This blog post has been a major labor of love. Many hours of research have gone into its existence. Difficulties in PPE billing in dental offices nation wide have become its own virus of sorts. The cost of infection control procedures has skyrocketed and dental offices are facing a significant financial challenge navigating this environment. Further, costs of personal protective equipment (PPE) including N95 masks, surgical masks, face shields, gowns and shoe covers, has increased due to supply shortages with prices variable across the nation. Please be aware that simply billing a D1999 on a dental insurance claim form is not the answer. Some insurance companies are simply putting a credit (if qualified) on your Henry Schein account or issuing a lump payment if you are on EFT and in-network. There are so many specifics that you must be aware of. This post includes a list of insurance companies and their current coverage of PPE at the very bottom. Please read each insurance company information carefully. There are many requirements, multiple payment methods, eft requirements and credits to Henry Shein Accounts for PPE. We encourage you to share with fellow dental offices. If you need help with your dental billing, let us know. We are happy to help you navigate these uncertain waters. You can schedule a call to learn more about Dentistry Support here. Recommended Fee Changes Dental offices are encouraged to either: Adjust the maximum allowable fees for all procedures or Allow a standard fee per date of service per patient to accommodate the rising costs of PPE. Alternatively, dental offices may wish to utilize the following code: “D1999 - unspecified preventive procedure, by report” to document and report the use and cost of additional PPE. Dentists can use this code once per patient visit/claim to attempt to cover the cost of PPE Frequently Asked Questions What PPE should I use? The use of PPE is dependent upon professional judgment based on hazard assessment including community transmission, administrative & engineering controls, availability of PPE as well as any states laws or regulations. How much can I charge for PPE? We are here to provide information rather than guidance on this area. Please note that: A dentist individually determines whether to charge and his or her full fee for any procedure delivered and reported with a CDT code. Neither the ADA nor the CDT Code establish fee schedules for the listed procedures. Third-party payers determine their own reimbursement amounts for services covered by the applicable dental benefit plan. It is always best to inform patients of any additional charges to avoid any surprise bills. Providing a documented financial policy and seeking consent is desirable. I don’t think the payment that the third party payer paid me covers the exorbitant costs of PPE I am facing. Can I balance bill my patients separately? If you are not a participating provider: yes, you are able to balance bill the patient up to your full fee. Inform the patients prior to the visit on any changes to your charges or financial policy. If you are a participating provider: it depends. Dentists who have signed participating provider agreements have a contractual relationship with their third party carrier. These agreements determine policies that the dentist has agreed to accept. Can I charge only my uninsured patients for increased PPE costs? It is unethical to only charge uninsured patients or only seek reimbursement for insured patients to address the costs of PPE. I heard that payment may be delayed because I reported a D1999 code? In general, a “by report” code may prevent auto-adjudication of claims. Manual review is typically required to process codes with accompanying remarks resulting in a delay in processing payments. How do I find more information on the State Medicaid and Children’s Health Insurance Program (CHIP) Agencies and what they are doing during COVID-19? Here is a link to the most up to date FAQ page. I heard that some payers may pay a standard fee without my reporting a D1999 code? Yes. Some payers have begun launching programs to provide financial support for reopening or recovery of dental offices and/or to support the cost of PPE. We will list more information on this at the bottom of this blog. Payments, Programs, Policies for reimbursement of PPE Please read this section carefully. We periodically update this page as new information is released to us. All information listed below is updated as of July 30th, 2020. MCNA Nebraska Medicaid MCNA is covering Personal Protective Equipment (PPE) for a limited time. Effective March 13, 2020 through June 30, 2020, the following code may be utilized: D1999 - unspecified preventive procedure, by report – Fee $10 This code is to document and report the use and cost of PPE. Limited to one per member, per date of service (DOS) by the same provider, facility, or group. Must be submitted with other services. If your office has already submitted claims for PPE utilizing D1999, no further action is necessary. MCNA will reprocess the claims that fit the criteria listed above. If your office submitted claims from March 13, 2020 through June 1, 2020 that did not contain reimbursement for PPE utilizing D1999, MCNA will automatically process each claim submitted and pay a single D1999 at $10. You do not need to take any further action and the criteria listed above will apply Humana As of June 1, Humana will pay an additional $7 per Humana member dental claim – for all fully insured Humana dental members [excludes ASO, Network Access, and Discount plans] At the end of each month, Humana will send a stipend to its dental provider partners, based on the total number of claims for Humana members that month. At this time, the additional funding will be available from June through September 2020 for all fully insured Humana dental members. Anthem Anthem will provide in-network dental providers a PPE Credit of $10 per patient, per visit, from June 15th through the end of August. CareFirst BlueCross BlueShield CareFirst is reimbursing $7 per claim, per date of service for personal protective equipment. This reimbursement is for dates of service June 1 through August 31, 2020, and is limited to once per patient, per provider, per day. During this time period, claims should be submitted with code D1999 and must include the primary service(s) performed. Cigna Cigna will reimburse in-network providers in both PPO and Cigna Dental Care® networks at $8 per claim, per date of service. The allowance is for claims processed between June 15 and July 31, 2020, and is limited to once per patient, per day. During this time period, claims should be submitted with code D1999 for reimbursement consideration. Reimbursement for dates of service on or after April 1, 2020, is limited to U.S. Commercial and Individual dental plans and may be excluded by certain clients. Standard policies regarding infection control remain in place as outlined in our Dental Office Reference Guides which are incorporated by reference into the provider agreement. United Concordia (UCCI) Allowing providers $10 per patient visit for dates of service from 5/1/2020-6/30/2020 to help cover the costs associated with purchasing masks, sterilization procedures, and other CDC requirements resulting from COVID-19. This coverage will apply to United Concordia administered business only, including: PPO commercial, Medicare Advantage, TRICARE Dental Program (TDP), Active Duty Dental Program (ADDP), Federal Employees Dental and Vision Insurance Program (FEDVIP), Gateway Health Medicare and Medicaid and its partnership business. To align with ADA guidance, please use procedure code D1999 unspecified preventive procedure, by report. Claims must include procedure code D1999 to be eligible to receive payment for PPE. D1999 can be used once per patient visit to cover the additional costs for PPE UPMC Health Plan Starting July 15, UPMC will be reimbursing $7 per claim with the code D1999 through September 30, 2020 for both Commercial and Government programs. Balance billing to patients is prohibited. Lincoln Financial Group Offering a temporary Personal Protective Equipment allowance of up to $10 (or contracted PPO fee if applicable) per patient visit for dates of service beginning August 1, 2020 continuing until further notice. This payment applies to both in- and out-of-network providers and insured dental members. The payment is available for all fully insured plans. Self-funded groups may opt in, but not required to cover. Claims must include procedure code D1999 to be eligible to receive payment for PPE. Excludes ortho monthly payments Principal Offering a Personal Protective Equipment payment of $7 per patient for June – December 2020 for in-network dental providers and insured dental customers. This payment is intended to support our in-network dentists and keep member’s safe during this time. Charges for PPE are considered non-covered services. Any amount charged over $7.00 for Personal Protective Equipment is patient responsibility. The $7.00 payment does not apply to the member’s calendar year maximum benefit amount. HealthPartners Dental Plan Beginning June 17th the HealthPartners Dental Plan will reimburse providers in the network the amount of $10 per visit through the use of the CDT code “D1999 - unspecified preventive procedure, by report” to document and report the use and cost of additional PPE. Dentists can use this code once per patient visit/claim/day to attempt to offset the heightened cost of PPE. The provider agreement does not allow billing or balance billing the patient directly for this procedure. This program will remain in effect through September 30, 2020. This reimbursement will impact our fully-insured book of business and will exclude all Medicaid. Work is underway determining how this would apply to self-insured clients as, by definition, this is their ultimate decision. HPDP is strongly encouraging them to cover this claim. United Healthcare Enhanced Provider Payment (EPP) financial relief program requires enrollment by eligible providers at www.UHCDental.com. Eligible providers include those who are Par Providers, Commercial (PPO), Medicare Advantage (FFS), and Medicaid (FFS) participating providers. DHMO and Direct Compensation Providers are not eligible for this program. Providers currently enrolled in UHC’s Electric Payment System (EPS) will receive the relief payments starting the 1st of the month after enrolled in EPP. If not currently enrolled in EPS, visit www.UHCDental.com to enroll. EPP payments will be earned for claims that include payments for codes D0120 ($5), D0140 ($10), D0145 ($5), or D0150 ($10). Providers are not required to submit a separate claim or line item on a claim to receive the additional EPP financial relief payment as payment is automated once the provider enrolls and will be limited to 4 payments per patient per provider per month. This program is available to providers submitting claims with dates of service between June 24, 2020 and December 31, 2020. Claims with dates of service beginning the first of the month after your enrollment date will be eligible for additional payments. Example – if you enroll in the program on June 24, all claims with a date of service beginning July 1 and beyond will be eligible for payment. Patients cannot be charged an additional service fee when receiving an EPP payment from United Healthcare Dental for the same visit. Unless specifically permitted by state regulatory agencies through publicly available documentation, providers are not permitted to pass through additional charges related to protective equipment, sanitation procedures, or other equipment or administrative needs to Medicaid members. Similarly, providers are not permitted to pass through additional charges related to such equipment, procedures, and needs to Medicare Advantage members Dominion National Dominion will provide payments to its participating dentists of $5 per in-network PPO, ePPO or Preventive covered plan visit to help with the costs of PPE, which includes N95 masks, gowns and other protective equipment designed to help with infectious disease control due to COVID-19. PPE payments will begin for services starting June 15, 2020 and may extend through the end of the year. Subject to change based on state mandates and experience. The Dental Care Plus Group DCPG will reimburse your office $10 per patient visit during May and June of 2020. This reimbursement will be paid monthly 'outside' of the normal claim payment processes and will be based on claims with a date of service in May and June. Separate payment will be issued in June and July of 2020 for the prior month’s patient encounters. DCPG prefers that D1999 not be used for PPE. Payments will be made without the use of this code. Florida Combined Life (Florida Blue)/ Arkansas BlueCross BlueShield Dental/ HMSA Dental (Hawaii Blue Cross) Authorizing participating dental providers to bill charges for personal protective equipment (PPE) using CDT code D1999, per visit per member for dates of service occurring 5/1/2020 through 12/31/2020. Orthodontists will need to file a claim for member visits to receive reimbursement; this will not be included with your monthly schedule payments. A maximum allowable charge will be added to the fee schedules. This compensation will be in accordance with the appropriate fee schedule and will not apply to the member’s annual maximum. A maximum allowable charge will apply, and balance billing is not permitted. BCBS Kansas To help offset these additional PPE costs, BCBSKS will provide an add-on increase to all dental allowances starting with dates of service May 15, 2020 for the remainder of the year. This special add-on increase does not require any action on the dentist's part, nor does it require any special CDT code billing. As such, we will continue to deny D1999 when billed as content of service. BCBSKS will automatically include an add-on allowance to every covered service that our local network dentists’ bill. The new add-on allowances are figured based on a percentage of the maximum allowable payment (MAP) for services. Please note there will be a reduction beginning September 1 based on the anticipation that supply and demand of PPE will eventually level out and prices will come down. General Dentistry, Pedodontics, Periodontics: 3.0% (May 15-Aug. 31); 2.25% (Sept. 1-Dec. 31) Oral/Maxillofacial Surgery, Orthodontics, Endodontics: 2.0% (May 15-Aug. 31); 1% (Sept. 1-Dec. 31) Delta Dental Insurance Company (DDIC) Alabama, California, Delaware, Florida, Georgia, Louisiana, Maryland, Mississippi, Montana, Nevada, New York, Pennsylvania, Texas, Utah, Washington, D.C., West Virginia For services beginning June 22, 2020 through October 20, 2020, DDIC will offer a $10 “Return to Care” as supplemental reimbursement for network providers. [Prior dates of service are not eligible]. Covered networks include DeltaCare USA, Delta Dental PPO, Delta Dental Premier, Delta Dental Federal (Legion) Qualifying evaluation and consultation codes are: D0120, D0140, D0145, D0150, D0160, D0170, D0180, D0190, D0191, D8660, D9310 and D9430. Do not submit D1999 to receive reimbursement. Any additional charge for sterilization/infection control is not billable to the patient. If patient exceeds the frequency limitation or has exceeded their plan maximum for their benefit plan for one of the qualifying CDT 2020 codes, they will be responsible for the allowed amount, which will include the temporary supplemental reimbursement. Delta Dental of Arizona The Interim PPE Support Program is available to all Delta Dental of Arizona contracted dental offices, which includes any dentists working under the same Tax ID Number (TIN). The contracted dental office must be (1) Located in Arizona, (2) Participating in the Delta Dental network as of the date of claim, (3) Participating in the Delta Dental network as of the date the check is issued. A $10 PPE support payment will be calculated for all Delta Dental of Arizona member claims paid to the dental office from April 1 through July 31, 2020, with a maximum of one PPE support payment per patient per day. PPE support payments will be made as separate, monthly lump-sum payments that reflect the total number of Delta Dental of Arizona claims paid to the dental office for the period. Claims paid during the timeframe of the program are the only claims eligible for the PPE support payment. The minimum lump-sum payment is $50. Payments will not be made for less than 5 claims in a single month. The lump-sum payment will be paid by check for each location operating under the same TIN and mailed to the payment address on file. First lump-sum payment for April and May paid claims will be issued by June 30. Subsequent PPE support payments will be issued by separate check in the month following the claims paid date: July (for June) and August (for July), provided eligibility is met. Per the Participating Provider Agreement, PPE/infection control is not billable to the patient at any time. No application or action is required by an eligible dental office to receive PPE support payments. Delta Dental of Missouri Assistance for network dentists with costs of reopening, such as purchasing PPE • One-time payment based on practice claims volume with DDMO. A total of $3 million in Reopening Relief. Checks will be mailed the week of June 8, 2020, to the practice’s primary office address. Dentists do not need to apply and no repayment is necessary. Delta Dental of Idaho Delta Dental of Idaho is committing $500,000 dollars to support our network providers through this program. The PRSP will provide financial support with a one-time payment to each Delta Dental PPO™ and Delta Dental Premier® practice with currently effective provider agreements in good standing. Payment will be based on the number of in-network DDID members seen by the provider in 2019. Each network provider in good standing will receive a payment subject to a minimum award of $100 and a maximum award of $2,000. No application and No repayment is required for this program. Automated Clearing House (ACH) enrollees will receive deposits on or before July 15, and checks will be mailed on or before July 15 for those not currently enrolled in ACH. DDID will not pay separate fee for PPE; and they are not billable to the patient. Delta Dental of Massachusetts Delta Dental of Massachusetts will begin paying participating Massachusetts dentists an additional $10 per visit for DDMA members between June 1 and August 31. Payment will be automatically be sent to dental offices on a monthly basis without any other paperwork. Delta Dental of Virginia Historically, expenses relating to the cost of doing business are understood to be broadly covered via the overall fee structures for treatment and expenses related to PPE as not billable to the patient. However, due to new health and safety protocols, Delta Dental of Virginia has created the new Provider Assistance Program to help meet PPE expenses during this time. Learn more about this new program above. Delta Dental of Virginia will be distributing $3 million among Virginia Delta Dental network dentists by the end of June. There will be no application process for receiving these funds. Funding amounts will be based on a measure of the practice’s Delta Dental of Virginia patients. Northeast Delta Dental Covid-19 Interim Supplemental Program available for at least the next two months (May/June dates of service). For Maine, New Hampshire, and Vermont participating dentists, when treating patients covered by Northeast Delta Dental, NEDD will be providing an additional $10 payment, outside of the normal claims processing payment, for each patient treated in-office on any given day. The payment will be $10 regardless of the dentist’s network status (Premier/PPO) or specialty. Payment will not exceed $10 for any unique patient for services provided on the same day, and payment will be paid to the practice based on Tax Identification Number (TIN), not the individual dentist. The payment will not be made when the claims are adjudicated. Around the 15th of the following month, NEDD shall run a report identifying all the patients your office saw in the prior month, and then an administrative check will be cut outside the normal claims process. For claims adjudicated in May, with May dates of service (DOS), a report will be run approximately June 15th, followed closely by the mailing of an administrative check to your office for those claims. The same process will be followed for claims adjudicated in June with June dates of service (and any May DOS run-out), with a check to follow in July. The need for any extension of this COVID-19 Interim Supplemental program will be reassessed at that time. Delta Dental of Kansas From June 1, 2020 through July 31, 2020, for each patient visit, Delta Dental of Kansas will provide an additional $10 per patient to help assist in covering increased PPE costs. Delta Dental of Kansas will pay participating dental practices in Kansas $10 per patient visit for patients that are DDKS covered members only. No enrollment or applications needed to receive these payments. Participating Dentists will submit claims as usual (no special codes or notes needed). Claims must be received within 30 days of the date of service in order for DDKS to calculate payments. Payments will be issued monthly as a bulk payment for the total number of DDKS patient visits for the prior month. Our Professional Relations team is available to help with the program and answer any questions. Delta Dental of Colorado DDCO is offering a personal protective equipment (PPE) Reimbursement Program for Delta Dental PPO and Premier network providers in Colorado. From May through July 2020, DDCO will automatically pay $8 per adjudicated claim for billable dates of service between May 1 and July 31, 2020. Claims must be received by DDCO on or before August 31, 2020. Dentists do not need to submit claims or procedure codes for PPE; those will be denied as not billable to the patient and will delay payment. DDCO’s first lump-sum payment would be made in June 2020 for adjudicated claims for billable dates of service rendered from May 1 to May 31, 2020. A second lump-sum payment would be made in July 2020 for adjudicated claims for services rendered from May 1 to June 30, 2020 (excluding claims included in the first payment). A third lump-sum payment would be made in August 2020 for adjudicated claims for billable dates of service rendered from May 1 to July 31, 2020 (excluding claims included in the prior two payments). And a final lump-sum payment would come in September 2020 for adjudicated claims for billable dates of service rendered from May 1 to July 31, 2020 (excluding claims included in the prior three payments) and received by DDCO on or before August 31, 2020. Unless DDCO decides to extend the PPE Reimbursement Program, the cut-off for the receipt of claims eligible for this program is August 31, 2020, and any claims received after that date will not be eligible for this program. Existing open orthodontics claims will receive a one-time payment of $24 per adjudicated claim to cover the full program period. New orthodontic claims will receive a prorated allowance based on banding date. Dentists do not need to submit an additional claim for open treatment cases. To be eligible for the PPE Reimbursement Program, providers must: 1. Be enrolled in the DDCO PPO or Premier network as of the date of service. 2. Currently participate in DDCO’s EFT/Direct Deposit or enroll by June 12, 2020. 3. Remain enrolled for the remainder of the program. Hawaii Dental Service (HDS) Offering the HDS COVID-19 Interim Supplemental Program (the “Program”) for participating HDS dentists in Hawaii, Guam, and Saipan to receive a $10 supplemental payment per eligible patient visit, retroactive from May 1, 2020 through July 31, 2020. The Program is a new, temporary financial support program that does not have to be repaid to HDS – to help practices alleviate the costs associated with resuming dental operations during the COVID-19 pandemic. Participating dentists do not have to opt-in to the Program and will automatically receive monthly supplemental payments for eligible patient visits. Patient visits are counted once per patient, per date of service, per provider, and per service location, during the Program time period, May 1, 2020 through July 31, 2020. Pre-authorizations, duplicate claims for patient visits, non-par visits, and teledentistry patient encounters are not eligible. Per HDS Policy, dentists may not charge PPE costs to the patient. Delta Dental of Arkansas $2,500 grants are available to Delta Dental of Arkansas providers to help offset some of the costs of additional Personal Protection Equipment and sanitization supplies Applications will be accepted May 13 – June 1, 2020 Grantees must spend all funds before December 31, 2020. DDAR considers infection control costs to be part of the procedure such that there is not a separate payable amount and it is not be billable to the patient. Delta Dental of Rhode Island Allocated $1 million to assist our participating dentists with acquiring much-needed (PPE) supplies as they reopen. The amount of each allocation is based on Delta Dental patient volume in the practice. Delta Dental of Wyoming Operation #WyomingSmiles, a grant program to help Wyoming dentists acquire much needed supplies, equipment, and technology. Delta Dental will be funding a $1,000 “allowance” or credit available to all participating dentists in Wyoming, to purchase dental products and services. Dentists can learn more about participation in Operation #WyomingSmiles by contacting Delta Dental of Wyoming. Delta Dental of Wisconsin Practice Recovery Supplement Program (PRSP), to help dental practices offset some costs as they prepare to resume providing routine care to Delta Dental of Wisconsin members. Delta Dental of Wisconsin is committing $5 million dollars to support network providers through this program. The PRSP will provide financial support with a one-time payment to all Delta Dental PPO™ and Delta Dental Premier® practices in good standing. Payments will be allocated based on the average number of in-network DDWI member visits in 2019. Orthodontist awards will be based on average number of office visits expected per patient for a full year of treatment. All network practices in good standing will receive an award. The minimum award is $500, and the maximum award is $100,000. Practices with multiple locations will be aggregated to one minimum or maximum award. For example, if there are three locations that each qualify for $100, the total award will be $500. The cumulative award for any practice or aggregate of multiple locations will not exceed $100,000. No application required. No repayment is required for this program Delta Dental of Iowa Reopening Support Payment. Participating network (Premier, PPO, and Hawki) dentists will receive $10 for each claim they file for Delta Dental of Iowa members. [Still finalizing payments for DWP members]. The support payment will apply to services members receive between May 1 and August 31, 2020. © 2020 American Dental Association All rights reserved. Last Reviewed: July 7, 2020 15 COVID-19 Coding and Billing Interim Guidance: PPE These support payments will be applied to all claims and there is no need to submit for payment. The first payments will begin around June 15. Dentists are not able to charge a separate infection control fee for services. This is not a billable charge to the member or Delta Dental. Delta Dental of South Dakota (DDSD) Has increased reimbursement for six different exam codes by an average of 6% to help offset offices' new added PPE costs. The exam codes are D0120, D0140, D0145, D0150, D0160 and D0180. The fee increase is effective May 1, 2020. Costs for infection control and OSHA compliance are included in the DDSD fees for the dental services, a separate fee for infection control is not billable to the patient by a DDSD participating dentist. Delta Dental of Tennessee Operation #SmilesMatter, a grant program to help dentists acquire much-needed supplies, equipment, and technology Committing more than $3.3 million for Operation #SmilesMatter Grants are available to all licensed dentists practicing within the state of Tennessee who have active NPI numbers. Each eligible dentist will receive a $1,000 grant. Program will be administered through Henry Schein, Inc. in the form of a credit on the eligible dentists' account with Henry Schein, to be used towards existing account balances and then toward any future purchase of any dental products and/or services from Henry Schein1. Dentists with existing Henry Schein accounts at the start of the program will have funds posted to their account in the form of a credit no later than Sunday, May 31. This program will begin May 11, 2020, and end on December 31, 2020. Delta Dental of New Jersey (DDNJ) and Delta Dental of Connecticut (DDCT) Will pay participating Delta Dental dentists in New Jersey or Connecticut $10 per patient visit for DDNJ and DDCT members only for a two-month period. PPE Program assists dental offices with increased costs related to N95 masks and other sterilization requirements resulting from the COVID-19 crisis. Must be enrolled in EFT Delta Dental members should not be charged for infection control or D1999. Office visits counts will be calculated by Delta Dental of New Jersey and Delta Dental of Connecticut based on submitted claims. These payments will begin when New Jersey and Connecticut lift emergency care restrictions, and dental professionals are once again permitted to provide routine and preventive dental care. No repayment is required for this program. Delta Dental of Michigan, Indiana & Ohio All licensed dentists in Michigan, Ohio and Indiana with active Type 1 NPI numbers are eligible to receive a $1,000 credit to Henry Schein to be used toward existing account balances or toward any future purchase of dental products and/or services from Henry Schein. More than one dentist in a practice may receive the credit as long as each dentist is licensed and has an active Type 1 NPI number. Dentists with existing Henry Schein accounts at the start of the program will have funds posted to their account in the form of a credit no later than June 12, 2020. If you do not already have an account with Henry Schein, call 844-269-4204 or set up your account on the Henry Schein website. Once your account has been created and you have submitted the Delta Dental form, we will confirm your eligibility and provide notice to Henry Schein, who will then credit your account. The program will begin for eligible dentists on May 26, 2020, and end December 31, 2020. Unless Delta Dental of Michigan, Ohio, and Indiana decides to extend the credit period, the credit will not be applied to any accounts after December 31, 2020. Current Delta Dental policy is that PPE is not billable to the patient. We wish you the very best in your dental billing journey. If you have questions or need help, please contact us at any time. info@dentistrysupport.com Always happy to help, Resources: ADA AGD DentistryIQ 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 us help you learn your resources.... In preparing this blog post, I interviewed several of our clients, fellow dental industry colleagues of mine and emailed for feedback over 40,000 dentists nationwide and here are the top 10 ways we learned professional criminals are stealing from dental offices. According to a 2018 survey conducted by the American Dental Association’s (ADA) Council on Dental Practice (CDP), nearly 49% of the dental practices that responded to a survey on theft by employees reported having experienced employee theft; nearly 46% of those practices reported experiencing theft or embezzlement more than once. Pretty alarming, right? Top 10 Theft Issues Found in Dental Offices Dental front office team members are opening business checking accounts in the name of the dental office and depositing checks from insurance companies. Theft of both front and back office supplies. Dental office team members writing down patient credit card numbers and making purchases online with patient credit cards. Dental office team members failing to post cash payments to ledgers and instead writing off balances or deleting procedures. Writing off or deleting procedures for family members or friends. Dental office team members processing virtual credit card payments (received from dental insurance companies) through personal merchant accounts such as Square or PayPal. Dental office petty cash misappropriated or stolen. Fake dental insurance bills are sent on behalf of your practice and the check is sent to friends or family members of the dental office team. Checks have been made out to CASH. A familiar face can get away with this at a bank by using a rubber stamp of the doctor’s signature or forging the doctor’s name. (Do not have rubber signature stamps in the office.) Staff has used the company credit card for personal use. (Carefully review your statements.) What can you do to safeguard your dental office? Consider outsourcing your front office administrative work. Using a company like Dentistry Support will allow you to have your payments posted remotely and you handle the deposits personally. Be an Active Leader: It is important that the doctor participate in the management of the front desk. Act like you care about the business side of your practice and understand the business systems that are used in your office. All policies and practices pertaining to handling money in your office, must have your sanction and approval. Reconcile with your Accountant or CPA every month. If the numbers are off, get a 3rd party company involved. Run a month end and review adjustment types. Upload Fee Schedules and do not run your ledgers off of UCR. When you do this, there is a lot of room for adjustments to happen. When you have large adjustments you can hide money taken. Get to know your patients, do they know your front office? If so, monitor their ledgers for write offs. Keep inventory of all office supplies and know where it goes. Watch invoicing and bills. Do not just write a check for a bill, know the bill, know the vendor. Try to use EFTs for as many accounts as you have unless you will be monitoring all mail and personally taking checks to the bank. Go cashless in your office and place a sign up front. Set up your own usernames and passwords for insurance company websites and assign limited access logins to your dental office team members. Limit permissions in your dental software. Get rid of Petty Cash. Remove all front office staff and go to a fully remote team who cannot physically touch anything in your practice. It is much easier to control access (and shut it off). Cross train employees and switch their roles every month. Split up workflows randomly so one person is not fully dedicated to a single position. Implement touchless credit card processing. Never let your team touch a patients credit card. Watch for warning signs such as employees spending outside of normal means, unexplained adjustments or out of balance situations and high insurance aging or patient aging. Have someone else work your Dental Accounts Receivables. When someone else is researching payments and denials you have removed this from inside of the office. There are many ways outstanding claims can hide money being stolen. We continue to update this blog with tips and tricks from people in the industry. Do you have a story or situation you think we should share with our followers? Email us at info@dentistrysupport.com. Knowledge is power and this information should be shared with our dental families. Happy to Help, Resources: ADA OralHealth Legal Disclaimer: I assume this goes without saying, however sharing this information comes with a great responsibility. I am nervous about it. I am scared it will get into the wrong hands (or be seen by the wrong eyes). This comes from the fact that this blog is read by those wanting to protect themselves as well as those potential thieves. This information can be used for either purpose which is the scariest part. This is not meant as a ‘how-to’ instruction manual. I must caution those who are reading this, if you are reading this with ill will in mind, you will be caught and your consequences are great. Please be warned. 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.

Talk about a hot topic. Oh my! We have heard so many different offers of advice. We decided to compile everything together for you here in one happy place. Billing for PPE Ok I have seen and read so many comments (negatively) about adding the cost of PPE and this is the cost of doing business. Please note, the suggestions about this are coming directly from the ADA and the understanding that dental offices are suffering dramatically with not only being closed but reopening with higher expenses than ever before. First, the ADA has requested dentist increase the fees of procedures to include the added cost of PPE. Prior to such adjustments taking effect, dental offices may wish to use CDT code “D1999 - unspecified preventive procedure, by report” to document and report the use and cost of additional PPE. Dentists can use this code once per patient visit/claim to attempt to cover the cost of PPE. Dentists should develop a standard office policy to document the additional PPE that will be used across all patients. This documentation methodology will justify a standard fee across all patients. Alternatively, dentists may wish to add a note in the patient’s record to document the details of PPE uniquely necessary for the visit when charging different fees based on the level of PPE used. When adjudicating such claims, the ADA believes that it is inappropriate for any third party benefit program to unfairly place the cost burden on dentists by disallowing or bundling charges for PPE on the pretext that the payment for additional required PPE is included in the payment for any other procedure billed for the visit. Denied claims are typically billable to the patient. For Medicaid patients, please check with your state Medicaid agency. Pre-Collecting Payments for PPO Patients (In + Out of network) Due to the massive amount of people who were furloughed or are now unemployed there is a high probability that insurance plans are now termed. With that, many dental insurance companies were closed and have not updated the policies within their systems. So, it is advisable to dental office to pre-collect from everyone when possible. Not only is this a great best practice to implement but it will also help minimize contact with patients when they are in the office. Remote admin support Many of employees will be scared about working in the office. Remote support is a huge component to the continued success of your office. If your team is not willing to come back to work right now, allow them an option from home but closely monitor their activity to ensure productivity is still achievable. Continuing Teledentistry Teledentistry has been a massive part of our business especially in the last 8 weeks. However, we are here to encourage you to keep the process going. Offer this element of services for patients who are skittish about coming into the office right now. If you need help getting this started, we have several blogs on this very topic and are happy to answer any questions (free of charge of course). Organizing the schedule Your schedule looks different now; less hygiene schedules, one patient per hour, screening patients upon entry and so much more. Take time to develop a plan that works for everyone. Here is a quick list of things to get in place as soon as possible. Send a mass email, text and social media campaign informing your patients things will look different. Those different things can be payment processing, scheduling, confirming, entry into the office and availability of the schedule. When sending emails and communications, do not bombard them with all of the information in one email. Keep the first communication (informational) and let them know more is to come. This will keep them open to reviewing the next communication you send. Do not call patients and verbally inform them of changes. It is WAY TOO MUCH to say over the phone and your team will be bombarded with questions they cannot answer. Utilize text, email and social media when ever possible. Pre-collect for all visits to reduce contact with the patients. Make sure all patient forms can be completed digitally. Set up your confirmation screening of patients and set expectations with them what it will look like when they arrive. Communicate about the PPE fees and let them know insurances will be billed when possible. Check dental insurance eligibility before the appointment and the day of the appointment. Cheers to the mass re-open of dental offices. We are rooting for you every step of the way. All my very best,

You have arrived at our REPLAY Page! Thank you for joining us this past week. Your Q+A are answered at the very bottom of this page. You can view ALL printables from the webinar below. This is a FREE webinar but all CE's have already been issued and no further CE's will be issued for this course as it is now over . COURSE DESCRIPTION: This webinar will cover telephone technique, scheduling etiquette for teledentistry and elective procedures as well as reviving old treatment plans that may seem stagnant.  We are excited to share with your methods to bring your practice back to life with not only teledentistry and the latest list of insurances covering but also managing ever changing dental office schedules. Join us. And learn how to keep your patients engaged and putting their dental health at the forefront of their mind, even during a pandemic. COURSE OBJECTIVES: Phone and scheduling technique for teledentistry and elective procedures. How to bring back old treatment plans that may seem stagnant, with teledentistry. The most up to date information on insurances covering teledentistry. COURSE REPLAY Printables Feel free to print and share with your fellow dental families and friends. 1.) Temporary Office Closure Checklist 2.) 5 Step Teledentistry Process 3.) Teledentistry Billing Guide 4.) Teledentistry Contact Guide Q + A Received post-webinar. Can you perform teledentistry with a phone voice call? Yes, but please ask the patient to send you a picture so you have some sort of documentation of proof that the patient communicated with you and a visual of the nature of the call. Does it count as teledentistry if an existing patient calls with a problem and they are referred? Yes, you diagnosed and referred out. Where can I find the printables? Scroll up! ;) We have had thousands of dental professionals join our webinars to date. Thank you for being one of them. Thank you for joining us,

The webinar is open for registration now. APRIL 9TH, 2020 AT 6PM EST FREE CE's (2) Pace Approved [from the Academy of General dentistry] FREE printables/shareables regarding teledentistry FREE checklists for your team Click any picture or any link and it will bring you right to the registration page. COURSE DESCRIPTION: This webinar will cover telephone technique, scheduling etiquette for teledentistry and elective procedures as well as reviving old treatment plans that may seem stagnant.  We are excited to share with your methods to bring your practice back to life with not only teledentistry and the latest list of insurances covering but also managing ever changing dental office schedules. Join us. And learn how to keep your patients engaged and putting their dental health at the forefront of their mind, even during a pandemic. COURSE OBJECTIVES: Phone and scheduling technique for teledentistry and elective procedures. How to bring back old treatment plans that may seem stagnant, with teledentistry. The most up to date information on insurances covering teledentistry. We had thousands of people join our last FREE Webinar. Join us again! You wont want to miss this. We hope to see you there,

Did you attend our LIVE Webinar on Teledentistry? Perhaps you missed it? Here is the long awaited replay! We are hosting another free webinar with FREE CE's on Teledentistry 2.0. Stay tuned. Stay Healthy and enjoy the replay, Want to know more about how Dentistry Support can work for your dental practice? Learn more here.

Dentistry Support has partnered with the incredible Tracy Jacobs, RDH of Wizdom Dental Education Solutions to bring you CE right in the comfort of your own home. With dental offices closed across the nation, our goal is to get them back open. We have a very short window of time where we can utilize insurance benefits for teledentistry and we are ready to equip you and your dental office with the tools, tips and tricks to get revenue flowing. Join us for this FREE Webinar coupled with CE's for your dental team. Click here to register! Come join us for an hour of everything you need to know to care for your patients and maintain your dental business during this unprecedented time. See you Saturday, March 28th, 2020 at 11:00am PST Happy to Help, Learn more and join us on social media: Dentistry Support Wizdom DES Facebook Group

The hot topic after recent dental office closures due to COVID-19/Coronavirus is Teledentistry. If you have not been talking about it, do the right thing and start talking about it. If you are an office manager or front office team member, you can get yourself back in the office just by bringing it up. This week, I have been a broken record "Close your dental office, but not your dental business." Let's cover Teledentistry. (SOO many awesome links at the bottom) What is it? Telehealth refers to a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery. Teledentistry refers to the use of telehealth systems and methodologies in dentistry. Both consultations and continued follow up with a patient are considered methods of Teledentsitry. Why use Teledentistry? Recent studies on the use of telehealth services have shown that 70 percent of patients are comfortable communicating with their healthcare providers via text, email or video in lieu of seeing them in person, and 76 percent of patients prioritize access to care over the needs for face-to-face interactions with their healthcare providers. In fact, 30 percent of patients already use computers or mobile devices to check for medical or diagnostic information. Methods of Teledentistry PROHIBITED public-facing technologies (examples): Facebook Live, Twitch, and TikTok. ALLOWED: (examples): Apple FaceTime or Skype, Facebook Messenger video chat, Google Hangouts video Be sure to get a script prepared in advance for your calls. A simple checklist of what to cover on every call will save you time and ensure a thorough c Is texting or emailing a patient a form of Teledentistry? Regarding emails and text messages, there has been no mention or addressing email and text communication. HIPAA does not prohibit using email or text communications, but a dental office that wishes to communicate with patients this way must conduct a written risk analysis and implement reasonable and appropriate safeguards. Which Dental Insurance's are Covering Teledentistry? As of 04/01/2020 the following dental insurance companies are covering Teledentistry procedures. (We will update this page daily with any new information we receive) Unum/Colonial Life Liberty Metlife UCCI Aetna Principle Human Guardian Ameritas Delta Dental Envolve: D9995 will be reimbursed at $12.27 and D9996 will be reimbursed at $14.80. Sunlife Unum/Colonial Life Blue Cross Blue Shield Massachusetts Argus Anthem Dominion National Coding/Billing If you physically see a patient in your dental office during the current COVID-19 quarantine environment the services you render in the office should be coded and billed per your current office routines. When you are providing services in a teledentistry environment one or the other of the following codes would be reported in addition to those cited below: D9995 teledentistry – synchronous; real-time encounter Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service. D9996 teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service. D0140 limited oral evaluation – problem focused D0170 re-evaluation – limited, problem focused (established patient; not post-operative visit) D0171 re-evaluation – post-operative office visit D9992 dental case management – care coordination Documentation for Claims Screen shot or phots of the conversation Proper clinical documentation of the exam Always remember any Teledentistry code submitted must be reported in addition to another procedure (diagnostic code). These are not stand alone codes. Why? Serving patients who are unable to get to a dental office with dental hygiene powered by teledentistry can go a long way toward satisfying progressive state dental hygiene regulations. Also, dental needs get documented and reported. Teledentistry creates collaborations between dental hygienists, dentists, patients and caregivers. The silver lining is when necessary dental work can be coordinated with a local dentist for those patients who can accept treatment. Links/References ADA Teledentistry Guidance Worksheet ADA COVID-19 Billing Guidance Worksheet Teledentistry resources used in this publication: Link Arizona Teledentistry Information Dentaquest Teledentistry Article Impact of Remote Care All information contained here is meant to guide your office in teledentistry billing, it is no guarantee of payment by any insurance company. Happy to Serve our Dental Community,

There are so many places you can visit to learn what to do right now, we want to be that resource. This page will include both advice for Dental Offices, Employees and Patients. We hope you find this helpful. You can also visit our latest blog on specific details of what you can do if your office is still seeing any patients. Patients You may find your dental office is closed. They will reopen. However, if you have pain or swelling, call them. They can still speak with you and provide tele-dentistry along with the option to see you for non-elective procedures. For now, your regular cleaning will have to wait. Rest assured, they will reopen and they are praying for your return to help their business grow. Employees Your Dentist does not want to close their doors, I promise. However, if they had to make this tough and terrifying decision, please be kind. If they are not able to cover your wages, here are helpful links and tips on what you can do. Healthcare Continuation Ask your employer if they would be willing to continue these benefits (if you currently have them). Ask for Reduced Hours Rather than just accept the lay off, try to be a resource for your employer and offer to do things that help your dental office continue to grow and prepare for reopen (see below for activities). Confirm with your employer in writing that they won't contest unemployment. Do not be afraid to ask for this in writing, this will help you down the road and your Dentist will likely help with this. File for Unemployment Your state website may be bogged down. Be patient, this will be the hard part. Keep trying and visit those websites during non-peak hours such as early morning (before 5am). Dental Offices First, we are so sad you had to close but we completely understand your reasoning. This was a hard decision and you did what is best for your patients and team. We are praying for you and trusting you will reopen and be stronger than ever. We will cheer with you the day you reopen! Stay positive. All of us small businesses need to rally together and we are rooting for you. Here are some of the things we are doing for our existing clients. Feel free to share these ideas as they may save your staff during this tough time. Helpful Links: CDC Corona Virus Update Page: Link American Dental Association Current COVID-19 Information: Link Academy of General Dentistry COVID-19 Resources: Link Live Coronavirus Numbers (Worldwide): Link USA Government Coronavirus Update Page: Link We are taking on new clients right now and our onboarding process is typically 10 full business days. We would be honored to get your practice ready to go live by the time you reopen. Please visit our onboarding page and enroll today. If your office is closed, now is the perfect time so we can prepare your office for excellence when you reopen. Our average flat rate fee is 1-5%-2.5% or less of your total production. We never close, we work 100% remotely for your dental office. Thank you for your time, stay healthy,

Hey There Dental Friends, This Coronavirus/COVID-19 has been a doozy on all of us, especially our communities, small businesses and your Dental Office. Our team at Dentistry Support is here to help and be of service to everyone in the dental community. We put our heads together to figure out the very best way to give back. We have a plan, and we are putting it into action. If your dental office: Is short staffed at your front desk due to illness or team members needing to take care of family, you can count on us. Is closed due to quarantine and you need someone to handle incoming calls or rescheduling of appointments. Is needing extra support to educate patients prior to their arrival regarding prevention, sanitation, and precautions pertaining to COVID-19/Coronavirus. We are happy and willing to provide phone support for your dental office completely free. YES, this is for new and existing clients. We will not charge you anything. No Fees, No payment, WE DO NOT WANT ANYTHING in return. This is our way of helping you and giving support in a time of need. We promise, no catch. What will Phone Support look like: We will set up a dedicated line just for your office. We will handle, document and forward you daily a recap of all calls handled. We will answer questions or provide information to your patients as you request. We use Text, Email + Phone to communicate. We have 24 hours per day, 7 days a week, 365 days a year support staffed. Our team is completely remote and we do offer bilingual (Spanish) team members. We can re-appoint patients in certain circumstances and can discuss this when you enroll. If you are interested in enrolling in our FREE Phone Support, please visit our onboarding page. When prompted to put in payment information, you can put in ALL ZERO's. Again, we will not be accepting any payment for this support. *Free Phone Support is eligible for use from 03/16/2020 - 04/16/2020. Should we see an increase in impact, the dates of Free Phone Support may be extended to future dates. We will communicate with each office at that time. If we happen to meet the capacity of which we can enroll new offices in Phone Support, we will notify you and still attempt to support your practice. Contact us, we would love to help you. For updates on the Coronavirus/COVID-19 and how this impacts your dental practice please visit here. We look forward to helping you! Praying for Our Dental Community and Patients,

You've read the social media posts, you've researches symptoms, you're seemingly well prepared. Here at Dentistry Support, we have compiled the best of the best tips and tricks for your dental office to be fully prepared for this pandemic. *****Please see the BOTTOM of this post for the most UP TO DATE Links regarding your DENTAL OFFICE FREE Phone Support for all Dental Offices Businesses and Employers Actively encourage sick employees to stay home Separate sick employees Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees Perform routine environmental cleaning Check the temperature of any patient prior to bringing them to their operatory room Require handwashing at the entry of your building. Advise employees before traveling to take certain steps (link) CDC Recommendations Everyone can do their part to help us respond to this emerging public health threat: It is currently flu and respiratory disease season and CDC recommends getting a flu vaccine, taking everyday preventive actions to help stop the spread of germs, and taking flu antivirals if prescribed. Individuals and communities should familiarize themselves with recommendations to protect themselves and their communities from getting and spreading respiratory illnesses like coronavirus disease 2019. Older people and people with severe chronic conditions should take special precautions because they are at higher risk of developing serious COVID-19 illness. If you are a healthcare provider, be on the look-out for: People who recently traveled from China or another affected area and who have symptoms associated with COVID-19, and People who have been in close contact with someone with COVID-19 or patients with pneumonia of unknown cause. (Consult the most recent definition for patients under investigation [PUIs].) If you are a healthcare provider or a public health responder caring for a COVID-19 patient, please take care of yourself and follow recommended infection control procedures. If you are a close contact of someone with COVID-19 and develop symptoms of COVID-19, call your healthcare provider and tell them about your symptoms and your exposure. If you are a resident in a community where there is an ongoing spread of COVID-19 and you develop COVID-19 symptoms, call your healthcare provider and tell them about your symptoms. For people who are ill with COVID-19, but are not sick enough to be hospitalized, please follow CDC guidance on how to reduce the risk of spreading your illness to others. People who are mildly ill with COVID-19 are able to isolate at home during their illness. If you have been in China or another affected area or have been exposed to someone sick with COVID-19 in the last 14 days, you will face some limitations on your movement and activity. Please follow instructions during this time. Your cooperation is integral to the ongoing public health response to try to slow the spread of this virus. *Feel free to print and post in your dental office* Helpful reminders from all of our offices Send an email notice to all of your patients. Do not simply post a picture on your front door. Get ahead of the issue. Inform your patients you are taking extra precautions to keep them safe. Place hand sanitizer and tissue where ever patients frequent in your office. (place a sign offering a mask to anyone in need, but do not leave them out to be contaminated) Keep masks properly stored as many offices have reported the theft of such. As always, follow any guidelines provided by the CDC and OSHA. Toilet paper has nothing to do with this virus, stocking up does not prevent it. Helpful Links Hand Washing: https://www.cdc.gov/handwashing/ CDC Coronavirus page: https://www.cdc.gov/coronavirus/2019-ncov/summary.html OSHA Coronavirus page: https://www.osha.gov/SLTC/covid-19/ OSHA Control/Prevention page: https://www.osha.gov/SLTC/covid-19/controlprevention.html#health ADA Coronavirus UPDATE: https://www.ada.org/en/publications/ada-news/2020-archive/march/ada-asks-congress-to-include-dentists-and-patients-in-coronavirus-legislation ADA Virus Update Page: https://success.ada.org/en/practice-management/patients/infectious-diseases-2019-novel-coronavirus?utm_source=adaorg&utm_medium=VanityURL&_ga=2.235313602.233405974.1584375099-452174153.1584375099 Small Business Association: https://www.sba.gov/page/guidance-businesses-employers-plan-respond-coronavirus-disease-2019-covid-19 Stay Healthy,

First thing's first, as business owners we embrace the rising costs of taxes, payroll and every other expense coming our way with pure class. Maybe not all of us, but I promise we all embrace it with a fierce drive to change it. Dental Offices today are seen as "money hungry" and feared because they "charge too much." If only our shaming audiences could see we are struggling to right size P&L's just as much, if not more, than every other business out there, boy would they see different?! Can we get an "amen"? What if we could change those payroll percentages? With each ever rising cost we [Dentistry Support] have developed plans to help your Dental Office minimize costs while still growing your practice. The average cost of a dental biller or front office team member ranges from $16-$25 per hour ($2,560-$4,000 per year). This cost is for just one person, in one position. Dentistry Support now offers remote support for dental offices covering three dental positions for less than 2% of your total revenue (in most cases). Services include Dental Billing, Dental Eligibility Verification and Dental Appointment Confirmations/Scheduling. Each service is fully customized to your dental offices needs through the detailed onboarding process for each office. The onboarding process follows 5 simple steps covering every important best practice your office already has in place. Your office is easily migrated with Dentistry Support to expand your reach, improve your billing and impress even your accountant with the P&L growth. If you are a dental practice with goals of growing or a lack of hire-able talent in your area to fill these positions/roles in your office, give us a try. We come with a 90 day trial period where you get to learn all the ways we fit perfectly into your dental practice. Schedule a call today! We look forward to supporting your dental practice to thrive. P.S. We totally know you have those incredible patients who support you and bring home baked goods each week to your every friendly front office. Cheers to each of you who are crushing it ever day with the incredible customer service that keeps your patients referring and coming back. Happy to Help,