THE ADA PRACTICAL GUIDE TO EXPERT BUSINESS STRATEGIES 9 Contributor Biography Dr. Charles Blair is dentistry’s leading authority on practice profitability, fee analysis, insurance coding strategies and strategic planning. He has individually consulted with thousands of practices, helping them identify and implement new strategies for greater productivity and profitability. Dr. Blair’s extensive background and expertise makes him uniquely qualified to share his wealth of knowledge with the dental profession. A widely-read and highly-respected author and publisher, Dr. Blair offers two publications, Coding with Confidence and the Insurance Solutions Newsletter. He also founded www.practicebooster. com, which optimizes insurance administration and aids in maximizing reimbursement. He holds degrees in accounting, business administration, mathematics and dental surgery. You can contact Dr. Blair through email at info@practicebooster.com or by phone at 866.858.7596. Equally important is that the third-party payer uses the code properly and does not try to require a dentist to submit a code based on their coverage, rather than to accurately reflect the procedure performed. A practice can only work with insurance carriers if both sides use the language appropriately and that language is in the current CDT Code set. The individual who is responsible for submitting claims to the insurance plan must be well-trained in the “language” of insurance and be able to communicate fluently with the carriers using the CDT language. Just like any other language, being understood on a basic level may not be that difficult when the information being communicated is largely rudimentary. Likewise, when submitting a dental claim for a service provided where the procedure provided is complex, a deeper understanding of the insurance language is needed. As the nature of the procedure becomes more complicated, education and experience can be the difference between a reimbursed and a denied claim. Denials and delays in reimbursement are expensive and frustrating. The investment in the team is money well spent. Beyond understanding CDT and how the codes are used to describe the service provided, the individual submitting claims must also understand the differences in the plans described above and how the language of the contract can impact reimbursement. A working knowledge of different plan types and their restrictions and limitations helps reduce delays or denials. Many times, it is difficult to understand why a certain procedure is paid without question by one plan, must be documented thoroughly by another plan, and is denied outright by another plan. Until proper training is provided to the business staff member (with the caveat that part of the learning process may be trial and error), the practice will be unable to work well with the insurance carriers. Conclusion Working with insurance companies to maximize legitimate reimbursement requires great effort and the process is ongoing. Business staff must begin by learning and understanding the language of dental insurance. The world of dental insurance is changing rapidly and the dental profession must be willing and able to change with it. Knowledge is power. Know as much possible about the carriers, their contracts, and the dentist’s rights and obligations. What is the bottom line? Being knowledgeable will help you to understand and work with dental insurance providers.