Join ADAMember Log In




ADA/NADP share views on educating front office staff

The front office staff at a dental practice is often on the front line. They’re communicating with patients, educating them on their benefits and helping them understand all of their options. These integral tasks make it important for dental office staff to be informed on what they’re telling patients.

IMAGE: Dr. Smiley
Dr. Smiley: “CDBP maintains an ongoing dialogue with third-party payers.”

This topic relaunches a series of ADA News articles about the dental benefits industry’s Top 10 concerns submitted to the ADA about dental claims processing. Articles have been periodically published since 2006 examining the Top 10 dental claims concerns that dentists reported.

The series was developed in response to the Council on Dental Benefit Programs’ discussions with the National Association of Dental Plans and the payer industry to facilitate communication and help reduce common claims problems for members and patients. NADP member companies represent around 90 percent of the estimated 166 million Americans covered by dental benefit plans.

“To address the concerns voiced by members, CDBP maintains an ongoing dialogue with third-party payers,” said Dr. Chris Smiley, CDBP chair. “In order to build better understanding, we are pleased to provide a forum for benefit carriers to share their top concerns with dental offices and our ADA response. We hope you will find this series helpful in resolving difficulties you may have with the claims submission and adjudication process.”

The articles will include perspectives from ADA members, NADP members and CDBP. Future topics include prompt resolution of patient complaints, how fees for services are developed, diagnostic codes, recommending treatment outside of dental benefits plans and supplying enough dentists to meet demand.

Visit www.ada.org/thirdpartyconcerns to read other installments in the series. For more information about dental benefits issues, call the ADA toll free or send an email to dentalbenefits@ada.org.

Education of dental office staff

Dentist perspective

The ADA agrees that education of dental office staff can go a long way in helping a dental office submit dental benefit claims in a timely and efficient manner. The same holds true for dental insurance companies. Companies that have a trained and educated customer service staff can greatly assist dental offices with questions and concerns while filing dental benefit claims.

It was also noted that many plans provide online information to network providers. Since the benefit plan is for the benefit of the patient and because the patient has the right to enact a point of service option, all online information should be available to any willing provider and not limited by network participation status.

Several of our member dental offices have reported that often there are long wait times to speak to a customer service representative and this takes time away from dental office staff that have other responsibilities as well. Another suggestion that would greatly help dental offices is the ability for the dentist to speak with a dental consultant when a claim has been denied or when the carrier has asked for specific information. Allowing the dentist to speak to a dental consultant on a professional level can help to resolve problems and concerns quickly and can help speed up the claim adjudication process.

ADA resources for dental practice staff

The ADA has valuable resources available to help dental offices understand dental benefit plan design, third-party issues, procedure coding and claim submission. 

To start, there are currently three courses prepared by the Council on Dental Benefit Programs that are posted on the Internet at www.adaceonline.org. Each of these programs offers continuing education credit.

  1. Dental Benefits 101 is designed to educate dentists on the various types of dental plans in the marketplace and how these plans can affect their patients. This includes a discussion of the various cost containment measures used by dental plans to control costs.
  2. Introducing the Code: What It Is and How It Works for You is a general introduction to Current Dental Terminology and its Code on Dental Procedures and Nomenclature and how CDT codes are used when preparing claims.
  3. The Code: Changes Published in CDT 2011-2012 is a self-guided introduction to what has changed in the version of the Code effective Jan. 1. In addition to identifying each change, the program explains why these changes were made.

A popular brochure titled, Why Doesn’t My Insurance Pay for This? (available for purchase at www.adacatalog.org), is designed to help patients understand dental insurance by explaining why some procedures are not covered and it describes annual maximums, preferred provider organizations, least expensive alternative treatment clauses, pre-existing conditions and treatment exclusions.

Dentists and practice staff seeking assistance on third-party issues, claim submission or procedure codes are encouraged to call the ADA’s Member Service Center at the toll-free number. In addition, if you wish to provide the ADA with information on challenges you’ve experienced with third-party payers, please visit www.ada.org/702.aspx and complete the online request for assistance form. Specific questions on dental procedure coding may also be sent by email to dentalcode@ada.org.

Another valuable resource for dentists is the annual National Dental Benefits Conference which is scheduled for Sept. 14, 2012, at ADA Headquarters in Chicago.

The conference is sponsored by the ADA’s CDBP and consists of a full day of informational presentations and seminars regarding the dental benefits industry and how it may affect your practice. There is a $50 registration fee and dentists receive CERP continuing education credits for attending. 

Finally, for dentists considering joining a dental preferred provider organization, dental health maintenance organization or a discount dental plan, the ADA’s Contract Analysis Services educates members, in clear language, regarding the terms and provisions contained in participating provider contracts. ADA members can utilize this service at no charge by submitting a contract analysis request through their state dental society. For more information on the ADA Contract Analysis Service, go to www.ada.org/memberlegal or contact your state dental society.

Dental benefits industry perspective—communications methods and training

An efficient front office staff is key to a thriving dental practice. A top-notch front office staff greatly improves the odds for timely receipt of claims payments and patient goodwill, both critical factors in maintaining a thriving practice. A savvy front office staff has an in-depth knowledge of CDT codes, plan participation, benefit designs and claim filing requirements crucial to ensuring pertinent information regarding each patient is communicated swiftly and accurately. The result: expedited reimbursement to the rendering dentist.

Another key element to operational success is communication. Today’s technology makes it easy and cost-effective for the modern dental office to communicate quickly and efficiently via electronic formats. Email, web portals and other electronic communication are ideal for keeping insurance plans and dental offices connected and in synch. 

Most dental benefit companies have Internet and electronic communication capabilities to enable easy access to patient information and related documentation. Improved flow of information in a prompt, efficient manner—allowing the streamlining of daily tasks, reducing errors, manual processes and overall labor costs—is an attractive benefit.

For dentists participating in network plans, many benefit companies offer access to an array of network information and related documentation through their websites, portals or other electronic means. Provider manuals, network updates, fee schedules and other vital information may be accessed online; making use of these online resources ensures documents are always current, and eliminates postage and handling costs. Specific patient eligibility information, claims and remittance advice are also often available through the benefit company’s secure portal, reducing the need to call on eligibility or to check the status of pending claims.

The establishment of office protocols for proper and acceptable Internet usage along with filtering software will allow for a safe and proper online environment while affording the office staff the advantages and many benefits of the Internet. 

A real-time communication exchange between front office and dental plan staff using available technology and plan tools should be the ultimate goal, allowing for a more informed, accurate and efficient experience for the dental office, the benefits company and the patients. 

Tips:

  • Use the National Electronic Attachment (NEA), FastLook, to identify dental benefit company attachment requirements.
  • Get a complimentary FastLook subscription for 2011 at www.nadp.org.
  • Consider electronic claim submission to transmit documents for rapid reimbursement.
  • Use the current ADA Dental Claim Form as published in the ADA Practical Guide to Dental Procedure Codes.
  • Refer to dental benefit company websites for eligibility, specific plan coverage information and claim status information.
  • Be familiar with and utilize the latest ADA CDT codes for claim submission.

Dental benefits industry perspective—understanding dental benefits and role as payer

It’s a common scenario. Patients do not know the coverage details about their own dental plan and expect your office staff to be the experts in this area. It’s a communications gap encountered by dental offices on a daily basis: the patient’s general understanding of having dental insurance, versus the reality of actual reimbursement for services they receive.

Managing patients’ expectations of the level of benefits from their dental plan can be challenging. Often a patient’s expectation of having a dental plan can be roughly translated to the plan will pay for everything. With guidance from dentists and their office personnel, patients can better understand the role of dental plans through a few essential points.

Patient expenses: Plans are designed to assist patients with their oral health costs, not reimburse them totally for all types of dental treatment. Few, if any, dental plans today are meant to insulate covered patients from all out-of-pocket expenses.

Affordability: Most plans have generous benefits for preventive and diagnostic care, and provide helpful reimbursement for procedures such as extractions, fillings, root canals, periodontal treatment, major restorations and oral surgery. Some include benefits toward orthodontics. But plans remain affordable through the use of co-payments, co-insurance, deductibles, plan exclusions, frequency limitations, annual or lifetime maximums and payment based upon alternative methods of treatment.

Treatment options: All treatment options are available to patients; there are no restrictions to patient choices. Dental plan administrators do not attempt to determine treatment but provide benefits within the confines of the contractual agreement with the plan sponsor (employer). With dental plans serving the role of providing reimbursement with limitations, dental offices can work with the patient in balancing expected plan payment, overall affordability and oral health needs to determine the best treatment possible.

Tips:

  • Determine the patient’s benefit plan type, and explain the benefit. Patients enrolled in medical HMOs, for example, may not know their dental benefit is a PPO plan or even understand the difference. They may even be unaware their dental benefit is with a different company from their medical coverage.
  • Emphasize first with the patient what the plan does cover, to more easily set the stage for what it may not.
  • Help patients understand a primary goal of dental benefits is to encourage them to receive preventive care at a dental office on a regular basis.