Today, many dental benefit plans use auto-adjudication to process a high number of their claims. While auto-adjudication can speed up claim processing, if an office is not aware that this type of technology is being used, the office can be confused and frustrated by processing errors as the result of manual claims submission. The following three examples illustrate how a plan might use auto-adjudication and how that process might affect dental reimbursement.
Improvements to the Medi-Cal Dental program continue with new options for dentists who treat Medi-Cal members, including the ability to provide fluoride treatment and fluoride varnish as a benefit once every four months for patients under age 6. The increase in the benefit periodicity underscores the state’s commitment to regular preventive oral health visits for young children in California.
Beginning Jan. 1, 2020, it will be more difficult for most employers in California to classify workers as independent contractors, rather than employees, and in some cases will make employees out of independent contractors. And although CDA secured an exemption for dentists, employee classification still isn’t clear-cut, and dentists will need to err on the side of caution when classifying their workers.
Direct-to-consumer orthodontic patients will gain new protections when CDA-supported Assembly Bill 1519 becomes the law in January 2020. The first of its kind in the nation, the new law will protect patients from DTC orthodontic companies that are putting profits before patients by taking potentially unsafe shortcuts to the accepted standards of care.
A private dental practice in Dallas, Texas, has agreed to pay $10,000 to the U.S. Department of Health and Human Services’ Office for Civil Rights to settle potential violations of the HIPAA privacy rule. The HHS reported that the OCR completed its investigation of a complaint by a patient who alleged that the practice disclosed on social media the patient’s last name and the details of the patient’s health condition.
A medical center in St. Petersburg, Florida, is the first to face enforcement action by the U.S. Department of Health and Human Services for failing to promptly provide a patient with medical records. The HHS Office for Civil Rights announced early this year that it would vigorously enforce its Right of Access Initiative that allows patients to receive copies of their medical records promptly and without being overcharged.
Gov. Gavin Newsom has signed a new bill extending the deadline for sexual harassment prevention training. Under SB 778, employers with five or more employees now have until Jan. 1, 2021, to complete the mandatory one- or two-hour employee trainings to be compliant.
Adding or dropping a contract with a dental benefit plan is a personal business decision. There is no “one size fits all” in these types of business decisions, as what might work for one dentist might not work for another. You may be asking yourself how a dentist can make a good decision about adding or dropping a dental plan/network participation, but there is one key element in each success story.
With so much emphasis on the need for employers to establish written policies mandated by federal, state and local laws, it’s easy to overlook the important day-to-day employee management policies on everything from hygiene and smoking to use of personal electronic devices. Discussed below are four areas of employee conduct and attire expectations that you might consider addressing through a workplace policy, if you don’t already have one in place.
The day-to-day running of a practice can be hectic at times, so many dental professionals use set systems and procedures to streamline their work. After all, less time on the backend means more time on patient care. But occasionally, cutting corners can lead to unwanted risk. This is especially true when it comes to patient records. Taking shortcuts on charting, such as using preestablished templates, can cause more headaches down the road.
Health care facilities that produce pharmaceutical hazardous waste are required to properly manage the disposal of that waste according to the Environmental Protection Agency. Among other provisions, the EPA’s finalized rule issued in July prohibits facilities from pouring pharmaceutical hazardous waste down sink drains or toilets, a practice known as “sewering.”
A new state law prohibits discrimination on the basis of hair textures or protective hairstyles that are historically associated with race. Senate Bill 188, also known as the CROWN Act, was signed in July by Gov. Gavin Newsom and will take effect Jan. 1, 2020. California’s Fair Employment and Housing Act was amended by the law to include in the definition of race “traits historically associated with race, including, but not limited to, hair texture and protective hairstyles.”
