Resources
Breakdowns and Estimates: Are You Using the Correct Fee Schedule? (INN, UCR, MAC)
Insurance can be complex and highly detailed on a good day, and therefore easy to get tripped up even for the most experienced dental insurance coordinators. A pitfall we have seen of late occurs when offices are compiling their breakdowns and estimates and inadvertently use an incorrect “fee schedule.” In this article, I want to talk about the various “Fee Schedules” and their relationships to each other, highlighting where there are sometimes points of confusion which can result in an inaccurate estimate. Inaccurate estimates create surprise bills for patients and then no one is happy.
Read MoreMake Sure Coding Matches Lab Cases and Fees
Here are some common mis-coding scenarios where you’ll want to always “double-check.
Read MoreNavigating Year End Considerations in Dental Offices
As the year draws to a close, dental offices must consider a range of factors to ensure their practice operates efficiently and effectively. This article delves into key aspects, including insurance, patient scheduling, equipment management, and the use of marketing letters, offering valuable insights and guidance.
Read MoreTop 10 Ways to Improve Savings and Profitability in Your Dental Office
With the current economic market, it has never been more imperative to assess our business practices and find ways to counter the rising costs of overhead expenses as well as stagnant insurance fees. A review of your expenses should be done more than once a year to make sure you aren’t overspending.
Read MoreHandling Insurance Audits
Facing an audit is one of the most frustrating challenges for any practice, but it doesn’t have to be. With the right knowledge, preparation, and prevention, you can avoid major headaches. In this article, we break down two different types of audits—each with unique processes and outcomes—and how both in-network and out-of-network offices can be impacted.
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12 Tips to Maximize Reimbursement from Dental Claims
Discover ways to navigate your dental insurance challenges more effectively. This article contains 12 actionable solutions to streamline office operations, enhance the satisfaction of your patients while also boosting the profitability of your practice.
Read MorePeriodontal Maintenance vs Prophylaxis - Can You Alternate These Codes?
This debate has persisted for decades within the dental community and its teams. On one side, there are those who firmly assert, "once perio, always perio." Conversely, there are those who argue, "it depends on the current health of the tissue."
Read MoreResponding to Insurance Requests that Do Not Make Sense
Sometimes the questions requested by an insurance company are system-generated and as a result are very generic. The way to think about a relatively vague question is not to focus on the exact words they use (which could be incorrect), but instead focus on the type of information they are looking to receive.
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Part 2 - The Inlay/Onlay Dilemma - How to Get Insurance Coverage
The initial segment (Part 1) of this series explores the complexities surrounding inlays and onlays when seeking reimbursement through dental insurance. To summarize, both procedures often get "downgraded" by insurance providers to the level of fillings, leading to increased costs for your patients. The subsequent sections of this article are dedicated to exploring potential remedies for this issue.
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Part 1 - The Inlay/Onlay Dilemma - Challenges
Some dentists will recommend or offer the option of either an inlay or onlay for patients in an effort to stay more conservative when treating teeth. This approach effectively aims to preserve teeth that have incurred partial damage. However, a common hurdle arises when submitting an insurance claim, only to encounter denials or service downgrades from the insurance company.
Read MoreShould You Outsource Your Dental Insurance Billing?
Outsourcing aspects of your business to an outside provider has been a common tactic of many businesses for years. It’s becoming much more prevalent in dentistry post-covid, due to challenges many offices are experiencing challenges finding and retaining enough team members to stay functional.
Read MoreWhy You Should Think Twice Before Criticizing Fellow Dentists
The majority of dentists are compassionate individuals who have chosen their profession with the genuine intention of aiding others. Nevertheless, perhaps due to our extensive educational backgrounds and inherent attention to detail, we may occasionally find ourselves excessively critical of our peers.
Read MoreInsurance Forms
Denture Timelines - Levels 1-3
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Treatment Plan Template
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ADA Non-Covered Services Form
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Crown Narrative Form
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Insurance Overpayment Letter
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Insurance Letter Deny Refund
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Patient Forms
Do Not Bill to Insurance - Patient HIPPA Restriction Request Form
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1) Patient Form - Getting To Know You As Our Patient
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2) Patient Form - Financial and Insurance Form
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3) Patient Form - Medical History
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4) Patient Form - Dental History
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5) Patient Form - Informed Consent for Services
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Consent for Use and Disclosure of Health Information
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Dental History Form
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Secondary Insurance
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Update Medical History
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Sample Hygiene Clinical Note for SRP
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Consent Forms
Consent for Use and Disclosure of Health Information
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In Office Bleaching Consent Form
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Informational Informed Consent: Oral Sedation
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Oral Sedation Informed Consent
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Perio Informed Refusal
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Employment Forms
I-9 Form
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W-4 Form
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Employee Key Agreement Form
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General Team Expectations
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Reference Letter Sample
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Team Dental Benefits Option 2
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Practice Management
End of Year Letters
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Bleaching Syringe Log
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Bleaching Trays Tracking Sheet
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Lab Case Tracking
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Lab Cases
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Limited Exam Checklist
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Limited Warranty
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Medical Consult Request
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Refund - Liability Release
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School/Work Excuse
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X-Ray Protocol
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XRay Training- Anterior PAs
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Non-Covered Services by State
Laws preventing insurance companies from dictating fees for non-covered services.
Read MoreInterpreting Non-Covered Services Laws - Cheat Sheets
(Member Benefit) Breakdown interpretation of how to understand Non-Covered Service laws in each state.
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Assignment of Benefit Laws
State laws requiring insurance companies to send AOB to OON providers when requested.
Read MoreInsurance Recoupment Laws
Insurance recoupment laws encompass several key concepts. It is essential for stakeholders to be aware of these nuances to ensure compliance within the complex landscape of insurance recoupment.
Read MoreInsurance Commissioner Contacts by State
Read MoreInternal Coding Examples
Many procedures and visits are not covered by ADA codes, hence the need for offices to create a good set of internal codes for both tracking and patient billing purposes. Here is a basic list to help you think about what codes you may need to create for your office's function.
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How to Handle an Appeal Chart
Let´s face it, insurance claims get denied. When it happens, it´s important to understand what recourse you have. This chart lists the most common EOB denial language, whether an appeal can potentially change the outcome, and what specific action is recommended.
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Secondary Insurance Calculator
This calculator is designed to assist teams with correctly inputting reimbursements from multiple insurance companies. It will help you determine the correct input and write offs for accounts and claims that involve secondary insurance.
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Buy the Book! Understanding Dental Insurance: A Guide For Dentists and Their Teams
This book, written by Dr. Travis Campbell, serves as an additional training tool offering in-depth information for the more experienced, as well as a quick “look up” to have in your office for anyone with questions about dental insurance. Packed with information, illustrations, examples, tips and case studies, this guide covers every aspect of dental insurance from claims for simple fillings to complex hybrid denture and implant cases in real life situations.
Read MoreOld habits die hard. If your current dental insurance claims process hasn’t been updated, it’s likely outdated.
Up-to-date, ongoing billing education isn’t just helpful, it’s essential for your practice to thrive.
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