03/31/2016

Dental benefits subject tackled at CDA Presents


The dental benefits market has undergone considerable changes in recent years. These changes have been reflected in shifting payment policies by dental benefit plans. And dental practices have been challenged to adjust as well.

At CDA Presents the Art and Science of Dentistry in Anaheim, CDA will engage in conversation with representatives of the dental benefits industry about the likely direction of dental benefits into the future, the payment policies that challenge dental practices today and the practical approaches in the dental office to successfully administer patients' dental benefits. Entitled "The View Into Dental Benefits," the program is scheduled for Fri., May 13, from 2 to 4:30 p.m.

Rather than a formal lecture, which attendees of past CDA dental benefits lectures have been used to, the format of this presentation will be a conversation with two dental directors of plans in California about the present and future of dental benefits and a CDA practice advisor about the administration of benefits.

Paul Manos, DDS, dental director of United Concordia, will discuss what bodes for the future and the more immediate trends in dental benefits. These are developments that will impact not only what dental plans may look like in the future, but also how they will be doing business. This discussion will show what dentists will need to adapt to continue to be successful in working with dental plans.

In considering the future of dental benefits, Manos will address questions regarding how structural changes in the general economy have affected the economics of dentistry; shifts in the dental benefits marketplace away from pure indemnity toward preferred provider organization designs; dentistry's likely role in new organizations for the provision of care, such as accountability care organizations (ACO); the evolution of dental coverage due to requirements of the Affordable Care Act and state health market exchanges; what the trend is toward coordinated care across professional disciplines; the trend toward increasingly paying for dental care through medical coverage; trends in paying for measurable treatment outcomes instead of procedures performed; the challenges of balancing consumers' demands for lower cost for health coverage; and the need to provide adequate reimbursement to providers.

Charles Stewart, DMD, is the dental director of the western territory for Aetna. He will be discussing common issues that can turn problematic for dental offices when administering the dental benefits of patients. Among the topics to be discussed with Stewart are what constitutes "medical necessity" when rendering dental care; the reason behind many of the refund demands that plans may make after payment for care; dental plans' performance in promptly paying claims and why some claim payments tend not to be paid promptly; the distinction between standard commercial plans and federally regulated self-funded plans; typical requirements for documentation, and assuring that the correct documentation accompanies claims; why coordination of benefits between two payers is often a problem; what dental offices should understand about the dentist's contract with dental plans in order to avoid payment problems; common reasons why claims are denied; and the advantages of moving to electronic claim submissions.

Shaun Pryor is a CDA practice advisor with extensive experience managing dental practices. From her experience, Pryor will discuss the practical aspects of administering patients' dental benefits in as problem-free of a manner as possible, including the importance of collecting patient information and keys to patient communication to assure their eligibility for coverage; properly understanding a patient's breakdown of benefit coverage; properly notifying patients of payment responsibility upfront, prior to care; addressing payment guarantees when a plan does not accept the patient's assignment of benefits to the dentist; managing claim aging reports to avoid claims from going unpaid for a lengthy period of time; avoiding common mistakes which result in claim denials; and assuring X-ray and intraoral photograph quality to demonstrate the need for the care provided.

This program will be repeated at CDA Presents in San Francisco.

For more information, visit cdapresents.com.


Topics: CDA Presents

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