An insightful and informative newsletter from the Art of Practice Management. A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.

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Have you been frustrated by claims that are denied by
insurance carriers? How do you handle those denials? If you
haven’t been very successful or you haven’t even tried to
appeal denied claims, then you are missing the boat. Read on
for the steps to make that boat ride smoother.
Claims can deny for many reasons as is evident by the multiple denial codes that
carriers use. Some claims deny legitimately but there are times when a denial should
not be accepted without a fight. Not examining your denied claims to determine if they
are legitimate denials means that you are losing money either by patients not paying
the full balance which can result in bad debt write offs or by delays in patients paying
the balance in full. It is a fact that when a practice takes the time to effectively appeal
a claim, denials can be overturned and the practice can be more profitable.
The following are the steps to successfully appeal a dental or cross coded medical
insurance claim:
 Stay timely – Don’t create a problem folder for denied or problem claims and
let the claims sit untouched in that folder for too long. Insurance carriers
have time limits set for appeals, so you must be careful not to wait too long.
If a problem claim requires multiple contacts with the insurance carrier which
results in a lengthy time period, be sure to document each contact by
recording the date, time, name of the representative, and notes on what the
representative told you. The carrier will have a record of these
communications also, so they will not be able to use the time factor against
you.
 Read EOB’s carefully to look for problems. Not all claim problems are easily
evident, especially when a partial payment is made. If you accept a partial
payment as the final payment without looking for the reasons why the carrier
only paid a partial payment, you will be missing the chance to obtain a higher
benefit for the patient. Become a coding detective with your EOB’s.
 You can use several different methods to file an appeal – by phone, on
paper, or through the carrier’s website. You will need to investigate which is
the best method for each.
 State the facts – Review the documentation of the case and glean from it the
pertinent details to state your case:
 Attach copies of attachments.
 If the denial states that the procedure was non-covered, state why you
believe that it should have been considered a covered procedure.
 Problems with bundled services – With medical insurance carriers, they
may not have recognized your modifier that showed that services should
not have been bundled, so you will need to either call the carrier and
have them look at their copy of the claim or include a copy of the claim
that shows the modifier and indicate that they did not process the claim
correctly and need to reprocess it.
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Articles
Handling Appeals Effectively
Marianne Harper

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 Evaluate problem claims as to whether an appeal or a correction is required.
Not all denials require appeals because some of the following situations
might apply:
 Incorrect patient data entry – Misspelling names or errors in subscriber
ID numbers.
 Date of service was incorrect.
 Wrong codes were used – either diagnosis, CPT or CDT. Also, with
medical claims, the diagnosis code(s) must always support the
procedure code(s).
 Incorrect rendering provider is listed on the claim.
If you determine that the problem lies with errors made by your staff, you will
need to contact the insurance carrier for their instructions on how to file a
corrected claim.
Make a difference – take the extra steps – to make your claim filing system run
efficiently, effectively and profitably.
Bhaskar’s Formula
Colleen Rutledge, RDH
I recently presented a course on ultrasonics and the last segment discussed pre–
procedural rinses and irrigation. Pre-procedural rinsing/irrigating is important
because it greatly reduces the bacterial count in oral cavity and thereby aerosol
created by ultrasonics. Among the medicaments discussed was chlorhexadine
gluconate, essential oils, subgingival tetracycline and povidone iodine. The interest
and questions from the audience centered on tetracycline subgingival paste,
commonly known as “Bhaskar’s Formula”.
Bhaskar’s Formula was created by Dr. S.N. Bhaskar, a California periodontist /
national speaker. Anyone who has ever attended his courses leaves well-informed
and totally entertained! Dr. Bhaskar made a “paste”, with 2 - 3 days substantivity,
from 250 mg tetracycline mixed in a gel medium. A homogenous paste is formed by
mixing the ingredients with a flexible spatula on a glass slab or oil resistant pad and
placed in a BD 3 ml 22G 1 ½ precision glide syringe. It can be refrigerated for up to 3
weeks. One syringe can treat the entire oral cavity.
For the exact formula and clinical photos showing how it is used, email me at:
Colleen@PerioAndBeyond.com.
Save 10% on our "Do-It-Yourself" Dental Hygiene Department Consulting Kit
until May 15th, 2013. Visit www.PerioAndBeyond.com and use code APRILMEZ
at checkout.
Dental – According to Michael Uretz, a contributing writer for DrBicuspid.com, the
topic of EHRs (electronic health records) and EDRs (electronic dental records) will
become more prominent and important this year. He reports that the EHR
mandate, the United States’ meaningful use program, is what is fueling the rapid
adoption of EHRs in medical practices. He states that the mandate is not
applicable to dental practices at this point but it has gotten the interest of many in
the dental field who see the eventual migration to electronic patient records.
This statement should speak to those dental practices that are still filing paper
claims. The time is approaching when all claims will need to be electronic so why
not take the challenge and move to electronic claims? It’s easier than you might
think and creates a much more efficient and effective insurance system. Contact
your practice management software company to learn how to make the change.
Insurance Alert

3. Medical – When cross coding, make sure that you are using modifiers when
necessary. Modifiers are part of the CPT code set and insurance carriers use
these codes to evaluate whether a normal benefit is applicable to a procedure
because a treatment was altered by a specific circumstance. Examples of such
circumstances are:
 -25 – If you need to report that an exam was separate from an x-ray on the
same date of service and should each be paid individually
 -26 – If you only provide the professional component of a procedure (e.g.
the evaluation only of a scan)
 -52 – You provide a TMD appliance that was fabricated by an outside lab
Update Time is Past Due –
Medical Codes and Dental Codes for 2013
And your updated medical coding manual contains the new CDT
codes also
CPT Code (medical procedure code set) will update as of January 1, 2013.
Purchasers of "CrossWalking – A Guide Through the CrossWalk of Dental to
Medical Coding" and/or the "Quick Look Up Cross Code List" – you should
have received an email that provides information on the way to order the update.
Medical insurance carriers will not accept outdated codes and will deny claims for
that reason. I am offering a less expensive update to the paper manual this year
in an electronic format. So take advantage of the savings and keep your codes
up to date.
Click Here to Update Now!
CDT Code Update – Past Due – The ADA has announced that CDT codes will
update on January 1st of every year. If you haven't already purchased your 2013
code set, now is the time. I recommend Dr. Charles Blair's "Coding with Confidence."
It is the best source for all the detail that you need to understand the CDT codes. In
addition, consider a subscription to "Insurance Solutions Newsletter." Not only will
you receive a newsletter packed full of great coding information but the subscription
also includes a coding support service. You can't go wrong with that kind of help. To
order either or both of these, please click here.
May 1, 2013 -- Medicare PECOS Phase II Activation -- Dentists and others who are
eligible to order and refer items or services for Medicare beneficiaries need to
establish their Medicare enrollment record through either a paper form CMS 8550 or
online through Medicare’s PECOS site. Due to the impending date, the online
method is the best. Without this enrollment, denials will occur. Dentists must make
sure that they have enrolled in order to be sure that the Medicare claims submitted
by pathology labs will be paid. In addition, providers who refer Medicare patients to a
dentist must be enrolled or the Medicare claim submitted by the dentist will deny.
This enrollment is not for claim submission but to ensure that the ordering and
referring provider is a part of Medicare’s enrollment record.
September 23, 2013 – HIPAA Omnibus Final Rule – The updates to this rule were
published on January 25, 2013. The compliance date is September 23, 2013.
October 1, 2014 – The new date for ICD-10 implementation.
Time Line

4. My Favorite Quotes:
“Efficiency is doing things right; effectiveness is doing the right things.”
Peter Drucker
Tips – For our Patients:
Tis the season! No, I’m not crazy, I know that it’s not December. However, it is
allergy season and it seems as though a lot of us are fighting allergies. A
suggestion provided on the Dr. Oz blog (http://blog.doctoroz.com/oz-experts/5-
natural-herbal-helpers-for-allergies#more-1594) is the following:
“To soothe itchy eyes, use a peppermint tea bag as a warm compress for washing
your eyes. Steep the tea bag in hot water for 30 seconds, let it cool to warm and
place it gently over your eyelids. Leave on for 5 to 10 minutes. Mint in general is
considered to have allergy-reducing properties, so a cup of mint tea might help,
too!”
Points of Interest:
Abraham Lincoln was elected to Congress in 1846.
John F. Kennedy was elected to Congress in 1946.
Abraham Lincoln was elected President in 1860.
John F. Kennedy was elected President in 1960.
Both were particularly concerned with civil rights.
Both wives lost a child while living in the White House.
Both Presidents were shot on a Friday.
Both Presidents were shot in the head.
Now it gets really weird.
Lincoln's secretary was named Kennedy.
Kennedy's Secretary was named Lincoln.
Both were assassinated by Southerners.
Both were succeeded by Southerners named Johnson.
Andrew Johnson, who succeeded Lincoln, was born in 1808.
Lyndon Johnson, who succeeded Kennedy, was born in 1908.
John Wilkes Booth, who assassinated Lincoln, was born in 1839.
Lee Harvey Oswald, who assassinated Kennedy, was born in 1939.
Both assassins were known by their three names.
Both names are composed of fifteen letters.
Now hang on to your seat.
Lincoln was shot at the theater named "Ford."
Kennedy was shot in a car called "Lincoln" made by "Ford."
Booth and Oswald were assassinated before their trials.
And here's the "kicker":
A week before Lincoln was shot, he was in Monroe, Maryland.
A week before Kennedy was shot, he was with Marilyn Monroe.
AND...................:
Lincoln was shot in a theater and the assassin ran to a warehouse...
Kennedy was shot from a warehouse and the assassin ran to a theater...
Timeline Photos • Jan 10 at 11:18pm
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5. The Art of Practice Management
2217 Fox Horn Road • New Bern, NC 28562 • Phone: 1-252-637-6259
www.artofpracticemanagement.com • a.p.m.1@suddenlink.net
Perio-Therapeutics & Beyond
724 Fitzwatertown Road • Glenside, PA 19038 • Phone: 267-241-5833
www.perioandbeyond.com • colleen@perioandbeyond.com
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About us | Privacy policy | © Copyright 2013 - Marianne Harper
The contents of this publication reflect the opinion of the authors only. This publication is for informational purposes only.
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