Insurance providers rely on customer satisfaction in the same way that dental practices do. If patients have negative experiences with the dental practices in a network, they will be more likely to take their business elsewhere. As a result, it behooves providers to have a high-quality practice base. One survey of patient loyalty to dental practices found that patients rated their loyalty a 1 on a scale of -100 to 100. For comparison, the financial services rating has a 39 rating, and the retail sector has a 46 rating. Improving loyalty to dental practices and insurance companies is a priority for both parties. Dental consultants work with practices to improve the quality of billing procedures and increase precision. Aside from saving providers time and money, it also strengthens the quality of the insurance provider and the happiness of their customers.

Ensure a Mutually-Beneficial Relationship

Insurance providers and dental practices work together to connect patients with excellent dental care. Instead of interpreting the addition of a dental consultant to the provider-practice relationship as an attempt to only benefit the practice, providers should see it for what it is—a way for both parties to get the best possible results from their relationship.

APEX Reimbursement Specialists Is a Skilled Dental Consultant

If you want to learn more about how APEX can help your practice improve your numbers and gain more insight into how you’re doing, contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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The Surprising Side Effect of a TIN Change: Lower Fee Schedules

Did you know that when your practice undergoes a tax identification number (TIN) change, some insurance companies will offer you a lower fee schedule? Paying close attention during your transition is essential, whether you’re purchasing a new practice and wanting to stick to the last owner’s fee schedule or opening a new location and seeking the same fee schedule.

When Could You Undergo a TIN Change or Need to Update Your TIN?

Most PPO providers require dental practices to submit a new TIN form whenever they open a new office, transition an office to new ownership or during the sale or purchase of a practice.

What to Monitor During a TIN Change

If you are purchasing a practice, you should always start by checking the W9 for accuracy. Then, you should take a look at current fee schedules and UCR fees. Take your time when reviewing the schedule before you approve it, and pay close attention to how many disparities there are between fee schedules and which codes are being impacted the most.

Unfortunately, many insurance carriers offer lower fee schedules during the TIN change process. If you want to keep the same rates that you or the last owner had, you must negotiate or work with a third-party negotiation service to preserve the past rates. Some carriers choose not to work with third parties during the TIN change process, so you should be prepared to put your foot down. Always make educated decisions and remember that this is your first opportunity to ensure reasonable reimbursement rates.

Other Things to Consider During Transition

If you are purchasing a dental practice, there are several hiccups that can occur with billing during the transition process. You cannot bill under the TIN or contract of the previous owner, but some insurance providers allow for retroactive billing within a certain amount of time. Be clear with patients if there will be a period of time when you are out of network, so they understand they will be responsible for a greater amount than normal.

Partner with APEX Reimbursement Specialists

The experts at APEX Reimbursement Specialists can help you to explore the best options for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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Why Are My Providers on Different Fee Schedules?

In 2010, preferred provider organizations (PPOs) made up 74% of the dental benefit market. Numerous dental practices are contracted with more than one PPO. Sorting through all of the contracts and fee schedules can be confusing for your billing professionals and your bottom line. Thankfully, there are ways to streamline your carrier contracts and make the entire process easier.

Understanding Fee Schedules

As a PPO office, you first need to understand that you will not collect your full fee for any given procedure. Instead, you will be reimbursed in accordance with your fee schedule. You should be reviewing your fees on a regular basis and adjusting based on the market around you. When it’s time to recredential with every provider you partner with, you should also take a close look at how much the provider is offering you. If they are unwilling to negotiate, are the reimbursements you’re receiving and the patients you’ve attracted worth signing again?

The Benefits of Streamlining Carrier Contracts

Many practices do a poor job of tracking contracts and fee schedules due to being contracted with so many entities. If you sign a contract with a third party with access to numerous markets, you should keep that in mind when condensing things. Streamlining your contracts and getting a consistent fee schedule across PPOs will make things easier on your billing department and your budget.

Utilize a PPO Negotiation Service

Fee negotiation is complex and can take some time. Unless you have one provider and only a few codes you are interested in negotiating for, it’s a great idea to work with a professional service like APEX Reimbursement Specialists. We can help you determine which fees are most important to your practice’s bottom line and negotiate with PPOs on your behalf to get the most out of your fee schedule. We can also take care of renegotiating when you recredential with dental practices. By staying on top of your fee schedules and contracts, it will be easier to balance your fees with providing the best level of care to your patients. 

Partner with APEX Reimbursement Specialists

The experts at APEX Reimbursement Specialists can help you to explore the best options for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

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Code Changes Every Dental Practice Should Know About for CDT 2019

Every new year brings along with it changes to CDT codes, and 2019 is no different. This year, the Code Maintenance Committee reviewed a wide variety of codes related to new technologies, procedures and materials designed to improve oral health. In this blog, we are focusing on the notable CDT 2019 code changes every dental practice should know.  

Added Codes

Following the addition of D0411-HbA1c in-office point-of-service testing to CDT 2018, D0412-blood glucose level test—in office using a glucose meter has been added to CDT 2019. The addition of another code shows the important role that all healthcare professionals, including dentists, play in ensuring patient health. Learning blood glucose levels before major procedures could be critical in determining whether or not the procedure is appropriate.

The addition of D931-temporomandibular joint dysfunction, non-invasive physical therapies to CDT 2019 is remarkable because it is the first time a code has been issued for a physical therapy-based treatment of TMJ symptoms. This code change falls in line with the growing understanding that treatment of TMJ should go beyond appliance therapy.

Changes in the D15– section of CDT 2019 all attempt to more precisely describe the space maintainer procedures being performed. Instead of utilizing a single code for all space maintainer procedures, now there are codes to identify specific areas.

Some of the notable additions include:

• D0412: Blood Glucose Test in Office
• D1516: Space Maintainer Fixed Maxillary
• D1517: Space Maintainer Fixed Mand
• D1526: Space Maintainer Removable Max
• D1527: Space Maintainer Removable Mand
• D5282: Remove Unilateral Part Dent Max
• D5283: Remove Unilateral Part Dent Mand
• D5876: Metl Subcs to ACR Dent per Arch
• D9310: TMJ Non-Inv Phys Therapies
• D9613: Infl Sustained Therapeutic Drug
• D9944: Occlusal Grd Hard Appl Full Arch
• D9945: Occlusal Grd Soft Appl Full Arch
• D9946: Occlusal Grd Hard Appl Part Arch
• D9961: Duplicate/Copy Patients Records
• D9990: Cert Trns OR SGN-Lan Srv Per Vis

Deleted Codes

Two of the notable deleted codes have been removed to make space for new, more specific codes to describe where space maintainers are being utilized.

Some of the notable deleted codes include:

• D1515: Space Maintainer—Fixed—Bilateral
• D1525: Space Maintainer—Removable—Bilateral
• D5281: Removable Unilateral Partial Denture—One Piece Cast Metal
• D9940: Occlusal Guard, By Report

Updated Codes

The five updated CDT 2019 codes have new wording to better describe the procedure or service being performed. For example, D7283-placement of a device to facilitate eruption of impacted tooth has an updated description to better reflect where the procedure is performed. Previously, it was considered an orthodontic procedure, so the code description change reflects the reality that it is not always considered part of orthodontics.

Some of the notable updated codes include:

• D5211: Upper Partial Denture—Resin is now Maxillary Partial Denture—Resin
• D5212: Lower Partial Denture—Resin is now Mandibular Partial Denture—Resin
• D5630: Repair/Replace Broken Clasp is now Repair/Replace Broken Clasp—TH
• D7283: Unerupted Tooth Device is now Device—Eruption IMP Tooth
• D9219: Eval Deep Sedation/Gen Anes is now Eval—Mod—Deep Sedation/Gen Anes

The Latest CDT 2019 Information from APEX Reimbursement Specialists

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