American Dental Association (ADA) and Delta Dental Plans Association (DDPA) Class Action LawsuitDecember 10th, 2019 - Christine Taxin
The American Dental Association and two individual dentists filed a class-action lawsuit Nov. 26 against the Delta Dental Plans Association, its affiliated national entities, and 39 independent Delta Dental companies, alleging the provider network has engaged in anticompetitive conduct and violated federal antitrust laws.
The complaint alleges Delta Dental allocated territories ...Regence: Dental Procedures Under The BlueCard Program?December 9th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
This information can be found on Regence/Blue Cross Dental procedures explaining additional benefits for dental procedures. Regence currently does not offer dental benefits, however, there are times a patient can receive treatment with a Blue Cross provider and qualify under their medical benefits. In addition, Regence informs the providers to file these claims ...Hypertension ICD-10-CM Code Reporting TableNovember 25th, 2019 - Wyn Staheli, Director of Research
In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.Medical Insurance Coverage for TMJ Disorders (TMD)November 19th, 2019 - Christine Taxin
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...Documentation TipsNovember 18th, 2019 - Christine Taxin
Documenting Medical NecessityTo receive reimbursement from medical insurers, you need to make a case that proves that dental surgery is necessary for the patient. To make your case, you need to explain your decision process in terms that a medical insurer can understand, using ICD-10 codes and CPT codes. These ...Are you providing TMD treatment and having a hard time receiving payment from Medical? Take a look at the law for your state!November 3rd, 2019 - Christine Taxin
TM TREATMENT AND THIRD PARTY INSURANCE COVERAGEMinnesota, in 1987, became the first state to adopt legislation requiring health insurance policies issued within the state to include coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders on the same basis as other joint disorders. At ...Wellness In the Dental PracticeSeptember 25th, 2019 - Christine Taxin
This course is the beginning of change. Understanding that patients have additional benefits under their dental plans will provide you with the changes taking place in the world of billing.
Professionally your team members will be pushed and stretched as you develop your new system. They will require advanced training ...Help is on the way!September 17th, 2019 - Christine Taxin
Dental carriers are starting to deny coverage for treatment considered a medical necessity! Dental offices are just charging the patient for those services or patients are refusing the treatment. Have you considered why that service should be full fee for the patient when they have coverage under their medical insurance? ...A Step by Step Guide to Medical BillingAugust 20th, 2019 - Christine Taxin
The next 4 weeks we will be providing you with a step by step guide to why medical billing is now part of our Dental future.
Dental surgery is performed to treat various conditions of the teeth, jaws, and gums. Surgical procedures that dentists perform include dental implants, treatment for temporomandibular ...Medical ID TheftAugust 16th, 2019 - Namas
Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...The OIG Work Plan: What Is It and Why Should I Care?August 9th, 2019 - Namas
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...Tips to Preventing AuditsJuly 23rd, 2019 - Christine Taxin
There is an ever-increasing number of dental claims that have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and billing practices. When payers identify the activities they deem ...Are you Treating & Billing Medical Patients Tooth InfectionsJuly 16th, 2019 - Christine Taxin
A tooth infection, or an abscessed tooth, generally occurs as a result of tooth decay and poor oral hygiene. However, it can also develop due to previous dental work or traumatic injury. When an infection occurs, it causes a pocket of pus to form in the mouth as a result ...5 Ways to Minimize HIPAA LiabilitiesJuly 12th, 2019 - BC Advantage
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ...The Oral ConnectionJune 24th, 2019 - Christine Taxin
The mouth is, was, and forever will be part of the body. The old model in traditional medicine of treating symptoms and body parts in isolation is flawed. Pioneers in functional medicine like Dr. Mark Hyman, Dr. Mike Roisen, Dr. Axe, Dr. Fuhrman, Dr. Amy Doneen, Dr. Brad Bale, and ...Auditing Hospitalist ServicesMay 31st, 2019 - Namas
Auditing Hospitalist Services
The inpatient side of coding and auditing can be enormously complex, with many more moving parts than are typically found in the outpatient setting. In this audit tip, we will discuss a few of the challenges that come with auditing one of the most important players in the ...