Podcast
Questions and Answers
What is the responsibility of the Guarantor in a dental practice?
What is the responsibility of the Guarantor in a dental practice?
What is the term used for monies owed to the dental practice by patient guarantors for unpaid services rendered?
What is the term used for monies owed to the dental practice by patient guarantors for unpaid services rendered?
In dental practices, how is account aging categorized for tracking and collection purposes?
In dental practices, how is account aging categorized for tracking and collection purposes?
What is the purpose of the Fair Debts Collections Act in relation to communication about debts with guarantors or patients?
What is the purpose of the Fair Debts Collections Act in relation to communication about debts with guarantors or patients?
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True or False: If a dental practice receives a bankruptcy notice regarding a patient’s account balance, the practice must cease all communication with the patient or guarantor regarding the debt.
True or False: If a dental practice receives a bankruptcy notice regarding a patient’s account balance, the practice must cease all communication with the patient or guarantor regarding the debt.
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What is the purpose of a Preauthorization (Predetermination) in the context of dental insurance claims?
What is the purpose of a Preauthorization (Predetermination) in the context of dental insurance claims?
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Why is it important for dental practices to perform insurance eligibility verification for scheduled patients?
Why is it important for dental practices to perform insurance eligibility verification for scheduled patients?
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What role does a National Provider Identifier (NPI) play in the healthcare industry?
What role does a National Provider Identifier (NPI) play in the healthcare industry?
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Which statement accurately describes the use of Dental Procedure Codes (CDT) in dental billing?
Which statement accurately describes the use of Dental Procedure Codes (CDT) in dental billing?
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What is one advantage of being an in-network contracted provider for a dental insurance company?
What is one advantage of being an in-network contracted provider for a dental insurance company?
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Study Notes
Dental Procedure Codes
- CDT (Dental Procedure Codes) are universally accepted as 'billing codes' for dental procedures, categorized into 12 categories.
Dental Insurance Claims
- A Preauthorization (or Predetermination) is a dental claim sent to the insurance company to obtain specific procedure code reimbursement information prior to providing treatment.
- Employee social security number should not be submitted on all dental insurance claims to identify policy holder.
- An insurance company/payer requires an IRS Request for Taxpayer Identification Number and Certification W-9 form connected to the billing entity Tax ID on the insurance claim.
- Insurance eligibility verification should be performed by the practice prior to every appointment for scheduled patients with dental insurance.
Provider Identification and Credentialing
- A National Provider Identifier (NPI) is a 10-digit unique number used to identify an individual healthcare provider (Type 1) or organization (Type 2).
- Credentialing is the insurance company provider review process to qualify a dentist to become a contracted provider.
Dental Insurance Benefits and Plans
- Insurance carrier dental benefits vary based on the employer or group options selected.
- One advantage of being an in-network contracted provider for a dental insurance company is new patient referrals through the insurance company provider website.
- Health Savings Plans and Flex Spending Plans are used for individual healthcare expenses and are usually funded with pre-tax income.
Payment and Billing
- The Responsible party or Guarantor is the individual responsible for payment for dental services received by the patient, regardless of insurance status.
- Payment arrangements for dental services should be made prior to treatment completion.
- Monies owed to the practice by patient guarantors for unpaid services rendered are referred to as accounts receivable.
- Account aging is categorized as an unpaid account balance from the date of service as Current, 30, 60, 90 days past due (or more) for tracking and collection.
- All communication with a guarantor or patient regarding a debt is subject to the federal Fair Debt Collection Act.
- A collection agency is the third-party company hired by the dental practice to collect a past due account balance from the guarantor.
- If a practice receives a bankruptcy notice regarding a patient's account balance, the practice must cease all communication with the patient or guarantor regarding the debt.
Patient Recall and Financing
- The Truth in Lending Act is a federal law that requires lenders to provide standardized information so that borrowers can compare loan terms.
- Patient recall or recare is a preventive dentistry system within the practice to schedule patients on a consistent frequency basis for hygiene maintenance and an oral examination.
- Generally, most patients with a healthy periodontal condition are seen for recall in 6-month intervals.
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Description
Test your knowledge on dental procedure codes (CDT) and preauthorization in dental insurance claims. Learn about the 12 categories of CDT codes and the process of obtaining reimbursement information through preauthorization. Determine if employee social security numbers are required on dental insurance claims with a true/false question.
