Get Reimbursed: Medical and Dental Coordination of Benefits and Non-covered Services - On Demand Bundle

Contains 6 Component(s), Includes Credits

Learn how to correctly understand and properly apply the rules governing coordination of benefits and non-covered services during this 90-minute webinar. When your OMS practice learns how to accurately navigate these rules, staff time can be better spent supporting patients instead of dealing with insurance companies. There also exists the potential for significantly greater reimbursements and overall practice revenue. Without knowing which services are covered, when such services are covered and the pre-operative requirements for coverage, your practice’s financial standing can be negatively impacted. Insurers/carriers can deny non-covered services as well as covered services for which pre-operative conditions were allegedly not satisfied. Participants in this webinar will learn how to determine whether services are covered and the appropriate steps are followed to create a more efficient practice with stronger patient satisfaction when they do not have to incur undue charges. It is difficult to collect reimbursement when you do not know the appropriate party to charge and from whom to seek such payment. For this reason, a comprehensive understanding of the coordination of benefit rules – in particular the rules set forth in patient plans and governing their coverage – is imperative. With such knowledge, your practice will be able to better understand who is primarily responsible for payment, to what extent, and the processes you need to go through to secure the reimbursement that you have surely earned. Participants in this webinar will listen to Thomas J. Force, an attorney and owner of a successful medical billing company specializing in these aspects, share his knowledge as well as techniques to ensure the most efficient and profitable operation. Code: WCW220615R

Learn how to correctly understand and properly apply the rules governing coordination of benefits and non-covered services during this 90-minute webinar. When your OMS practice learns how to accurately navigate these rules, staff time can be better spent supporting patients instead of dealing with insurance companies. There also exists the potential for significantly greater reimbursements and overall practice revenue. Without knowing which services are covered, when such services are covered and the pre-operative requirements for coverage, your practice’s financial standing can be negatively impacted. Insurers/carriers can deny non-covered services as well as covered services for which pre-operative conditions were allegedly not satisfied. Participants in this webinar will learn how to determine whether services are covered and the appropriate steps are followed to create a more efficient practice with stronger patient satisfaction when they do not have to incur undue charges. It is difficult to collect reimbursement when you do not know the appropriate party to charge and from whom to seek such payment. For this reason, a comprehensive understanding of the coordination of benefit rules – in particular the rules set forth in patient plans and governing their coverage – is imperative. With such knowledge, your practice will be able to better understand who is primarily responsible for payment, to what extent, and the processes you need to go through to secure the reimbursement that you have surely earned. Participants in this webinar will listen to Thomas J. Force, an attorney and owner of a successful medical billing company specializing in these aspects, share his knowledge as well as techniques to ensure the most efficient and profitable operation.

Learning Objectives

At the conclusion of this program, participants should be able to:

Recognize and examine plan terms governing covered services.
Learn to examine plan terms governing coordination of benefits.
Apply the plan terms, as well as applicable laws, to practice operations.
Determine appropriateness of challenging denials.
Discuss how coordination of benefits can affect reimbursement.

An Internet-based CDE/CME Activity
Original Release Date: June 15, 2022
Expiration Date: June 15, 2025
Estimated time to complete this educational activity: 1.5 hours
Method of participation: Self-Study

Thomas J. Force Esq.

As a licensed attorney in New Jersey and New York, Thomas J. Force has over 34 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based accident and health insurance company, where he served as Chief Compliance Officer, propelled the founding of The Patriot Group. He is nationally recognized as an expert in revenue collection techniques, appeal strategies and healthcare compliance. Force, a former U.S. Marine, is an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, several state medical associations and other healthcare organizations.

Disclosures: No Relevant Conflict of Interest Disclosures were reported.

Continuing Education Provider Approval
The American Association of Oral and Maxillofacial Surgeons is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education.

ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

The American Association of Oral and Maxillofacial Surgeons designates this activity for 1.5 continuing education credit(s).

AGD - Accepted Program Provider
FAGD/MAGD Credit
11/1/22-12/31/26
Provider ID# 214680

The American Association of Oral and Maxillofacial Surgeons (AAOMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Association of Oral and Maxillofacial Surgeons designates this internet-based enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Navigating the Contracting and Credentialing Process: What OMSs Need to Know - On Demand Bundle

Contains 6 Component(s), Includes Credits

Deciding whether to become a participating provider for insurance companies is vital to the OMS practice’s patient acquisition strategy. Equally important are validating credentials and selecting the right payer contracts. Additionally, understanding the contracting and credentialing process while avoiding pitfalls reduces administrative frustration. Credentialing is an ongoing process that impacts claims payment, amount paid and profitability, and it must be incorporated into all steps of expansion planning. This 90-minute webinar will focus on recent network participating agreement language and steps for organizing documents for submission in the contracting role. OMS practice owners, administrators and team members will learn how to stay up-to-date with dental insurance industry changes. Important tips for being efficient when credentialing practice doctors will be shared. Code: WCW241113R

Deciding whether to become a participating provider for insurance companies is vital to the OMS practice’s patient acquisition strategy. Equally important are validating credentials and selecting the right payer contracts. Additionally, understanding the contracting and credentialing process while avoiding pitfalls reduces administrative frustration. Credentialing is an ongoing process that impacts claims payment, amount paid and profitability, and it must be incorporated into all steps of expansion planning. This 90-minute webinar will focus on recent network participating agreement language and steps for organizing documents for submission in the contracting role. OMS practice owners, administrators and team members will learn how to stay up-to-date with dental insurance industry changes. Important tips for being efficient when credentialing practice doctors will be shared.

Learning Objectives

At the conclusion of this program, participants should be able to:

Identify factors to consider when deciding on network participation.
Discuss key words and phrases in contract language that may have an adverse financial impact on the OMS practice.
Recognize verification vehicles via organizations like the Council for Affordable Quality Healthcare as well as what to consider when outsourcing.
Examine the steps to successfully credential OMSs to become participating providers with various third-party payers.

An Internet-based CDE/CME Activity
Original Release Date: November 13, 2024
Estimated time to complete this educational activity: 1.5 hours
Method of participation: Self-Study

Patrick J. O'Rourke

Founder/CEO

Practice Quotient, Inc.

Patrick O’Rourke began his career in operations management at a dental & vision insurance company in Florida, which after several acquisitions and mergers, is now MetLife. He spent five years at Humana in Atlanta selling in the large group segment (100+ employees). In addition to several awards throughout his career, he has earned many professional certifications. Understanding the nuances involved with all aspects of risk management helped business partners rely on his expertise to guide client recommendations. He is an insurance insider that has built dental networks, worked in operations management, designed dental plans, and opened markets. In 2013, he founded Practice Quotient, which specializes in dental insurance PPO network contract analytics and reimbursement guidance, representing the dental provider. As a national public speaker, Patrick educates doctors on how dental managed care participation impacts up to 50% of practice revenue, the importance of diligent contract management, and how to develop criteria specific to a patient acquisition strategy for choosing the best carrier business partners.

Disclosures: No relevant financial relationships were disclosed.

Continuing Education Provider Approval
The American Association of Oral and Maxillofacial Surgeons is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education.

ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

The American Association of Oral and Maxillofacial Surgeons designates this activity for 1.5 continuing education credit(s).

AGD - Accepted Program Provider
FAGD/MAGD Credit
11/1/22-12/31/26
Provider ID# 214680

The American Association of Oral and Maxillofacial Surgeons (AAOMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Association of Oral and Maxillofacial Surgeons designates this internet-based enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Unlocking Claim Confusion: The Key is Proper Documentation - On Demand Bundle

Contains 6 Component(s), Includes Credits

Proper documentation is a critical key to efficient claim processing. Submissions that are complete, accurate and include the right supporting diagnostics are processed faster and reduce the need for resubmissions, which both delay adjudication and increase staff and patient frustration. This webinar will review key sections of the ADA claim form, current CDT codes that tend to be problematic, and appropriate diagnostics and narratives as well as discuss the administration of an alternate benefit provision. Code: WCW240417R

Proper documentation is a critical key to efficient claim processing. Submissions that are complete, accurate and include the right supporting diagnostics are processed faster and reduce the need for resubmissions, which both delay adjudication and increase staff and patient frustration. This webinar will review key sections of the ADA claim form, current CDT codes that tend to be problematic, and appropriate diagnostics and narratives as well as discuss the administration of an alternate benefit provision.

Learning Objectives

At the conclusion of this program, participants should be able to:

Describe what constitutes a clean claim submission.
Assign appropriate coding and identify diagnostic attachments to aid in claim processing.
Explain how the administration of an alternate benefit provision impacts the allowable benefits of the OMS and patient.

An Internet-based CDE/CME Activity
Original Release Date: April 17, 2024
Expiration Date: April 17, 2027
Estimated time to complete this educational activity: 1.5 hours
Method of participation: Self-Study

Stewart R. Balikov, DDS

Stewart R. Balikov, DDS, earned his dental degree at the University of Southern California School of Dentistry. He serves as the National Dental Director and Director of Dental Special Investigations for Elevance Health, having previously held the position of National Dental Director of Utilization Management for Aetna. Dr. Balikov is a Certified Dental Consultant and a past president of the American Association of Dental Consultants. He also is an Accredited Health Care Fraud Investigator through the National Health Care Anti-Fraud Association and a Certified Quality Assurance Consultant through the California Association of Dental Plans.