Dental Benefits and Practice Management: A Guide for Successful Practices

Dental Benefits and Practice Management: A Guide for Successful Practices is a practical tool that helps you manage your office in tune with the realities of modern dental practice. Written by both dentists and insurance industry professionals Practical explanations to effectively and legally process claims Describes the changes in dental practice management to make your practice patient centered Competitive strategies for dentists and organizations INDICE: Chapter 1 Why Dental Benefits?Michael Okuji .Introduction 2 .The Coming of Health Insurance 3 .Private Health Insurance 7 .Moral Hazard 8 .Indemnity insurance 10 .Benefit service plan 11 .Direct service plan 13 .Direct reimbursement 14 .Health Insurance The Blues 15 .Federal Health Benefits 17 .Dental Benefits 20 .Dental Service Company 21 .What is Dental Insurance? 22 .Indemnity insurance 23 .Dental benefit plan 23 .Preferred Provider Organization 24 .Health Maintenance Organization 25 .Direct service plan 26 .Direct reimbursement plan 27 .Discount plan 28 .Administrative Services Only 28 .Bundled payment 29 .Accountable Care Organization 30 .Antitrust 31 .Conclusion 32 .Chapter 2 Dental Benefits get it doneMichael Okuji .Introduction 2 .Dental Benefits 3 .Plan design 6 .Participating Provider Agreement 7 .Credentialing 8 .Medicare Opt–In Opt–Out 9 .Fees 11 .ADA Dental Claim Form (American Dental Association) 11 .Dental claim field changes (2012) 13 .Dental claim new fields 15 .NPI (National Provider Identification) 17 .TIN (Tax Identification Number) 18 .Narrative attachment 18 .EOB (Explanation of Benefits) 21 .CDT Code 22 .CDT Code Use 23 .Categories of service 27 .Exclusion and Limitation 29 .Limitation 30 .Frequency limitation 30 .Narrative for exclusion, limitation, frequency 31 .Electronic Claim Submission 32 .Clearinghouse 32 .Electronic attachment 33 .Code Maintenance Committee 33 .Non–Dentist Provider 35 .Diagnosis Code 37 .ICD–10 38 .Conclusion 40 .Chapter 3 Dental Benefits get it rightMichael Okuji .Introduction 2 .Get–it–right 3 .Participating Provider Agreement 3 .Fees 4 .Utilization 5 .Utilization review 5 .Prospective utilization review 6 .Quality assurance audit 7 .Appeal and dispute resolution 9 .Appeal preparation 10 .Termination 11 .Summary 12 .Dentist and Dental Plan Design 13 .Dental Plan Contract 14 .Dental Claim Process 15 .Benefit eligibility 15 .Evidence of coverage 17 .Coordination of benefit 17 .Non–duplication of benefit 18 .Unbundled procedure 19 .Balance billing 19 .Non–covered service 20 .Up–code 21 .Deny and Disallow 21 .Appeal a claim determination 22 .Electronic Services 23 .Eligibility 23 .Pre–determination 24 .Claim submission 25 .Electronic funds transfer 25 .Claim Filing Tips 26 .Desktop Procedures 38 .Conclusion.39 .Chapter 4 Patient–Centered PracticeDavid Okuji .Introduction 2 .Key to Transform the Health Care System 4 .Transformation: Impact on Dentistry 8 .Transformation: Evidence in Healthcare and Dentistry 11 .Two tier financing 12 .Two tier delivery system 13 .Accountability 14 .Electronic Health Record 15 .Population health outcomes 16 .Integration of medicine and dentistry 17 .Population health outcome 18 .Evidence based care 20 .Mid–level provider 21 .Group practice model 22 .Oral Health Care Delivery Model 23 .Organizational structure 24 .Organizational Structure: Opportunity 27 .Integrated medical and dental practice 27 .Networked and integrated medical/dental practice 28 .Stand–alone networked large group dental practice 29 .A Networked solo practice 30 .Patient Centered Care: Competitive Advantage 31 .Conclusion 36 .Chapter 5 Streamline the PracticeMichael Okuji, Dennis Lewis .Introduction 2 .Private Practice 4 .Systems and operation 4 .Electronic eligibility 5 .Pre–determination 6 .Claim submission 8 .Electronic claim submission 8 .Electronic direct deposit 9 .Electronic dental record 10 .Access to the dental record 13 .Diagnostic code 15 .Airline Analytics 16 .Sarrell Dental Center 18 .Call center 19 .Administration 20 .Workforce 20 .Community 21 .Medical dental integration 21 .Sarrell Dental Center team 22 .Quality 23 .Social Determinant of Health 25 .Patient support system case management 26 .Disease management 28 .Generational determinant of health 29 .Conclusion 30 .Chapter 6 Patient Protection and Affordable Care ActDavid Okuji, Michael Okuji .Introduction 2 .ACA quality 3 .Healthcare Insurance Marketplace 4 .Public exchange 4 .Private exchange 5 .Affordable Care Act 6 .Title I. Quality, affordable healthcare for all Americans 7 .Title II. Role of public programs 7 .Title III. Improve quality and efficiency of health care 7 .Title IV. Prevention of chronic disease and improve population health 8 .Title V. Health care workforce 8 .Title VI. Transparency and program integrity 9 .Title VII. Improve access to innovative medical therapies 9 .Title VIII. Community living assistance service and support 9 .Title IX. Revenue offset provision 10 .Title X. Strengthen quality, affordable healthcare 10 .Key Provisions 10 .ACA Essential Health Benefits 12 .Medicaid Expansion 13 .ACA Funding 13 .Drivers of Health Care Reform 14 .ACA Quality and Outcome 15 .ACA Themes 16 .Actuarial Value 18 .ACA Dental Benefit 19 .Impact on Dentistry 20 .Cost of Care 22 .ACA Implication for Dentists 23 .Pediatric specialist extenders 24 .Society s expectations 26 .Conclusion 27 .Chapter 7 Ethics and Ethical BehaviorGary Herman .Introduction 2 .What is a Profession? 3 .Ethical vs. legal 4 .Ethics and professionalism 5 .Ethics of quality of care 6 .Perceptions of ethics and professionalism 7 .Situational Ethics 9 .Responsibility to the patient 9 .Responsibility to improve health 11 .Responsibility to family 12 .Dentist as Expert 13 .You re the doctor! 13 .Dentist as estimator and advisor 15 .Self interest 16 .Pattern of practice 17 .Ethical practice decisions 18 .The importance of profitability 19 .Owner versus Employee 20 .Employee in a small private practice 20 .Employee in large group practice 21 .Employee in a public health setting 22 .Employees in a dental support organization 23 .Dental Board 23 .Value of Treatment Alternatives 25 .Standard of care 26 .Appropriate pattern of practice 26 .The wallet biopsy 27 .Social Media and Ethical Behavior 28 .Will Yelp destroy a practice? 29 .Dissemination of fees 30 .Future of Dental Ethics 31 .What is future ethical behavior? 32 .What is quality and who determines? 32 .Conclusions 33 .Chapter 8 Stay Out of TroubleMatthew Cassady .Introduction 2 .Fraud, Waste, and Abuse 4 .Fraud 4 .Waste 5 .Abuse 7 .Bad Behavior 8 .Bill for services not rendered 8 .Right a wrong 9 .Undocumented treatment 10 .Unnecessary service 12 .Unbundle 14 .Up code 14 .Kickback 16 .Alter date of service 16 .Discount 17 .Who s Looking? 19 .Fraud, Waste, and Abuse in Your Office 26 .How to avoid fraud, waste, and abuse 28 .Record retention 33 .Conclusion 40 .Chapter 9 Analysis to ActionMichael Okuji .Introduction 2 .Premise 2 .Competition 4 .Information 5 .Small Private Practice 5 .Streamline 8 .Group Practice 12 .Specialist group practice 13 .Permanente Dental Associates 14 .Dental group productivity 15 .Group Practice System 16 .Corporate practice of dentistry 17 .Dental support organization 19 .Competitive advantage 20 .Re–brand 20 .Off–brand 21 .Integrate vertically 21 .Spin–off service 22 .New service 22 .Partnership 23 .Dentist training model 23 .Hub & spoke 24 .Safety Net System 25 .Premise 26 .Competitive strategy operations 26 .Airline capacity model 27 .Competitive strategy partnership 28 .Competitive strategy leadership 29 .Organized Dentistry 30 .Quality 30 .Tele–dentistry 32 .Integrator Organized Dentistry 34 .Group purchasing organization 34 .Options for action 34 .Integrator Independent Practice Association 37 .Integrator Information Technology Company 39 .Conclusion 41

• ISBN: 978-1-118-98034-7
• Editorial: Wiley–Blackwell
• Encuadernacion: Rústica
• Páginas: 216
• Fecha Publicación: 19/01/2016
• Nº Volúmenes: 1
• Idioma: Inglés