Coding Abuses On The Increase
With the ever expanding volume of dental trauma claims, some providers are taking advantage of claim examiners bogged down by the sheer number of claims they handle daily. By utilizing similarities in the procedure descriptions, these providers put in for payment of a higher paying procedure, when indeed they have performed a lesser paying procedure, which sounds like the higher paying one. For example, procedure code 21240 is a TMJ Arthroplasty, for which the UCR fee range is $3,500.00 to $4,500.00 while procedure code 29804 is a TMJ Arthroscopy, with a UCR fee range of ONLY $2,500.00 to $3,300.00. The claim examiner who is handling a multitude of claims at the same time and is not familiar with dental procedures may be tricked into paying for a procedure which was not performed. NADENT recommends you request an operative report from the provider so that we can assure proper coding of the claim.
The Cost Of Insurance Fraud
Recent news stories documenting the rise of insurance fraud around the country have revealed astounding financial estimates. In 1990 - 1991 it was estimated that health insurance fraud cost each family in the United States $448 per year. Today that cost is estimated at more than $2,000.00 per family. NADENT savings to the insurance industry in 2013 is estimated to be more than $12,000,000.00 (twelve million dollars) because of their recognition of false and exaggerated dental trauma claims. Cost containment personnel in insurance companies and self insureds throughout the United States recommend the utilization of NADENT services to fairly and accurately review their dental trauma claims.
When Is A Specialist Not A Specialist?
Among the multitude of dental trauma claims arising daily due to motor vehicle accidents, on the job injuries, episodes in chewing on food and other areas, TMD (temporomandibular dysfunction) claims represent a substantial quantity. Dentists treating these disorders often refer to themselves as "TMJ Specialists". Currently the American Dental Association does not certify dentists as "specialists" for the treatment of TMD disorders. Any licensed dentist may treat these problems. This is very important to know when auditing fees for Phase I TMD therapy.
For more information on any of these items, call 800-632-3334.
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