Considerations when billing an associate in the dental office

By Cindy Hartwell, Dental Benefits Analyst at CDA Practice Support

At least once a day, I answer a call from a member who is hiring an associate dentist for the first time. Their question is always the same: “How do I bill the plans when my associate / employee dentist is performing the treatment?”

When considering the proper way to bill the attending dentist, remember that a dental claim is a legally binding document and, as such, everything documented on the claim form must be correct.

Today, many dental plans have adopted a contract based on the contract and compensation of the attending dentist, not just the billing dentist (owner).

When billing for a dental plan, the information documented in the claim sections regarding the dentist or billing entity, attending dentist, and place of treatment must be accurate. While the treating dentist documented on the claim differs from the treating dentist listed in the patient’s chart, the dental benefit industry considers this billing practice to be fraudulent billing because the treating dentist is misrepresented on the claim.

Bill correctly by registering all treating dentists
Let’s take a look at how an office can bill properly by registering all attending dentists in the office with a dental plan.

When adding a new attending dentist to the office, the billing dentist should try to contact the dental plans well in advance of the associate’s start date to find out how to add the attending dentist to the plan’s records system. . This is done either by contracting them with the plan or by listing them as an off-grid dentist.

If the attending dentist contracts with plans, remember that in most cases the plan will consider the dentist to be out of the network until the plan completes the accreditation and contracting process. This means that many plans will treat the dentist who makes a request to their network as being off-network while the plan will work to complete the request for that dentist.

Different plans, different contractual protocols
Keep in mind that regimes have different procurement protocols, including compensation. Determining a plan’s contract protocol well in advance, including how long it will take for the plan to process the contract, is essential for a smooth transition when adding a treating dentist to the office. .

In addition, not all PPO policies allow for the attribution of benefits when a non-contract dentist performs the treatment, which means that the patient, rather than the office, will receive payment for the services provided. In addition, many plans will reduce a patient’s benefits when seeing an out-of-network dentist. So if the goal of the practice is to have the attending dentist networked with plans due to the previously mentioned factors, it is important to try to align his start date with the time frame provided by the plan for them. contract.

Considerations When Adding an Attending Dentist to the Office
If your practice plans to add an attending dentist, here are a few things to remember:

  • The dentist performing the treatment must be documented as such on the claim in the attending dentist section.
  • If the attending dentist contracts with the dental plan, the billing dentist should know the plan’s contracting requirements and timeframes.
  • If incorrect billing is done, the billing dentist may be found in breach of contract with the dental plan and would be penalized for the incorrect billing i.e. misrepresentation of the treating provider on the claim form.
  • The billing dentist must meet the contractual obligations set out in the plan to report any treating dentist working in his office.
  • Some dental insurance plan contracts are transferable, while others are not. If a contract is not transferable, the dentist will need to sign a new contract with the plan if they want to become a network dentist in a new location – even if the dentist is currently under contract with a plan at another practice location.

Finally, contract and compensation rates for dental plans change from time to time. For this reason, do not assume that the dentist added to the practice will be offered the same contract or compensation as the billing dentist who has purchased the plan in the past.

To learn more about billing an associate, see the related CDA practice support resource.

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