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Annual benefits conference adds new topics

Annual benefits conference adds new topics
Dr. Smiley: ADA representative to the Dental Quality Alliance.

The agenda for the National Dental Benefits Conference Aug. 20 at ADA Headquarters looked quite different than in years past.

"I'm delighted to report the conference was a huge success, with an attendance of more than 125 participants. There was greater diversity in this year's program than in past years," said Dr. Bert Oettmeier, chair of the Council on Dental Benefit Programs.

"Topics included a discussion of the newly formed Dental Quality Alliance, Internet defamation, dental plan trends, dental claims fraud from the claims reviewer's perspective, and a research report on the effects on medical care costs in individuals with diabetes who received periodontal treatment," Dr. Oettmeier said. "I believe this diversity in our program was responsible for the increased attendance."

Dr. Oettmeier: Council on Dental Benefit Programs chair welcomes the group
Dr. Oettmeier: Council on Dental Benefit Programs chair welcomes the group.

The staples were also there: an update of federal and state government affairs, dental plan trends for the year and simplifying provider data collection.

Dr. Christopher J. Smiley, CDBP member and representative to the Dental Quality Alliance, and Dr. Conan Davis, chief dental officer for the Centers for Medicare & Medicaid Services, provided an overview of the DQA, which will develop programmatic performance measures to assess oral health care quality for Medicaid patients.

The CMS proposed to the ADA in 2008 that a DQA be established and the ADA take a leadership role in its formation. It's also a federal mandate from both the Children's Health Insurance Program Reauthorization Act in 2009 and the American Recovery and Reinvestment Act, Dr. Smiley said.

Dr. Smiley informed those at the conference that the next meeting of the DQA is Oct. 29 in Washington, D.C., and the agenda includes a discussion on funding and planning the development of performance measures to begin in early 2011. The measures should be reliable, valid and feasible; evidence-based as much as possible; and point to outcomes of meaningful oral health improvement, he said.

Internet discussion: Jeffrey Segal, M.D., J.D.,  founder of Medical Justice Services/Dental Justice, talks about Internet rating sites.
Internet discussion: Jeffrey Segal, M.D., J.D.,  founder of Medical Justice Services/Dental Justice, talks about Internet rating sites.

The growth of Internet rating sites was the focus of "Angry Bloggers and Egregious Rating Sites: Definitive Solutions for Dentists in the Internet World." Jeffrey Segal, M.D., J.D., and founder and CEO of Medical Justice Services/Dental Justice, provided information on doctor rating sites, explaining how patients or people posing as patients can post comments about medical professionals on websites without them being able to defend themselves.

The vast majority of websites will have about three or four comments about a particular doctor, Dr. Segal said. Compare this with the 1,000 or more patients a physician or dentist typically sees and there is nothing statistically significant to be found, he said.

"Doctors are foreclosed on telling their side of the story. Because of state and federal privacy laws, doctors can't get into their patient's cases and I'm not sure they'd want to," said Dr. Segal.

The liveliest debate came during the dental fraud session, presented by Dr. Stewart R. Balikov, Aetna's national dental director of utilization management. He listed these as red flags that indicate fraud:

  • Consistent billing at the highest level;
  • Unsigned claims;
  • Letterhead that’s not used in narratives;
  • Requested receipts or records that are unidentified.

He showed some examples of fraudulent claims and encouraged dentists to look at the claim history and patterns for clues.

The conference is held annually to educate attendees on new and emerging trends in the dental benefits industry. It provides an opportunity to exchange ideas and information and allows conference-goers to meet people across the country who are directly involved in dental benefits issues. In addition, dentists earn continuing education credits.

Copies of the presentations from the conference can be obtained by calling Ronda Frazier at Ext. 2746.