【US】Audits, collections and dropping dental plan contracts: What dentists need to know

Answers, resources and upcoming CDA Presents courses

 

Quick Summary:

CDA’s Dental Benefits Analyst Lisa Greer answers member calls and emails Monday-Friday on a range of topics, from appeals to coordination of benefits. But she says most of the questions she fields fall into three areas: audits, collections and contract terminations. Greer and other CDA Practice Support experts will teach several courses covering dental benefits at CDA Presents in Anaheim May 12-14, but the experts offer a few key points and resources members can start utilizing in the practice now.

 

 

Photo: cda.org

 

 

 

 

CDA’s Dental Benefits Analyst Lisa Greer answers member calls and emails Monday-Friday on a range of topics, from appeals to coordination of benefits. But she says most of the questions she fields fall into three areas: audits, collections and contract terminations.

 

Greer with two additional CDA Practice Support experts will teach several courses covering dental benefits topics at CDA Presents The Art and Science of Dentistry in Anaheim May 12-14, but the experts have also assembled here a few key points and resources members can start utilizing in the practice now.

 

Understanding dental plan audits

 

“Dental benefits plan audits are common occurrences,” Greer says.

 

One question she receives frequently from members is “What will the auditor look for?”

 

California’s Knox-Keene Act and a dental plan’s contract with its network providers both give dental benefits plans the authority to conduct dental office assessments. The assessment enables a dental plan to demonstrate to state regulators that it is providing quality care to its enrollees and that the overall provider network is adequate to ensure timely care for plan enrollees.

 

An on-site assessment, a structural review and an assessment of the patient care process may occur.

 

The structural review encompasses accessibility and access to appointments and emergency services, the quality and maintenance of the facility and equipment, the existence of emergency procedures and equipment and compliance with sterilization and infection control requirements.

 

During an assessment of the patient care process, auditors will review documentation in patient files, such as medical history information, dental history and treatment progress notes, quality of care categories, existence of a treatment plan and treatment outcomes.

 

Members’ top dental benefits questions answered at CDA Presents

 

Dentists and their teams can learn more about dental plan audits in a free course at CDA Presents. Greer will review and answer the top 10 dental benefits questions she hears from members and their staff.

 

“I will cover audits, contract stipulations and more, and I’ll explain how the current dental benefits marketplace and trends are impacting dentists and their teams,” Greer says.

 

“Ask the Expert: Dental Benefits” will take place 3-4 p.m. Friday, May 13, at The Spot in Hall D of the Anaheim Convention Center. The course offers 1 unit of core C.E.

 

Greer also encourages members to log in to their CDA accounts to access the following resources to improve their understanding of audits in the dental practice, including whether the auditor has the authority to access patient records and what happens if the practice “fails” a quality assurance audit.

 

  • Dental Benefit Plan Handbook, Chapter 11
  • Conducting a Self-Audit
  • Patient Records – Requirements and Best Practices

 

Dropping dental plan contracts

 

Dentists who are considering terminating a contract with a dental plan want to know how that decision will affect their patients and their practice.

 

Implementing a plan withdrawal usually takes six months to a year from the time the decision to terminate a plan provider agreement is made.

 

“It is critical that you have sound financial policies in place for your practice and address any issues related to case presentation before you move forward,” Greer says. “This means you need to follow a set of actions for each step of the process: before, during and after termination.”

 

For example, during the termination process, the practice should develop a communication plan that includes patient messaging and team training. It should also expect a call from the plan’s representative once the termination notice is received and be prepared to discuss how the decision to terminate may impact enrolled patients. The practice should anticipate and mitigate loss of some patients due to the change.

 

What You Need to Know about Dropping Dental Plan Contracts provides a checklist of termination actions to take and also includes customizable sample letters for notifying the dental plan of termination and informing patients that the dentist is no longer contracted with the patients’ plan.

 

Additionally, chapter 2 of CDA’s Dental Benefit Plan Handbook will help dentists understand plan contracts and fees and includes a section to help the plan evaluate its participation in existing dental plans and whether that participation presents any challenges.

 

CDA members can log in to their accounts to access both resources.

 

To contract or not to contract?

 

A free lecture at CDA Presents in Anaheim will discuss the pros and cons of contracting with dental benefits plans and help attendees understand how to determine when a plan is a right fit for their practice.

 

CDA Practice Analyst Matthew Nelson acknowledges that with so many different dental plans on the market, dentists may not know how to select plans that are the best fit for the practice.

 

“We’ll help you evaluate and conduct an analysis for each plan,” says Nelson, who will co-present the course with Greer.

 

“To Contract or Not To Contract? Working With Dental Benefit Contracts” offers 1 unit of core C.E. and takes place from 11 a.m. to noon Friday, May 13, at The Spot in Hall D of the Anaheim Convention Center.

 

Collect with confidence

 

Managing patient collections in the dental office requires confidence, knowledge and strong billing practices and tools ― starting with the current edition of the CDT code book published annually by the American Dental Association.

 

“Your front office sets the stage for managing patient collections and strong billing practices,” says Katie Fornelli, senior practice management analyst at CDA. “If your practice has implemented clear and defined collection and billing systems, your day runs efficiently, and patients understand payment expectations.”

 

Fornelli says dentists sometimes fear that they will lose patients when the practice establishes financial policies.

 

“In fact, the majority of patients will appreciate and abide by the policies,” Fornelli says. She suggests CDA members log in to review Patient Financial Protocols, a thorough resource that explains how to determine patients’ financial options, the role of the financial coordinator, financial consultation and the ins and outs of collection.

 

Learn how to administer your billing and collections systems

 

Dentists and their teams can learn more about collections, including how to administer the practice’s billing and collections systems, in a free course at CDA Presents in Anaheim.

 

Fornelli and Greer will present “Collect With Confidence” on Saturday, May 14, from 8:30 to 10 a.m. The course offers 1.5 units of core C.E. and will take place in California room A/B in the convention center.

 

“You’ll leave the course knowing how to navigate the most difficult patient billing and collections scenarios,” Greer said.

 

More dental benefits plan resources from CDA

 

Log in to your CDA account to access dozens more resources on dental benefits plans.

 

Advance registration is required for all courses at CDA Presents in Anaheim. View the schedule and learn more about the speakers.

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