Time magazine has a Top Ten of Everything in Arts and Entertainment list. No doubt, Star Wars The Force Awakens will eventually top the movie list for 2015 and maybe of all time. Topping the 2015 dental professional frustration list and maybe of all time is dealing with insurance. In 2016, practices can optimize CDT coding, be prepared to cross-code medical (including Medicare) and prepare for merging of dental and medical records with one simple change: routine documentation of the dental-medical necessity for care-Twitter-style.
Twitter-Style Less is More
One of the best ways to improve your writing is to cut unnecessary words. Many people tend to over-write similar way to how they speak. In March 2016, the online social network Twitter will celebrate its 10th anniversary. Twitter taught users to send and read short 140-character messages. That isn’t 140 words or even 140 letters, its 140 characters including letters, numbers, symbols, punctuation and spaces. Twitter writing squeezes the excess leaving only the nourishing juice.
Like tweets, dental-medical necessity is concise writing.
Sample: High risk pregnancy. High risk caries. Plaque induced gingival disease modified by systemic factors-pregnancy, #14-15 Chronic Periodontitis 2mm bone loss
That is a 153-character dental-medical necessity gives medical information, risk assessment and a periodontal diagnosis. It isn’t difficult yet takes team cooperation, new thinking and practice.
Why Dental-Medical Necessity?
Many studies in recent years have investigated the relationship between oral and systemic conditions. An increasing number of dental carriers are recognizing the medical nature of certain dental procedures. Dental-medical necessity is the reason why a test, a procedure or an instruction is given. Dental-medical necessity is different from person to person and changes over time. There is benefit to all practices to document it routinely to help optimize dental benefit coverage and cross-coding opportunities.
Polypharmacy, those long, long lists of medications that our patients take every day often contribute to dry mouth. Lack of saliva is much more than just irritating; it can be a contributing factor in caries infection, oral cancer and periodontal disease. This means, the medications themselves as well as what they treat are part of the dental-medical necessity.
Sample: Diabetes & Coronary artery disease. Vasotec, Topamax, Albuterol, Lipitor, 81mg. aspirin. Extreme oral dryness.
This patient’s dental-medical necessity is evident with this concise, specific 111 character tweet. It isn’t difficult yet takes team cooperation, new thinking and practice.
Diagnostic Images Tweeting
Practices have been getting notices from dental benefit carriers questioning the number and frequency of diagnostic images. Taking images based on a calendar has long been the routine in dentistry. Radiographic Recommendations is a resource created by the Food and Drug Administration (FDA) and updated in 2012. It states: “Radiographic screening for the purpose of detecting disease before clinical examination should not be performed.” Diagnostic images should be ordered by the dentist based on the examination. Benefit carriers, through utilization review, have begun to ask for the documentation of the reason and result for images. What can make all the difference? The dental-medical necessity.
Sample: Endodontic treatment #19. Clinical evidence of periodontal disease with generalized tissue bleeding.
This statement is only 101 characters with 2 reasons from the guidelines to take radiographic images. It isn’t difficult yet takes team cooperation, new thinking and practice.
Tweeting Takes the Whole Team
Documenting a patient’s dental-medical necessity is not the role of the administrative team member alone. It can’t be; though it starts and end with the administration person. Here are the 6 circular steps and touch everyone in the practice.
- The administrative person documents from the phone call, the patients chief concern, one of the most important aspect of dental-medical necessity.
- The dentists order tests and risk assessment.
- The assistant or hygienist performs risk assessment and tests.
- The dentist interprets results risk assessment and tests and make diagnosis and orders treatment.
- The dentist, assistant and hygienist work together to concisely document Steps 2-4 which is the dental-medical necessity.
- The administrative person transfers Step 5 dental-medical necessity to insurance submissions.
It isn’t difficult yet takes team cooperation, new thinking and practice.
One Simple Change
Often we read articles hoping for that one simple step. A simple change has been offered yet as Steve Jobs said “Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains.” Twitter style documenting dental-medical necessity isn’t difficult yet takes team cooperation, new thinking and practice. Perhaps in 2016, taking this simple approach can move insurance down on the frustration list and one day remove it altogether.