Dear ,
Another snowy day here in the Northeast. Two blizzards in less than a week. The landscape is beautiful, there is something so magical
about new snow. The picture it paints outside my window is breathtaking.
Along with the storm also come some disruptions: flights that never got out, client visits that will need to be rescheduled, office closures, etc. What to do with these “extra” found days on my schedule?
Today I am sitting here in my
living room in front of a warm fire catching up on emails, reading newsletters, email forums, journal articles, and there is one constant in the majority of the messages: Insurance, billing and reimbursement changes and updates. Insurance guidelines are getting stricter and are ever changing.
What do we know to be true:
- Timely filing for medical plans
is getting tighter and tighter; the majority of plans being 90 days instead of one year.
- Carriers are telling us one thing over the phone regarding coverage and then processing claims in an entirely different way. For example, D7953 (socket graft) when we call for benefits we are being told yes there is coverage, however when the claim processes we find out the graft will not be covered until the implant is placed.
- Delta Dental (here in MA) is trying to push through a new contract that would require all providers to become enrolled in the PPO network.
- You may be contracted with a carriers’ dental plan, not the medical and yet claims you send to the dental carrier are being processed by the medical plan and everyone is surprised by the end results (not a happy surprise).
- Cigna and Anthem’s
potential merger for next year is now on hold by the federal government.
- Cigna dental has updated their appeals process.
- Coordination of Benefits between carriers is getting more and more confusing.
- Medicare opt out and the changes with Delta Dental’s Medicare Advantage plans and participation. Check out the DD website for more info on this topic.
And I won't even begin to try to comment on what is happening with the Affordable Care Act and the impact any changes will have on how we do our jobs.
The new coding updates for 2017 haven’t had time to really process through fully enough for us to know for certain how the new provisional implant crown code is going to pay, or not pay.
How much “unbundling” was really done with the new moderate sedation codes and the procedures we do in OMS?
What I do know…you need to be in the loop and you need to stay in touch with the carriers, Read their new bulletins that come across your desk and log into their websites for updated information. Ask as many questions as you can from as many sources as you can (join email forums,
reach out to colleagues, etc).
On this snowy day I am committed to keeping communication open, sharing with you what I am seeing and learning as each week goes by. We are here to help and support you in any way that we can. In the meantime, I am going to pour another cup of tea and add another log to the fire.
Keep Calm and Code On!
Terri
