Articles
It's 1099 Time. Is Your Information Accurate?
CDT-3 Reminder
Digitized X-Rays
Technology Update Computer Telephony Integration (CTI)
Every Dentist Needs A Signed Contract
Ethical Dilemmas
Volunteers Sought for Dental Program for Disabled
Incorrect Addresses Delay Claim Payments
Thinking About Trying Electronic Claims? Here's What Some Office Managers Have to Say
Vicarious Liability
Golfers Raise $40,000 for Special Olympics
Got a Minute? That's All the Time Our Website Survey Takes
Handbook Revisions Sent
Periodontal Maintenance Procedure (04910) Processing Policy Revisited
Consultant's Corner Ethical Considerations of Insurance Billing
A Patient Says Thanks

It's 1099 Time. Is Your Information Accurate?

As you are already aware, in conjunction with receiving direct reimbursement from Delta Dental it is necessary for your office to provide your tax identification number for IRS Form 1099 reporting. But…did you know that the tax identification name for IRS Form 1099 reporting is just as critical as the number? Failure to provide Delta Dental with the correct "name" may subject your office to a 31% withholding of future claim payments. Under the federal tax regulations, when the IRS detects a mismatch between a 1099 and your annual tax filing, Delta Dental is required to hold back 31% of the payment.

Just as one tax identification number is required per IRS Form 1099, so is one name. To verify if your office has reported to Delta Dental the correct name, please refer to a current claim voucher. Your name for IRS Form 1099 on record at Delta Dental is also the name that will be printed on your claim-payment vouchers (checks). Both the tax identification number and the name must be the same as your annual tax filing.

To ensure that your office has the correct information on file, contact the Professional Relations Department at (973) 944-4588 and ask to be sent a blank substitute W9 form for IRS Form 1099 reporting. Before returning this document to Delta Dental, please be sure to indicate all dentists' individual names and license numbers. This includes associates and salaried employees within your practice.

Together, withholding of future claim payments can be avoided.

CDT-3 Reminder

Delta Dental Plan of New Jersey has completed implementation of CDT-3 codes for claims processing. It is important to use these codes on all claims since failing to do so may cause processing delays. Acceptance of these codes does not necessarily mean that they will be benefited procedures. Chapter Nine of the Dentist Handbook has been revised to reflect the new codes, as have Delta Dental's processing policies.

Digitized X-Rays

Delta Dental Plan of New Jersey is excited to announce that it has begun a pilot program with National Electronic Attachment, Inc. (NEA). This technology will enable Delta Dental to begin accepting digitized x-rays and other electronic attachments from NEA through their secure Internet website.

This pilot is initially limited to a few select dentists in order to establish workflows and address any issues that may arise. We expect this pilot to be completed and have this technology solution fully implemented by the end of this year. A progress update will be given in our next issue of Dental News.

Technology Update
Computer Telephony Integration (CTI)

Delta Dental Plan of New Jersey is in the process of rolling out its new CTI Customer Service enhancement. What is CTI? CTI allows information that callers input from their touch tone phone to "pop" information onto the Customer Service agent's computer screens as the calls arrive at their desks. This will save you time and eliminates having to repeat information you have given to the representative.

As an example, assume you want a breakdown of benefits. Once you have entered the member's identification number on the telephone keypad, if the call is transferred to a representative, that person will have the member's record appear in front of them as you are connected.

To get the most out of this technology, we need your assistance.

1. You should use the Voice Response System (800-452-9310) as often as possible to obtain information on eligibility, benefits, claims status, remaining maximum and deductibles and to order forms.
2. If you choose to speak with a representative, always enter the member's identification number first. This will reduce the time the representative will need to obtain information to assist you.

Delta Dental continues to look for opportunities to improve our service to you.

Every Dentist Needs A Signed Contract

Has your practice added an associate lately? Please make sure every new dentist also signs a participating agreement with Delta Dental and is credentialed. Delta Dental requires both the owners of a dental practice and each individual treating Delta Dental patients to participate.

"In order to be properly reimbursed, every dentist in the practice must sign a contract with Delta Dental," explains Beatrice Buccos, Manager, Network Development. "Even if the owner participates, if the doctor who actually rendered the care never signed a contract with Delta Dental, the claim must be paid as non-participating because the patient was treated by a non-participating doctor. The check would go to the subscriber and not the dental office."

To confirm whether a dentist participates with Delta Dental, call Professional Relations at (973) 944-4588. Please have the doctor's license number handy. To request an application to become a Delta Dental participating dentist, please call our Dental Network Coordinators at (888) 396-6641.

Ethical Dilemmas

A big problem has to do with relativity. Almost all dentists recognize that billing for procedures that were never done is clearly unethical and illegal. Most dentists agree that charging different fees based on whether the patient has insurance or not, or waiving co-payments, is not fair, either to patients or insurance companies. But what about charging for exams to patients with insurance when you don't ordinarily charge for an exam? Or back dating a claim to help out a patient in financial difficulty?

Every office faces these nagging decisions on nearly a daily basis. It's easy to judge a colleague who has been arrested for insurance fraud, lost a license and maybe spent time in jail for bilking an insurance company. It's a lot harder to apply the same standard to a dental office that holds a claim and dates it a week later so that a prophy will be covered by insurance. Both of these actions are, strictly speaking, illegal and unethical, but most people will not view them in the same way because of the relative difference in severity of each case.

Ethical Principles

Professional codes of ethics developed as a way to protect and better serve the public. This was done to build public confidence in all members of the profession. There are five recognized ethical principles to be considered:

Autonomy: the patient's right to make his own decisions.

Non-maleficence: the requirement to do no harm to the patient.

Beneficence: the requirements to provide for the betterment of the patient and community.

Justice: to treat people fairly.

Veracity: to be truthful.

At the risk of sounding pompous and naive, I would suggest that ethical behavior requires us to play by the rules set down by insurance companies. The ethical principles listed above should apply not only to the patients we treat, but to other parties we deal with as well. While making a misstatement on a claim form may uphold the principle of beneficence toward the patient, it will violate both the principles of veracity and justice relative to the involved insurance carrier. Furthermore, while pleasing the patient initially, it may plant seeds of doubt regarding the dentist's overall integrity and character.

Ethics and Benefits Carriers

It is important to remember that insurance company benefits are, essentially, a contract between the carrier and the premium payer. The patient is the beneficiary of the contract, and the dentist is just an agent in the process. Dental treatment planning must be between the dentist and the patient, after which the insurance benefits should be considered. It is clearly unjust to the patient to base determination of a patient's needs on the specifics of the insurance benefits available. It is equally unjust to the carrier to provide false information that causes undeserved benefits to be paid.

Some offices, especially those aggravated by unresponsive and unhelpful insurance companies, feel no need to play by all the rules. It should be remembered that insurance companies will make necessary business decisions. If carriers have higher than expected utilization, they will simply increase premiums or decrease benefits, to the detriment of your patients and all other covered patients.

In conclusion, remember that ethical behavior toward insurance carriers and patients requires dentists to play by all the rules. Like pregnancy, you can't be a little bit unethical. Your actions ultimately reflect on your character and affect all in the profession.

-Dr. Gary Herman

Dr. Gary Herman is in private practice and is a Group Director, General Clinic and Lecturer of Restorative Dentistry at the UCLA School of Dentistry. He lectures on patient communication and dental ethics. Dr. Gary Herman can be reached at (310) 206-9556 or by email: garyh@dent.ucla.edu.

Volunteers Sought for Dental Program for Disabled

Are you looking for an opportunity to help those who desperately need dental care but cannot obtain it?

Donated Dental Services (DDS) is a nationwide program that provides services to disabled or aged people who cannot afford dental treatment and are not eligible for public assistance. Delta Dental Plan of New Jersey has donated more than $100,000 to DDS. Many of the people served by DDS suffer from kidney diseases, cancer, respiratory problems, mental illnesses or mental disabilities. Most have multiple disabilities and are considered permanently unemployable.

DDS currently provides services in 25 states, with plans under way to expand into 10 others. More than 8,000 dentists and 1,700 laboratories donate their services nationwide. Collectively, DDS will generate more than $6.5 million of donated care this year.

New Jersey's program has consistently been one of the most effective nationwide. The 112 laboratories and 797 dentists who volunteer have donated almost $5.5 million worth of care since the program started in 1988. More than 4,000 disabled and elderly people have received the comprehensive dental care they so desperately needed.

One person helped is Mr. S., who is 73, suffers from severe asthma and is on supplemental oxygen. When he requested assistance from DDS, he had not been to a dentist since receiving his dentures in 1975. His gums were receding, and wearing dentures was painful because they no longer fit. Mr. S. does not receive enough money from Social Security to pay for his rent, food and medication, let alone the cost of seeing a dentist.

Through DDS, a dentist donated the realignment and fittings for dentures and a lab fabricated the dentures at no cost. Without the support of these volunteers, people like Mr. S. would not get the vital dental care they need. Mr. S. wrote, "Dr. K. did a fine job of making me dentures that fit perfectly and alleviating the jaw pain I used to suffer with. I can't praise DDS enough."

The DDS approach is to provide comprehensive care to the most vulnerable, rather than providing minimal care to many people. DDS dentists treat patients in the convenience of their own dental offices.

All applicants for the New Jersey DDS program are screened for eligibility. Program coordinators then refer DDS patients to volunteers with offices near their homes. They also verify that DDS patients have transportation, and stress the importance of being on time and not missing appointments. Clients who are careless about appointments may be disqualified from receiving service.

Despite the large number who have been helped, many more still need care. For information on how you can become a DDS volunteer, please contact DDS coordinators Margaret Belowsky or Gladys Reyes at (800) 829-4619.

Incorrect Addresses Delay Claim Payments

Do you routinely check to make sure your patients' addresses are up to date? Incorrect patient addresses are a major reason behind claim-processing delays, which can result in payment delays to your office.

Please help Delta Dental serve you better by verifying your patient's address at each appointment.

It's a quick, easy way to make sure payments arrive in a timely manner.

Thinking About Trying Electronic Claims? Here's What Some Office Managers Have to Say

Regular readers of Dental News know that Delta Dental encourages dental offices to file dental claims electronically. But how do people who actually file electronic claims feel about doing so? We recently interviewed several insurance and office managers about their experiences to find out if filing electronic claims really does make life easier for dental office staffs.

"It's great!" says Joan Raposa, office manager for Dr. Richard Raposa's practice in Denville, which began submitting electronic claims in May. "After I did it the first time I thought, 'Why haven't I been doing this before? Why did I wait so long?'"

Paperwork has decreased significantly since moving to electronic claims, she explains. "It saves me hours. I used to have a mountain of charts on my other desk, and now the paperwork is gone. Before patients are out the door, I have their claims ready to send."

Even when paperwork is required, the amount is minimized and the process streamlined, says Cathy Carpenter, office manager at West Morris Dental Associates in Succasunna. "X-rays don't usually need to be submitted with electronic claims. If Delta Dental does require an x-ray, we get prompt feedback saying they need the information. Then we send the x-ray in a preaddressed yellow envelope to a special post-office box for priority processing. It definitely speeds turnaround time."

Electronic claims also speed payment processing, says Joanne Fortunato, insurance manager for Dental Horizons in Succasunna. "It's much quicker with electronic claims. It takes an average of two weeks or less, compared to four or six weeks or longer with paper claims." Electronic claims also simplify some tasks, such as coordination of benefits, says Chris Berkeypile, office manager for Dr. James Berkeypile in Berkeley Heights. "We began electronically filing with Delta Dental shortly after I met Beth DeCapio, EDI Coordinator, at the New Jersey Dental Convention in Atlantic City. She told me about some of the major advantages of filing electronically that I was not aware of. For example, if Delta Dental is the primary and secondary carrier for a patient, Delta Dental automatically coordinates benefits when the claim is filed, which saves having to do it twice."

Each of these dental office managers has called on Beth DeCapio as a resource to help their offices maximize their electronic filing capabilities.

Dr. Richard Raposa's practice was just about to begin submitting electronic claims when DeCapio first visited. "She went over how it would really help our office-the advantages of doing claims electronically, the turnaround times, what was required," says Joan Raposa. "When she left, I couldn't wait to get started. Her visit was very helpful."

West Morris Dental Associates invited DeCapio to its monthly staff meeting. Even though the office had been filing electronic claims since the mid '90s, DeCapio's advice resulted in several improvements. "We learned that we were submitting a lot of things unnecessarily," said Carpenter. "She helped us streamline our processes."

Dental Horizons called DeCapio for help with a specific problem. "We are a group of doctors who are under two specific specialty numbers," says Fortunato. "We were having difficulty sending a claim with the specialty numbers. The clearinghouse kept denying the claims. She came in and explained what we had to do. She made things so much clearer and easier. She also gave us a special fax number for perio charting, which was really helpful, because I had been mailing those claims."

DeCapio is available to meet with you and your staff at your office to show you how to make the most of electronic claims submission in your practice. To arrange a visit, contact Beth DeCapio at (973) 285-4035 or bdecapio@deltadentalnj.com.

Vicarious Liability

This article originally appeared in the January/ February 2000 issue of SAFECO Dental News. Permission to reprint this article was granted by SAFECO.

It is logical to presume that a dental claim would arise from something a dentist did or failed to do when treating a patient. However, the dentists or dentist who owns a practice is also liable for the actions of his or her employees, and may be held liable for the acts of independent contractors. This indirect liability is known as vicarious liability.

The dentist's liability may originate without the dentist having any direct involvement with the party filing the claim. In fact, the dentist may never have seen or treated the patient and still be named in a lawsuit. In most instances, it is the owner of a dental practice who will become party in a suit when only a circuitous connection exists. This doctrine is called respondeat superior (Latin for "let the superior or master respond" for the wrong that was done). There are ways to transfer the risk and avoid filing a claim for defending against this vicarious liability exposure.

One way to transfer the vicarious exposure is to establish (with a qualified attorney) a written independent contract agreement that clearly addresses whose insurance carrier will defend the vicarious liability of the other. Another method of transferring the risk of vicarious liability is to be added as an additional insured on the other's Dental Professional Liability policy. This method of risk transfer is only necessary if there are different companies insuring the dental relationship. In most cases, additional insureds are granted defense coverage for their vicarious liability arising out of the acts of the named insured. Contact your insurance agent if you have further questions on how to take advantage of the additional insured endorsement.

SAFECO offers participating dentists who have completed Delta Dental Plan of New Jersey's credentialing requirements a special 10% premium discount (over and above other available discounts) for qualified dentists insured under the SAFECO Insurance Company Preferred Dental Professional Liability Program. For a no-obligation estimate, call (800) JAMISON (526-4766), ext. 352, or e-mail lbarbaro@jamisongroup.com.

Golfers Raise $40,000 for Special Olympics

When rain threatened to dampen the 10th annual Delta Dental Classic in June, organizers felt that canceling the event was not an option. Last year's golf outing, which supports Special Olympics New Jersey, had also been rained out. "We couldn't disappoint golfers and Special Olympics supporters two years in a row," said Diane Belle, Assistant Vice President, Corporate Communications.

Rescheduled for August 21, the event at Cherry Valley Country Club drew 130 golfers and raised more than $40,000 for Special Olympics programs. Since it began in 1991, the Delta Dental Classic has raised $265,000 for Special Olympics New Jersey. Contest winners include:

1st Place Low Gross (Ladies):	Dr. Leslie Skurla
1st Place Low Gross (Men):	Tom Miller
1st Place Gross Team:	Kevin Croly James DeMarco Tom Miller Pat Scheffer

Special thanks to all of our participants and sponsors, including the New Jersey Dental Association.

The date for next year's Delta Dental Classic is June 5, 2001.

Got a Minute? That's All the Time Our Website Survey Takes

The next time you visit Delta Dental's website, you may encounter a pop-up screen asking you to participate in a brief survey. The random survey seeks your feedback about what you like and don't like about our website, and what we should do to make it better. If you receive the brief survey, please take a minute to answer our questions. Your comments are important to us and will help us create a website that you find valuable, easy to navigate and worth visiting again and again.

For your contribution, you will also earn 50 points with FreeRide (www.freeride.com), an Internet shopping program in which you trade points for merchandise.

Delta Dental's website is at www.deltadentalnj.com.

Handbook Revisions Sent

In July, dentists in New Jersey and Connecticut were mailed revisions to the Participating Dentist Handbook.

These revisions include new coding information, as well as associated DeltaUSA processing policies, updated addresses of Delta Dental Plans in other states, new bylaws for New Jersey dentists, an updated diagnostic materials chart and new information about coordination of benefits.

If you did not receive the handbook updates or have questions, please contact your dental network coordinator at (888) 396-6641.

Periodontal Maintenance Procedure (04910) Processing Policy Revisited

The June 2000 Dental News announced that effective September 1, 2000 Delta Dental Plan of New Jersey (DDPNJ) would be implementing the DeltaUSA National Account Processing Policy regarding code 04910 -Periodontal Maintenance Procedures. The DeltaUSA National Account Processing Policy disallows the fee for evaluations (such as CDT-3 D0120) as included in the fee for the 04910. DDPNJ has reconsidered the policy and will not be implementing the policy with respect to coverage provided by DDPNJ. However, the policy remains in effect when coverage is provided through a different Delta Dental Plan. Dentists who have refiled their fees based on the anticipated implementation of the DeltaUSA Processing Policy will be contacted by DDPNJ to make any changes to their filed fee for 04910 as appropriate.

Consultant's Corner
Ethical Considerations of Insurance Billing

Ethical Considerations of Insurance Billing This article originally appeared in the November 1999 issue of Trojan Today. Permission to reprint this article was granted by Trojan Professional Services.

Your patient completes his treatment, thanks you, and, when you escort him to the front desk, he tells you and the office manager that his insurance ran out last month. He asks if you could backdate the services so the insurance will pay for them. Suddenly, you and your staff are put into an uncomfortable ethical dilemma. Does your office "help out" the patient, and risk committing fraud, or comply with legal and ethical requirements at the risk of upsetting your patient?

Many dental offices seem to have an "us against them" relationship with insurance carriers. After years of having claims seemingly arbitrarily adjusted, delayed, denied and "lost," many dentists and their staff feel that "white lies" on insurance forms are not a big deal, as they benefit the patient. This reasoning can start the office on a slippery slope of rationalization leading to serious problems.

A Patient Says Thanks

"I would like to say thank you," writes a subscriber with Delta Dental. "I had dental work done while on vacation. The dentist submitted the claim and called me one week later. He wanted to make sure I was feeling better and to tell me that the payment had been mailed to his office. He could not believe how quickly the claim had been processed. Within two weeks, the claim had been processed and paid. I appreciate your company's quick processing, before a financial strain is placed on the family. So thank you, and keep up the excellent work."