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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