Will My Insurance Cover? Changing Habits

For many of us, routine is the order of the day. When patients ask anything about their insurance, it is heard as ‘they won’t have whatever care is being presented if insurance doesn’t cover it.’ This assumption is often incorrect and a self-fulfilling prophecy. What we believe, we achieve becomes real. We believe patients will reject care and that is exactly what happens. Changing our expectations is the challenge because for real change to happen, we need to change our habits.

Dentistry is no longer just fixing teeth but  dental medicine. Interoperable electronic health records (EHR) will be the most dramatic change in your dental practice in the next five years. Change is not coming; change is here. Dentistry must move to a diagnostic-centered care model in order to be interoperable with the rest of health care. Coding is at the forefront of this process.

The ADA Dental Claim Form (2012 © American Dental Association) had a field added for diagnostic codes. Currently, only ICD-9 medical codes are available for dentistry. (Note: The requirement to use ICD-10 starting 10/1/15 has again been delayed.) Selecting the correct codes should be based on medical necessity. Medical necessity is not commonly documented in dentistry. It is the reason why a test, a procedure or an instruction is performed. Medical necessity is different from person to person and changes as the individual changes. The team, including hygienists and dentists, must provide consistent methodical documentation of medical necessity for coding.

Habits are important. Habits are comfortable. Yet it is time to look at our habits and determine if they are still serving us. Automatic routine beliefs and responses about benefits need to change. A quote from Jump Start Diagnostic Coding says it this way,

If coding is the same for everyone, or you think you already know the codes, you are not doing it right. To do it right, you must think and understand. DiGangi/Taxin

Habits are not destiny. Our world is constantly is changing and we must adapt. What we believe, we truly can achieve.

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