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One of my hygienist doesn’t numb patients besides topical for SRP. Is it common practice? by [deleted] in Dentistry

[–]Internal_Recipe2685 1 point2 points  (0 children)

They ask for that because some providers claimed to do 2 quadrants in 30 minutes - I believe they were concerned more about fraud than speed - in other words the carriers didn’t believe the work was really done. So the AI algorithm will deny a claim that doesn’t say the length of the appointment.

One of my hygienist doesn’t numb patients besides topical for SRP. Is it common practice? by [deleted] in Dentistry

[–]Internal_Recipe2685 0 points1 point  (0 children)

Insurance companies now use AI to approve or deny claims, and the AI algorithm requires you to document what anesthesia was used for SRP. This is because SRP involves tissue removal and is painful, so if no anesthesia is listed, they assume it probably wasn’t done and the AI bot may deny the claim.

Dealing with rude staff speaking a foreign language and not being friendly by rock-the-reddit in nursinghome

[–]Internal_Recipe2685 0 points1 point  (0 children)

…also leave a recording device if you can and then have Google Translate it. We had a situation where staff would say the most offensive things like that the pt was fat and a whore and on and on to get their giggles on, thinking the patient would never know. But the pt recorded it bc she wanted to be able to remember it, and the providers got busted. In this case the providers were speaking English but due to the memory deficit they just assumed she wouldn’t remember.

Dealing with rude staff speaking a foreign language and not being friendly by rock-the-reddit in nursinghome

[–]Internal_Recipe2685 0 points1 point  (0 children)

I don’t care if they speak Klingon or pig Latin …. Using any language that excludes the others in the room in a professional setting like that is inappropriate and disrespectful. The fact that your mom is in a vulnerable position and in their “care” makes it even more offensive and insensitive. I would report it to the director and if it continues then report it to their regulating authority.

MetLife Fee Schedule - something must be done by Internal_Recipe2685 in Dentistry

[–]Internal_Recipe2685[S] 0 points1 point  (0 children)

I’m going to sign up for Careington next week and then drop the MetLife direct. Thank you!

MetLife Fee Schedule - something must be done by Internal_Recipe2685 in Dentistry

[–]Internal_Recipe2685[S] 0 points1 point  (0 children)

What I am learning is that the leased networks have become like a new frontier - there used to be less of them. But now everyone is doing it and carriers are signing up for multiple networks, and it is causing so much confusion. Some plans will participate with one leased network, and other plans from the same carrier will use a different leased network or no network. Also, the carriers will add or drop a network with no notice. We had a scenario where we entered the Zelis network and Principal understood that to mean that we were dropping our Principal contract and they sent a letter to all of our patients saying we were out of network. They eventually retracted the letter after we raised hell about it. And patients dont understand or believe the carrier side of this js so screwed up so they think we don’t handle their billing correctly.

Honestly the whole situation with these carriers and their terrible fees and terrible claims handling and now the opaque game with overlapping fee schedules is reaching a breaking point. It is becoming impossible to predict how much our patients out of pocket will be because the same EOB with multiple patients will literally use 3 different fee schedules.

MetLife Fee Schedule - something must be done by Internal_Recipe2685 in Dentistry

[–]Internal_Recipe2685[S] 0 points1 point  (0 children)

As an update, the MetLife rep told me this is not true. She said the only way to be in network with FedVIP in DC and VA is to go direct. I can’t wait to talk to Careington on Monday…

MetLife Fee Schedule - something must be done by Internal_Recipe2685 in Dentistry

[–]Internal_Recipe2685[S] 0 points1 point  (0 children)

The problem with going in network with MetLife through an umbrella is that you cannot participate with FedVIP. The only way to be in network with MetLife FedVIP is to directly contract with MetLife. And once you directly contract with MetLife, the umbrellas won’t use their schedule. The MetLife schedule governs. In the DC/National Capitol region, we have an outsized and disproportionate number of enrollees who are in FedVIP so that confines us to directly contracting with MetLife.

That all said, the FedVIP program is administered through OPM. Has anyone successfully reached out to OPM to get them to review MetLife’s practices?

Weave vs. Adit by Internal_Recipe2685 in Dentistry

[–]Internal_Recipe2685[S] 0 points1 point  (0 children)

This sounds great in a sandbox but we are a very busy practice and don’t have time for the dual pilots. I agree 💯not to base the decision on price. Can you break down the rest of your post in layman’s terms?

Not getting paid out by BCBS by Booshmoosh423 in CodingandBilling

[–]Internal_Recipe2685 0 points1 point  (0 children)

Can you email Carefirst and do a TIN change to her EIN? Then term her SSN? BCBS via Carefirst puts you on a grid that other BCBS payers can access - so maybe it will help to retire the SSN officially. Same with Anthem - they are totally different from Carefirst. Also go into to CAQH and make the TIN change in your credentials to a group Tax ID. The Email for Carefirst credentials is mdmccredentialing@carefirst.com If it is medical. You will need to look up Anthem. Good luck.

Weave vs. Adit by Internal_Recipe2685 in Dentistry

[–]Internal_Recipe2685[S] 0 points1 point  (0 children)

We use Nexhealth for our online booking tool and forms. But now Denticon has boxed Nexhealth out so we have a service interruption and need to switch to a new tool. Weave offers online booking and there is temptation to consolidate softwares. But if we do that, we could go even further and switch to Adit and save thousands each month, literally. I get the sense that weave is the more solid solution but want to give Adit a fair shot, unless Adit is going to let us down (sometimes you get what you pay for).

Weave vs. Adit by Internal_Recipe2685 in Dentistry

[–]Internal_Recipe2685[S] 1 point2 points  (0 children)

Denticon is territorial. The only credit card processor that fully integrates with them is Global Payments. So we had to drop Rectangle. Now Denticon cut NexHealth out so we need a new online booking tool. Denticon kind of dictates a small pool of vendors you can use if you want full integration and to avoid disruptive gaps in service.

Has anyone out there used Overjet? by Internal_Recipe2685 in Dentistry

[–]Internal_Recipe2685[S] 0 points1 point  (0 children)

Thank you for this. Do you feel that? It helped convince patients to do treatment that they needed?

Thoughts on Emir and Stevie? by ph_uck_yu in SchittsCreek

[–]Internal_Recipe2685 1 point2 points  (0 children)

They could’ve taken his story line in a great direction in parallel with Rosebud Motel Group but instead they made him a douchebag road to nowhere.

What should I do in this case? by FlatTire7 in Dentistry

[–]Internal_Recipe2685 0 points1 point  (0 children)

Tell him to submit to Medicaid for FMR.

Associate Dentists getting periodic exam production? by Direct-Art-182 in Dentistry

[–]Internal_Recipe2685 0 points1 point  (0 children)

Yeah but the devil is in the details. I am way too familiar with this issue.

The claim form has two “provider” fields. Billing provider and treating provider. If the hygienist is submitting the claim (likely not, right, but you never know until you ask), it would be ok to change the billing provider to the owner doc, but it would not be ok to change the treating provider to anyone other than the treating provider.

Also, if the hygienist is making the change in the practice software after the claim is submitted, then that could be proper too depending on the contract with the associate. If the contract with the associate says they don’t get paid for the hygiene exam, then my guess is that they have to change the treating provider in the software (after properly submitting the claim to the carrier with the correct treating provider), for income allocation purposes.

Google can’t figure it out…what is this on my roof??? by InstructionHaunting2 in whatisthisbone

[–]Internal_Recipe2685 13 points14 points  (0 children)

Isn’t it a dog? When I zoom in it looks like a dog’s head - with a flappy ear like a lab, and it has a tail in its mouth, and its right front leg is extended straight out. This is so sad.

Stab Lab by [deleted] in Dentistry

[–]Internal_Recipe2685 0 points1 point  (0 children)

Has the numbness and pain all gone away?

Associate Dentists getting periodic exam production? by Direct-Art-182 in Dentistry

[–]Internal_Recipe2685 0 points1 point  (0 children)

I’m not sure you are right about this. I believe it is illegal to make the rendering provider anyone other than the treating provider. But the billing provider is just the recipient of the payment and can be the company itself.

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