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The following fees will be updated:
HMO/ DMO fee
HMS through its’ Associates Subcontractors will verify the patient’s dental insurance benefits prior to their date of service. There would be 3 types of verification windows available.
1. EMERGENCY or Same Day Verification:: Our Subcontractors will work on the verification of the same day appointments which are scheduled on the same day or on an emergency basis. We would need the dental practice to send the insurance verification requests via email to our group’s email address, we would need 2 hours to accomplish the verification process since there would be an expected “holding time” on the phone, from dental insurance companies while processing the dental benefits eligibility, and some insurance would provide dental benefits verifications via fax, which may take additional time. Nevertheless, we need to further verify the availability of dental benefits by phone once we have received the fax, to go over omissions and exclusions the dental insurance company may have overlooked on the fax, and we would be subjected to the “holding time”, and the turnaround time (TAT) of the fax from the insurance companies. When this happens, we would make sure to inform the dental practice the reason for the delay, on a timely manner. Once the verification is completed, the status will be shared with the respective dental practice via email.
2. Next Day Verification: Our Subcontractors, will work on the verification for the next day (Next working day) 1 day prior to the appointment, and we will generate the report for the next day’s appointments from the Practice Management Software (PMS) and accomplish the verification on the same day. This will help the dental practice to get the verification completed, 1 day prior to the date of service (DOS). Once the Next Day verification is completed, we will share with the respective dental practice, in a spreadsheet report, via email by the end of the business day. By using this reporting style, all the appointments which are added to the PMS for the next day, will be included in the verification report, the dental practice would not need to send any extra email.
3. Future Verification: Our Subcontractors, will verify appointments of future dates which are scheduled in advance by retrieving future dates’ appointments (maximum next 5 working days) and verifying those according to date of service First-in First-out (FIFO). The dental practice will receive future reports 2 days prior to the appointment, allowing the dental practice to prepare the Treatment Plan for patients. The practice will have sufficient time to communicate with patients in cases such as: the laboratory case is not completed; certain dental materials are in back-order and not available for the date of the appointment; or the patient’s dental policy is not active; or we need additional information from the patient to complete the dental insurance verification process.
Plan Creation or Evaluation (Group dental benefits administration in the PMS): Our Subcontractors, will have the responsibility to create the new employers’ or group plan corresponding to the dental benefits obtained from the insurance, following the dental practice’s instructions. If the plan is already available in the PMS, we will update the plan as per the instructions provided by the dental practice.
Breakdown Forms: Our Subcontractors, will process the insurance eligibility verification on the Customized Breakdown forms selected by the dental practice.
Full Form: (For the PPO and Indemnity policies and the New Patients)
Short Form: (For the existing patients with the PPO and Indemnity policies)
HMO/ DMO Form: (For the patients with the HMO/ DMO policies)
Specialty Forms: (For the patients who will be seeing the specialist; Endodontic, Periodontics, Oral Surgery, Orthodontic, etc.)
Source of Verification: We will use various sources to obtain the dental insurance eligibility benefits of the patients. Those are:
Verification over the phone
Verification from insurance Website (the dental practice will provide the Website credentials),
Verification from fax received from insurance
Verification from the insurance IVRU (Interactive Voice Response Unit)
I. EMERGENCY or Same Day Verification:: The status will be shared with the dental practice instantly.
If the “Family File” has not been created, our subcontractors will create the plan on a “test account” in the PMS and they will share the same with the dental practice. Once this has been created, the dental practice will have the instant plan to attach to the respective patient’s “Family File.”
If the “Document Center” or the “Case Note” (the module in PMS where the patient’s breakdown is posted) is not available, the breakdown will be share via email with the dental practice. Once the same is created, the dental practice will be able to post the instant breakdown to the module.
II. NEXT DAY VERIFICATION:
The status will be shared with the dental practice at the end of the day, for all the appointments of the following day. For example:
On Monday: The report of Tuesday will be shared at the end of the day.
On Tuesday: The report of Wednesday will be shared at the end of the day.
On Wednesday: The report of Thursday will be shared at the end of the day.
On Thursday: The report of Friday will be shared at the end of the day.
On Friday: The report of Monday will be shared at the end of the day.
III. Future Verification:
On Monday:The report for Wednesday will be shared at the end of the day.
On Tuesday: The report for Thursday will be shared at the end of the day.
On Wednesday: The report for Friday will be shared at the end of the day.
On Thursday:The report for Monday will be shared at the end of the day.
On Friday:The report for Tuesday will be shared at the end of the day.
Many CDT codes can be sent to the Medical insurance of the patient. This helps the dental practice obtain more reimbursements on certain costlier procedures and therefore, patient out of pocket expense is reduced significantly.
Based on the dental practice location, we will ask you to provide us with the list of most commonly used Medical Insurances. You can accomplish this, by asking your office staff to request patients’ their Medical Insurance cards in addition to the Dental Insurance information when they are coming to the dental practice. By implementing this practice, you will get an approximate list of the most common Medical Insurances from your patient base.
Once we receive the list of Medical insurances, our Medical billing experts will start the credentialing documentation process for the Dentist/s and we will fill out and complete all of the required documentation for the dental providers from our end. We will update the dentist(s) with a periodic status report, and we will ensure that the dental provider gets in-network with the Medical insurance companies within 30 to 90 days.
In order to proceed with the process we would need a list of the following documents:
The most important aspect of Medical Billing for Dental Procedures is the Dental Professional’s documentation thought process. It is important to document the “Medical Reasons” behind the required dental treatment; and also, the health consequences if the dental condition is not treated.
The following are some of the medical reasons for dental treatment:
HMS’s Medical Insurance expert billers will help dental practices obtain maximum reimbursements from patients’ Medical Insurance. Important points in Medical billing:
HMS can assist your dental practice in getting paid from Medical Insurance Providers:
Medical and dental billing shares the following:
Differences between Medical Billing and Dental Billing:
Let Health Management Solutions, Inc., assist you to implement Medical Billing for Dental Procedures in your dental practice, please give us a call.
Insurance Claims Aging Report: Health Management Solutions Inc. through its Associates Subcontractors, will obtain the minimum 21 days (most of the insurances release payments of claims within 3 weeks/ 21 days) insurance claims aging report from the PMS every week, and we will follow up with dental insurances to obtain the status of submitted claims. Additionally, we will update the practice, with a written excel report, of the status of all pending claims, and in their respective patient’s Ledger (module in the PMS).
By the end of the week, the worked claims report will be shared with the Account Receivable (AR) Manager of the respective Dental Practice. The report will contain the following details which were obtained from the different dental insurances: (the following list, is subject to change as per the need of the dental practices and the AR Manager’s specific requests).
Mailing address where the check is sent
Amount on the check
Single or Bulk Check
Any adjustment done for the excess payment made for the previous claims (Off-Set)
Check status (Cashed or not)
EFT (Electronic Fund Transfer) payment detail
Deductible adjustment detail
Primary insurance settlement detail (COB and EOB information)
Claim number (from the insurance database)
For denied claims, we will re-submit claims which are expected to be paid with some additional documentation. However, in order to do so, we will need specific access of the PMS from the dental practice in order to obtain additional requested documentation. Our hours of operation are very flexible and we can set up a specific time, at a mutually agreed time frame, to access the PMS in order not to disrupt the practice access to their PMS, we always respect the client’s need.
Health Management Solutions Inc. through its Associates Subcontractors, will work on the Credentialing of Dental Providers with various insurance companies and Network Administrators. Our Subcontractors have more than 8 years of experience with various insurance provider relations’ representatives giving us an edge in achieving an expedient completion of services.
New Credentialing: Any new dentists who are independent contractors, need to be accredited by the different dental insurance companies they desire to be a participating provider of.
Re-credentialing: Once a dentist is contracted, those accreditations need to be validated and renewed annually. We can help dentist with their renewal credentialing insurance agreements.
We will collect the enrollment forms from the respective Dental Insurances and complete the details and the Authorized Signatures as instructed by the dental insurance, and we will submit the same to the dental insurances via email or fax. Further, we will follow up periodically with dental insurances to inquire on the status of the enrollment, the results will be shared with the Dental Practice Manager in a documented spreadsheet report.
Dental Billing: We will ensure, through our Subcontractors, that the Dental Practice has no account receivables, as our professional expert billing team will follow up on claims within 30 days of submission.
At the end of the workday at the practice, someone from our office will retrieve the reports and the list of patients who were treated with insurance.
All claims will be sent appropriately with any kind of required documentation attachments.
Our professional expert billing team will ensure that the Dental Practice receives payments on time.
Reports will be sent to the Dental Practice of all the claims which are submitted on a daily basis.
Thank you for contacting the Board of Dentistry. The Board office cannot advise a dental practice on office closure. Offices will need to use their best professional judgment to make this decision. The American Dental Association released recommended guidelines for dental practices to follow. Unless the Governor issues a mandate for office closures, it is left up to each practice to use their best professional judgment in making a decision for their practice.
Florida Board of Dentistry
4052 Bald Cypress Way, BIN C-08
Tallahassee, Florida 32399
DentalMax is a completely integrated, turnkey dental practice management solution.
Web enabled in nature, and available in real time, DentalMax offers Clinical Records, it offers Facilities Management, it offers Payment Management, and it also offers a robust Back Office operation enabling Billing, Accounting and Financial Reporting.
Available through a simple internet connection on just about any internet ready device, no special equipment is ever required, it directly integrates with your present X-Ray system, there’s no further need for system back-ups, there’s no longer a need for merchant accounts or credit card terminals, there’s no more loss of data due to power outages or other irregularities, there’s no more patient data stored on local computers, there are no more HIPPA nor OSHA violations.
DentalMax is without a doubt, the ultimate path to a successful, compliant, automated practice.
Here are some of the Clinical Records highlights:
Here are some of the Facilities Management highlights:
Here are some of the Payment Management highlights:
Here are some of the Accounting and Financial Reporting highlights:
Insurance Payment: HMS through its’ Associates Subcontractors, will post insurance payments received in the practice’s Ledger as per the instructions of the (AR) Manager. We will collect payment information from various sources; however, the dental practice is responsible to inform HMS and its associates, about the availability of the payments and related documents via email. Those sources are:
As per the guideline defined by the AR Manager, we will write-off the payment in the Ledger.
Timeline: We will follow the timeline defined by the AR Manager, to post payments because it is necessary to have a crystal clear understanding of the DOD (Date of Deposit) and the Closer time-table (usually happens at the end or beginning of the month).
Reporting: On a daily basis, we will share with the Account Receivable’s (AR) Manager the Run-Tape (spreadsheet which contains the summary report of payments). In the same report, we will also highlight payments, which were not posted due to certain discrepancies, or they require the AR manager’s immediate attention and clarification. As per the indicated time-table, we will share the Monthly Report with the AR Manager.
Credit Card payment: Following the instructions of the AR Manager, we will also post Credit Card payments which were made by patients. In order to prevent fraud and misuse of the financial data, we follow strict confidentiality and security practices, and we abide by HIPAA’s Privacy Act requirements.
We will make sure that all the patients’ documents are kept in their respective patient’s account, in the Document Center of the PMS. Such as:
1) EOB (Explanation of Dental benefits),
3) Driving License,
4) HIPAA form,
5) Other Contract Agreement,
6) Dental Benefits Breakdown
A good decision is, allowing an expert to conduct a Compliance inspection, a Risk Management Evaluation and/or a HIPAA Risk Assessment, to identify areas of potential risks. Our team of professionals can help you identify your practice’s needs and improve your practice’s Compliance level, address any HIPAA Risk Assessment deficiencies, correct Documentation Issues and implement Required Guidelines from different organizations. You may have a professional or personal financial need, and at HMS, we have a group of expert financial professionals that will work with you and your other advisors by designing a financial plan in-line with your lifestyle and professional goals. HMS will help you make good professional and personal financial decisions and improve your risk management Practices.
Health Management Solutions promises to provide seasoned professionals to help you with your practice’s professional continuing education and compliance staff training; business risk management efforts, and to help your with your business and personal financial goals