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Administrative Efficiencies Summit focuses on electronically scaling paperwork mountains

July 01, 2019

By David Burger

“Moving the needle” was the repeated mantra of the 2019 ADA Administrative Efficiencies Summit, as more than 30 stakeholders from across dental landscape came together June 10 to brainstorm digital solutions to the problem of administrative burdens and paperwork overwhelming dentists and their staff.

The summit, convened at ADA Headquarters, was a continuation of last August’s first Administrative Efficiencies Summit, in which member dentists, led by the ADA Council on Dental Benefit Programs, initiated a conversation about the pain points of the administrative costs of a dental practice and how they keep them from focusing on patient care.


Trio: From left, Drs. Mark Mihalo, Christopher Bulnes and Brett Kessler of the ADA Council on Dental Benefit Programs run the Administrative Efficiencies Summit June 10 at ADA Headquarters in Chicago.

“The goal is to bring practical solutions to existing inefficiencies,” said Dr. Christopher Bulnes, chair of the Council on Dental Benefit Programs as well as summit chair. He emphasized that the summit focused on everyday concrete results for dentists, starting by facilitating an honest and open dialogue about how changes to business as usual are necessary.

The attendees who came together in the same room to collaborate included representatives from varied sectors of the dental community, including dentists, dental benefit plans, dental practice management system vendors, clearinghouses, dental service organizations and financial institutions.

Gladys Wheeler of the Centers for Medicare and Medicaid Services reviewed the agency’s  compliance enforcement of electronic transactions.

The ADA Center for Dental Benefits, Coding and Quality conducted a front-office survey on administrative burdens that aligned with the summit’s five focal points:

• Patient eligibility and benefits verification.
• Coordination of benefits.
• Electronic funds transfer and electronic remittance advice.
• Claims and attachments.
• Dentist credentialing.

The survey found that each of these areas present obstacles impeding easy and efficient use of electronic transactions, Dr. Bulnes said.

Eligibility verification can be complex and time-consuming for dental offices and is often the starting point in the administrative workflow.

“Dental offices verify eligibility and the extent of available coverage prior to each patient appointment,” said Dr. Brett Kessler, vice chair of the Council on Dental Benefits Programs. “This is most often a manual process where information is transcribed during a telephone transaction with dental benefit plan staff or from information posted on a dental benefit plan’s online portal. A dentist’s treatment planning and discussions with patients becomes easier when specific and detailed information about available benefits is accessible in real time.”

Standardization of this process across third-party payers is the challenge, Dr. Kessler said, so that dentists can obtain comprehensive, real-time information on eligibility, available coverage and claim history electronically, thereby simplyfing the administrative burden. Automation is the key, he said.

Dr. Mark Mihalo, member of the Council on Dental Benefit Programs, said the council hoped the summit would encourage dental practice management software vendors to make the necessary updates  for improved eligibility verification.

Other aims of the summit included:
• Payers should deliver fully HIPAA-compliant standard electronic transactions, and government agencies are beginning to focus on compliance. HIPAA is an acronym for the Health Insurance Portability and Accountability Act of 1996.
• Practice management software vendors need to integrate eligibility and payment information received from payers into patient records in a manner that can be easily reconciled by office staff.
• Payers, clearinghouses and financial institutions need to make it easier for dentists to seamlessly enroll into electronic funds transfers and receive electronic remittance advices through their practice management software.
• Streamlined attachment requirements by payers and greater adoption of electronic methods will reduce burden and reliance on manual methods such as mail and fax.
• Standardized use of CAQH ProView across the dental industry would accelerate dentist adoption of a single electronic source for credentialing to facilitate timely and accurate data collection. CAQH is an acronym for the Council for Affordable Quality Healthcare.

The ADA Center for Dental Benefits, Coding and Quality will review summit feedback as it develops further recommendations for change and outreach.

The council encourages members and office manager to communicate to dentalbenefits@ada.org about the administrative burdens they face in their offices.

The full meeting report is here.

There are a number of online resources available for members located at the ADA Center for Professional Success, including topics that range from practice management to dental benefits. Access the resources at Success.ADA.org.