Coordination of Benefits, part 2

Practice Booster’s Dr. Greg Grobmyer discusses recent changes to dental insurance companies’ claims requirements for scaling and root planing (SRP) and other periodontal procedures. Learn how your office needs to document for D4341 and D4342, when to instead call it D4346 (gingivitis), what attachments and radiographs are appropriate for claims, how Artificial Intelligence (AI) plays a part, and how to minimize SRP claim denials! To view the full video of this podcast episode, click HERE! Healthy tooth and unhealthy tooth with periodontitis with gum inflammation infographic. Help minimize SRP claim denials. D4341 and D4342 Periodontal Scaling and Root Planing Claim Requirements Are you seeing an increase in denials or downgrades for periodontal services in your dental practice? While the criteria for staging and grading periodontal cases has not changed, many dental insurance companies have added to their list of requirements or criteria that must be met before they will pay a claim. Some of these criteria are things that need to be documented in the clinical notes, and some are things that need to be present on radiographs, particularly your bitewing set. Dr. Greg Grobmyer will walk you through the recent changes to claim requirements for SRP and other periodontal services that he has seen with his clients. Learn how to minimize SRP claim denials. This podcast is now available in both audio and video formats. Dr. Grobmyer is currently the Chief Editor of Dr. Charles Blair’s Dental Coding with Confidence book and Practice Booster’s Insurance Solutions Newsletter, a contributing editor to the Dental Administration with Confidence, Dental Technology with Confidence, and Dental Documentation with Confidence books, a course creator and lecturer for DentalZing.com, Practice Booster’s lead Revenue Enhancement Program Specialist, and host of The Dental Code Advisor Podcast. Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, UCR dental practice fee analysis, and more. Visit us online at https://dentalcoding.com. The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org. Resources to Minimize SRP Claim Denials Dental Coding with Confidence and Dental Documentation with Confidence may be purchased in the Practice Booster Store found here: https://dentalcoding.com/shop/ The Insurance Solutions Newsletter article on Updated Periodontal Documentation may be found by logging into your Practice Booster account and clicking this link. Note, you must hover over the bottom of the newsletter image to advance to the next page: https://dentalcoding.com/newsletter/cdt-2025-revised-and-deleted-codes/ The full video of this podcast episode may be viewed on YouTube here: https://youtu.be/BEp9RvkNxjg

Listen to Practice Booster’s Dr. Greg Grobmyer as he outlines the proper way to use CDT coding for reporting the use of lasers in dentistry. From using diode laser for cutting tissue, to laser bacterial reduction (LBR) and laser assisted periodontal therapy (LAPT), to the LANAP and LAPIP procedures (as instructed by the American Academy of Periodontology) Dr. Grobmyer provides guidance on how to code and what may and may not be done when dental insurance is involved. Gum correction surgery with a laser. Coding for Lasers in Dentistry Want to know how to code for dental laser procedures? Is there a CDT Code for laser? Coding for lasers in Dentistry is a common question topic we get through our email and call center support hub. While frequently viewed as a tool for the delivery of a procedure, there are certain circumstances where laser usage may be reported and billed separately from the procedure. In this episode of the Dental Code Advisor Podcast, Dr. Grobmyer will go into detail as to when separately reporting and coding for in lasers for dentistry is appropriate and what to expect from insurance payors. Dr. Grobmyer is currently the Chief Editor of Dr. Charles Blair’s Dental Coding with Confidence book and Practice Booster’s Insurance Solutions Newsletter, a contributing editor to the Dental Administration with Confidence, Dental Technology with Confidence, and Dental Documentation with Confidence books, a course creator and lecturer for DentalZing.com, Practice Booster’s lead Revenue Enhancement Program Specialist, and host of The Dental Code Advisor Podcast. Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, UCR dental practice fee analysis, and more. Visit us online at https://dentalcoding.com. The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.

Join Practice Booster’s Dr. Greg Grobmyer as he discusses two CDT codes that every practice should be using to maximize insurance reimbursements; D0180 comprehensive periodontal evaluation and D4346 scaling in presence of moderate or severe gingival inflammation. Learn when to use the codes, how to properly document in the clinical record, what attachments to submit with the claim, and what a difference utilizing D0180 and D4346 correctly can make for your practice. . This podcast episode may make a significant difference to your bottom line! All general dental practices and even some specialty practices can benefit from proper reporting of these two procedures. D0180 comprehensive periodontal evaluation and D4346 scaling in presence of moderate or severe gingival inflammation are both codes that likely already apply to patients in your office, but it is very possible you are not utilizing these codes to their full extent! Dr. Grobmyer is currently the Chief Editor of Dr. Charles Blair’s Dental Coding with Confidence book and Practice Booster’s Insurance Solutions Newsletter, a contributing editor to the Dental Administration with Confidence, Dental Technology with Confidence, and Dental Documentation with Confidence books, a course creator and lecturer for DentalZing.com, Practice Booster’s lead Revenue Enhancement Program Specialist, and host of The Dental Code Advisor Podcast. Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, UCR dental practice fee analysis, and more. Visit us online at http://www.practicebooster.com. The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.

Join Practice Booster’s Dr. Greg Grobmyer as he discusses updating your dental practice fees the right way, including which fees to update and when, how to properly submit fees on claims, and resources to provide you with strategic practice fee schedules. Learn more about custom consulting on fees and CDT code training for your office here! . Dr. Grobmyer is currently the Chief Editor of Dr. Charles Blair’s Dental Coding with Confidence book and Practice Booster’s Insurance Solutions Newsletter, a contributing editor to the Dental Administration with Confidence, Dental Technology with Confidence, and Dental Documentation with Confidence books, a course creator and lecturer for DentalZing.com, Practice Booster’s lead Revenue Enhancement Program Specialist, and host of The Dental Code Advisor Podcast. Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, UCR dental practice fee analysis, and more. Visit us online at http://www.practicebooster.com. The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.

Join Practice Booster’s Dr. Greg Grobmyer as he talks with Dr. Dominique Fufidio about the use of Artificial Intelligence in dental insurance claims adjudication, document scanning, image interpretation, and more! Dr. Dominique Fufidio, DDS, FAGD, is the founder and main coach at Fufidio Consulting Group (FCG). Dr. Fufidio has pioneered a unique coaching experience focused on teaching an understanding of the dental insurance claims review process and the rationale behind the decisions on the EOB. Dr. Fufidio has established herself as a successful, fee-for-service, former private practice owner, dental artificial intelligence co-creator, and top-performing dental claim reviewer and Utilization Review Director for the largest Utilization Review Agent in the United States. Now, she is on a mission to bring clinical alignment to dental providers and the dental insurance payor market, helping dental offices get paid for what they do! Each insurance carrier is different and each reviews claims differently. Each payor selects claims to review differently and has clinical criteria that are different from one another, albeit largely similar. The concern across the industry is that the clinical documentation submitted needs to substantiate a “proof of loss” and true “medical necessity” for the treatment rendered. It is crucial to understand that the decision from the insurance payor is a benefit determination, not a treatment recommendation. The treatment recommendation is clinically yours, and yours alone. You must make the best recommendations for your patients and submit your diagnostic evidence in support. Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, and more. Visit us online at http://www.practicebooster.com. The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.

Join Dr. Greg Grobmyer as he speaks with Attorney, former dental assistant, and Dental Compliance expert Olivia Wann about CDC guidelines, OSHA compliance, and HIPAA concerns. Meet Olivia Wann Olivia Wann founded Modern Practice Solutions, LLC in 2000 and later expanded her professional offerings by establishing The Law Office of Olivia Wann & Associates, PLLC in 2012. As an attorney, Olivia sets herself apart by prioritizing client education. She demystifies complex legal issues, empowering her clients to make informed decisions. Olivia is a dedicated member of the Wealth Council, ensuring that her expertise in estate planning and trust law remains at the forefront of the field. Choosing our firm for your estate planning, probate, or civil representation needs is a decision you won’t regret. Why the focus on dentistry? Olivia brings a unique, ground-up understanding to the dental industry. Her experience spans roles as a dental office manager, a registered dental assistant, and a dental software trainer. Academically, Olivia is no slouch either. She graduated magna cum laude with a Bachelor of Science in Health Care Administration from St. Joseph’s College of Maine and earned her Doctorate in Jurisprudence from the Nashville School of Law. Find out more at https://www.oliviawann.com. Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, and more. Visit us online at http://www.practicebooster.com.  The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.

In this episode of the Dental Code Advisor Podcast, join Dr. Greg Grobmyer as he interviews the “A/R Ninja” himself, Andy Cleveland. Learn about recent changes to laws that affect the way your dental office should go about handling accounts receivable and collections. “I am an industry expert and consultant that enjoys helping dental practices nationwide prosper by developing Accounts Receivable strategies and bring multiple systems that complement their goals and individual needs of the practice. I enjoy working with clients that want to improve their process and are open to idea exchange and collaboration; this is my driving force and energy creator. I live for getting results and connecting trusted business partners in the dental community is also extremely rewarding. Currently, I am the “FACE”​ of Accounts Receivable Management in the dental consulting space and welcome connecting with others who can provide value to the dental community. I also enjoy speaking to study clubs, dental schools, creating and attending networking groups, being interviewed for podcasts and providing educational content to dentists. I always will go the extra mile to make sure my reputation is protected and let my track record of satisfied clients speak for me.” – Andy Cleveland Learn more at https://andycleveland.com! Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, and more. Visit us online at http://www.practicebooster.com.  The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.

In this episode of the Dental Code Advisor Podcast, Dr. Greg Grobmyer speaks with Christi Billquist, the Director of Operations with Unitas PPO Solutions, about the current PPO fee negotiation climate. Learn about PPO negotiations, network optimization leveraging direct vs. leased network arrangements, the annual PPO audit you should be doing, and more! Christi Billquist is the Director of Operations at Unitas Dental. Christi began a career working in the insurance industry while completing her Bachelor’s degree at Utah State University. Christi spent 15 years working for a national insurance company focusing on fraud investigations. In 2012, Christi decided to leave the corporate insurance world to join Unitas Dental. Over the past 9 years, Christi has become a dental insurance industry expert and has been instrumental in Unitas Dental’s growth in providing PPO negotiations, optimization and credentialing services to thousands of dental practices across the country. Christi genuinely loves helping dental offices understand and increase their PPO revenue, and especially enjoys helping new business owners navigate the transition from associate to practice owner. Find out more at https://unitaspposolutions.com. Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, and more. Visit us online at http://www.practicebooster.com.  The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.

Dr. Greg Grobmyer speaks with Penny Reed, Practice Booster CEO, about PPO Participation. Learn how to evaluate plans, the concept of the dollar value per chair hour, when you should join, when you should exit, and what to do if you do decide to leave a plan. Penny Reed served as CEO of Practice Booster from Oct 2021 – Sep 2022 and has served as the Chief Growth Officer for eAssist Dental Solutions since Oct 2022. PPO Participation is great for some practices and an anchor for others. Participation is helpful when practices need to grow, as it serves as a form of advertising to get patients in the door. At a certain point, established practices with sufficient patient numbers may choose to drop certain plans in order to keep a larger percentage of production and make more while seeing fewer patients overall. In this podcast, Penny Reed provides insight into how to determine when you should consider making this change and which plan can be dropped, as well as considerations on the process of exiting the plan. Listen in to learn more about how your practice could benefit from being choosy in plan participation. Practice Booster is the leading resource for information on how to best utilize the CDT code set; featuring the Code Advisor database, the Insurance Solutions Newsletter, administration resources, coding support call center, and more. Visit us online at http://www.practicebooster.com.  The CDT codes are the property of the American Dental Association. Interpretations of the CDT codes in this podcast represent the opinions of our experts. Always refer to the latest CDT codes for use in your practice and contact the ADA directly for the ADA’s interpretation of the CDT codes. You are responsible for your own use of the CDT codes. For more information, refer to ADA.org.

In this episode of the Dental Code Advisor Podcast, Dr. Greg Grobmyer and Dr. Charles Blair continue their discussion of Preferred Provider Organizations (PPOs), including a look at the documents that define the relationship between the dentist and the PPO, “handcuffs” commonly found with participation, how to leverage optional services to obtain reimbursement, alternative benefits, and more.