The COVID-19 (coronavirus) has certainly changed our day-to-day lives, and as a dentist dealing with this pandemic you may be wondering how you are supposed to care for your patients and bill for those services.
On March 18,2020, the California Department of Managed Health Care (DMHC) issued an all-plan letter instructing health plans to take immediate steps to allow people to obtain health care via telehealth when medically appropriate to do so.
Plans are required to reimburse providers at the same rate for telehealth services as they would for services provided in person. If the service is one that would otherwise have been provided in-person but is now being provided via telehealth, the plans should reimburse for that service as if it were provided in person. The letter (APL 20-009 – Reimbursement for Telehealth Services) also says that plans must reimburse a service provided telephonically at the same rate as services provided via video.
"Telehealth" is the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.
For more information and guidance on teledentistry please refer to the ADA's resource: D9995 and D9996 – ADA Guide to Understanding and Documenting Teledentistry Event.
There are options available to care for your patients while practicing social distancing. In 2018 the ADA developed CDT codes related to teledentistry:
Medi-Cal has coverage/reimbursement information and reporting requirements within their current copy of the Medi-Cal Dental Program Provider Handbook; see the section on Teledentistry found on page 4-14.
In addition to the above information, on March 17, 2020, California requested a Federal government waiver to cover Medi-Cal recipients and expand telehealth options.
Remember you must accurately code for the treatment rendered. The following codes could be viable options for teledentistry coding during this crisis:
Properly document and chart any telehealth appointments, either electronically or by some other means, to ensure this information is added to the patient’s dental chart.
Just like many other businesses, many of the dental plans are experiencing delays in call answering and customer service inquiries, particularly as they transition some of their staff to remote work environments. Dental offices will find that many dental plans’ online portals provide access to their patients’ eligibility, benefits, treatment history, frequencies, remaining maximums and deductibles. Information about these portals can be found in the provider/dentist section of the dental plan’s website.
One of the easiest ways to reduce the risk of slow-pay claims from a dental plan is to submit claims electronically. Many plans allow for the transmission of claims and predeterminations free of charge through the dental plan’s online portal. The direct connection to the plan’s processing system expedites processing and claims payment more quickly. Information about these portals can be found in the provider/dentist section of the plan’s website.
Additionally, dental plans offer payment via electronic funds transfer (EFT), which allows for expedited payment to dental practices by directly depositing payments into the designated bank account for the dental practice. Given the current situation with limited dental office hours and some closures, signing up for EFT will simplify payments and eliminate the concerns of mail theft or lost checks. Signing up for EFT is usually available on the dental plan’s provider portal. Moving to EFT for claims payment does not authorize the dental plan to recoup funds from your bank account in the event of an overpayment. It is a one-way transaction and the plans can only deposit funds, not withdraw funds.