04/07/2014

Dentists learn to navigate dental benefits at CDA workshop


Dentists gained firsthand knowledge of practice model selection, contractual analysis, legal implications of claims and more at CDA's Dental Benefits Workshop.

Held at CDA's headquarters in Sacramento, more than 70 people, including dentists and staff from 40 practices, attended the March 20-21 event that was aimed at providing a roadmap to navigating the ever-changing world of dental benefits.

"Our overall goal is based upon significant member need to understand and address the rapidly changing dental benefits marketplace," said Michael Perry, DDS, president of a Northern California dental consulting business and chairman of the CDA Practice Support Workgroup, which was charged with developing the Dental Benefits Workshop. "The marketplace is creating economic pressures for our members and so our goal was to help them understand what is happening in the marketplace and to help them gain a knowledge base that they can use to make individual decisions for their practices."

Attendees were able to earn up to 12 hours of continuing education and improve their skills analyzing and evaluating existing dental plan contract performance in their practices. They also learned the differences between plan types and how to abate their influence, improve payment turnaround by minimizing claim denials and develop messaging for educating patients regarding their dental benefits.

Perry led a presentation on Practice Model Selection, in which he broke down the relationship with dental insurance into certain categories that he calls models of practice depending upon how much contracted insurance the practice has.

Below are the models:

  • Model 1: Hybrid - 2/3 fee-for-service, 1/3 PPO.
  • Model 2: Hybrid - 1/3 fee-for-service, 2/3 PPO.
  • Model 3: Hybrid - 1/4 or less fee-for-service, 3/4 or more PPO and/or HMO.
  • Model 4: Pure fee-for-service.

Each of these models have variations in terms of staff costs based on the level of training the front staff, registered dental hygienists and dental assistants have. Dentists can change which model they are in, but Perry recommends doing it carefully.

"For many of them, they are in a position to change the model of practice they are in, but if they are going to do that they would need to use a carefully formulated transition strategy," Perry said.

Participation in the workshop was limited to two people from each practice (one dentist and one staff member). LaJuan Hall, DDS, was accompanied by the staff member in her practice who handles insurance claims.

"I was interested in coming to the Dental Benefits Workshop to learn more about making wise decisions in interacting with insurance companies with all the changes in health care," Hall said. "It was really a lot of wonderful information that now I have to take back to the office with my insurance coordinator when we get back on Monday."

Katrina Pagonis serves as legal counsel with the Los Angeles firm Hooper Lundy & Bookman, P.C. Pagonis focuses on the representation of health care providers in matters relating to health care reform, as well as regulatory compliance. She led a presentation at the workshop on tips and common mistakes in contracting.

"We were trying to underscore the importance of a managed care agreement, that it dictates the relationship between the plan and the dentist, and underscore the importance of thoroughly reading that contract and understanding how it will impact your business," Pagonis said.

Attorney and recognized expert in Medicaid and Medicare reimbursement matters, Felicia Sze, also with Hooper Lundy & Bookman, co-presented with Pagonis. One tip that Sze had for attendees was simple: stay organized.

"Just maintaining the actual contract. So making sure that somewhere in the office there's a file that has the base agreement, it has all the exhibits and attachments to that agreement, it maintains any amendments to that agreement as well as updated fee schedules and updated provider manuals," Sze said.

Other speakers included Charles Stewart, DDS, dental director of Aetna's West dental territory, Scott Wellwood, president of CDA Endorsed Program DentalXchange and former board president of NDEDIC and Gary Dougan, DDS, MPH, national dental director, Liberty Dental Plan.

Wellwood, who discussed electronic dentistry, said a problem dentists run into is trying to guess based on historical information what the insurance companies want in a claim and choosing to mail complicated cases with various printed documents.

"It requires more work on the payer part and typically will delay the payment, where as if they send everything electronically, the systems are at a stage now where we can validate what the payer actually needs and only require you to send the documentation as needed," Wellwood said.

From claims paperwork to health care reform, there is a lot to cover over a two-day event. CDA used research and included a variety of dental professionals (plan representatives, practice management experts, etc.) to plan and execute the curriculum for the workshop. CDA dental benefit/plan research conducted by Edge Research in 2010 revealed dentists are extremely frustrated with the dental benefit world and consider this their No. 1 "pain point." The research also identified that much of this frustration is related to claims denial, down coding, benefit exclusions and a number of other procedural matters that oftentimes could be avoided through better training and education of dental office staff responsible for filing claims.

The Dental Benefits Workshop was intended to alleviate some of those frustrations.

Peter Lee, DDS, said he attended because he wanted his staff, as well as himself, to be updated on all the latest in the dental benefits industry.

"There's no question that I think that these Dental Benefits Workshops are excellent for any dentist," Lee said.

Attendees such as Lee and Hall will now be able to participate in post-workshop webinars and surveys.

Future Dental Benefits Workshops are in the planning phase and CDA will keep members updated on future opportunities in the Update and on cda.org. For practice support resources and more information on dental benefits, visit cda.org/practicesupport.