CDT Codes for Dental Exams and the Importance of Insurance Verification

CDT Codes for Dental Exams and the Importance of Insurance Verification

A professional dental billing company in the USA, Outsource Strategies International (OSI) provides a comprehensive suite of dental billing services including comprehensive dental eligibility verificat ion. In today’s podcast, Amber Darst, one of our Solutions Managers, discusses the CDT codes for dental exams and the importance of insurance verification.

Podcast Highlights

00:19 CDT dental exam codes

01:24 Importance of Insurance Verification

02:15 Hire an Experienced Dental Billing Company

Read Transcript

Hi this is Amber Darst, Solutions Manager here at Managed Outsource Solutions and I’ll be discussing the importance of understanding the various CDT codes for dental exams and verifying the insurance plan frequencies for each of these codes.

00:19 CDT dental exam codes

Coding dental exams correctly on insurance claims is crucial for proper dental billing. There are several different dental exam codes and knowing what each of them mean and when to use them is necessary for proper billing and reimbursement. Here are a few of the most commonly used codes.

  • D0150 is a comprehensive oral evaluation and this is for new or established patients.
  • D0180 is a comprehensive periodontal evaluation and this is also for new or established patients.
  • D0120 is a periodic oral exam. This is for established patients and this code is most commonly used when coming in for regular cleanings and checkups.
  • D0140 a limited oral evaluation, problem focused and this code is typically used for emergency visits.

01:24 Importance of Insurance Verification

Another important thing to keep in mind is that often times these codes will share a frequency. What that means is if the patient has been recently seen another dental office or has even come into your office say on like an emergency visit and had a limited exam completed, their insurance may not pay towards another exam within the next so many days or even months according to their plans, rules and regulations. The best way to ensure that you’ll get paid properly for the services that you provide is to always complete a thorough insurance verification for each patient prior to their visit. This will give you the information to know whether the patient needs to pay upfront for the exam or when they would be next eligible for another exam through their insurance.

02:15 Hire an Experienced Dental Billing Company

Hiring an experienced dental billing company can get this very tedious and time-consuming task off your hands and allows you more time to focus on what’s most important – patient care.

And that’s all. Thanks for listening in.

Importance of Insurance Verification to Understand Different Dental Coverages

Importance of Insurance Verification to Understand Different Dental Coverages

Outsource Strategies International has years of experience providing dental insurance verification services for diverse specialties. We understand that, in the field of dentistry, verifying eligibility benefits for every patient before providing services is the key to maintaining a smooth cash flow.

In today’s podcast, Amber Darst, one of our Solutions Managers, discusses the importance of Insurance verification to understand different dental coverages.

Podcast Highlights

00:29 Insurers don’t always provide standard coverage

01:21 Significance of dental insurance verification

Read Transcript

Hi this is Amber Darst, Solutions Manager for Managed Outsourced Solutions and I will be discussing the differences and dental insurance coverages and how important it is to complete insurance verifications for each of your patients prior to their appointment date.

Along with the rapid changes occurring in dentistry treatments, dental insurance reimbursement rates and rules and regulations are also changing.

00:29 Insurers don’t always provide standard coverage

A few examples of how insurance plans don’t always provide standard coverage across the board is some plans have deductibles that are actually applied toward preventative service in addition to basic and major services, or there are some plans that do not count codes for cleanings and exams toward the plan’s annual maximum. And another big one that can affect reimbursement rates from plan to plan is some insurances won’t pay at the prep day, instead they reimburse based on the seat date or the completion date.

01:21 Significance of dental insurance verification

While such insurance challenges are just a part of the industry, dental providers should always strive to do all they can to ensure that the plan benefits are understood by both the patients and the staff. The best way to do this is to perform a thorough insurance verification on each patient before their date of service. By doing so, you will have a clear understanding of the patient’s coverages and you can then relay this information on to the patients, so that they know what to expect financially for any treatment that would be provided. Hiring an experienced dental insurance verification specialist will help keep this very important but time consuming task off your desk, leaving you to focus on what’s most important – patient care.

And that’s all. Thanks for listening in.

Importance of Verifying Dental Insurance Coverage For Porcelain Veneers

Importance of Verifying Dental Insurance Coverage For Porcelain Veneers

One of the leading dental insurance verification companies in USA, Outsource Strategies International provides comprehensive support to verify patient eligibility before the scheduled office visit. Information that is verified includes effective coverage dates, waiting periods, maximums and deductibles, treatment history, benefits used to date, type of plan and fee schedule, coverage percentage by category, implant and orthodontic coverages, and more.

In today’s podcast, Amber Darst, one of our Solutions Managers, discusses the importance of verifying dental insurance coverage for porcelain veneers.

Podcast Highlights

00:14 What are Porcelain veneers?

01:06 Importance of insurance verification

Read Transcript

Hi, this is Amber Darst, Solutions Manager for Managed Outsourced Solutions, and for this podcast I will be discussing the importance of verifying dental insurance coverage for porcelain veneers.

00:14 What are Porcelain veneers?

Porcelain veneers are one of the most effective dental options to improve the cosmetic appearance of your teeth and achieve the smile your patients’ desire. Veneers are a porcelain cover that is placed over the front surface of healthy teeth to improve their color, shape and appearance. Veneers cannot be used for restoring badly failing teeth. Dentists will likely recommend crowns instead, if the patients have any decay, cracks or excessive wear. Porcelain veneers are inexpensive dental restoration and insurance coverage is generally not available for veneers that are placed for cosmetic reasons. Although rare, there are instances where insurance will pay towards this procedure if it can be proven to be medically necessary.

01:06 Importance of insurance verification

Knowing each dental insurance company’s policies by performing a thorough insurance verification for each patient in advance of their appointment is crucial for dental practices to understand the coverage for veneers and crowns and it also ensures that you will get the proper reimbursement for any treatment provided.

Outsourcing your dental billing to MOS can help keep your revenue flowing, while you focus on providing patients with the best options for their needs.

And that’s all. Thanks for listening in.

Important Considerations for Billing Dental Surgeries

Important Considerations for Billing Dental Surgeries

For more than 17 years, Outsource Strategies International (OSI) have been providing dental billing services for small as well as large practices. Our team provides dedicated dental insurance verification and authorization services for individual dentists, endodontists, orthodontists, or periodontists.

In today’s podcast, Loralee Kapp, one of our Solutions Managers discusses some important considerations for billing dental surgeries.

Podcast Highlights

00:10 Why are dental surgeries performed?

00:47 Factors to consider when billing for dental surgeries

00:52 Insurance verification

01:55 Established medical necessity

03:19 Obtain a pre authorization

03:45 Understand the importance of coding

04:48 Filling out and submitting claims

05:16 Outsourcing your verification authorization and billing needs

Read Transcript

This is Loralee Kapp, a Solutions Manager with Managed Outsourced Solutions. I’m gonna discuss with you some important considerations for billing dental surgeries.

00:10 Types of dental surgeries

Dental surgeries are performed to treat a variety of conditions that affect the teeth, jaw and gums such as temporal mandibular joint also known as TMJ disorder, wisdom teeth removal, facial trauma, corrective jaw surgery and periodontal surgeries to treat gum conditions like gingivitis and periodontitis. Billing the patient’s medical insurance for medically necessary dental surgeries can help patients maximize their health benefits. Utilizing a professional billing company can help ease this task as well as help increase reimbursement rates.

00:47 Factors to consider when billing for dental surgeries

The following are important considerations to make when billing for dental surgeries:

00:52 Insurance verification – Verifying dental eligibility by collecting the patient’s demographics and insurance information allows you to check their coverage and if their insurance will pay for the surgery. Collecting the following information will aid in this process. It is important to gather:

  • The patient’s name and date of birth
  • The name of the primary insured
  • Social security number of the primary insured
  • Insurance carrier
  • ID and group numbers, and
  • Contact information for the insurance company such as – phone number, website and claim submission address

With this information on hand, you can contact the insurance company to verify coverage, effective dates, in and or out of network coverage, if prior authorization is required for surgery, the patient’s portion such as deductible, co-pay and coinsurance. This will also help your patients plan for their out-of-pocket payments. Relying on a verification specialist and the billing company can simplify these tasks for your practice.

01:55 Establishing medical necessity – Medical insurance plans will reimburse for surgeries performed by a dentist if they can prove it is medically necessary and is properly coded as a medical procedure. You must provide documentation proving medical necessity. This is done to prove that the patient is medically compromised by a problem that the dentist treats. For example, tooth removal for impacted teeth, removal of teeth before radiation therapy or organ transplant. Medical plans may also cover tissue biopsies and extractions for surgical replacement of dental implants. Use the correct ICD 10 codes and CPT codes to document all aspects of care provided. This documentation should include

  • the chief presenting problem
  • any secondary or supporting diagnoses
  • diagnostic code for planned treatment
  • prior authorization for the surgery
  • letter outlining the medical necessity
  • a supporting letter of medical necessity for the primary care provider
  • procedures performed at the surgery location

This documentation should inform the payer that the patient’s concern is a medical one, not only a dental concern. All contributing factors for the patient’s medical history maybe stated in the letter to prove it is medically necessary.

03:19 Obtain a preauthorization– All dental surgery claims require a preauthorization from a medical plan. Dentist’s office must obtain this authorization before performing the surgery. Preauthorization involves contacting the insurance plan by phone or website in explaining the procedure and the day of the procedure. Failing to obtain a preauthorization may result in claim rejection.

03:45 Accurate coding –Know the proper ICD 10 codes and their uses. It is crucial for the insurer to note necessary information about the requested procedure. The first or primary diagnosis listed must relate to the most important aspect of the procedure being performed, followed subsequently by the secondary codes that pertain to the condition listed in order of lesser importance. The CPT codes on the claim must be listed in order, from the most expensive down to the least expensive procedure, not in the order that they were performed. This is done because payers reimburse for the first surgical procedure listed at the highest benefit level in each subsequent procedure at a lower or reduced rate. For example, the first procedure listed maybe paid out 100 percent, the second at 75 percent and any other additional services listed to be paid at 50 percent.

04:48 Filling out and submitting claims – After the dental surgery has been performed, the claim should be completed and submitted timely and correctly. The form should be checked thoroughly for typos and other errors that may lead to claims rejection or the delay of payment. The claims should be submitted to the insurance with all pertinent information provided including any supporting documentation such as lab or diagnostic imaging reports.

05:16 Outsourcing your verification authorization and billing needs – This is a great option to maximize your dental billing efficiency. Relying on experience companies that have experts dedicated to your practice and are up to date on all billing procedures such as – rules, claim submission processes, pricing coverage and the individual plans in each state, can enable you to focus more on your patient’s care, while resting assured that your billing needs are being handled by knowledgeable teams dedicated to ensuring that your back office needs are covered.

Insurance Verification vs. Insurance Authorization

Insurance Verification vs. Insurance Authorization

Outsource Strategies International (OSI) has extensive expertise providing insurance verification and authorization services. Our team will verify the insurance coverage details of each patient, both new and returning, before services are provided. Our support can eliminate risks of denials due to patient ineligibility and enhance practice cash flow.

In today’s podcast, Loralee Kapp, one of our Solutions Managers discusses the difference between insurance verifications and insurance authorizations.

Podcast Highlights

00:11 What is RCM?

00:29 What does RCM involve?

00:55 What is insurance verification

01:51 What details are collected before the patient’s visit

02:42 Benefits of proactive patient eligibility verification

04:00 What is insurance authorization?

05:11 Difference between insurance verification vs. insurance authorization

Read Transcript

Hey all, this is Loralee Kapp, the Solutions Manager with Managed Outsourced Solutions. Today I want to discuss with you the difference between insurance verifications and insurance authorizations.

00:11 What is RCM?

Revenue cycle management, known as RCM is the administration of financial transactions that result from the medical encounters between a patient, provider, facility and/or supplier, according to the Healthcare Business Management Association, the HBMA.

00:29 What does RCM involve?

RCM involves several processes from the time that the patient schedules an appointment to claim submission and payment collection. Insurance verification and authorization are key processes performed in the initial phase of RCM or medical billing insurance claims process. Though both aimed at preventing claim rejection and delays, insurance verifications and prior authorizations are distinct and different processes.

00:55 What is insurance verification?

But start with going over what insurance verifications are? The life cycle of a patient begins with the appointment scheduling and registration where demographic and insurance information is collected. This sets the stage for insurance verification – the process of checking the patient’s healthcare coverage and benefits prior to the encounter. The goal of this is to confirm –

  • if the patient has active insurance coverage
  • what procedures and services are or are not covered and
  • how much of each procedure the insurer will cover and the patients financial obligation

The following information is collected when the patient calls to schedule an appointment

  • the patient’s name and date of birth
  • the name of the insurance provider
  • name of primary insurance plan holder and their relationship to the patient
  • Patient’s policy number and group ID if applicable and
  • the insurance company’s phone number and address

01:51 What details are collected before the patient’s visit

A reliable insurance verification service provider will make sure that the all the required details about the insurance eligibility and benefits are collected before the patient’s visit. This includes

  • the type of plan and coverage details
  • calendar year or policy year
  • the effective date
  • plan annual maximum
  • plan deductible
  • primary and secondary insurance
  • per code coverage, if available
  • copays and deductibles
  • DME coverage
  • plan exclusions
  • referral or pre authorization requirements and
  • out of network benefits

Insurance verifications specialists will get a full breakdown of the patient’s insurance coverage and benefits by visiting payer web portals or calling the insurance carriers with the information collected from the patient during the initial phone call.

02:42 Benefits of proactive patient eligibility verification

Proactive patient eligibility verification is crucial for the success of a claim submission and medical billing:

This improves the patient experience – verifying the patient’s insurance before at the office and counter and communicating to them as to what their plan covers and doesn’t cover will ensure transparency. This will enable the patients to know about the cost of their care and can help them better prepare to pay their bills. With transparency throughout the political billing process, patients will not face any costly surprises.

This reduces claim denials – if the patient’s information is outdated and the provider uses that to submit a claim, it would result in an instant payment denial. Verifying patient eligibility upfront will ensure that claims are submitted with current and accurate data for a prompt payment. Insurance verification services minimize claim denials and save time and money that would go into working those denied claims.

This can also maximize your cash flow – proper insurance verification will ensure that claims are submitted with up to date information. Meaning, clean claims will be approved faster and speed up the medical billing cycle. With reduced denials and a larger number of clean claims submitted, this will increase a practices cash flow.

04:00 What is insurance authorization?

Now let’s go over what an authorization is. Insurance authorization or prior authorization is a health plan cost control process by which physicians and other healthcare providers must obtain advanced approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. The American Medical Association states that prior authorization is also referred to as pre- certification, pre-authorization, prior approval or pre-determinations. Insurance companies use the prior authorization process to determine if a prescribed medical treatment drug or medical equipment will be covered in full or in part.

The insurance authorization process begins when a service prescribed by a patient’s physician may not be covered by their health insurance plan. The physician’s office has to communicate with the insurance company and complete a prior authorization form along with documentation supporting the medical necessity of a specific procedure, test, medication or device and the prior authorization is a time consuming process that can delay a patient’s access to care.

05:11 Difference between insurance verification vs. insurance authorization

Now let’s go over the difference between an insurance verification vs. an insurance authorization.

The difference between insurance verification and insurance authorization are as follows –

Unlike insurance verification which is performed before the patient encounter, the prior authorization begins when a procedure, test, medication or device that the physician prescribes for patient requires pre approval from the insurer.

Insurance verification is related to the process of creating and filing medical claims and obtaining payment for patients services all prior authorizations about obtaining prior authorization for said services.

For a smooth pre authorization process, medical billing personnel need to be a knowledgeable about the CPT code for the service for which approval is requested. Insurance verification process focuses on coverage status, active/inactive status and eligibility status.

Both insurance verifications and authorizations are time consuming processes that can lead to denials. That’s why they are best handled by experts. Outsourcing these tasks to an experienced insurance verification company can go a long way toward saving time, preventing denials and delays as well as optimizing reimbursement and improving patient care and satisfaction.

6 Strategies to Increase Dental Practice Revenue

6 Strategies to Increase Dental Practice Revenue

One of the leading dental billing companies in the U.S., Outsource Strategies International (OSI) is a reliable provider of comprehensive dental eligibility verifications and other services.

In today’s podcast, Loralee Kapp, one of our Solutions Managers discusses some strategies that can boost dental practice revenue.

Podcast Highlights

00:33 Perform patient benefit verifications

01:06 Review the contracted fee schedules

01:47 Establish clear payment policies

02:21 Assign the correct codes

02:39 Ensure an efficient claim submission process

02:57 Track claims

Read Transcript

Hi all, this is Loralee Kapp, the Solutions Manager with Managed Outsourced Solutions. Today, I want to discuss with you strategies to help boost your dental practice’s revenue.

The financial success of a dental practice depends greatly on proper communication between the practice and insurance companies. This proper communication will help maximize your reimbursement. Outsourcing your back office needs to a reputable billing company can make this process much easier. Here are 6 strategies to boost your practice’s revenue.

00:33 Perform patient benefit verifications – The success to billing depends on performing comprehensive dental insurance verifications before services are rendered. Comprehensive verifications should include checking the patient’s eligibility, coverage as well as active benefits with the insurance companies as well as verifying the demographic information. An important step is to ask if there has been a change to the employment status of your patients. Such a change may affect the coverage of their benefits.

01:06 Review the contracted fee schedules – The fee schedules are constantly changing. It is important to review them annually to help ensure the long term financial success of your practice. In order to review and readjust fee schedules, you will need to individually negotiate fee increases with third party payers. The ADA news reports say that dentist may need it to provide payers with the information such as – the desired fees for procedures, the costs associated with operating the business, and the date when the fees were last revised. It is also very important to review your contracts with them very carefully.

01:47 Establish clear payment policies – Establish clear payment policies for patients such as – collecting a patient’s copays or fees not covered by their insurance at the point of service can help reduce the outstanding claim, having a written financial policy outlining the patient’s obligations and what happens if they are not meant as a proactive strategy. In order to ensure that you are collecting payments, it is important to implement a process of sending out statements on a weekly, bi-weekly or monthly basis.

02:21 Assign the correct codes – As ICD 10 and CDT codes are constantly changing, it is vital to ensure that you are signing the correct codes for procedures and services rendered. This is very important as assigning incorrect codes and modifiers can lead to allegations of fraud.

02:39 Ensure an efficient claim submission process – Having a proper system in place to timely submit insurance claims is crucial to ensure reimbursement. Submitting claims the daily and implementing a system of reviewing claims for accuracy before sending them out can help improve the turnaround time.

02:57 Track claims – This is one of the most important services provided by dental billing companies. We regularly monitor claims to ensure the timely correction of any issues. Tracking the claims process ensures timely follow up in payment posting. If a claim is rejected the claim can quickly be appealed with the necessary adjustments made. Many providers have chosen to rely on experienced dental billing companies as a cost-effective option that can help increase their practice’s revenue as well as ensure efficient claim submission and maximize your reimbursement.

For more information on how Managed Outsource Solutions can help you with your back office needs, please contact us.