Teresa Duncan, MS, FADIA, FAADOM is an international speaker who focuses on revenue, dental insurance & management issues. She is a Fellow of the American Association of Dental Office Managers. Her memberships include the Association of Certified Fraud Examiners, National Speakers Association and the Academy of Dental Management Consultants. She has been named one of the Top 25 Women in Dentistry by Dental Products Report. Teresa received her Master’s Degree in Healthcare Management.

Teresa Duncan, MS, FADIA, FAADOM

	Every New Year brings the opportunity to reevaluate your fees and update your codes. When the holiday activities settle your office will be busy with the January and February crowd eager to use their new benefits. Let’s prepare now to make 2017 as successful as possible!

	This is a good time to review your fees and compare them with your expenses. Did your 

 fees rise in 2016? Your corresponding restorative or orthodontic fees should also go up. Did you experience an increase in your disposables? Your fees associated with evaluations and hygiene should reflect this change-they are most likely your most common procedures. Did your medicaments and antimicrobials rise in cost for your periodontal treatments? Ask similar questions so that you can assess the relationship between providing treatment and absorbing the associated cost.

? And are you comfortable with your fees? Offices that have higher fees will see success only if the team members are comfortable presenting and explaining the investment to patients. Many great clinicians don’t see financial success due to a team member presenting fees in a less-than-confident manner. If the patient doesn’t think your 

	The American Dental Association amends the Current Dental Terminology codes (CDT) on a yearly basis. Your practice management software most likely issued an update in December-check to make sure you have downloaded and installed it. The new codes become effective January 1st.

	Several of the changes are just descriptor re-wordings, however, there are some new codes that will be of interest to most practices. Code D4346 (scaling in the presence of inflammation) is the big conversation piece in my webinars and lectures. This code has great potential for accurately tracking patient care, but only if your team understands it.

Read more: New gingivitis code helps you provide ethical care

	2017 is shaping up to be a year of change and anticipation. Stricter benefit guidelines for our patients means your office must stay current and progressive with its insurance knowledge. Keep an eye on 

 (used for medical billing) and the impending advent of dental diagnostic codes. These two factors mean that the dental office will need to up their documentation game in order to be profitable and successful. Don’t worry-we’re here to help you with it all! 

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A look at what you need to be thinking about in the new year and some of the questions that will help you be more successful this year.

Flip the calendar: review your fees and update your codes!

	Fee schedules: these two words are extremely important to your practice’s metrics and measuring productivity.

	If you are a fee-for-service office that does not bill to insurance, you are in the clear and don’t have to worry about this issue. However, most dental practices have to be conscious about their insurance numbers. As a preferred provider (PPO) office, you should first come to terms with the fact that you won’t collect your full fee. With this in mind, you will need to keep a strong grasp on your fee schedules.

	Here are some tips for you to manage this process:

1. Base your metrics on the insurance fee, not your full fee

	I know it doesn’t sound very appealing considering what you get from the insurance company, but you can’t expect to collect your full fee unless you are fee-for-service.  Basing bonuses and financial expectations on your full fee will not provide a realistic outlook on your accounting. The alternative is making sure your adjustments are accurate and that you are watching them closely. It’s worth putting in the time and effort to set up your practice management system so that it does the adjustment work for you.

HOT READ: How to deal with "flirty" patients in the practice

	This is a crucial step to tracking and maintaining your fees. A good software program should have a way for you to enter in your contracted fees and then calculate your production from 

 fees, not your full fee. Even better, both fees should print out on your treatment plans and show on your ledgers. What is wonderful about this is you are showing your patients the discount they obtain by utilizing an in-network provider. You should have no shame showing your full fee and what you are actually getting paid. I believe in being transparent and this is the perfect way to show it.

VIDEO: The changing role of the associate in the practice

	The explanation of benefits you receive from insurance companies will be your system of checks and balances. Ideally, you won’t have to make any adjustments when the checks are posted. If they don’t match up, then there is research to be done. You’ll need to determine why your numbers are not matching up. Not sure who to contact? Try your software support first, but be specific about what you’re trying to achieve. Ask to speak with someone who might be known as an expert on entering fee schedules. If that doesn’t work, consider hiring a trainer or a consultant with specific knowledge on the subject.

	Part of maintenance is ensuring your full fee goes out on all your claims. We’re often asked why this is so important. One reason is if the insurance companies won’t see your full fee otherwise which impacts their levels of decided reimbursement. Your fees should be reasonable and not just random numbers. When you receive insurance payments, carefully look at the numbers. If your software is set up properly, you should be able to spot discrepancies fairly easily.

FUN READ: Study shows connection between selfies and brushing

	Unless you are negotiating only 10 services codes for a single provider with a single insurance company, you probably won’t have the time to do it on your own. This is one of the most time-saving services you can outsource. Services like 

 not only help start-ups establish their base fees, they will completely take over the negotiations and help you determine what fee schedules are best for you. If it’s been a while since your office has evaluated your fees and contracts or you’ve had a specialist join your practice, it would be beneficial to investigate this type of resource.

	If you are about to open a new practice, it’s much easier to follow these steps and start out right from the beginning. Changing an existing system is a little harder and requires more time, but it will help keep ledgers clean and give you a clearer financial outlook. Who doesn’t want that?

Insurance experts Teresa Duncan and Bridget Fay break down the things you need to know about insurance in the dental practice.

5 best practices for fee schedules in the dental practice

Teresa Duncan, insurance editor for Dental Products Report, offers advice on how to lower some of the pain that dental insurance causes for so many practices.

5 insurance actions you can take now for a smooth 2016

	As the New Year launches, practices are gearing up for another year of patient care management.

For many offices, this includes updating brand new insurance plans or plans that have reset for the year. What can you do to ensure that your insurance systems are set up efficiently? A few easy precautionary measures can help you avoid uncollected copayments and rising accounts receivable. A common theme throughout all of my seminars and consulting is that “copayments are meant to be collected.” Remember that as we discuss how you can stay ahead of the dental insurance game.

	Continue to the following page to see the top five things you can do to make 2016 easier when it comes to insurance.

	1. Reset calendar year deductibles and maximums

	This sounds easy and many of us rely on our practice management systems (PMS) to handle this task. But if you don’t close out December or double check your treatment plan totals before handing them to the patient, then your estimates will not be accurate. Your team will never be confident in asking for copayments if they feel that the estimates are always wrong.

More from Teresa Duncan: Which reports do you really need to look at in your practice?

	2. Review plan designs at the beginning of the plan year

	Your patient who has always had Cigna insurance comes in after the new year. His deductible and maximum reset. His plan must be the same, right? Not always! The beginning of the plan year (usually calendar year) is when percentages and maximums change. A plan that covered restorative at 80% one year could very possibly cover the services at 60% the next year. If you are not checking the plan benefits at the start of the new plan year, then you will miss this and will have to chase the remaining copayment after the insurance pays its portion … and that’s if your staff recognizes the error and doesn’t just automatically write it off.

You said insurance was your biggest pain point in 2015. Read more of our exclusive survey results here.

	3. Once a year, run your insurance utilization report

	This will help you to determine how many patients are coming to you via an insurance company. We talk often in my classes about not having your practice dominated by one insurance company. You won’t know if this is happening unless you track how many patients are covered by which insurance companies. My rule of thumb is to not have more than 20% of your practice in one participating plan. In certain states, participation in Delta blows this number away simply because dentists feel that they don’t have an alternative.

More from Teresa Duncan: How streamlining adjustments reports can benefit your dental practice

	If you aren’t submitting claims and attachments electronically, now is the time to change that. It is concerning to me that I still have team members come up to me and say, “I wish I could put into practice what you’re teaching but my doctor won’t sign up electronic anything.” You can check eligibility and benefits online as well as submit your claims. Printing an attachment such as periodontal charting or a radiograph should be a rarity, not the norm.

	Existing electronic users could look into their system to see if they are utilizing all the services that are available. Many services now offer the ability to obtain benefit information for plans that are not easy to access online or via phone. Imagine not having a phone line (or two!) monopolized by hold time with insurance companies. Your colleagues are seeking this service for a reason … it makes financial sense. Your administrative team is more valuable talking to patients and working on your practice.

	Insurance networks are often changing and evolving. We are seeing mergers and acquisitions that will likely impact your practice. If you or your insurance coordinator can’t stay plugged into the environment, then your receivables will suffer. Take seminars, webinars, and continue to read articles such as these. My company offers a newsletter that gives you updates on networks along with insurance tips. 

.  Another very popular site with detailed participation explanations is 

. You can also click on my name on this page to find more insurance articles to read.

More from Teresa Duncan: How to streamline the insurance aging report

	Operating a practice has become more difficult in the past decade as fee schedules are squeezed and patient copayments are raised. In order for you to be efficient in your insurance management, you will need to actively monitor the process. I heard from many of you in 2015 who shared their success stories and tips. I always pay those forward in articles and seminars and I hope to be able to share even more of your experience in 2016. Remember, copayments are meant to be collected! 

	With November upon us, it is once again time for what has become our annual review of the additions, changes and deletions in CDT benefit coding.

	
	Changes in CDT 2016 came under the two general categories: Stand-alone changes and interrelated changes. Other influences shaping dentistry come from Medicare, insurance carriers’ mergers and teledentistry.

	Continue to the next page to see the changes.

	Several areas of related changes are with dentures, sedation and genetic testing. Dr. Doyle Williams, an insurance expert working with Aspen Dental, testified on the need for immediate partial dentures codes. He stated that Aspen does 45,000 immediate partial dentures but the only code available was the D9999 code. To close the gap and enable great specificity, four related codes were added.

	Sedation in dentistry was another interrelated hot topic with some believing the Code Maintenance Committee (CMC) had confused the codes over the past few years. A single code was revised, resulting in two new codes added to replace four different codes. Soft tissue grafts also saw two additions and five revisions.

	Scientists from academia, research and industry continue to explore current science and clinical applications for genetic testing in oral medicine. The CMC decided that the existing genetic testing code was not clear enough. This resulted in a decision to create separate codes for sample collection and analysis.

	Dr. Peter Milgrom, professor of Dental Public Health Sciences and Pediatric Dentistry in the School of Dentistry and director of the Northwest Center to Reduce Oral Health Disparities at the University of Washington testified at the CMC  meeting in favor of a unique code for silver diamine fluoride (SDF). A new stand-alone code was added: D1354 interim caries arresting medicament application. It is important to note that codes are not product specific. The nomenclature (name) and definition of this code could be appropriate for other treatment options. An additional response to changing technology which enables dental practitioners to acquire a bitewing image with no film or sensor resulted in an additional radiograph code.

	Other changes shaping dentistry in 2016 and beyond

	It’s all about electronic health records (EHR). Smarter equipment, a more reliable cloud connection, HIPAA requirements, 3D printing open-source CAD-CAM, 3D virtual treatment planning integration and more specific coding are all pieces and parts of EHR. Other influences come from Medicare, insurance carriers’ mergers and teledentistry. Dental offices will be asked to react to these changes. Flexibility in adapting to change will be a hallmark of successful dental practices.

	The Centers for Medicare and Medicaid Services (CMS) is a member Code Maintenance Committee and plays a large role in the dental coding world. As the largest single payer of health benefits in the U.S., Medicare is setting the standard for insurance reimbursements and many carriers will have to make changes to play in this arena. Dentists must make a Medicare participation decision – even if it’s one of non-participation – and have all paperwork completed by June 1, 2016.

	We don’t know and could not yet predict what changes might be in the works for dentistry with the merging of some of the biggest insurance carriers.

	Two proposed mergers involving four of the nation’s biggest health insurers could reduce competition in an important industry. Earlier this summer, Anthem agreed to acquire Cigna for $48 billion, and Aetna announced a $37 billion takeover of Humana. That will leave only three major national companies. Will less competition lead to higher prices? Will it mean lower quality coverage?

	Teledentistry became more of a reality in several state legislatures with more coming in 2016. California and Arizona began to use teledentistry in 2015. West Virginia, Hawaii, Oregon and Colorado are among the other states currently considering passing legislation that would enable them to offer teledentistry programs to residents of those states. The most common path being taken by states is to cover telehealth services in Medicaid programs. Currently 43 states and the District of Columbia provide some form of Medicaid reimbursement for telehealth services, with 19 states and the District of Columbia now requiring private insurance plans to cover telehealth services.

	This small preview gives you a taste of the changes shaping dentistry in 2016 and beyond. More details are available in a free e-Book 

, a company that builds technology services that make providing, receiving, and paying for dental services more like the consumer experience your patients have come to expect. 

With November upon us, it is once again time for what has become our annual review of the additions, changes and deletions in CDT benefit coding. Changes in CDT 2016 came under the two general categories: Stand-alone changes and interrelated changes.

CDT 2016: 6 changes shaping dentistry

	As a business owner, you should be aware of your transactions and adjustments on a daily basis. This means asking for and reading the end-of-day report. Not only are you evaluating reports for anomalies, but also assessing their accuracy.

	I can’t tell you how many dentists I speak with after lectures who confide that they don’t know how to run their reports or where to even start. The first few times I heard this I was shocked, but after years of hearing this I can empathize. These doctors are not alone. Often when 

 it is evaluated on the merits of radiograph integration, clinical record-keeping abilities and scheduling capabilities. I can’t expect a dentist to evaluate a software on financial capabilities if this is a topic that is new and often murky.

More on reports: How to streamline the insurance aging report

	The battle cry of electronic health records is not only interoperability (accessing information over different platforms) but also recognition of reporting tools. Perhaps it’s not highly studied or called out in articles, but it becomes very evident when you are the end user. The end-of-day reports can be kept to a minimum but still give you enough information to make tactical decisions. The manager and doctor should review these reports on a daily basis:

	Procedure report: Check for accuracy with an eye for procedures that were scheduled but not completed. Why not? Are there procedures listed that were unexpected? Perhaps a revisiting of treatment plan and scheduling protocol is needed.

 Scrutinize these especially the insurance write-off amounts. Are the categories very vague? Thousands of dollars categorized as “miscellaneous” is not indicative of much except that the stock adjustments were never customized.

 The money. Enough said! Actually not – you are looking at this side by side with your procedure report. For every restorative or surgical hygiene appointment you should see a corresponding payment amount. This shows that you are collecting copayments at time of service and not waiting patiently for the patient payment. This is my least favorite tongue twister.

More from Teresa Duncan: Why insurance coordinators need to be flexible in today's dental world

	Needed patient contact*: Are there any new patients that need to be called/thanked? What about patients who had difficult procedures? Some offices have a rule that anyone that received an injection receives a follow up call/text/email. Do you call scheduled new patients a day or two before their appointment to welcome them? 

*this is often manually kept/recorded by team members.

	The common questions I receive revolve around who actually runs/reviews the reports. Are you in a small office without a manager? No problem – your receptionist can generate them and hand them to you at the end of the day. No exceptions. I’ll say it again: These reports should come in at the end of the day – no exceptions. Doctors, as a business owner these are your pulse points or presenting symptoms of a problem.

More from Teresa Duncan: What does the future hold for dental insurance? [VIDEO]

	In a large practice with several managers? Your regional manager/supervisor should be reviewing these daily. A large chunk of their job description is metrics evaluation and reporting back to the owner/stakeholders. Daily monitoring can catch the receptionist in a far-flung location who has decided that copayments are not important enough to collect. It definitely happens.

	The difference in demographics or patient behavior should be taken into account with multi-location practices. Sometimes one location will never have an impressive collection rate no matter how much effort is poured in. This is where report history helps us to understand and plan for these behaviors.

	Finally what happens if you find anomalies in the reports? Perhaps there is one assistant who never remembers to post treatment changes? Or a receptionist who collects money but forgets to enter it? If the employee continues to make errors after you bring it to their attention then they have given you a gift. They are showing you that their place is not in your practice and with proper (and prompt!) documentation we can help these employees discover that there is life outside of your practice.

Trending article: The myth that patients should know their benefits

	These situations happen across practices every day. Imagine how compounded your problems could be if you detected them only after extended staff issues or worse – a slowdown of cash flow. Daily attention to detail is not only good for the health of your practice but for your peace of mind!

As a dental business owner, you should be aware of your transactions and adjustments on a daily basis. This means asking for and reading the end-of-day report. Not only are you evaluating reports for anomalies, but also assessing their accuracy.

The importance of the end-of-day report

	The adjustments report is one of the most emotion-inducing reports to read and analyze. It may even be the most depressing one, but it certainly is necessary. 

	Before we dive into the specifics, a few ground rules should be established. First, I’m assuming you are submitting your full fees on 

 and using fee schedules to post production amounts to the patient account. My second assumption is that you and your team are using passwords for adjustment entries. Almost every dental management software program has the ability to meet both of these requirements. 

More from Teresa Duncan: How to streamline the insurance aging report

	If you are not in the habit of running this report and are not sure what your adjustments are, don’t worry. It’s a new day, and now you will be aware of how much revenue floats around your practice. I say “floats around” because the interesting aspect of credits and debits is that they’re intangible and so can be easily ignored. When cash flow slows down, the first place we look is at our aging reports (insurance and accounts receivable), but do you ever look at the adjustments? Let’s start with the frequency of this report.

	As a business owner, you should be aware of your adjustments on a daily basis. This means asking for and reading the end-of-day report. Not only are you looking for production and collection numbers but also pay attention to your credits and debits. A few questions may arise if this is your first time looking at this information:

 A courtesy plus a credit card payment? How much am I losing here?

 This patient seems to always receive a credit-why?

More from Teresa Duncan: The importance of the end-of-day report

	For the sake of clarity, I recommend you itemize your adjustments as much as possible. It’s important that you see more than just “insurance credit”or “courtesy discount.” Not only are they not descriptive enough, but they are also large categories that could contain questionable transactions. 

	When adjustments are clearly labeled, the staff member will be able to pick the accurate one and not the one on the top of the selections. Examples of clearly labeled adjustments would be “Chamber of Commerce courtesy,” “insurance refund request,” “copayment estimation courtesy” or “Smile Club courtesy.” Notice that in all of these I said courtesy not discount. Discount is one of those words that have no place in the dental office-along with “oops” and “wow!” 

	Paying attention to your daily transactions will help you spot timely errors and correct them. Perhaps your last patient should not have received a five percent courtesy because you decided to stop offering it. Does that statement surprise you? Maybe it’s time to rethink that old standard discount. Audience feedback in my classes tells me this is not as common as it once was. The revenue manager in me echoes that sentiment!

Trending article: Why insurance coordinators need to be flexible in today's dental world

	Include adjustments as part of your monthly review of production and collection metrics. After all, your true collections number is not accurate until you’ve factored in the amount of money you’ve “discounted.” The conventional wisdom in our industry is that your collection total should be 98 percent of your production amount. This is where the first assumption comes into play; I’m not counting the difference between your full and contracted fees. If we counted that, it would be a truly emotional report as you’d see 30- to 40-percent write-off amounts.

	What if you find alarming items on the adjustment report? This is where you’ll be thankful my second assumption is in place. Passwords for adjustments are essential. Tracking down suspicious transactions to find out if there is a bigger pattern at play is not a fun activity, but don’t turn a blind eye. 

	Your adjustment report can give you clues to how well your team estimates copayments, how much money you actually forgive and if any team members attempt to steal funds. The information is in your system, but you have to take the time to run and analyze the reports.  

Trending article: Why now is the perfect time for your dental practice to examine its fees 

, is an international speaker who focuses on revenue, dental insurance and management issues. She is a Fellow of the American Assn. of Dental Office Managers. Her memberships include the American Academy of Dental Consultants, National Speakers Association and the Academy of Dental Management Consultants. She was recently named one of the Top 25 Women in Dentistry. Teresa received her master’s degree in healthcare management. She can be reached via email at teresa@odysseymgmt.com.

The adjustments report is one of the most emotion-inducing reports to read and analyze. It may even be the most depressing one, but it certainly is necessary.

How streamlining adjustments reports can benefit your dental practice

	Instagram is a dental nerd’s dream! I love scrolling through and see what is being shared and what is "hot" on social media sites. I often post things I find interesting 

A photo posted by Dental Products Report (@dental_products_report)

Along with DPR's page, I recently found 10 others that really jumped out at me as clever and filled with interesting dental information. Several of them are fascinating because they walk you through the clinical background of each case. Click on the pictures to read details of the procedures. Others are just plain fun and ... let's face it ... our industry is hard work so it's nice to see the lighter side of it!  Have you checked out these accounts lately?

Teresa Duncan on insurance:	The myth that dental patients should know their benefits

A photo posted by DENTISTRY MY WORLD® (@dentistrymyworld)

A photo posted by My Social Practice (@mysocialpractice)

A photo posted by Matteo__Negri (@matteo__negri)

A photo posted by Coach Mana (@eat.lift.floss)

A photo posted by Dentist And Hygienist Humor (@dental_hygiene_problems)

Teresa Duncan, MS, FADIA, FAADOM is an international speaker who focuses on revenue, dental insurance & management issues. She is also DPR’s Insurance Editor. She spends a lot of time between seminars in airports and kills time with 

 Instagram is a dental nerd’s dream! I love scrolling through and see what is being shared and what is "hot" on social media sites. I often post things I find interesting on my account. Of course, you know that Dental Products Report has an Instagram account, right?

10 dental-related Instagram accounts you should check out

	The insurance aging report is one of the least favorite reports for administrators to run, but is so important for keeping up your practice’s cash flow.

The time it takes to work this report is considerable and if it hasn’t been recently run then it is an even more daunting task. Unfortunately, I’ve seen team members overwhelmed because they were tasked with cleaning up an incredibly long list of unpaid, untracked and sometimes unsubmitted claims. 

Ideally the report should reflect mostly claims that are current (0-30 days). If you have claims in the 30-60 day aging group, you should look to see how many of those are secondary claim submissions. Are they not secondary claims? If your over-30-day claims are higher dollar amounts, then it’s very possible that attachments were not submitted or additional information was requested. I would love for the number of claims that are over 90 days old to be zero. A well-run insurance process will reflect in this category being a lonely, unoccupied column. I like it that way! 

Follow up on your oldest claims first since you may run into timely filing deadlines. This means that you only have between 90 days to 15 months from the date of service to submit your claim. Check your contract to find out what your deadlines are. I find that the majority of them are 12 months.  

When you are faced with an overly long claims aging report it is because of one of two reasons: Operator error or an underperforming claims clearinghouse. Let’s talk about the first reason, the person(s) in charge of your insurance system. Is he or she properly trained? When I ask doctors this question they often tell me that “she’s doing it for years so I hope she knows what she is doing” or “I’m not sure what he does to keep up with the process.” Neither of these are comforting answers. 

An insurance administrator who says they are an expert and doesn’t need to take any classes or read through any current manuals is fooling him or herself. The plan designs and contractual language have changed so dramatically in the past five. At minimum, a new coding guide should appear in your office annually (the codes are updated yearly now), but ideally the insurance coordinator should pursue live or webinar training to keep up with industry changes. 

If you are continuously resubmitting claims that the insurance company claims to have never received then you should reach out to your clearinghouse to let them know. You pay for their services so you should let them investigate as to why your claims are not reaching their destination. This would also include double-checking your information with the clearinghouse. Do they have your correct tax identification number (TIN), National Provider Identification number (NPI) and any other specific plan identifier, if applicable? Many of our clients find themselves switching clearinghouses if they are not happy with their questioning of the company. 

Is it your in-office process or is it your vendor? Whatever the reason, it is time to take action if your aging report is uncomfortably lengthy. Is this report new to you? Be prepared to run this every week so that you can work through it slowly and leave yourself notes. Many claims will need to be investigated and you won’t remember every customer service representative or conversation you’ll have. If you’re a long-time insurance coordinator like me you definitely will need reminders! Once you have worked the report regularly and are familiar with the names and situations you can begin a bi-weekly schedule. 

Working an insurance aging report does not mean resubmitting claims over and over again. You will need to put some phone time into it, either to the insurance company or the clearinghouse. Don’t be discouraged however; running the report to discover the opportunity for cash recovery is half the battle. Imagine how much revenue is lost when you don’t track outstanding claims and requests for information. Reports are not just a tracking mechanism, but are insight into the health of your practice. Don’t you want to know the condition of your cash flow? Run the reports!   

Teresa Duncan, MS, FADIA, FAADOM is an international speaker who focuses on revenue, dental insurance & management issues. She is a Fellow of the American Assn of Dental Office Managers. Her memberships include the American Academy of Dental Consultants, National Speakers Association and the Academy of Dental Management Consultants. She was recently named one of the Top 25 Women in Dentistry. Teresa received her Master’s Degree in Healthcare Management.

 The insurance aging report is one of the least favorite reports for administrators to run, but is so important for keeping up your practice’s cash flow.