The ADA has released statements on third-party payer reimbursement for the increased costs associated with the increased standards for PPE and on reimbursement for temporary procedures.
*UPDATED!* Reimbursement for PPE
The ADA provided additional information regarding coding and billing for PPE. In the long term, dentists whose overhead has remarkably changed may choose to approach third-party administrators to renegotiate their fee schedules. This document provides guidance regarding coding and billing for PPE.
In addition, to accommodate the rising costs of PPE, the ADA and FDA advocate that plans should either adjust the maximum allowable fees for all procedures or allow a standard fee per date of service per patient. Until plans make the above adjustments, you can use the CDT code “1999-unspecified preventative procedure, by report” to document and report the increased cost of PPE and can use this code once per patient visit/claim. In addition, when adjudicating claims, the ADA and FDA consider it inappropriate for a plan to disallow or bundle charges for PPE. To read the full statement, please click here.
The FDA received the following information from Florida Combined Life:
On May 28, approval was granted for Florida Combined Life to provide reimbursement for CDT D1999 for the increased cost of PPE. This approval is retroactive, so claims submitted with a treatment date beginning May 1, 2020 will be paid at $10 per visit to in-plan dentists only. At the current time, these claims are expected to be paid through the remainder of the calendar year, but are subject to review. We strongly encourage our dentists to provide the most appropriate, effective protection for their patients, staff and themselves using CDC and ADA guidelines. For those patients who are unable to attend a dental visit, teledentistry benefits remain available.
Your offices have been closed, except for emergency, urgent or medically necessary procedures since March 9. During the time, you have treated many patients to prevent them from seeking care in emergency departments. As your offices are able to resume normal operations, you will provide these patients with more definitive care. The ADA and FDA ask that plans not bundle fees for the emergency/temporary procedure with the permanent procedure that may be submitted in the future. In addition, we ask that the plans not establish arbitrary frequency limitations that are not in the best interest of the patient’s oral (and overall) health. To read the full statement, please click here
Handling Contract Negotiations
Dentistry faces increasing standards for infection control following the COVID-19 pandemic. The ADA and FDA anticipate that the cost of care will substantially increase for dental procedures. Under these circumstances, dental offices may see the need to readjust their fee schedules. For tips on negotiating your fee increases with the dental benefit plans you are a participating provider for, click here.
Handling Eligibility Verification
With high rates of unemployment, it's likely that patients coming to your offices for dental appointments as you reopen may have recent changes in their employment situation. It's vital that you verify eligibility on the date of service to avoid recoupment requests in the coming months. For more information, please click here.