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ADA urges third-party payers to adapt coding, billing procedures to help patients recover

Temporary procedures among new issues facing dentists, reimbursement

April 09, 2020

By David Burger

 Third Party Payer image

The American Dental Association sent a letter to third-party payers urging that administrators of dental benefit plans adjust and adapt reimbursement procedures important to dentists and patients — including coverage for temporary procedures and adjusting fee schedules to account for cost of increasing infection control procedures — in the midst of the “unprecedented and extraordinary circumstances dentists and their patients face” during the pandemic.

The letter identifies six areas that the ADA believes are particularly important in terms of coding and billing in the coming weeks and potentially months. The letter, signed by ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin, thanked the payers “for your support as we navigated issues related to coding and billing, specifically your support of a benefit for problem-focused evaluations conducted using telecommunication technology.”

One area of concern is the appropriate payment for temporary procedures.

“Many patients receive temporary or palliative care during the physical distancing mandates. We urge payers to not bundle the fee for the temporary procedure with the payment for the permanent procedure that may be submitted in future,” Drs. Gehani and O’Loughlin wrote.

The other areas of concern that have drawn the attention of ADA advocacy include out-of-network benefits, frequency limitations, telecommunication technology, point-of-care COVID testing and infection control expenditures.

“Almost all dental practices may have to adhere to higher infection control standards and increasing prices for personal protective equipment to protect our patients and care providers.” wrote the leaders. “We urge payers to consider these circumstances when reviewing fee schedules for contracted providers.”

The other areas, according to Dr. Gehani and O’Loughlin, include:

• Telecommunication technology. “Moving forward, the ADA recognizes that telecommunication technology can continue to be leveraged to support dental care. We urge payers to consider benefits for appropriate use of telecommunication technology as an integral part of a dental practice to provide triage and evaluations as needed.”
•  Out-of-network benefits. “Many patients may receive care from out-of-network providers due to closures of primary dental care sites. We urge payers to allow benefits for these patients equivalent to when care may have been sought in-network.”
•  Frequency limitations. “Many patients have not received required preventive care and may suffer from progressive disease as a consequence. We urge payers to consider removing any arbitrary frequency limitations on periodontal maintenance, topical fluoride and sealant applications to mitigate adverse consequences of lack of preventive oral care.”
• COVID-19 testing. “As point-of-care testing for COVID-19 improves, it will be vitally important for dentists, their staff and patients to have access to testing along with appropriate benefit and reimbursement for on-site testing. While state practice acts would determine the ability for dentists to perform such tests, we urge payers to begin to consider related coverage issues”

Drs. Gehani and O’Loughlin concluded, “We look forward to working with you to support dental patients and our communities.”


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