Wake up and smell the coffee, it's time for the morning huddle! This meet-up is the tooth fairy's secret weapon to get your dental dream team fired up and ready to tackle the day. Think of it as a pre-game warmup before the main event. Picture your dental squad huddled up, exchanging the latest leadership goodness, setting the day's objectives, and building a positive and supportive work culture, all while sipping on that much-needed caffeine fix. It's the ultimate morning pick-me-up, so start your day off right with a huddle that'll have your team grinning from cheek to cheek! You might be thinking our Huddles are NOT okay, because they are boring, they are repetitive, they are basically...lame. Let's put you in charge and change it. Hold on to your dental drills, folks, because we're about to dive into the nitty-gritty of the morning huddle. You might be wondering, "Why should my team know the production and anticipated collections for the day?" Well, let me tell you, it's like having a GPS for your dental practice. Knowing these numbers helps you navigate through the day and make sure you're on track to reach your destination, or in this case, reach your daily financial goals. But, let's not forget the real reason for the morning huddle: to spread positivity and make everyone feel like a million bucks! Here are three reasons why it's crucial to know the numbers and three tips for keeping your morning huddle as sweet as a sugar-free lollipop. 1. It helps the team stay organized and on track: Knowing the production and anticipated collections for the day helps your team stay organized and on track. It allows them to plan their schedule effectively, ensure that all necessary materials are prepared, and stay focused on their goals for the day. This can help to minimize disruptions and ensure that your team is providing the best possible care to your patients. 2. It promotes transparency and accountability: Sharing production and anticipated collections with your team promotes transparency and accountability. It allows team members to see how their efforts contribute to the overall success of the practice and helps them understand the financial health of the practice. This can foster a sense of ownership and help team members feel more invested in the success of the practice. 3. It sets the tone for the day: A positive and energizing morning huddle can set the tone for the rest of the day. It can help team members feel more motivated and engaged, which can lead to better patient care and a more positive work environment. Here are three ways to make the morning huddle positive: Keep it brief: A morning huddle should be brief and to the point. It is important to communicate necessary information in a clear and concise manner, so that team members can quickly get to work. Encourage participation: Encourage team members to participate in the morning huddle by asking for their input and ideas. This can help to foster a sense of teamwork and collaboration and can lead to better decision-making. 3. Start with a positive note: Begin the morning huddle with a positive note, such as thanking team members for their hard work or recognizing a team member for their contributions. This can help to create a positive and energizing atmosphere and can set the tone for the rest of the day. And there you have it, folks, the morning huddle is like a Swiss Army Knife for your dental team! It's a one-stop-shop for getting everyone on the same page, sharpening their focus, and organizing their game plan for the day. With a little bit of production and collection talk and a whole lot of positivity, you'll have your team feeling like they can conquer the world. Who knows, you might even inspire them to break out into a spontaneous dance party. The bottom line is, a morning huddle sets the tone for a successful and productive day, so make it a daily ritual and watch your dental practice soar to new heights! If you find your team struggling with any of these items, we are here to help! We provide unsolicited accountability daily to our dental offices. We would love to support you. Dentistry Support ® provides remote support for dental offices nationwide. We serve the needs of any size dental office including those with Spanish-speaking needs on both the east and west coasts of the United States of America. Learn more. Disclaimer: To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website.

Welcome to the world of dental insurance, where the jargon is dense, the rules are complex, and the confusion is real. But fear not, dear reader, for we are here to demystify this mysterious landscape and shed some light on why a dental team that knows its insurance vocabulary is worth its weight in gold. So buckle up, grab a cup of coffee, and get ready for a journey through the tooth and gum of dental insurance. You might even learn a thing or two! Dental insurance can be a confusing topic for both patients and dental professionals. However, it is crucial for a dental team to have a thorough understanding of dental insurance terminology and how insurance works. This not only helps the team provide accurate information to patients but also facilitates clear communication between the dental office and insurance companies. When the dental team is knowledgeable about insurance policies and procedures, they are better equipped to answer patient questions and help them navigate the complexities of their coverage. This can result in a smoother and more stress-free experience for patients, as well as improved financial outcomes for the dental practice. Ultimately, having a well-informed dental team benefits everyone involved, and demonstrates a commitment to patient satisfaction and quality care. Annual maximum - The highest dollar amount that an insurance plan will cover in a given year. Benefit period - The length of time during which an insurance plan will cover a specific procedure or treatment. Claims process - The steps taken by an insurance company to review and pay out a request for coverage. Co-insurance - The amount that a patient is required to pay for a covered service, typically a percentage of the total cost. Deductible - The amount that a patient must pay out-of-pocket before their insurance begins to cover treatment costs. Dental insurance - A type of insurance that covers some or all of the costs of dental care. Endodontics - The branch of dentistry that deals with the treatment of the inside of the tooth, including root canals. Exclusions - Procedures or treatments that are not covered by an insurance plan. In-network provider - A healthcare provider who has a contract with an insurance company to provide services at a discounted rate. Maximum benefit - The highest dollar amount that an insurance plan will cover for a specific procedure or treatment. Orthodontics - The branch of dentistry that focuses on correcting misaligned teeth and jaws. Out-of-network provider - A healthcare provider who does not have a contract with an insurance company to provide services at a discounted rate. Out-of-pocket maximum - The maximum amount that a patient is required to pay for covered services in a given year, after which the insurance company will cover all additional costs. Pediatric dentistry - The branch of dentistry that focuses on the oral health of children. Periodontics - The branch of dentistry that deals with the treatment of the gums and surrounding tissue. Pre-authorization - The process of obtaining approval from an insurance company before a specific procedure or treatment is performed. Preventive care - Dental care that is intended to prevent the onset of disease or other oral health problems. Procedure code - A code used to identify a specific dental procedure or treatment. Provider - A healthcare professional or facility that provides medical or dental care. Waiting period - The length of time that must pass before an insurance plan will cover a specific procedure or treatment. Annual deductible - The amount that a patient must pay out-of-pocket for covered services in a given year before their insurance begins to cover treatment costs. Capitation - A type of payment plan in which a healthcare provider is paid a fixed amount per patient per month, regardless of the number or type of services provided. Co-payment - A fixed amount that a patient is required to pay for a covered service at the time of treatment. Coordination of benefits - A process in which multiple insurance policies are used to cover the costs of a single treatment or procedure. Covered services - Procedures or treatments that are included in an insurance plan. Dependent - A family member who is covered by another person's insurance policy. EOB - An Explanation of Benefits, a document that outlines the details of a claim and the amount of coverage provided by an insurance plan. Expiration date - The date on which an insurance policy or coverage period ends. Flexible spending account (FSA) - A type of account that allows a patient to set aside money from their paychecks on a pre-tax basis to cover out-of-pocket healthcare expenses. And there you have it folks, the importance of a dental team understanding dental insurance vocabulary in a nutshell. We hope this has been informative and enlightening, and that you now have a better appreciation for the role dental insurance plays in the world of dentistry. If you have any further questions or comments, please feel free to reach out to us. Until next time, keep smiling and take care of those pearly whites! Dentistry Support ® provides remote support for dental offices nationwide. We serve the needs of any size dental office including those with Spanish-speaking needs on both the east and west coasts of the United States of America. Learn more. Disclaimer: To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website.

We are talking about 5 things that will systematically change your practice collections once and for all. The most important thing you will learn is... Also, we challenge you to repeat "Be a Better Dental Biller" 5 times fast. Can you do it without messing up? You realistically should never have 1 single dental insurance claim over 14 days aging and we are going to show you exactly how to do it. How to read an EOB Claim Errors Hold insurance accountable for what they told us in eligibility verification Write the perfect narrative How to focus on projected monthly collections. Filing dental claims can be a daunting task, especially if you're not familiar with the process. However, with a little preparation and understanding, you can make the process go smoothly and get the reimbursement you deserve. Here are some tips to help you file dental claims in the best way possible: 1. Verify their coverage. Before you even allow a patient to set foot in the dental office, make sure you understand what their dental insurance covers. Know your patient's plan's deductible, copayments, and maximum annual benefits. This will help you explain what the patient is responsible for paying out of pocket. 2. Keep accurate records for your patients. Make sure to keep all of your dental receipts (from vendors) and documents from referring specialty offices that had a part in your patient's care. These will be needed when you file your claim in some scenarios. Do not miss the post-op x-rays or the required clinical notes. 3. Submit your patient's claim promptly. Our best practice is to send claims immediately. Most insurance plans have a deadline for filing claims, usually within a few months of the date of service. If you miss this deadline, you may not be able to get reimbursed. Sending claims immediately also gives you a track record of initially sending the claim out so even if an insurance company says "no claim on file" you have proof you've sent out the claim with a tracer number. This is especially helpful if you are working on old claims that have exceeded the claim filing limit. You can still get paid for the claim because you have the initial claim information and it was submitted timely. 4. Over Communicate: When you send the claim don't assume that just because it is a basic or preventive procedure it doesn't require x-rays or attachments. Over-communicate with the insurance. It will never hurt to send more information, x-rays, or charting. When we say over-communicate, we mean to call the insurance incessantly until its adjudicated. Stay on top of it, the insurance company is banking on you NOT Staying on top of it. 5. Fill out the claim form accurately. Make sure to fill out the claim form completely and accurately. Double-check that all of the information, including dates of service, procedures performed, prior placement, and charges, are correct. Start with your ledger and the appointment itself. Create a guide for your front office team to audit and ensure you aren't leaving out important procedures that were completed. Most dental software has this digitally. We encourage you to verify the most current digital form is attached for claim submission. Many dental offices are using outdated ADA forms on the digital side because they simply don't know to check this. Take the time to call your digital dental software company and check your systems once a year for accurate attached forms. 6. Follow up EVERY 14 days. If you don't hear back about your claim within 14 days, don't be afraid to follow up. I would also venture to exclaim, YOU SHOULD demand an explanation. There are insurance commissioner laws to protect dental offices and the money the insurance company has to pay them, which require dental insurance companies to pay within 30 days. However, most dental insurance companies have automation for the adjudication of claims. Meaning they are paying out in 24-48 hours on claims. Help your patients understand their EOB if you don't they will think you are overcharging and 7. Anticipated collections. Do you know what this is? If your current team is not giving you this, there is a problem. When researching dental insurance claims your dental team should be asking what money is on the way and when it was sent. Anticipated collections should be shared with the dental office by the admin team at your dental office. By following these tips, you can increase your chances of a successful dental claim. Don't let the process intimidate you – with a little preparation and effort, you can get the reimbursement you deserve. The best tip we can give you is that your job as a biller is not just "send the claim" but focus on doing the right thing for the claim. Make a checks and balance list for yourself. Dentistry Support ® provides remote support for dental offices nationwide. We serve the needs of any size dental office including those with Spanish-speaking needs on both the east and west coasts of the United States of America. Learn more. Disclaimer: To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website.

This quick short read can be part of your next morning huddle or meeting with your leadership team this month. My journey in the world of dentistry has taught me many things, but the most important lesson I learned is that true leadership is all about serving others. I used to think being an Office Manager was the ultimate goal, but I soon realized that being a servant leader is where the real magic happens. Sure, I may have been a drama queen at times, and maybe I had a bit of an attention-seeking streak in my mid-20s, but I've grown and learned that true leadership is about putting others first. Traction in business growth happens when we put others first, seek to understand before control, and begin legacy-lasting leadership. With servant leadership, I can make sure everyone gets the royal treatment not just the patients. As a dental office leader, it is important to remember that the success of the practice depends on the combined efforts of the entire team. While it is important to have a clear vision and to make decisions that are in the best interest of the practice, it is equally important to approach your role with humility and to serve the needs of your team. This type of leadership, known as servant leadership, focuses on putting the needs of others first and empowering them to achieve their full potential. Here are three ways you can be a servant leader in a dental office: Encourage open communication: A key aspect of servant leadership is creating an open and inclusive environment where team members feel comfortable voicing their opinions and suggestions. As a leader, it is important to actively listen to your team and to make an effort to understand their perspectives. By fostering open communication, you can create a culture of trust and collaboration, which can lead to better decision-making and improved patient care. Foster a culture of continuous learning: As a dental office leader, it is important to create opportunities for your team to learn and grow. This could involve providing training and professional development opportunities, encouraging team members to attend continuing education courses, or simply creating a culture of learning and curiosity. Check out our full free training here. By investing in your team's development, you can help them feel more fulfilled and motivated in their roles, which can ultimately lead to better patient care. Lead by example: As a leader, it is important to model the behavior you expect from your team. This includes being punctual, respectful, and professional at all times. It also means going above and beyond for your patients, whether that involves staying late to finish a procedure or going the extra mile to make them feel comfortable and cared for. Your leadership will be known by your team by the actions you set and the tasks you make a priority in your dental office. By leading by example, you will inspire your team to follow your lead and strive to provide the best possible care to your patients. Legacy generating: As you become a grand leader, you will be creating like-minded leaders and before long every action you take your team will follow you in taking. My biggest words of encouragement "If you are not doing any of this now, just start. It is never too late" Being a humble leader in a dental office and any business is essential for creating a positive and collaborative work environment. By adopting a servant leadership style, you will empower your team to achieve their full potential and provide the best possible care to your patients and teammates. Last bit. We often make our stance as a leader in dental all about the patients. This is good. However, we cannot forget about the team. Servant leadership empowers us to think beyond ourselves, beyond the patient, beyond the employees, and drive our dental offices and businesses to be complete and wholly lead. If you are passionate about your patients you should be equally passionate about loving your team. Do not succumb to being that manager that demands control by saying "I do this for my patients" be the leader that is an example of what you want to be done and encourages everyone around you to be a leader for complete servant leadership. Dentistry Support LLC TM provides remote support for dental offices nationwide. We serve the needs of any size dental office including those with Spanish-speaking needs on both the east and west coasts of The United States of America. Learn more. Disclaimer: To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent Dentistry Support, LLC TM has included links to any third-party website (s), Dentistry Support, LLC TM intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support, LLC TM makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website.

Did you know that congress has not amended dental coverage under Medicare since 1980 when the blanket exclusion of coverage was first in effect? That is a big gap of time for questions to linger and mistakes to be made in billing dental to Medicare. Let us help bridge that gap! This read is every bit worth it. 1. Know Coverage Principle Coverage is not determined by the value or the necessity of the dental care but by the type of service provided and the anatomical structure on which the procedure is performed. 2. Familiarize yourself with the dental coverage for A + B: Medicare doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare Part A (Hospital Insurance)will pay for certain dental services that you get when you're in a hospital. Part A can pay for inpatient hospital care if you need to have an emergency or complicated dental procedures, even though it doesn't cover dental care. 3. Medicare Advantage (Part C) is a company contracted with Medicare and is an additional expense to the patient. These plans can offer coverage for dental and vision health items in addition to also offering the same coverage as Original Medicare. Most also include prescription drug coverage as well as other benefits such as hearing health coverage and gym memberships. 4. Have the Patient Sign the ABN if Medicare will not Cover a Service/Item: If Medicare does not cover a service/item that the patient wants, it is important that the patient signs the ABN (Advanced Beneficiary Notification) form. This confirms that the patient understands that Medicare will not cover the service/item and agrees to pay out of pocket for it. ABN forms are not necessary for things that Medicare typically doesn’t cover such as routine dental services like cleaning, root canals, etc. 5. Verify Benefits. Benefits for any type of Medicare Advantage plan can vary. Know policy effective dates, obtain prior authorizations or pre-determination of benefits, and verify what the patient will be required to pay. We also encourage you to record any calls for verification to help when needing to appeal a claim as well. This is included in all of our support. 6. Use the Medicare Beneficiary Identifier (MBI) Beginning in 2020, Medicare did away with using a beneficiary’s Social Security number for billing purposes. Dentists must now use the 11-character alphanumeric MBI when billing Medicare. Failure to use the MBI, or even a failure to enter it correctly, could result in a rejected claim. The MBI uses numerals 0-9 and uppercase letters only. The letters B, I, L, O, S, and Z are not used, and no hyphens or spaces should be included when entering the MBI on a claim form. Also, replace the Social Security number with the MBI in patient records. 7. Wait on the Part B deductible If you accept Medicare assignment, the Centers for Medicare & Medicaid Services (CMS) recommends not charging or collecting the Medicare Part B deductible amount from a patient until you can confirm whether or not it has been met. The reason for this is that if you end up over-collecting, the CMS may consider this abuse, and it could lead to part of your reimbursement check being sent to the beneficiary. Or you might face a demand letter from the Medicare Administrative Contractor (MAC) outlining a repayment request. Neither is good for your bottom line. 8. Know the Stark Law changes You may be familiar with the Stark Law, which prohibits you from referring Medicare and Medicaid patients to entities with which you have a financial relationship. But are you familiar with the changes to the law that went into effect in January 2021? Brush up on the changes to see how the new regulations can create more streamlined revenue opportunities for your practice. 9. Remain up-to-date on coverage determinations What’s covered or not covered by Medicare is largely in the hands of Local Coverage Determinations, National Coverage Determinations, and Medicare Administrative Contractors. Staying in the know about these coverage decisions can help you better shape the service offerings of your practice. Signing up to receive CMS listserv updates can help keep you informed. 10. Follow Up. Stay on top of your outstanding claims. Honestly, every reason in the book comes up as to why claims are denied or delayed. Sometimes they could even fully process but the payment is sent to the patient.... see #7!! Need help? Disclaimer: These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support, LLC TM has included links to any third party website (s), Dentistry Support, LLC TM intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support, LLC TM makes no representations or warranties about the information provided on those sites. Sources: Medicare.gov Christian Worstel, BA ADA Centers for Medicare & Medicaid Services

Let's focus on "smarter, not harder" for a moment. Let's see how you can dream easier for the growth of your Dental Office. Also, this is 3 minutes... you can do anything for 3 minutes, let's help you become more profitable. Keeping this simple is the only way we can all benefit from it. Knowing what numbers to look for in your office can be tricky because it seems scary to give away the information on how much your dental office makes. It's intimidating to Managers, Dentists, and Owners because the "staff might ask for more pay." Let's change that mindset. Scroll to the bottom for Preventive, Restorative and Perio maximizing codes. What if it meant we brought clarity to the costs of the business and allowed everyone the opportunity to help grow the company to benefit the entire room? I've worked in many dental offices that thought, more patients = more money. Not so much. How about more quality patients = more money.. Yes, yes that is it. The data to the left is what every dental consultant will tell you. We think a little differently. How about knowing the difference in what you could be making on all of those patients you already have. Work smarter... They are already coming in the door. Adding a $75 Scaling, $100 Preventive Resin, and $75 in PA's to a $150 Hygiene visit could give you $400 JUST. LIKE. THAT. (insert my "hands raising in exclamation) Okay, enough jibber-jabber, let's tell you what codes you should be verifying and using to increase production per patient. Because it is always easy to say "Just get a crown out of every patient, but what about maximizing benefits and services where ADA codes exist? Yep, let's do that. Preventive codes may seem obvious but the following are just a couple of scenarios you could be missing out on. Scaling in conjunction with a prophy. PA's with each recare/recall appointment. Palliative Exams (esp. if they are not combined with other exam freqencies) Restorative has the same beautiful options to know how you're getting paid and how you can maximize the benefits of plans and even offer a more comprehensive plan for noninsured patients who deserve the same care. Periodontal services come in all shapes and sizes. Check out these codes you could be missing out on. There are age limitations with some period code that could hurt big time if a patient expects the insurance to cover. The ADA has incredible coding resources available on its website. See below for direct links to learn more. Verifying benefits for patients can be very time-consuming. Working with a third-party verification team is always advised especially when you are looking to reduce costs and improve your overall Profit and Loss of your dental business. If you are looking for more ways to educate your team, check back in our free training section for tips and tricks to build your dental office. For dental certification courses and more in-depth training for your team or new hires, check out this online dental front office academy. Part 2 of our Coding Education series will be posted soon (covering Endo, Oral Surgery, Implants and more)! ADA Coding Education ADA 4355 Resource ADA 4346 Resource If you find this information helpful, share it with a friend! Disclaimer: These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support, LLC TM has included links to any third party website (s), Dentistry Support, LLC TM intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support, LLC TM makes no representations or warranties about the information provided on those sites.

Part 2: Understanding EOBs (A little bit on appeals too!) What is an EOB? EOB: Explanation of Benefits. EOB does not mean dental claim. An EOB is similar to a receipt you may receive from a contractor. If you complete services for a patient you receive an EOB and a check for payment. While I wish there was a one size fits all EOB, this just is not the case. All EOBs are different and reflect different ways insurances factor their payment and deductions from payments made to a rendering provider. We are going to look deeper into this in just a moment. Simply put, your EOB is an important record of your office's dental services rendered for a patient. Five Main Things You'll find on an EOB: Claim information (what was submitted by the dental office?) Service and coverage information (the benefit of the patient's dental insurance plan) Explanation (was the claim paid? Details about the payment or denial) Patient identifiable information such as policy number, group number, and date of birth) Details on resubmissions needed (if applicable) How should you store an EOB? How long should you keep them? What do I do if my front office accidentally deleted it or forgot to upload it? First, always reach out to your state/local dental association for their requirements. This can vary by state. Second, insurance companies are required to keep these on file as records of payment for 7-10 years depending on their local rules and regulations. Ok, let's get to the good stuff. Scan EOBs into the patient's chart electronically, but if you have older dental software or an older computer this could bog down your server. It may be easier to store them in a file on your desktop by the date you posted the payment or closed the claim. Our biggest advice is DO NOT store paper copies. Now, if you want to, that is up to you but that MUST be locked on its own within your office. How do I properly bill for an associate doctor who is not credentialed yet? I see offices overcomplicate this all the time. It's simple. Always use the current and most recent version of the ADA Dental Claim form. There is a space for the location and rendering provider. If they are out of network, it will be paid out of network even if the office is in-network and according to those terms set forth by the dental insurance company. Credentialing must be done for any provider to whom you are seeking in-network benefits to be paid out. Why did the insurance pay less on the EOB than what we have written on the Breakdown of benefit? Most common reason: The office is not a participating provider or the insurance company needs updated credentialing information. If that is not the case, check the EOB for accuracy and resubmit with updated information along with a letter explaining why it was initially submitted in error. What is the formula for calculating the patient portion with a deductible? Fee - deductible x patient out of pocket % + deductible = patient portion Example: $1,000 crown $50.00 80% coverage by the insurance and 20% patient portion Let's solve the problem: $1,000 - $50 = $950.00 x .20 = $190.00 + $50.00 = $240.00 total patient cost. 7 steps to appeal Know the rules from the insurance company. Every insurance company is different and you want to follow the rules for how to send (electronic/snail mail) an appeal and submit for one. Always write a separate letter, Do not try to add notes to a claim. It will likely NOT be read and you will be reappealing. What should you write: Office Name Office Address Office Phone Number Office Email Address (They may email you updates) Patient Full Name Patient Address Patient Phone Number Patient Date of Birth Patient/Member ID Claim Number Reference Number 4. Use Clinical Notes. But give them sterroids. Add more information and make it worthy of reading. (Check out our narratives that can be added to your clinical notes.) 5. Attachments, send them again but give them sterioids. Add perio charting and intra oral photos. Do everything you can to give the most information possible. Seek out final reports from specialty dentists if you referred the patient out. 6. Change your words. If the dental insurance company said the initial claim is denied, you have to change it up. We want to avoid using any of the same nomenclature from the initial claim. Using the same verbage = the same denial. 7. Notify the patient the claim has to be appealed and ask them for help. The member calling the insurance is a BIG DEAL. Appeal Letter Template: Office Name Office Address Office Phone Number Office Email Address (They may email you updates) Patient Full Name Patient Address Patient Phone Number Patient Date of Birth Patient/Member ID Claim Number Reference Number Attachments: [List all attachments included with the letter] This is the [# of appeal] appeal submitted by the request of [patient name]. [Dental Office Name] has received a denial dated [date]. You have been provided sufficient proof [patient name] required [list treatment and tooth numbers]. Despite this medical and dental neccssity you have denied the claim due to [reason stated in denial]. The [list the treatment and tooth numbers] are necessary due [list narrative/clinical note reason here]. [Insert Doctors name] expressly requests you to consider the health and dental wellness of [patient name]. [Insert Doctors name] diagnosed and determined a need for this treatment. The standard of care for a patient with this condition is [insert treatment and tooth number rendered]. [Insert Doctors name] asks you to review the evidence provided and allow our patient the benfits they are rightly owed and qualified to receive. Common Definitions on EOBs: (Not all are listed from every insurance company, these are the most common) TH: Tooth Number SURF: Surfaces of the tooth treated (if applicable) Service Date or Date of Service: The date the patient was seen for the services they received in the dental office. Procedure Code: ADA code submitted by the dental office to define the service the patient received. Submitted Amount: The fee amount attached to the ADA code submitted by the dental office. Approved Amount: Depending on network status this is the maximum allowed amount the office can charge for the service. The dental insurance company will not pay on any amount exceeding. % Copay or Payment Level %: The dollar amount or percentage your dental insurance plan will cover per procedure. Contract Allowed or Allowed Amount: This amount depends on your employer's contract with Delta Dental, as some employers may place a dollar limit on certain procedures. In most cases, the approved amount and allowed amount will be the same. Coinsurance: The percentage above the allowance that is patient responsibility. Reference Code, Adjustment Notice, or Process Policies: Explains any limitation on your insurance coverage for the procedure you received. Procedure Description: Describes the treatments and procedures the patient has received at the dentist’s office. Fee Adjustment: The difference between the approved amount and the submitted amount. Claim Number: The number assigned to the claim that corresponds to the EOB. Other Insurance Paid: The amount paid by any other insurance a patient may have. Benefit Period: The period of time of a patient's coverage. Annual Maximum: The maximum dollar amount dental insurance will pay toward the cost of dental services and treatment. Tip: This is not the most a patient will pay out of pocket per year that is seen in medical insurance plans. Annual Maximum Used to Date: The amount of the patients plan maximum used to date during a benefit period. Overmax: The amount which exceeds the patients plan maximum during a given benefit period. Did you love this? Share it. K Thanks :) Disclaimer: These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support has included links to any third party web site(s), Dentistry Support intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support makes no representations or warranties about the information provided on those sites.

Part 1: Narratives and Attachments To say this training was a labor of love is NO JOKE! I am so excited to share with you the best tips for getting your claims paid and a couple of tips and tricks we have found helpful over the years. (PLUS insurance company-specific requirements). This hot topic is big and we never want content that takes more than 10 minutes to learn so, here is part ONE. Come back for part two soon. First, dental billing is waaaayyyyy different than medical billing. The coding and sending of claims is a unique process. It requires specific attachments, narratives, and information not readily needed on medical claims. Dental coding is based on Current Dental Terminology codes which are governed by the American Dental Association. Each year, the ADA provides code updates, revisions, deletions, and more. Staying up to date with these will be the first step to ensuring your claims are always submitted properly. Most dentists do not readily outsource their dental billing and coding procedures and we highly recommend this. Oftentimes, we see tiny breaks in processes of narratives, attachments, and claim submissions which can be avoided with just a few tweaks. Dental billing is a position that should be maintained by a specific position in the office rather than a blanket job for everyone to have a hand in. This training will provide your dental office with those very tweaks needed to improve claims and close the revenue cycle much faster. Narratives + Attachments Let's break this down by category and what you need to submit with claims. You might be like me and find that our doctors do not always put a clinical note in that helps us get a claim paid. So, we are going to help you with some templates you can use. No, we don't guarantee anything however if clinical notes are sparse, these templates can work wonders. Always check with your owner before implementing anything you find here. Alrighty... let's go... Osseous Surgery: Attachments: Intraoral photos if possible Narrative: Necessary to detoxify the root surface and to prevent further bone loss. 4263 +/or 4265 Bone Graft Replacement: Attachments: Intraoral photos if possible Narrative: Necessary to potentiate new attachment and to promote bone regeneration. 4341/4342 SRP- Scaling and Root Planing: Attachments: FMS (Full Mouth Series) and Periodontal Charting/Perio Chart) FMX and PERIO CHART attached. Narrative: Scaling and Root Planing necessary to remove subgingival microbiota both alive microorganisms and dead to prevent further bone loss. Optional Narrative: The patient has BOB, inflammation, unattached gingiva, with puffing interdental papilla, 5mm pockets in each quad or higher, sub and supra calc with tartar, poor OH. Needed due to gingival migration and bone loss. The patient presents heavy deposits and severe gingivitis. To treat patients needed to be anesthetized for a through S/RP. Radiographs show loss of crestal bone and to prevent further bone loss and attachment S/RP was diagnosed to which the patient agreed to treat. 4355 Full Mouth Debridement: Attachments: FMS + Periodontal Charting) Narrative: Full Mouth Debridement is necessary to remove heavy build-up of plaque and calculus in order to perform a comprehensive examination in the future. D4910 Periodontal Maintenance Treatment: Attachments: Periodontal Charting/Perio Chart Narrative: For CIGNA AND METLIFE (mandatory documentation): Include the SPR Hx(history) as narrative. Ex: SPR done on (mm/dd/yyyy) at UR and LR. Gingivectomy: Attachments: Intraoral photos if possible Narrative: Gingivectomy is necessary due to excision of the soft tissue wall surrounding a gum pocket in [Teeth #'s]. Inlay/Onlay (Code varies by material type): Attachments: pre-op x-ray and post op x-ray Narrative: Multiple fractures cusps, decay/recurrent decay, existing failing restoration minimally invasive procedure performed. Favorable prognosis and the patient has no further symptoms. 2740 Crown (Code varies by material type): Attachments: pre-op and post-op x-ray Narrative: Indicate if it is an initial placement or a replacement. Initial placement or existing crown replacement [date] . (SEAT DATE NOT PREP DATE). For replacement: Improper/poorly fitting EXISTING crown open margins, recurrent decay, the tooth requires full coverage support and favorable prognosis ….pt has no symptoms. Prior placement on [date]. 2931/ 2930 -Stainless Steel Crown/SSC: Attachments: pre-op and post-op x-ray Narrative: Stainless steel crown on #_____ to restore the tooth from decay for longer-term effectiveness in preventing recurrent caries. More on Crowns... Crown due to decay: Attachments: pre-op and post-op x-ray Narrative: [Tooth #] has been destroyed by caries/fracture and requires crown restoration. Crown with core build-up due to composite failed: Attachments: pre-op and post-op x-ray Narrative: Initial placement of a crown on [Tooth #] due to large old composite filling that is broken & recurrent decay. <50% natural tooth left. A build-up & crown is necessary to properly restore the tooth. Crown with core build-up due to amalgam failed: Attachments: pre-op and post-op x-ray Narrative: Initial placement of a crown on [Tooth #] due to a large old amalgam filling that is broken & recurrent decay. <50% natural tooth left. A build-up & crown is necessary to properly restore the tooth. Crown for Implant: Attachments: pre-op and post-op x-ray Narrative: [Tooth #] was extracted on mm/dd/yyyy. A surgical implant was placed to replace the missing tooth on mm/dd/yyyy. Implant crown and custom abutment were placed to restore chewing function in the arch and to retain the integrity of the bone and facial structures. Crown Lengthening: Attachments: PA x-ray and BW x-ray Narrative: Crown lengthening needed on [Tooth #] due to improper biological width. Without the procedure, the crown margin would have been placed too close to the bone. Redo Crown/Core Build-up: Attachments: pre-op and post-op x-ray Narrative: [Tooth #] date of original placement was mm/dd/yyyy. Needs build-up and new crown restoration due to excessive decay and/or margin opening. Veneer Attachments: pre-op and post-op x-ray Narrative: Large missing or damaged Enamel, or incisal, facial surfaces require coverage due to lack of support/structure, the only alternative would be a crown, DDS diagnosed least invasive procedure. Favorable prognosis and the patient has no further symptoms. Bridge Attachments: pre-op and post-op x-ray Narrative: Bridge prepped site [Tooth #] and [Tooth #] was extracted on mm/dd/yyyy or (cognitively missing). To preserve the site and occlusal plane. Favorable prognosis and the patient has no further symptoms. (The wing or retainer is dental code D6548 for porcelain. The pontic tooth is dental code D6245 for porcelain.) Root Canal Tx (Endodontic Therapy): Attachments: pre-op and post-op x-ray Narrative: Gross decay into the nerve and Root Canal performed unto the pulp and apex of the tooth, all decay removed, build up space will be required. Favorable prognosis and the patient has no further symptoms. Core Build-up after Root Canal: Attachments: pre-op and post-op x-ray Narrative: Build-up required due to previous root canal therapy and tooth structure loss upon removal of decay. Build-up performed to restore occlusal plane and successful final restoration support. Favorable prognosis and the patient has no further symptoms. Extraction: Attachments: PA x-ray and BW x-ray Narrative: Due to Gross Decay [Tooth #] required extraction to preserve sight and surrounding teeth. Favorable prognosis and the patient has no further symptoms. Extraction site to be restored at a later date. Extraction of Wisdom Teeth (1, 16, 17, 32): Attachments: Panoramic x-ray Narrative: Extraction of wisdom teeth number(s) 1,16,17 and 32 due to the patient is having pain/swelling. Teeth are difficult to clean - preventive measures to avoid serious problems in the future. Bone Graft: Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray Narrative: Bone graft placed at site [Tooth #] to preserve the site and occlusal planes for future restoration. Favorable prognosis and the patient has no symptoms. Extraction and Bone Graft Placement: Attachments: PA x-ray and BW x-ray Narrative: [Tooth #] extracted due to extensive decay and non-restorability. Bone graft needed for ridge preservation for future restoration. Extraction of Primary Tooth: Attachments: PA x-ray +/or BW x-ray Narrative: Over-retained [Tooth #] causing inflammation of the gingiva Membrane: Attachments: Intraoral photos if possible Narrative: Barrier use to protect and promote ridge preservation and success of the graft site. Frenulectomy: Attachments: Intraoral photos if possible Narrative: Frenectomy performed increases the range of motion of the tongue and will allow the child to position the tongue normally in the palate. This can help with chewing, swallowing, and speech. 6010 Implant: Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray + date tooth # was extracted. Narrative: Implant placed at site [Tooth #] of which was extracted on mm/dd/yyy. To preserve the site and occlusal plane for future restoration with favorable prognosis. The procedure was medically necessary for patient to chew and masticate food properly. Favorable prognosis and the patient has no symptoms. Abutment: Attachments: PA x-ray +/or BW x-ray Narrative: Custom abutment [Tooth #] placed to restore chewing function in the arch and to retain the integrity of the bone and facial structures. Denture: Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray Narrative: Denture on [Teeth #'s] or Maxillary or Mandibular for the replacement of missing teeth necessary for pt to chew and masticate food properly. [Teeth #'s] extracted on mm/dd/yyyy. ***If replacement denture include the initial date of delivery for prior denture(s). 5820 Interim Partial Denture: Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray Narrative: Interim partial denture needed to replace [Teeth #'s]. The patient plans to get an implant placed in the future and the interim partial denture is intended to be in place for the next 12 months. [Teeth #'s] extracted on mm/dd/yyyy. 9920 Behavior Management: Narrative: The patient is uncooperative and difficult to manage resulting in dental staff providing additional time, skill, and/or assistance to render treatment. 9230 Analgesia: Narrative: Analgesia needed to reduce anxiety. Night/Occlusal Guard: Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray Narrative: Acute bruxism and occlusal wear with head, neck, and jaw pain. Occlusal guard diagnosed with favorable prognosis. 1999 PPE: Narrative: PPE per levels required by the CDC for transmission-based precautions ORAL CAVITY CODE GUIDE (used for coding on Dental Insurance Claim Forms) Did you love this? Share it. K Thanks :) Disclaimer: These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support has included links to any third party web site(s), Dentistry Support intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support makes no representations or warranties about the information provided on those sites.

We promise, by the time you read this 5-minute blog your team will be equipped to fill your dental office schedule, immediately. Don't worry, if you are short on team members, just connect with us and we have your back... and your schedule :). Six months ago was the beginning of the Pandemic. Six months ago, everything changed in Dentistry and a lot was left on the table we could not finish. So, before you read the best practices we recommend, head back to April and take a look at what was on the schedule then and completed (if you were able to). Alrighty...What patients to call...its the big question... Follow these steps... they really really work. Do not start with everyone who is due next month... Start with patients who were scheduled 6 months ago that were not able to be seen. Work your way forward on your schedule from there. Pull a list in your software of everyone due from six months ago to today. Once you contact all of those patients (according to the schedule below, then pull a reactivation list (patients 18 months back who have not returned) The first thought must be, let's get the low hanging fruit first. It is better to call people due that aren't scheduled. We think it all depends on what your dental office considers low hanging fruit. We have tried so many versions of pulling reports and contacting patients, and this method has proven to be most successful for our team. How to contact... Did you know, 70% of patients prefer text/email contact over phone contact? I bet you are about to say you have an automated texting service that currently is working great for your office and it's already in place, cool... yep... we love it. We actually recommend many offices go ahead and get an automated reactivation going as a backup. Now let's talk about what you can still do... Those texts are the same verbiage every office uses to schedule. Your patient is likely reading the first couple of lines and then never calling in. I mean maybe 10% scheduling (if we are lucky) is coming from this. Verbiage is key. What we say is everything and if the verbiage you're saying/texting is still a version of "Hi Sam, you are overdue for your next cleaning appointment, please call 777-777-7777 to schedule your appointment" "Hi Angie, this is Sarah Beth from Happy Smiles Dentistry and I am calling because Dr. Tooth is concerned because you are overdue for a cleaning." I think we are missing the boat on "sticky statements" "A sticky statement is that one line, that one statement that if the patient wants to disregard anything you're saying, they will most likely to respond to this statement." -Sarah Beth Herman CEO, Dentistry Support So, how do we do this? How do we get the patient to respond when we know we are calling to "sell them on an appointment"? Here is what works for us ... (Our current record is over 30,000 Continuing care calls in 1 month) Verbiage First, let's talk about the best one-liner ever. Truths about this statement: 1.) We are calling about their dental appointment. We are hoping to schedule it. 2.) It generates a call especially if the patient does not think they have a dental appointment. 3.) If the patient calls, it means it (the best "one-liner" ever) worked. We generated a call!!!! Get the phone ringing. How to Answer... When the patient calls back and proclaims they "have no appointment" be sweet. Share with them you did not mean to alarm them but were hoping to schedule an appointment for their next cleaning appointment. You can express concern, or simply well-being sentiments for them. The nicer you are, the more you smile, the kinder you sound... the more likely the patient will respond in likeness. So, what is "the magic?" I once had a dentist tell me, I had the magic. I always knew what to say and how to say it to change everything about the way a patient would schedule or accept treatment. I had the magic to just make it happen. Well, I'm sharing the magic we use here at Dentistry Support with you now. This one sentence below is the one I hope you will always remember. When you speak to the patient and are hoping to schedule them, say only this. What if they still do not want to schedule and they are irritated? This is an opportunity to still get them on the schedule. We can still count this as a success because we did connect with them. Focus on updating their contact information or private information if it has been a while What can I say when they do not want to schedule or want to call me back? Why would I say this? We do want to schedule now. We always want to say we had a "change" in the schedule. Avoid the word "opening" because it gives the illusion that the schedule is open, and at any time if they cancel in the future, you will offer their "opening" to another patient and it will be just fine. We always encourage dental offices to please focus on today first. Today is the best day for any patient to come in. When is the next best day? TOMORROW! :) Our goal is to schedule no further out that the most immediate 5 business days. We need our chances of someone arriving for an appointment to be greater than 50%. Can I force my patient to schedule? Well, kind of... When a patient says no, and then no again and they just want to get off the phone, how about you try this? Offer to place them on the schedule 1 week from now (yes we know there is a more than 50% chance they will no show) and tell them you will call them 2 days before the appointment to check availability and ensure they can make it. Explain how important it is that we do schedule now. Of course, if the patient is uninterested, that is ok. You have done your best. You have made every effort and we will keep trying. Begin again with the same message, call about their appointment, after all, you hope to schedule it. We hope you found this mini-training helpful. We hope you are using the tips here to fill your schedule and bring more patients than ever into your dental office. Disclaimer: These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support has included links to any third party web site(s), Dentistry Support intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support makes no representations or warranties about the information provided on those sites.

Hey, we all Google things some times, and that is ok! So, let's chat about what Labor Day is... First, thank you for your contribution to the dental world. We appreciate you and all you have helped our industry become. Without your dedication to advancements in both technology and patient experience, a dental appointment would never be what we know it to be today. Hey, this is a quick 4-minute read, and who doesn't want to know a tiny bit of history? History of Labor Day Labor Day: What it Means Labor Day, the first Monday in September, is a creation of the labor movement and is dedicated to the social and economic achievements of American workers. It constitutes a yearly national tribute to the contributions workers have made to the strength, prosperity, and well-being of our country. Dental Labor Facts In 1840, the first dental college (Baltimore College of Dental Surgery) opened, establishing the need for more oversight.  In the United States, Alabama led the way by enacting the first dental practice act in 1841, and nearly 20 years later, the American Dental Association (ADA) was formed. The first university-affiliated dental institution, the Harvard University Dental School, was founded in 1867. Other Fun Teeth Facts Hesy-Re was an Egyptian scribe who lived around 2600 B.C. and is recognized as the first dental practitioner. Paul Revere, famous for warning Colonial troops that the British were coming, was also trained as a dentist by America’s first dentist, John Baker. Edward H. Angle, who started the first school of orthodontics in 1901, created a simple classification for crooked teeth in the late 1800s, a system still in use today. The first dental X-ray was used in 1896. Labor day legislation... The first governmental recognition came through municipal ordinances passed in 1885 and 1886. From these, a movement developed to secure state legislation. The first state bill was introduced into the New York legislature, but the first to become law was passed by Oregon on February 21, 1887. During 1887, four more states – Colorado, Massachusetts, New Jersey, and New York – created the Labor Day holiday by legislative enactment. By the end of the decade Connecticut, Nebraska, and Pennsylvania had followed suit. By 1894, 23 more states had adopted the holiday, and on June 28, 1894, Congress passed an act making the first Monday in September of each year a legal holiday in the District of Columbia and the territories. Founder of Labor Day More than a century after the first Labor Day observance, there is still some doubt as to who first proposed the holiday for workers. Some records show that Peter J. McGuire, general secretary of the Brotherhood of Carpenters and Joiners and a co-founder of the American Federation of Labor, was first in suggesting a day to honor those "who from rude nature have delved and carved all the grandeur we behold." But Peter McGuire's place in Labor Day history has not gone unchallenged. Many believe that Matthew Maguire, a machinist, not Peter McGuire, founded the holiday. Recent research seems to support the contention that Matthew Maguire, later the secretary of Local 344 of the International Association of Machinists in Paterson, N.J., proposed the holiday in 1882 while serving as secretary of the Central Labor Union in New York. What is clear is that the Central Labor Union adopted a Labor Day proposal and appointed a committee to plan a demonstration and picnic. The First Labor Day The first Labor Day holiday was celebrated on Tuesday, September 5, 1882, in New York City, in accordance with the plans of the Central Labor Union. The Central Labor Union held its second Labor Day holiday just a year later, on September 5, 1883. By 1894, 23 more states had adopted the holiday, and on June 28, 1894, President Grover Cleveland signed a law making the first Monday in September of each year a national holiday. A Nationwide Holiday The form that the observance and celebration of Labor Day should take was outlined in the first proposal of the holiday — a street parade to exhibit to the public "the strength and esprit de corps of the trade and labor organizations" of the community, followed by a festival for the recreation and amusement of the workers and their families. This became the pattern for the celebrations of Labor Day. Speeches by prominent men and women were introduced later, as more emphasis was placed upon the economic and civic significance of the holiday. Still later, by a resolution of the American Federation of Labor convention of 1909, the Sunday preceding Labor Day was adopted as Labor Sunday and dedicated to the spiritual and educational aspects of the labor movement. The character of the Labor Day celebration has changed in recent years, especially in large industrial centers where mass displays and huge parades have proved a problem. This change, however, is more a shift in emphasis and medium of expression. Labor Day addresses by leading union officials, industrialists, educators, clerics, and government officials are given wide coverage in newspapers, radio, and television. The vital force of labor added materially to the highest standard of living and the greatest production the world has ever known and has brought us closer to the realization of our traditional ideals of economic and political democracy. It is appropriate, therefore, that the nation pays tribute on Labor Day to the creator of so much of the nation's strength, freedom, and leadership – the American worker. Resources: Department of Labor AEDA Disclaimer: These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support has included links to any third party web site(s), Dentistry Support intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support makes no representations or warranties about the information provided on those sites.

Let's have a chat. For real, we gotta chat. There is some seriously mixed information running around town about primary and secondary insurances and once and for all, we want to be the resource that helps bring clarity to this confusing topic. This is a 6-minute read you need to take the time to look over. Let's go. What if my favorite unicorn patient walks in with two dental insurances? Do I wave the white flag of surrender? Do I tell them the age-old phrase "We are just a 3rd party, how your insurance works is between you and your insurance company, we are filing this claim as a courtesy... figure it out." Do I tell them, we don't process secondary claims? No ma'am/sir, and we can teach you exactly how to process dual insurance. Personally, it's our opinion dental offices across the nation have become accustomed to these phrases, quotes, lines, and what have you because we simply just do not know how to process dual insurances. So, here is a bunch of free carrots for you today. Oh, and if we beg please don't be one of those "I know everything" people with the hopes of proving it wrong, we went to the experts like the ADA, Delta Dental, and the National Association of Insurance Commissioners for this information. We worked hard to put this together and want to bring you all the good stuff we possibly can. Let's be here to encourage and build each other, not break down and criticize :) Alright, let's do this... When a patient has two dental insurances, this is called "dual coverage." This does not mean "double" the coverage (contrary to popular belief). However, it may reduce out-of-pocket expenses depending on treatment diagnosed by a dentist. Dual coverage works the same way whether a patient is covered by two dental plans that are the same or two entirely different dental insurance companies. You will notice many insurance companies do in fact work together to coordinate your patient's benefits. So, which plan pays first?? The chicken, or the egg? Haha... We are only kidding... For real though, the dental insurance plans set forth rules to determine which plan pays first, ("primary") and which plan pays afterward ("secondary"). The general rule is that the plan that covers the patient as an enrollee is the primary plan and the plan which covers the patient as a dependent is the secondary plan. For a child's coverage, generally, the primary insurance company is determined by the birthday rule (i.e., coverage of the parent whose birthday —month and day, not year — (SAY IT LOUDER FOR THE PEOPLE IN THE BACK) comes first in the year YOU ARE CURRENTLY IN is considered to be your children's primary coverage). A divorce agreement or other court ruling may supersede the birthday rule. Better safe than sorry to ask for this if you have a divorce or court situation (especially you pedo and ortho offices that see way more of this...) How dual coverage works For example, if both of your patient's plans provide two cleanings a year, each with 80 percent coverage, then: Your patient would not be entitled to four cleanings a year. Your patient may want to argue this but we promise we are right here... The primary plan pays its benefit as if there is no other insurance Yep, you read that right... The secondary plan will act as a supplement to the primary plan with its payments limited to the lesser of its normal benefit or the patient’s out-of-pocket costs under the primary plan. Ok, we know some of you are about to send an email right now because you have seen BOTH insurances pay the max amount of the prophy on a single visit. Your office knowingly accepting this is insurance fraud. You need to do the right thing, call the insurance, and request the process of a recoupment. A simple audit can be done and the insurance company will request it anyways. Do not hold on to it, the headache of them recouping it on their own accord by subtracting from another patient's insurance payment is NOT worth it. What does Non-duplication of benefits clause mean? Some dental benefit plans have "non-duplication of benefits" provisions. This means that the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows for that dentist. For example, if both the primary and secondary carriers pay for the service at an 80 percent level but the primary allows $100 and the secondary carrier normally allows $80 for the same treatment, the secondary carrier would not make any additional payment. However, if the primary carrier only pays 50 percent of the dentist’s allowed fee, then the secondary carrier would reduce its payment by the amount paid by the primary plan and pay the difference. In this case, the secondary carrier would pay $14 ($80 x 80 percent - $50 = $14). Types of coordination of benefits (COB) Many factors determine how COB is handled, including state laws, processing policies of the carriers involved, contract laws, fully insured versus self-funded plans, and types of COB used. The ADA has brought us many resources to explain the Coordination of Benefits. There are many different acronyms, titles, and slang terms for COB methods, here are a few of the most common we have seen. • Traditional—Traditional coordination of benefits allows the beneficiary to receive up to 100% of expenses paid from a combination of the primary and secondary dental insurance plans. • Maintenance of benefits (MOB)—This reduces covered charges by the amount the primary plan has paid, and then applies the plan deductible and coinsurance criteria. Consequently, the plan pays less than it would under a traditional COB arrangement, and the beneficiary is typically left with some cost-sharing. • Carve out—Carve out is a coordination method that first calculates the normal plan benefits that would be paid, then reduces this by the amount paid by the primary plan. • Nonduplication COB—In the case of nonduplication COB, if the primary carrier paid the same or more than what the secondary carrier would have paid if it had been primary, then the secondary carrier is not responsible for any payment at all. Nonduplication is typically used in self-funded dental plans. A self-funded dental plan is one in which the plan sponsor bears the entire risk of utilization. • Self-funded plans are exempt from state insurance statutes and are generally governed by the Employee Retirement Income Security Act (ERISA). In 2012, 49% of people with a dental benefit had a self-funded plan. It is important that dental offices understand that not all patients will have a dental plan that is subject to the state’s COB laws. ADA policy opposes non-duplication provisions, and at least one state, California, has enacted legislation prohibiting such provisions. Network plan write-offs The difference between the dentist’s full fee and the sum of all dental benefit plan payments and patient payments is the amount of the write-off. Write-offs should not be posted until all plans have paid accordingly. If a write-off is posted after the primary pays and then posted again based on the secondary payment, it is possible the dental office may incorrectly apply a credit to the patients’ balance. Remember to always submit your full fee on the dental claim form. Medicaid, Medicare, and Coordination of Benefits By law, all other available third party resources must meet their legal obligation to pay claims before the Medicaid program pays for the care of an individual eligible for Medicaid. Thus, Medicaid is typically secondary to any other benefit plan. In cases that involve a patient presenting with a retiree plan, Medicare and the patient has coverage on a spouse’s plan, generally any dependent coverage pays first, Medicare pays second and any nondependent coverage (e.g. retiree coverage) pays third. National Association of Insurance Commissioners (NAIC) The NAIC has drafted model regulation on coordination of benefits and recommends that states pass similar legislation so that benefits can be coordinated uniformly across states. The ADA supports this also and recommends that state dental association’s attempt to pass similar legislation. Overall, navigating the path of coordination of benefits can be a frustrating and time-consuming endeavor for dental offices trying to settle accounts for patients with more than one dental benefits plan. In addition, state laws and regulations often mandate coordination of benefits. If after the claim payment has been made and it appears to have been incorrectly adjudicated it is recommended that the claim determination be appealed and if necessary the state insurance commissioner’s office be contacted for assistance. Read this blog twice if you need to. Know what you are looking at and honestly, the success of understanding this all begins with the proper insurance verification. References ADA NAIC Interested in learning more about how we can support your dental practice? Take a look around our website and schedule a call to chat, we would love to learn more and help your practice to thrive!! If you find this information helpful, share it with a friend! Also, stay tuned because we have a blog coming up ALL ABOUT WRITE OFF's, you don't want to miss it. Disclaimer: These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support has included links to any third party web site(s), Dentistry Support intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support makes no representations or warranties about the information provided on those sites.

Proper Care + Generating Revenue: A guide to the best breakdown of benefits you've ever seen. We think it is time our breakdown of benefit's leveled up! Let's talk about what your dental offices breakdown of benefits... we're talking the "should and should not's" of this hot topic. First, prepare your practice to verify benefits with the mindset that this is for the best patient care possible and to generate revenue. Your dental practice is a "for-profit" company. Yes, you are in the medical/dental field so you have a duty to provide care for patients according to the oath taken at dental licensing. But does that oath mean you do not work to know how you can maximize benefits and patient care, simultaneously? No. The answer is emphatically, no. Second, every time you hire someone for dental front office, dental admin or dental office manager, you are going to receive a new opinion or theory on how things should be run in the dental office. This is tough because how do you know what is the right thing to do? Welp, look no further, come back to this blog post for all the updates you ever need, and yes, they are free. Ok, let's get to business here. I think it's best to bullet point this mama of information so we can keep track. Let's start with my favorites... Did you know... In the average dental practice, there are over 3 million dollars in pano's and pa's that go overlooked throughout the lifetime of the dental office? $3,000,000.00 Let that sink in for a minute. The 4210 + 4211 codes can be billed for crown lengthening when used with a laser? There are some insurances who have a specific number of days you must wait to perform a 4910? Some require only 6 weeks and therefore this can be done sooner than 3 months after the 4341/4342. Some insurance companies allow coverage for a temp crown (2799) and it is not inclusive of a crown code? Irrigation can be a covered benefit but if you do not ask "is it inclusive with SRP?" it can still be denied? 4346 (scaling) + 4355 (FMD) can have age limitations? Implants can downgrade to partials? Bone graft can be covered but if placed with an implant it can be denied if there is no implant coverage? I mention these top 8 questions because it is what I see first with breakdowns when we onboard new clients. Breaking down the Breakdown (yes, we really use this form for our clients and its fully customizable for your dental office.) Let's talk initial information. Not every insurance offers all of the information your office may want to gather. Be patient and understand that some insurance companies have spent a lot of time creating plan policy while others have more straight forward payment processes. Get the Representatives name + Reference number if you call for a break down. (say it louder for the people in the back) We have had more than one occasion where a rep states coverage and the claim is later denied. We record all calls and document every reference number and rep name. So, when the claim is denied, we appeal it with the reference number and recording and BOOM - you've got yourself a PAID CLAIM! (We always call and escalate this ahead of time) Pre-Auth's... Check this. You do not want to be caught with a plan where pre-auth's are required and you never sent one in. Coverage details are important, especially if your office offers Orthodontic treatment. If you need help with ortho billing, check out our blog on this topic. It is seriously a life-saver. Know the difference in ortho max vs plan max (two different things). Check your waiting periods Check for missing tooth clause. (A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. But it also hinders the patient if they were unable to get insurance until that point and need to have treatment done to improve their dental health). Diagnostic and Preventive is a category often over looked. Let's take a look at the value of checking the information we have pictured here. CBCT, check it. Of course if you do not offer this, thats ok. But imagine how many night guards you can get here??? Many patients are silent sufferers. Find out if BWX are downgraded to FMX, if you do not you could end up writing off services rendered. Are exams shared? If they are not, you could have frequencies available to use for different exams. If they are, you could be performing an exam that is not covered. Do not just assume its going to be covered because it is a different code. Fluoride, Sealants and Preventive Resin Restorations all should have Age checks, Pre-Molar Checks and HISTORY! Say it again, folks... HISTORY!!! Restorative eligibility verifications can bring great information to your dental practice, as long as attention to detail is made. Check for downgrades + what the alternate benefit code is. A standard practice for most dental practices is to assume a downgrade is to a PFM but it could downgrade to a base metal. Know insurance plan provisions and policy. Do you know when to bill out the crown? Some insurance plans will not pay unless the crown is seated and they require a PA of the area to prove it!! Are you checkin inlays/onlays etc? All of which are a great alternative to fillings due to the structure. (I know you know this.) Last but not least, my fav.... Are crowns covered for Bruxism? This is relatively new (last 1-2 years) but it is becoming increasingly common for this type of coverage). The thing about Implants, Oral Surgery and Adjunctive is that most front office or administrative team members have little knowledge on how this works. So, if thats you, it is ok! Just start slow and learn your terminology. Learn how plans interact with various types of procedures. Some insurance policy's actually pay implants regardless of coverage in certain scenarios. In recent months we have begun to see separate maximums specifically for implant coverage that does not apply to the standard maximum (similar to Ortho). Check to see if Implant coverage exists but the code is downgraded to a partial and paid at the partial fees/benefit level. Bone grafts/implants: Insurances can be super tricky and deny coverage if placed the same day or in conjunction with an implant. Of course, we have breakdowns of benefit which are much more detailed than this. Every break down we create for our clients is specific to their office needs. The information you are reading here is likely less than 5% of everything you need to know about verifying insurances for your patients. The key is to understand how your dentist diagnoses and treats patients so you are able to understand how their plan will work in your office. Every dentist is different and their level of urgency, conservativeness and experience will all vary. Each of those three things play large roles in delivering treatment plans. We often update this page frequently with tips and tricks for break downs. This information is free for everyone and not intended to replace or undermine the diagnosis of any dentist or dental professional. Interested in learning more about how we can support your practice? Take a look around our website and schedule a call to chat, we would love to learn more and help your practice to thrive!! If you find this information helpful, share with a friend! Disclaimer: These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances.This content is not intended or offered, nor should it be taken, as legal or other professional advice.You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support has included links to any third party web site(s), Dentistry Support intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support makes no representations or warranties about the information provided on those sites.