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Roz and Maria Pia have over 100 Answers to Insurance Coding Challenges
Here are just a few:

  • If you do not accept assignment of reimbursement but file insurance claims for patients, do you still have to notify the insurance company that a courtesy was given to the patient? - Answers
  • If you are contracted with an insurance company and a patient has met their annual maximum, a claim has been filed, are you still required to do the write-off? - Answers
  • If an office is contracted with insurance companies, is it best to only submit their allowed amount or should our regular UCR fees be submitted on claims? - Answers

Q: If you do not accept assignment of reimbursement but file insurance claims for patients, do you still have to notify the insurance company that a courtesy was given to the patient?

A: Yes, anytime a discount/courtesy is given to the patient, notification was being given to the carrier to show that the actual fee charged was not the actual fee collected.

Q: If you are contracted with an insurance company and a patient has met their annual maximum, a claim has been filed, are you still required to do the write-off?

A: Yes, your contract will have a clause in it that even after the patient has reached its annual maximum, the difference between the allowed amount and the actual fee charged must be written off. In other words, you are to accept only the allowed amount from the patient, not the UCR fee.

Q: If an office is contracted with insurance companies, is it best to only submit their allowed amount or should our regular UCR fees be submitted on claims?

A: It is best to always submit your regular UCR fees when filing claims for several reasons: The first is because it shows the insurance company what your actual UCR fees are and they may increase your allowed amount because of the UCR fee. The second reason is that you will have a better idea annually as to how much the practice is writing off per insurance company and how much percentage is being lost annually because of being a PPO provider.

Q: Can the code D0170 be used at the same visit of an existing patient, seen within the last 12 months comes in with a broken tooth that will have a crown or a filling done the same day?

A: Yes because the patient was informed during that time the tooth was "sick" needed treatment, patient did not schedule and has returned with a problem now and is getting "definitive" treatment completed.

Q: What code should be used for a difficult prophy?

A: At this time, there is not a specific code to use so it is recommended to use D1110 if patient has no signs of Perio disease, bone loss, mobility and recession. The fee is usually higher and it is important to put a narrative as to why this fee was charged. The narrative might be that the Patient has not been to the dentist for the past year, is a smoker and suffers with heavy stain, plaque buildup and was not a routine prophy.

Do you know the DAVe System? Daily Asset Verification

  1. Compare the practice schedule to each charge that was done per patient for the day and the sign in sheet. Cross-check them with each other.
  2. Review all payments, cash, checks (in mail and over-the-counter) and credit card payments and credits, plus outside financing (care credit, etc.)
  3. Review all credit adjustments (none that say "credit adjustment") be specific with adjustment coding.
  4. Review audit trail report for that day and question any "deletions" that occurred that day.
  5. Review daily deposit and YOU take it to the bank.

The Top Dental Software Training Issues

  • Are your security levels in place?
  • Is your software password secure?
  • Who is really managing your software?
  • How legal are your templates for clinical notes?
  • What notes should be where on the system?
  • Does the ledger match the codes of service?

What is on Your Wish List for Training?

  • Legal documentation
  • Insurance coding for maximum reimbursement
  • Protecting the assets of the practice
  • Dental software - Maximizing the benefits of your program
  • INTERACTION between patients and YOU!
  • Career hiring skills
  • Patient commitment to appointments
  • Customized letters, documents, visits, get it created for you!
"I have given the practices that you referred to us a call and they all are raving about you… that is so great! Every office I spoke with highly recommended you and thought you could be a great help to us… as you were to them."
— Jill Durand, Financial Coordinator
Meridan ID
"Uniqueness, iced with expertise and sprinkled with passion is how I describe Maria Pia and what she brings to helping dental practices achieve their goals.  Maria Pia will help you implement skills that can make you more efficient and productive, hence adding more to the bottom line and making your life easier.  Maria Pia is worth every penny! Thank you, Maria Pia, for all that you have helped us with over the years!! "
— Dr. Zana
Scottsdale

If it's not on the above list, Roz and Maria Pia will customize it just for you!
It is all about the relationship!

Each client is different and each office has unique challenges. Let Roz and Maria Pia help get the most out of your practice.


AFFILIATE MEMBER OF:

Crown Council American Association of Dental Office Managers Mission Possible Best Hygiene University of Florida Academy Dental of Management Consultants