NEA Presents...

Survey Says…The Top Procedure Code Causing Headaches for Dental Practices is D4341

In August, NEA launched a survey of our clients asking a variety of questions. Today, we’re excited to share with you the results of a few of the key findings – and to announce the winner of the $500 American Express Gift Card.

According to the survey, the top three procedure codes that require the most supporting documentation for adjudication and the top three codes that are most often rejected first pass are the same. These troublesome codes are: D4341, D2740 and D2950.

Apparently, practices and payers are having issues with the new code for perio scaling –  D4341-Periodontal Scaling and Root-Planing. More and more dentists and hygienists are using periodontal scaling and root-planing as treatments to help patients control their periodontal disease. Unfortunately, many offices also run into insurance-benefit problems. While most indemnity carriers cover D4341, restrictions and requirements for payment are abundant. A recent Dental Economics article goes into more detail on this troublesome code.

Beyond coding issues, we asked survey respondents what was the average time it takes their practice to receive reimbursement for claims requiring some type of supporting documentation (x-ray, narrative, EOB, etc.) Surprisingly, 46 percent of respondents said it takes three weeks to a month, 19 percent say 30-plus days and 32 percent said that they are reimbursed within one-two weeks.

Over 40 percent of respondents said that, on average, 10-25 percent of their claims required supporting documentation or attachments, with 36 percent stating that between 26-50 percent of their claims require additional documentation.

We also asked the question “what’s your practice’s greatest pain point in dealing with insurance” and boy did you give us some great responses! It was tough to evaluate all 440 responses, but we culled from the data the 10 most commonly reported issues. These are presented in no particular order of importance:

  • Processing delays
  • Following up on claims not paid / rejected claims; rejections causing slower turn around payments
  • Verifying eligibility; Verifying coverages prior to procedures and then being told the procedure is not covered after we have received verification that it is.
  • Payers claiming they never got the documents that were sent; payers not accessing the NEA # attached to claim
  • Reimbursement levels
  • Rejections / requests for additional information
  • Long hold times / not getting a person on the phone / automated systems
  • Coordination of benefits
  • Downgrades
  • Medical billing for dental

And, finally, one area that was surprising and encouraging from the perspective of data security in particular was the reporting that 50% of respondents use secure email in their practices to communicate with referring or other specialists. This was great to see given the security concerns related to communications particularly in healthcare. One area of concern, however, was the other side of the coin where nearly 20% of respondents stated that they use standard (non-secure) email for these types of communications.

NEA offers a bit of advice for those practices using standard email –  make sure that you are not sending any PHI over non-secure email as this could cause a HIPAA compliance issue for your practice. If you’re interested in learning more about user-friendly, affordable options for secure email, check out our partner Virtru and take advantage of NEA’s exclusive pricing for this service. It’s only $15 per month / per practice for up to 15 email addresses. Virtru is easy to use and provides you with peace of mind for your email communications with specialists and referring providers.

A huge “thank you” to all of those that participated in our survey and CONGRATULATIONS to the winner of the $500 American Express Gift Card – Valerie Schmelzer of Michael A. Chapman, DDS PC! Your combined feedback has given us greater insight into your business challenges. The more we understand about the issues you’re facing – especially related to insurance and coding – the better positioned we are to try and address those challenges in the industry.