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New Dental Billing Codes and Descriptor Changes for 2023

As with most things in life, dental billing codes and descriptors are changing again for 2023. Dental billing coding may be one of the most difficult aspects of working in a dental practice. Dental coding is essential to the billing process, and your practice may suffer without the proper knowledge of billing processes. Many dentists are missing out on revenue due to claims that can’t be processed because of incorrect coding or documentation.

Every change in coding means more opportunities to be specific with your billing process so you get the most out of your hard work. If you don’t know about these changes, you aren’t giving your practice every opportunity to be as successful as possible. Make sure your dental staff stays updated on changes to help you keep business booming and profits rolling in.

What Are the Changes?

One of the most significant changes is the introduction of new codes for teledentistry. With the COVID-19 pandemic changing the way we live and work, teledentistry has become an increasingly important option for dental practices. While dentistry is a difficult service to provide without being up-close and personal, more practices have found a way to provide some services like consultations or follow-ups via telehealth.

Although it may be a tool used to take precautions and limit exposure to germs, it has become quite convenient for patients and dentists alike, allowing patients less time away from the important parts of their daily lives and allowing dentists to prioritize the patients who need to be seen in-office.

With the new codes, it’s easier to bill and manage the telehealth services your practice provides for patients.

The new codes include D9995, which is for synchronous teledentistry services provided in real-time, and D9996, which is for asynchronous teledentistry services that are provided on a delayed basis. These codes are particularly helpful for practices that offer remote consultations or follow-up appointments, allowing for more efficient billing and reimbursement.

Other New Codes

Aside from those codes related to teledentistry, more codes have been created to help your practice be more specific about the services you provide and procedures you perform. While it is a challenge to remember new codes and apply them, it can be a positive change to help you get the money you’ve earned from your work.

Among the new codes, things like diagnostic imaging, 3D scanning, guided tissue regeneration, and HPV vaccinations are addressed.

Another important notation is that, while there are 6 new codes related to guided tissue regeneration (GTR) procedures, another separate code has been created for removal of non-resorbable barrier. While this surgical procedure may technically fall under GTR procedures, the ADA made the decision to make a specific code related to the removal of a non-resorbable barrier, because the procedure may take place at a different time than the other procedures under GTR codes, and possibly by a specialty dentist.

Descriptor Revisions

Several of the codes have undergone revisions to descriptors, so the meanings of what the codes describe have varied slightly. For example, the descriptor codes D0210, D9110, and D4355 are among those that have been revised. These codes don’t have large changes to their descriptions, but rather a single specific word that changes their meaning. This trio of codes all had language that included the word “complete,” which has now been changed to “comprehensive.” While only a word has changed, it seems to clarify the procedures further to ensure correct billing.

What Do These Changes Mean for Your Practice?

These code changes can mean important things for your dental practice. Without updating your code information, you could be looking at an increase in claim denials for services, which means several things for your practice.

Claim denials will mean a longer waiting time for reimbursement after a procedure or other patient care. Unfortunately, equipment repairs, payroll, and utility bills don’t wait until claims reimbursements come in, so delays in payment for your practice can be detrimental to your patients and employees.

Claim denials also take up more time than necessary from your hardworking secretarial staff. Denied claims mean redoing work that could’ve been done the first time and the potential for upset customers correctly when insurance hasn’t covered a procedure.

The measure twice, cut once mentality applies in this situation. Double-check that your billing codes are correct before bills are submitted and you’re less likely to have to do more work or do the same work over again later.

If you’re looking for assistance with filing dental claims and increasing your dental practice’s revenue. PPO Negotiation Solutions can help. PPO Negotiation Solutions can help you get the highest claims reimbursement possible and make sure none of your hard-earned money is left on the table. Visit us online to schedule a consultation or utilize our complimentary assessment.

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Looking for a Permanent Dental Jobs in Michigan?

If you are hard working, dependable, and professional, and looking for a career to greatly impact your income and livelihood, the dental industry may be right for you! The team at SPS Dental Academy in Shelby Township, Michigan, provides the very best training at the lowest possible cost to you. Their students are sought after by many dental practices. Not only have their programs helped thousands of students begin their new careers in dentistry, they have raised the bar for the standard of education in the dental field. Don’t take out thousands of dollars in student loans when there is a better option. SPS Dental Academy offers their students a more affordable education while making their students more confident and successful in their dental careers.

Career as a Dental Assistant

If you are looking for a permanent dental job in the State of Michigan or elsewhere, you have a high school diploma or equivalent, and are 18 years of age, you can apply for the Dental Assistant Program at SPS Dental Academy. In addition, you must have an up-to-date immunization record and possess a government-issued photo ID. 

The dental assisting program does not require prior experience in the dental field. The program is designed to provide you with all the training and knowledge you will need for a career in dental assisting. A good place to begin to find out if you will be happy and committed to becoming a dental assistant is to shadow your dentist, or family or friend who is a dentist, to get an idea if it is the career choice for you.

Important Qualities of a Dental Assistant

One of the numerous qualities that a dental assistant commonly possesses is being detail-oriented. There are specific rules and protocols a dental assistant must follow when assisting a dentist in treating a patient. They must also be knowledgeable of their scope of practice when it comes to the tasks they are allowed to perform in Michigan or other states.

Another quality they need to possess is dexterity. Dental assistants work in tight places on small parts of the body using precise instruments, so they must be good at working with their hands. Compassion is another quality that is good for a dental assistant to possess. They deal with the dentists and patients on a daily basis, and patients may be in extreme pain or distress. The dental assistant needs to be sensitive to their patient’s needs.

They must be a good listener to follow precise directions in order to help treat patients and complete essential tasks. They should be well organized, because they need to have all the correct tools in place for the dentist or hygienist to use on their patient for the procedure to be performed.

Important Information Regarding COVID-19 

Before looking for permanent dental jobs in Michigan or elsewhere, you should know about current compliance regulations that are required for infection control. The recent COVID-19 pandemic caused many new protocols to be implemented for safety of both patients and team members. Many of these requirements are still in place in some dental practices, such as wearing masks and gloves when interacting with patients.

Throughout dental practices in Michigan, OSHA/MIOSHA COVID-19 compliance initiatives were implemented in 2021, and for the most part, haven’t changed. Everyone entering the office is screened and refused entry if they are suspected to be COVID-19 positive. Screening records retention is no longer in place. Patients and employees are not required to wear face coverings, regardless of vaccination status. CDC guidelines do still recommend face coverings for everyone who enters a dental setting.

Dentists may choose if they wish for face coverings to be a requirement in their dental practice. The MDA still recommends dental offices to follow CDC guidelines. There are no longer social distancing requirements in dental offices. Dental practices must continue to maintain a COVID-19 preparedness plan in the office. Dental offices must also ensure each employee receives or has received training consistent with their COVID-19 preparedness plan.

The SPS Dental Academy is committed to helping their graduates by offering employment assistance to all students. Workshops and other classes are offered for lifelong learning opportunities as well. Other dental programs are coming soon, so be sure to check their website for more opportunities in the near future or email them for more information at info@spsolutionteam.com.

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What Should You Expect from the Credentialing Process?

The credentialing process is necessary to become in-network with one or more PPO insurance providers. This is good for your dental practice to obtain new patients and help the practice grow. Your main job is to provide quality health care service to your patients. But since you are running the business, you should also benefit from it as well.

The first step to become credentialed is to enroll with a company or companies you want to become in-network with. The information you will need to provide consists of such things as practice history, education, certifications, licenses, etc. You will need to complete a very thorough application for each company with which you have enrolled. Each application requires approximately 40 hours to complete. If you make an error when filling out the application, you must start over. Once you begin the application document, you have to finish it. This can be quite a daunting task and require your dental team to spend hours on completion.

Select An Insurance Company

In order to determine the insurance company or companies you choose to become in-network with, you will need to do some research. You may want to look to see what large companies are in your surrounding area and which insurance providers they use. When you do this, you will have a larger patient base from those companies. Because other dentists in the area may not accept their insurance. The name of your dental practice may also be given to the employers/employees of these companies on their list of participating providers.

Contact the Insurance Company

You might consider reaching out to the provider relations department for each of the insurance companies you have enrolled with. This is in order to assist you with their credentialing process. Otherwise, you will spend way too much time determining the following:

  • who you need to speak with
  • what is the best time to call
  • where to send an email, etc.

Negotiate Expenses

The first item that has to be settled before submitting your credentialing application to an insurance company is to agree on a fee schedule. Always check to find out if fee negotiations can be done. At this point, if fee negotiations are allowed, you will want to speak with a rep to get the highest fee schedule they will offer. Once this process is complete and your credentialing application has been submitted, you will be locked into a fee schedule for 12-36 months before you are allowed to negotiate another fee increase.

Complete Insurance Application

All questions must be answered and all supporting documentation must be submitted when completing the credentialing application. If you fail to answer all questions or to submit one required document, you will have to begin again. The insurance company will verify if your information is correct. This is referred to as the vetting process. If you answer incorrectly or skip a question or do not submit all required documentation, this will only prolong the lengthy processing time with the insurance company.

Once you become credentialed with the insurance company, you are bound to your contract and must follow their fee schedules, which will determine what you can or cannot charge your patients. It is of most importance you read and fully understand your contract. It will allow for the insurance company to audit your dental practice. If you have multiple dentists in the office, they will all need to credential separately. If each of the dentists in the practice are not properly credentialed, the claims being submitted to the insurance company in question may be sitting somewhere for a long period of time and not get paid. It is a very good idea to contact the provider relations department. This is to make sure they have the needed information to process claims. Your payments will arrive much quicker.

Out-Of-Network Providers

The dentist has to make the decision which plans are the best to participate in based on the nearby competition. Dentists who decide to remain out-of-network will receive larger payments because they are not bound by contract. However, they could find themselves losing patients to in-network providers due to the patient having to pay less out-of-pocket for services.

Benefits of In-Network Status

Gaining in-network status can be very beneficial for your dental practice. If you are an in-network provider, you can post it on your webpage to inform prospective patients which coverage you accept. PPO providers might refer new patients to you as well. Being an in-network provider may give you leverage over other practices in the area if patients save money by visiting your practice for treatment.

As you can see, the entire credentialing process and gaining the in-network status is a very complex and time-consuming job to undertake. It can be very taxing for you and your team members. If your dental practice becomes in-network, it is very important to look at how you participate with insurance companies to maximize your profits. PPO Negotiation Solutions can help your bottom line. After all, they have 30 years of experience in handling PPO negotiation and participation optimization. Let them put their impeccable reputation to work for you!

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Dental Credentialing in 2022

As dental offices begin a new year and leave behind a year of unexpected challenges, many are considering what changes they can implement to grow their practice. Everything from marketing to updated technologies is on the table. In 2021, COVID-19 was feared and ways to control spreading were the first priority. There were limits on treatments provided and on how many patients could be treated. People are trying to make up for the treatments canceled in the previous year. And now is a great time to consider ways to get your practice name in the forefront. One way to produce growth is becoming credentialed.

In-Network Status vs. Out of Network

If you become in-network, you open your dental practice to a whole new influx of patients. Entering an insurance contract with a particular insurance carrier can increase your patient base and business opportunities. Insurance carriers have their own vetting processes for dentists to become credentialed. Which includes providing proof of their dental degree and license, malpractice insurance, law compliance, and other factors.

When considering entering a new contract with an insurance carrier, the plan, fee schedules, and charges allowed to patients must be read carefully. The dentist is agreeing to certain contractual obligations, such as audits of the practice and their documentation and if certain procedures can be billed. It is essential to give their utmost attention to the contract before signing it.

Some dentists remain out-of-network, which results in direct payments and less insurance management but a smaller pool of patients. These patients generally pay higher out-of-pocket rates and fees. They may search for in-network providers to pay less or no out-of-pocket expenses.

How to Start

Look to the top larger employers in your city and county and their insurance carriers. This will put your practice into a large customer base. Review insurance carrier fee schedules before making a decision among the carriers to insure the fairest payout. The front office can assist in this process by making a list of the insurance plans most asked to participate in by patients and calling other practices in the near vicinity. This is a very important decision, so be selective and negotiate fees.

The Dental Credentialing Application

Getting the dentists in your practice credentialed is one of the first things you should do if you decide to accept insurance, whether you are a new practice, new dentist or just hired a new dentist. Dental credentialing is done on individual terms. In a dental practice with multiple practitioners, each must make the decision individually to be in-network or out-of-network and which plans to accept.

To become in-network with a PPO insurance provider, you must enroll with the company, and for each one, complete an application form. Each application takes about 40 hours to complete, so it is quite an ominous task. Also, if an answer to one question is incorrect, you have to start again from the beginning. Credentialing is a very tedious and arduous process because insurance companies want to confirm you are a practicing dentist and in good standing.

Upon completion and submittance of the application, the insurance carrier will review your information and verify it is correct. This is called the “vetting” process. If you do this correctly and ensure all information is submitted, it will save much time. Payments will be processed and arrive much quicker. Only the dentist can make the choice of which plans are in their best interest to participate with. This is based on the companies and competition in the area.

Without proper dental credentialing, practitioners in your office will have delayed claims leading to increased time in getting paid. Insurance changes are occurring almost monthly, so it is very important for your peace of mind to know someone is managing your credentialing making sure it’s accurate and up-to-date. If you choose to hire a third party to handle your credentialing, it would save your front office much time and stress by taking care of relevant forms and documentation. The third party will also keep pace with dental credentialing requirements and any new additions to your office.

Even if you are totally out-of-network, PPO Negotiation Solutions can often negotiate fees higher than your standard fees, putting you in-network and able to attract far more new patients. They help you operate with PPOs from a position of power! Hire PPO Negotiation Solutions to assist your practice with increasing insurance reimbursements and creating a larger patient pool. Their goal is to increase your revenue and increase your practice’s knowledge of insurance negotiations. They work full time on your dental contract negotiations so you don’t have to worry about neglecting other aspects of your dental practice. Save time and money and contact them today!

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Acknowledging Where Your Money Goes

Whether you have a dental practice up and running already or you are looking to start your first corporate journey, it is important to keep track of where your profits are going. Money can get lost quickly in the details of running a business if you do not have an established tracking method. And that means soon you will be asking yourself, “Where did all my money go?” Here, we will discuss a breakdown method of tracking your income, and ways to save money for your future endeavors, so that you can keep your dental practice running smoothly.

Taxes

I do not know of anyone who enjoys paying taxes but, unfortunately, there are numerous laws that govern when and how taxes must be paid. That includes business and personal taxes. Personal taxes can account for an average of 12% of a person’s income. There is not much you can do about tax payments for you or your business. But one way to help is to stay updated on the latest tax reform laws as it relates to dental practices to make the most of your hard-earned dollars.

Personal Spending

Of course, you have your own bills to pay. For most people, expenses include food, living expenses, basic utilities and personal miscellaneous spending. But the range of your personal spending is largely flexible and dependent on you. It is reported that Americans spend an average of 4% of yearly income on entertainment, 3% of yearly income on clothing and 2% of income on other miscellaneous purchases and services. That is nearly 10% of yearly income that is flexible.

So, if you are earning $300,000 yearly, that is an estimated $30,000 of flexible spending. We are not recommending that you skip a much-needed vacation, but it could be beneficial to evaluate what personal purchases eat up the most income and consider ways to save costs.

Debt

Debts can include student loans, personal loans and credit cards, as well as home and auto debt. The average American citizen’s debt totals nearly $53,000. The number one largest debt is mortgage, followed by student loans and auto loans. If debt is calculated to be where most of your money is being spent, consider talking with a loan adviser about ways to reduce your monthly expenditures.

Savings

A key to having healthy finances and living a more comfortable life is to save, save, save! Ask yourself, what are your goals? If you are considering retirement, you should consider saving 10-15% of your yearly income. Some employers offer matching retirement contributions, in which case your 5% contribution would be matched to meet the 10% recommended savings.

In the case of an emergency, do you have enough in savings to live and pay your bills for 3-6 months? Maybe you want to save up for a particular item. If your goal is to buy a car in one year, calculate the cost of the car divided by 12 months and you have the total monthly savings you will need to set aside.

Evaluate and prioritize what is most important to you. Then you will have an idea of how much savings you will need for each project or idea.

Ways to Save

Now that you know where your money is going, it is time to investigate ways to save your hard-earned bucks. Perhaps, the first area to evaluate where you can save is your amount of owed debt. Paying off debt quickly will save you money in the long-term. There are a couple of methods to pay off debt quickly. Two of them are the avalanche method and the snowball method.

The snowball method differs from the avalanche method in that you will start paying off your smallest debt first, gaining momentum to pay your largest debt. The debt avalanche method tackles debts with the highest interest rates first. With average credit card rates nearing 18%, debts can get out of hand and one of these methods can save hundreds or even thousands of dollars long-term.

Other methods of saving include debt consolidation and refinancing. With debt consolidation, multiple debts are combined into one debt. One way to do this is with a personal loan, eliminating multiple monthly payments and multiple interest rates. Refinancing may be an option for debts like mortgages when interest rates are lower. A financial advisor could provide more detail about which cost-saving option would work best for you.

If you are still looking for financial advice, look no further than PPO Negotiation Solutions for your business needs. PPO Negotiation Solutions takes a multi-step approach to ensure that your business is receiving the most revenue possible. Whether you are an established dental provider office or are starting a new service, they can help you get on track, financially. Call for a free consultation and assessment!

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What CDT Code Changes Has the ADA Implemented for 2021?

Given the nature of our current global circumstance concerning  COVID-19,  in addition to dental technologies advances and ever-evolving dental procedures, there is now an updated version of the American Dental Association’s code on dental procedures and nomenclature.  Following two ADA Code Maintenance Committee meetings held in March and April of last year,  Current Dental Terminology (CDT) changes were implemented to place best interests on behalf of those in the dental profession, their patients, and third-party payers.  CDT codes are the only HIPAA-recognized dentistry code set and are required when electronic health care transactions occur. As well, when the ADA alters the codes, carriers must adopt said updates. It’s important for dental practices to stay up-to-date, informed, and well-versed in CDT code changes.

What Has Changed With CDT 2021

  • 28 new codes
  • 7 revised codes
  • 4 deleted codes
  • 22 editorial changes (actions that clarify without changing the CDT Code entry procedure’s extent or purpose).

New dental codes for 2021 provide greater specificity for accurate patient record-keeping and to make claim processing simpler. Note that a new or revised code does not dictate reimbursement from insurance providers. In addition, while codes may be recognized, they may not at all be reimbursed. In essence, codes are provided in numerical terms and help articulate the services between providers and insurance companies.

In short, CDT 2021 contains new codes for dental procedures related to:

  • Testing to identify patients who may potentially be infected with the coronavirus
  • Counseling for the control and prevention of negative impacts on oral, behavioral, and systemic health deriving from high-risk substance use, including vaping
  • Caries prevention medicament application
  • Teledentistry-derived image captures performed by a licensed practitioner to forward to another dentist for interpretation

Update Your Billing System Each Year to Reflect Code Updates

Updating your practice’s billing system each year to reflect CDT code changes will help clarify treatment for team members, patients, and third-party payers.  Doing so provides accurate estimates for your patient load and allows for proper reimbursement. Prior to the year’s end, most insurance carriers notify in-network providers of their requirements and reimbursement protocols.

Establish and Execute an Annual Four-Step Protocol

The objective of CDT Code is to attain uniformity, consistency and specificity in accurately documenting treatment in the dental industry. Therefore, establishing and executing a yearly four-step protocol helps to ensure that your practice, billing system, and insurance coordinator all reflect the new CDT updates.

Here is a sample protocol for consideration:

  1. Remove deleted codes from your billing software.
  2. Set fees for the newly enlisted codes.
  3. Contact insurance companies to review processing guidelines for the changes.
  4. With your staff, cover how CDT updates/impacts may alter chart note records, posting, and communication with patients for procedures offered.

CDT 2021 Code Changes Overview 

28 New Codes

  1. D0604: Antigen testing for a public health-related pathogen, including coronavirus
  2. D0605: Antibody testing for a public health-related pathogen, including coronavirus
  3. D0701: Panoramic radiographic image – capture only
  4. D0702: 2-D cephalometric radiographic image – capture only
  5. D0703: 2-D oral-facial photographic image – capture only
  6. D0704: 3-D photographic image – capture only
  7. D0705: Extra-oral posterior dental radiographic image – capture only
  8. D0706: Intraoral occlusal radiographic image – capture only
  9. D0707: Intraoral periapical radiographic image – capture only
  10. D0708: Intraoral bitewing radiographic image – capture only
  11. D0709: Intraoral complete series of radiographic images – capture only
  12. D1321: Counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance abuse
  13. D1355: Caries preventative medicament application – per tooth
  14. D2928: Prefabricated porcelain/ceramic crown – permanent tooth
  15. D3471: Surgical repair of root resorption – anterior tooth
  16. D3472: Surgical repair of root resorption – premolar tooth
  17. D3473: Surgical repair of root resorption – molar tooth
  18. D3501: Surgical exposure of root surface without apicoectomy or repair of root resorption – anterior
  19. D3502: Surgical exposure of root surface without apicoectomy or repair of root resorption – premolar
  20. D3503: Surgical exposure of root surface without apicoectomy or repair of root resorption – molar
  21. D5995: Periodontal medicament carrier with peripheral seal – lab-made – maxillary arch
  22. D5996: Periodontal medicament carrier with peripheral seal – lab-made – mandibular arch
  23. D6191: Semi-precious abutment – placement
  24. D6192: Semi-precious attachment – placement
  25. D7961: Buccal/labial frenectomy
  26. D7962: Lingual frenectomy
  27. D7993: Surgical placement of craniofacial implant – extraoral
  28. D7994: Surgical placement of zygomatic implant

7 Revised Codes

  1. D1110: Prophylaxis adult – removal of plaque, calculus, and stains from tooth structure and implants
  2. D1120: Prophylaxis child – removal of plaque, calculus, and stains from tooth structure and implants
  3. D1557: Removed language that specified the procedure was done by a dentist or practice that did not originally place the appliance
  4. D1558:Removed language that specified the procedure was done by a dentist or practice that did not originally place the appliance
  5. D6011: Removed language specific to access to place a healing cap or to enable placement of an abutment
  6. D6091: Removed language that the procedure applies to the replaceable male or female component of the abutment
  7. D9971: Defined per tooth specifications

4 Deleted Codes

  1. D3427: Several new codes replace this code for greater accuracy
  2. D5994: Replaced with D5995 and D5996
  3. D6052: Replaced with D6192
  4. D7960: Replaced with D7961 and D7962

 

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