Question

Yes, if you are informed of active Medicaid coverage within the timely filing period (typically 12 months) of the rendered treatment.

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.

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?

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.

To make a fully informed decision, doctors must analyze each PPO contract to determine the potential for profitability.