CDT Dental Coding & Reimbursement Update: Identifying Common Practice Mistakes – Paul Bornstein

Without a thorough understanding of insurance reimbursement, today’s dental office is at a serious disadvantage. In this economy, dental professionals need to ensure that they are getting reimbursed as adequately as they can. Insurance companies use various tactics and strategies that, unless understood, will cause unnecessary delays and rejections during claims processing. Each office has unique insurance problems. All offices have common insurance problems. We will teach you how to be aware of the potential problems and offer possible solutions!

Why this Program is Unique:

• Get your practice up to speed with an experienced dentist who ran a dental insurance company and practiced for 30 years.
• You will be given a consultant’s perspective on records and billing, so you can do your own audits, increase your income, and decrease your risk.
• You will obtain helpful, realistic, and practical risk management and practice management tips.
• You will be given the information you need to file claims correctly and challenge denials with appropriate documentation and narrative.
• You will understand how insurance companies evaluate your claims.

Most Offices Can Immediately Increase Income with the Information in this Recording:

• Overcome a down economy with LEGAL ways to maximize billing.
• Implement proven strategies to improve patient collections.
• Bill properly for general practice, periodontal, and oral surgery services.
• Help prevent rejections.
• Identify what insurance companies look for other than fraud.
• Assess the claims process from the insurance company’s perspective.
• Examine the pros and cons of accepting Medicaid.
• Analyze dental contract language and determine how to best educate the entire dental practice, including the staff, doctor, and patients.
• Formulate the best narratives and documentation.

1. Identify what you need to be aware of to maximize billing.
2. Examine the intricacies of the dental insurance world.
3. Discuss how your office is being watched and how to avoid billing fraud.

The Dental Contract

• Insurance carrier rights
• Trends in today’s contracts
  • Changes in benefit frequency
  • Oral-systemic disease link
  • Avoiding dental fraud
  • PPO participation

Practice Management

• Fees
• Patient communication and managing the patient
• What consultants look for – common practice mistakes
• The importance of self-auditing records
• Risk management tips

Avoid Dental Fraud

• Avoiding “red flags”
• Suspicious claims
• Fee discounts
• Over-utilization
• Accepting Medicaid: Should you/shouldn’t you?
• Examples of legal action

The Complete Claim Form

• How to look at claims like a claims reviewer
• Correct X-ray, photograph, and narrative submission

Insurance Strategies

• Learn how the insurance company thinks
• Learn to correctly resubmit claims for appeal
• The truth about insurance company stall tactics – Are they real?
• Effect of the HIPAA laws on coding
• Effective communication skills
• Discover how to use the EOB to your advantage

Effective Coding and Billing

• Tips you can use to keep your practice afloat in a down economy
• Identify the biggest loss of income for your office and how to correct it
• CDT – the latest additions and revisions
• Documentation needed to support claims
• WILL YOUR RECORDS SURVIVE AN AUDIT?
• Correct use and maximization of codes
• Electronic claim filing
• Outside financing – Which lender should your practice recommend?
• The correct claim attachments and narratives – What needs to be included?
• Important tips to ensure a complete claim – the first time you submit it

Special Areas of Attention

• Learn to bill periodontal services correctly including the new D4346
• Fraud: Prevent fraud from occurring in your billing

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