08/12/2016

Join conversations on dental benefits at CDA Presents


The dental benefits market has undergone considerable changes in recent years. These changes, many of which have been driven by changes in the overall economy, are reflected in dental benefit plans' shifting payment policies. 

At the 2016 CDA Presents The Art and Science of Dentistry in San Francisco, CDA will engage in conversation with representatives of the dental benefits industry about the likely future direction of dental benefits, the payment policies that challenge dental practices today and the practical approaches in the dental office to successfully administer patients' dental benefits. The program, titled "The View Into Dental Benefits," is scheduled for Friday, Sept. 9, from 8 to10:30 a.m.

The presentation will take a conversational format 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 the direction dental benefits appear to be taking, as well as emerging trends in benefits. These developments will impact not only what dental plans may look like in the future, but how they will do business and how dentists will need to adapt to continue to work 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. "The Great Recession eight years ago, which the economy is still recovering from, didn't reduce the demand for dental care," notes Manos. "But it has affected the ability and willingness of consumers to pay for dental care." This reality has caused a shift in the marketplace — a shift away from pure indemnity toward preferred provider organization designs.

Manos will also discuss dentistry's possible 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; the trend toward coordinated care across professional disciplines; the trend toward paying for dental care through patients' medical coverage; trends in paying for measurable treatment outcomes instead of procedures performed; the challenges of balancing consumer demand for lower-cost health coverage and the need to provide adequate reimbursement to providers; and pressures from government for the merger of medical and dental services.

Charles Stewart, DMD, is dental director of the western territory for Aetna. He will discuss common issues that can turn problematic for dental offices when administering patients' dental benefits. Specifically, Stewart will discuss what constitutes "medical necessity" when rendering dental care; why dental plans may make refund demands after payment for care; dental plans' performance in promptly paying claims and why some claim payments are not paid promptly; the distinction between standard commercial plans and federally regulated self-funded plans; plans' typical requirements for documentation, and ensuring 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 and electronic payment.

Shaun Pryor is a CDA practice advisor with extensive experience managing dental practices. Pryor will discuss the practical aspects of administering patients' dental benefits in as problem-free manner as possible, including the importance of collecting patient information to assure their eligibility for coverage; properly understanding the breakdown of a patient's benefit coverage; properly notifying patients of payment responsibility 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 prevent claims from going unpaid for a lengthy period of time; avoiding common mistakes that result in claim denials; and assuring X-ray and intraoral photograph quality to demonstrate the need for the care provided.

For more information, visit cdapresents.com.



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