ASDA Dentist Insurance
-
Upload
dentistryinfo -
Category
Documents
-
view
353 -
download
0
Transcript of ASDA Dentist Insurance
![Page 1: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/1.jpg)
11
Legal Issues Involving Restorations
Tom Michael, DDS (East Wenatchee, WA)
Carol Sue Janes, JD (Seattle, WA)
© Copyright 2006 Bennett Bigelow & Leedom, P.S.
![Page 2: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/2.jpg)
22
When Is It a “Restoration”?
Dr. Michael providing MID treatment• early detection• microburs• flowable composite restorations• charted on treatment plan and notes
![Page 3: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/3.jpg)
33
When Is It a “Restoration”?Medicaid Audit alleged overpayment assuming:• That restorations were sealants
– lack of pre-operative x-ray evid of decay– some treatment w/o anesthesia– flowable composite “inappropriate restorative
material”– speed of restorations (no rubber dam) – some symmetry of restorations
• That restorations were not done– no post-operative x-ray evid of restoration– post-op visual clinical exam of some patients
![Page 4: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/4.jpg)
44
Patient SB15 OL, OB (pre-operative BW)
![Page 5: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/5.jpg)
55
Patient SB15 OL, OB
![Page 6: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/6.jpg)
66
Patient SB15 OL, OB
![Page 7: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/7.jpg)
77
CDT Codes for Restorations
When is it a restoration (vs. a sealant)?
Must be into the dentinResin-based composite – one surface, posterior
Used to restore a carious lesion into the dentin or a deeply eroded area into the dentin. Not a preventive procedure.
- ADA CDT manual
(CDT-4 D2391)
(CDT-3 D2381)
![Page 8: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/8.jpg)
88
Into dentin or not?
![Page 9: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/9.jpg)
99
CDT Codes for Restorations
What surfaces are involved in restoration?
- the number of surfaces of the restoration is defined by the number of surfaces that the restoration “extends to”
- ADA CDT manual (CDT-2, -3, and -4)(D2000-
D2999)
![Page 10: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/10.jpg)
1010
Which surfaces do you bill?
![Page 11: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/11.jpg)
1111
CDT Codes for Restorations
What surfaces do you bill?
The ones that you do? Or less?
How do I report two separate 2 surface restorations on the same tooth?
Reporting these restorations as a MO and a DO is appropriate.
- ADA CDT manual
(CDT-4 p. 91)
![Page 12: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/12.jpg)
1212
Patient SB15 OL, OB
![Page 13: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/13.jpg)
1313
Which surfaces do you bill? How many restorations?
![Page 14: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/14.jpg)
1414
Which surfaces do you bill?
![Page 15: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/15.jpg)
1515
The “Perfect Storm”
Medicaid Audit– alleges overpayment
Dental Board– Medicaid refers allegations to Board
Medicaid Fraud– Medicaid refers to criminal fraud investigators
Third-Party Payors– Terminate status as provider
![Page 16: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/16.jpg)
1616
Dental Board Findings
• lack of pre-op x-ray evid of interprox decay
• lack of post-op x-ray evid of interprox restorations
• lack of post-op evid (in clinical exam) of all surfaces restored
• use of amalgam billing codes
![Page 17: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/17.jpg)
1717
Discussion Points
• How to treat
– Risks: “overtreatment”/“undertreatment”
– “Dentally necessary”
– Patient consent
![Page 18: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/18.jpg)
1818
Range of practices for pit and fissure decay:
• Do nothing - “Watch”• Sealant with no preparation of tooth• Sealant with minimal preparation of tooth• Sealant with preparation in enamel only, but to
point where all margins are in non-stained, prismatic enamel
• Minimally invasive preparation removing all decay into dentin
• Traditional GV Black preparation
![Page 19: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/19.jpg)
1919
Discussion Points, cont’d
• How to bill
– Knowing the CDT/Billing Instructions/laws
– Read your contract
– Risks
![Page 20: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/20.jpg)
2020
Discussion Points, cont’d• Documentation!
– Not just x-rays/charts– Pre-op– Post-op
• Benefits of Documentation– Legal– Insurance– Patient education and confidence– Staff education and confidence– Enhanced quality control– Professional satisfaction
![Page 21: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/21.jpg)
2121
The Value of Documentation
![Page 22: ASDA Dentist Insurance](https://reader033.fdocuments.net/reader033/viewer/2022061509/55532c5ab4c905e12e8b46c3/html5/thumbnails/22.jpg)
2222
Concluding Thoughts
• Know the risks
• Practice preventive dentistry
• Legal battles are real and painful