AADOM QUICKcast – Enhance Your Revenue: Coding For Success

Video Description:

Join dental coding experts, Dr. Jim DiMarino and Dr. Greg Grobmyer, for a 20-minute, high-impact QUICKcast designed to help dental practices boost revenue through effective CDT coding strategies. This session emphasizes the importance of up-to-date CDT coding resources and how routine fee rebalancing can significantly increase production without adding extra workload. Attendees will also uncover the dangers of using deleted or custom in-house codes and learn about two underutilized CDT codes that can enhance both patient care and practice profitability.

You’ll walk away with strategies to maximize legitimate insurance reimbursements while minimizing risks. Plus, enjoy two exclusive bonus downloads:

• Practice Booster’s CDT Quick Reference Guide – Stay updated with code changes from the last three years.
• Whitepaper: “Increasing Revenue in a Complex PPO World” – A comprehensive 23-page guide packed with actionable insights for maximizing reimbursements while navigating PPO challenges.

This AADOM QUICKcast is essential for dental office managers and their teams seeking to optimize coding efficiency and drive financial success in their practice.

Course Learning Objectives:

• Understand the need to maintain up-to-date CDT coding resources
• Learn how regular fee rebalancing can boost production without increasing workload
• Avoid the risks of using deleted and custom (in-house) codes
• Discover two underutilized CDT codes that can enhance both patient care and practice revenue
• Explore valuable resources to help maximize legitimate insurance reimbursements while minimizing compliance risks

Enhance Your Revenue Without Increasing Your Workload

It is no secret that dentists nationwide are challenged with remaining profitable when PPO reimbursements are not keeping up with the costs of providing quality dental care. Trying to offset low reimbursements by increasing hours and seeing more patients often results in burnout and frustration.

Yet, most practices are still not fully leveraging the resources available to maximize revenue on the procedures they are already performing.

So, what steps can your practice take to increase revenue without further increasing the workload?

Ensure Comprehensive Coding and Documentation

A significant component of achieving these objectives is ensuring that proper and comprehensive CDT coding and clinical documentation occur with every patient procedure. Strategic coding to maximize revenue and minimize risk includes using the correct codes for each component of a patient visit and having the proper notes, images, and attachments to support the procedures performed.

1. Avoid “Global” Fees: When dealing with PPOs that have a maximum allowable fee schedule, reporting all the individual procedures that have established CDT codes (while avoiding the “unbundling” of services) will allow for higher overall reimbursements and reduce write-offs.
2. Know What Documentation To Include: Each dental procedure needs the proper images, clinical notes or narratives, and other attachments to show proof of medical necessity. Failure to include the necessary documentation will lead to claim delays or denials. Knowing what to include with each procedure to meet the claim requirements for reimbursement is essential to maximizing payments with minimal delays.

Utilize Updated CDT Coding Resources

CDT codes change every year to reflect advances in dental procedures and technology and to clarify procedural documentation.

Our company, Practice Booster, is present at the ADA’s Code Maintenance Committee meeting each year, which gives us insight into the code changes and their intended interpretation. We can then pass this first-hand information on to dental practices through our books and consulting. You may find our resources available online at https://www.practicebooster.com/store.

Here’s why maintaining up-to-date CDT coding resources is vital:

1. Financial Impact: Using outdated codes can result in denied insurance claims, leading to lost revenue and delayed payments. Insurers will reject claims with obsolete codes, forcing practices to resubmit claims and further delay reimbursement. Up-to-date CDT coding ensures services are billed with recognized codes, minimizing delays and maximizing revenue.
2. Legal and Compliance Risks: Incorrect or outdated coding can expose practices to legal and compliance risks. Inaccurate coding, whether intentional or not, can lead to audits, penalties, or accusations of fraud. Regular updates to your CDT coding resources help mitigate these risks.
3. Operational Efficiency: CDT code updates often reflect advances in dental techniques, introducing new codes for innovative procedures and eliminating those that are no longer relevant. Practices that stay current with these updates can more efficiently offer modern treatments, accurately document services, and avoid potential bottlenecks in claim processing.

Avoid Reporting Deleted and Custom Codes

Many dental practices unknowingly put themselves at risk by using deleted or custom (in-house) CDT codes. This can have significant consequences in terms of revenue loss, compliance issues, and inefficiency.

1. Deleted Codes: Since CDT updates often remove outdated codes, practices that continue using deleted codes risk claim denials and delayed payments, as insurance companies will not reimburse for services billed with invalid codes. By staying current with CDT updates, practices avoid this problem and ensure smoother reimbursement processes with fewer delays or denials.
2. Custom (In-House) Codes: Creating custom or “in-house” codes is fine for administrative record keeping, but using custom codes for procedures that are billed to the patient may create issues, as these codes are not recognized by dental payors or as a part of a legal electronic health record. The ADA “Golden Rules” of coding state that if there is no applicable code, you should document the service using an unspecified, by report (“999”) code, and include a clear and appropriate narrative. In addition, many plan uniform requirements state that all charges for procedures made to the patient must be submitted. Failure to provide all charges may be seen as a breach of contract or intent to under report.

Rebalance Fees Annually

Fee rebalancing is the strategic review and adjustment of your practice’s fees for dental services. It doesn’t involve simply raising fees across the board to a certain percentile or by a set percentage. It is instead a customized analysis of current fees and coding practices, tailoring fee suggestions based on practice protocols and target market.

Fees should be balanced in relation to the value of the service and the cost of the delivery of care. While raising fees may at first seem futile in a practice with high in-network participation and heavy write-offs, it is still an essential component of maximizing revenue. Find out more about our Revenue Enhancement Coding Analysis, CDT Coaching, and Fee Rebalancing at https://www.practicebooster.com/revenue-enhancement.

Here’s how regular fee rebalancing can benefit your practice, even in-network:

1. Keep More Of What You Produce: While it is true that fee schedules will limit maximum allowable charges for in-network patients, reporting a higher full practice fee can still result in higher reimbursements overall. Patients with more than one insurance that coordinate benefits allow you to keep up to your full reported practice fee when all reimbursements are totalled without being considered an overpayment. Additionally, any patients that are out of network may generally be billed for the difference between payments and the full reported practice fee.
2. Better Payor Negotiation: Dental practices often feel locked into low reimbursement rates from third-party payors. However, regular fee rebalancing provides leverage in negotiations with insurance companies. When insurers see that your fees have been updated and aligned with industry standards, it may open the door to negotiating higher reimbursement rates for common procedures, which improves overall profitability.
3. Reflect True Service Value: Over time, costs for materials, technology, and labor rise. Yet many practices neglect to adjust their fees in a timely manner, often out of fear of driving patients away. Regularly rebalancing fees allows you to charge appropriately for services, reflecting the true cost of delivery.

Identify Underutilized CDT Codes

Of the nearly 900 CDT codes, there are many that are underutilized by dental practices but could significantly enhance both patient care and practice revenue. Use of these codes would not only mean more precise clinical diagnosis and treatment, but also an overall increase in practice revenue.

Conclusion

Maintaining up-to-date CDT coding resources is critical for the success of any dental practice, as it directly impacts financial health, patient care, and compliance. Regularly updating your coding resources, rebalancing your fees, and using the correct codes can improve both patient care and revenue. Practices that stay informed and leverage available resources, such as those available at PracticeBooster.com, are better positioned to maximize legitimate insurance reimbursements while minimizing compliance risks.

Sponsored by: Practice Booster

Learn about the presenters:

Dr. Greg Grobmyer practiced clinical dentistry in Tennessee for over a decade before chemotherapy from a cancer battle left him with numb fingers. Having to exit clinical practice, he began coaching and consulting with dental offices nationwide on practice management topics.
In addition to coaching, he wrote on dental topics for numerous industry publications and websites and also contributed to many consumer publications, including Reader’s Digest, New York Magazine, Men’s Health, Slate, Insider Magazine. He even spent a few years moonlighting in stand-up comedy, which helped him become an engaging and entertaining speaker.
Dr. Grobmyer is currently the Chief Editor of Practice Booster’s Dental Coding with Confidence and Insurance Solutions Newsletter, an editor of Dental Administration with Confidence, a Revenue Enhancement Program private consulting specialist, and host of The Dental Code Advisor Podcast. His dynamic career and unique expertise make him a sought-after speaker and consultant in the dental field.

Dr. Jim DiMarino worked in the dental insurance industry for over a decade as a dental consultant, a State Dental Director, and a National Dental Insurance Director. In 2018, he completed the certification requirements to become an AADC Certified Dental Consultant and recently joined Practice Booster as CEO. Over the years, he also served as the Director of Medical Affairs for GlaxoSmithKline, ensuring safety/compliance/governance standards for Sensodyne, Pronamel, Biotene, and Aquafresh. As the Director of Clinical Affairs for Premier Dental, he coordinated product launch strategies, sales, and dealer training, led their key opinion leader engagement program.