ANSWER FROM PATTI DiGANGI, founder of DentalCodeology:
With a new dentist and different procedures, coding dilemmas will arise. The response to your question is less about the time and treatment and more about the contracts that have been signed by the practice. Contracts are serious documents with legal ramifications.
As I wrote in a previous Troubleshooter, many times contracts are signed by one person, but the administration of the contract is performed by someone else. Further, the administering person never sees the contract signed. Finally, whether the signer or administrator understands all the legalese in the contract is often questionable. Some offices sign on to a plan’s network only to discover that the plan has certain policies and procedures that the dentist disagrees with.
Analyzing and reviewing a contract prior to signing it can save considerable time and frustration. In my experience, contracts generally favor those who are bringing it. So, do contracts favor what the carrier wants? Absolutely, this is their business.
Get copies of each plan’s contract handbook. These will typically explain the benefits, limitations, and more. Make sure you know and are following the rules of the plan. Unfortunately, fraud by accident or ignorance of the policy signed is still fraud. If you are an in-network provider, you are obligated to follow the plan’s processing guidelines. If it states that no fees can be charged to the patient, then you cannot charge the patient. If the fee allowed does not seem adequate or does not cover the cost of doing business, other decisions need to be made.
One of those decisions includes a deep consideration while deciding on plan participation when those contracts come due for renewal. A good question to ask is, will contracting a plan damage my practice more than if I had never contracted? When starting a practice, these decisions are important.
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