Dental Procedure Codes and Preauthorization Quiz

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.