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Question
- Self-Funded Plans
- Refunds
- Record Retention
- Records
- Radiographic Images
- PPOs
- Patient Records
- Patient Dismissal
- Miscellaneous
- Medical Claim Submission and Reimbursement
- Fully Insured Plans
- Fees
- Electronic Funds Transfer
- Discounting Fees
- Copay Forgiveness
- Coordination of Benefits and Non-Duplication of Benefits
- Claim Submission
- Appeal
- Alternate Benefit
- Veneer
- TMD/TMJ
- Tissue Conditioning
- Teledentistry
- Snore Guard
- Restorative
- Radiographs
- Preventive
- Personal Protective Equipment
- Periodontal
- Orthodontics
- Oral Surgery
- Occlusal Guards
- Miscellaneous Services
- Implants
- Extraction
- Diagnostic
- Dentures and Partials
- Crown
- CBCT
- Bridge (Fixed Partial Denture)
- Pediatric Coverage
- Proper Claim Form
- Endodontic Treatment
- Incomplete Extraction
- Replacement of Broken Implant Screw
- BruxZir Crowns
- Record Retention – Treatment Plans
- Record Retention – EOBs
- Reporting the Proper Fee
- DMO vs. PPO
- Negotiating Fees
- Record Retention – Patient Death
- Multiple Fees
- Charging for a Failed Crown
- Copay Forgiveness
- Narratives
- Assignment of Benefits
- Alternate Benefits
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Retroactive Medicaid Coverage
Yes, if you are informed of active Medicaid coverage within the timely filing period (typically 12 months) of the rendered treatment.
- Non-covered Medicaid Procedures
- Fee Splitting with Specialists
- Medicaid and Diagnoses Codes
- Medicaid Overpayments
- Medicaid Balance Billing
- ACA and Orthodontics
- ACA and COB
- All-on-4
- Tips for Writing Narratives
- Guidelines for Writing Narratives
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TAP Snore Guard to Medical
I am billing a TAP snore guard to a patient's medical insurance. We have the referral/recommendation from her MD and a sleep clinic. I have never billed to medical insurance before. My main questions are which codes to use (if different) and if I can bill on the current ADA claim form.
- Writing Narratives That Will Result in Reimbursement
- Crown Narrative – Decay Not Obvious on X-ray
- Developing Narratives For Soft Tissue Grafts
- How to Write a Crown Narrative in Less Than a Minute
- How to Write a Crown Narrative in Less Than a Minute
- Q&A: Crown Narratives – Decay Not Obvious on X-Ray
- Autogeous Bone Grafts and Infuse Bone Grafts
- Keep Electronic Narratives Brief
- Supernumerary Tooth Extractions
- How Often Should We Spot Probe?
- How Often Should We Perio Chart?
- Missing Tooth Clause
- Can crowns never seated be billed?
- Child vs. Adult Prophylaxis
- Do evaluations (exams) include periodontal screening?
- Laser Reporting for Periodontal Procedures
- Coverage Issues – Bridge and Pontic
- Non-covered Cosmetic Services
- Records Retention
- Reporting Removal of Multiple Tori
- Locum Tenens Dental Providers
- Soft Tissue Grafts
- What fees should we report on claims?
- Dry Socket Treatment
- Desensitizing
- Operculectomy or Excision of Pericoronal Gingiva
- Cantilever Bridge
- Recementing
- Maryland Bridge
- Implant Bridge
- Radiographic vs. Surgical Implant Indexes
- Implant vs. Abutment Supported Crowns
- Mini-implants
- Uncovering Implants
- Coding Cusil Partial Dentures
- Crown Lengthening vs. Anatomic Crown Exposure
- Perio Protect Trays™
- SRP and Prophy
- Free Soft Tissue Graft
- Root Canal on Primary Molar
- Incomplete Endodontic Therapy
- Root Canals Reporting Date
- Pulpotomy vs. Pulpal Debridement
- Gramm Crown
- Cone Beam CT
- D0180 and SRP (D4341 or D4342) or D4910 on the Same Day
- Re-evaluation Frequencies
- Prompt Payment Laws – How Long Do Insurance Companies Have to Pay Claims?
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Evaluating PPOs By The Numbers
According to a report published by the National Association of Dental Plans, PPO plans represented 63% of the dental benefits market in 2009. Traditional fee-for-service dental plans only represented 17% of the market. Unfortunately, this domination of PPO plans has given some insurance carriers the leverage they need to reduce participating provider fee schedules. In certain areas of the country some of the nation's largest dental carriers appear to be in a bidding war to see who can reduce fees the most without losing a significant number of participating providers. What are your options when fees are reduced?
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Dental PPO Fees in the Spotlight
Dentists who participate in reduced fee networks should continue to bill full fees on all claims and account for contracted write-offs when posting payments. Doing so will improve the accuracy of fee data used to determine future fee increases, ensure that the latest allowable fees are paid on all claims, allow participating providers to compare the profitability of each PPO contract, and enable providers to analyze the effects of other discounts and patient incentives offered in their practice.
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Trouble Deciding Whether to Join or Drop a PPO?
To make a fully informed decision, doctors must analyze each PPO contract to determine the potential for profitability.
- Reporting Problem Focused Evaluations
- Reporting Case Presentation
- Plan Limitations for Oral Evaluation
- Plan Limitations for Limited Evaluation
- Billing Palliative and a Limited Evaluation on the Same Day
- Billing an Evaluation and Perio Recall on the Same Day
