Delta Dental of Iowa Maximizes Claim Payments
One of the distinguishing features of Delta Dental of Iowa is its not-for-profit status. In contrast to for-profit, commercial dental carriers, Delta Dental is not driven to maximize profits and shareholder return. As a result, more dollars are available to cover dental services and pay claims for services rendered.

Inline with prior years’ performances, more than 90% of Delta Dental’s premium dollars were spent on claim payments to providers in 2009. The remaining dollars were used to run the business and fund oral health initiatives through the Delta Dental of Iowa Foundation that focus on access to care, prevention, education and research.

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Guest Article: What Should Your Overhead Costs Be?
By Henry Hemmen
For over 44 years Henry Hemmen & Associates, Inc. has offered accounting and practice management services to the dental profession. This article provides information on suggested overhead costs.

As a business person, a general dentist should be embarrassed to admit to an overhead percentage in excess of 55% for their practice. Do you know there are general practices enjoying overhead percentages in the low to mid-40s? Why is it so easy then to accept overheads representing 60-65% and even into the 70s? For every dollar produced we find doctors willing to accept 30-35 cents or 40 cents. Maybe those doctors are not familiar with what the proper expense ratios should be. If not, here is a start.

During a typical review of a dental client’s financial statements, ratios to production need to be determined. The ratios are not determined by comparing expenses to receipts because the percentage of receipts, when compared to production, will vary according to the various third-party programs the practitioner participates with. Therefore, it is only fair to the practice for comparison purposes to relate expense categories to production.

In 2008, some estimates indicated that the average independent general practitioner’s net income from private practice was $176,650. If this is accurate, the practitioner operating with a 65% overhead would need to produce $504,714 to enjoy such an income. However, the practitioner operating with a 55% overhead needs only to produce $392,555 to earn $176,650. The difference is an extraordinary $112,159. That’s $112,159 of wasted expenditures.

To provide a sufficient cash flow for the 2010 dental practice, the following ratios to production should not be exceeded:

Laboratory Fees	8%
Occupancy Cost (rent, utilities, repairs and maintenance)	8%
Administrative, Accounting, Continuing Education, Dues	2%
Marketing	1%
Labor including Payroll Tax & Fringe Benefits	27%
Dental Clinical Supplies	7%
Office Supplies	1%
Equipment Replacement	1%
Maximum Overhead	55%

It can be done! These ratios are easily attainable through proper scheduling methods, proper marketing methods, a competitive and fair fee schedule, and a professional, communicative and caring staff. An efficient and effective staff’s contribution to the practice will reflect in proper scheduling, an efficient re-care program and a productive doctor.

The practices I mentioned earlier that enjoyed overhead percentages in the low and mid 40s range will typically have labor and related costs of 18-22%. Clinical supplies will reflect in the 5-6% range, laboratory fees in the 5-7% range and occupancy costs in the 6-7% range. Efficient use of staff, cost “shopping” and fee management are all common elements in such a practice.

Henry Hemmen and Associates, Inc.
1035 Lincoln Road Ste 204
Bettendorf, IA 52722
800-745-1438

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Duplicate Claim Submissions
Each duplicate claim submitted results in additional handling costs and claim filing expenses for you. The duplicate claim is also an additional expense for Delta Dental to process. If you currently file claims electronically, please check your electronic submissions to ensure you are not including claims sent previously. Duplicate filings occur in some dental office practice management systems when claims at the end of a transmission are not deleted and are subsequently resubmitted.

If you are unsure whether the claim has been filed, please access the Dentist Connection on Delta Dental’s website or use the voice response feature on Delta Dental’s interactive phone system to check the status of the claim before resubmitting it.

A member of Delta Dental’s Professional Relations team may contact your office if we find a high occurrence of duplicate claim filings. Delta Dental may be able to answer questions your office staff has regarding claim filing or identify training needs we can assist with.

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An Updated Health History Is More Important
Than Ever!
Taking and periodically updating a patient’s health history has always been a valuable and necessary part of the clinical evaluation. The importance of a health history in identifying a patient’s underlying medical conditions, treatments and drug regimens that may have a connection with their oral health is widely recognized.

It is even more important to update health histories today as additional dental benefits (e.g., cleanings, fluoride applications) may be available for patients with designated medical conditions under Delta Dental’s Enhanced Dental Benefits Program. One such medical condition is high-risk cardiac disease.

A recent guideline by the American Heart Association indicates that the presence of dental disease may increase the level of bacteria in the bloodstream and predispose at-risk patients to acquiring infective endocarditis or producing adverse outcomes associated with the disease. Up to four dental cleanings per benefit year are available for groups and their employees with this coverage.

Qualifying high-risk cardiac conditions include:

• History of infective endocarditis
• Certain congenital heart defects (i.e., one ventricle vs. two)
• Individuals with artificial heart valves
• Heart valve defects caused by acquired conditions such as rheumatic heart disease
• Hypertrophic cardiomyopathy (i.e., abnormal thickening of the heart muscle)
• Individuals with pulmonary shunts or conduits
• Mitral valve prolapse with blood leakage

If you have patients with plans that include coverage for the Enhanced Benefits Program, you can enroll the patient for the additional dental cleanings on the Dentist Connection of the Delta Dental of Iowa website.

Recently the Delta Dental National Policy Committee tasked dental researchers at the University of Michigan’s College of Dentistry to evaluate the current scientific evidence of the link between cardiac disease and oral health. You may access this evidence-based article on the Delta Dental website from the Dentist Connection in the Enhanced Benefits Program section to learn the most current evidence on this topic.

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Dentist Search Improvements
Improvements have been made to the Dentist Search on Delta Dental’s website. Additional details about you and your practice have been added for patients searching for a participating network dentist.

Some of the additional attributes listed include:

• Additional languages spoken in your office
• Wheelchair accessibility
• Access to public transportation
• Early morning, evening or weekend hours
• Accepting new patients
• Gender
• Website address
• Email address

A noteworthy change is the ability for us to link your office website to the Dentist Search. When a patient is looking for a participating dentist, not only can they view the additional attributes outlined above, but they can also click on a link that will take them directly to your office website.

With these improvements to the Dentist Search, it is very important that we have current information for you listed. We strongly encourage you to access the Dentist Search on Delta Dental’s website and review your office attributes. If any information is no longer accurate, missing, or if you have not provided us with your office website address, please contact Professional Relations at provrelations@deltadentalia.com or call 800-544-0718.

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Signing Patients Up for Enhanced Benefits
As mentioned in the article on Updating Health History, Delta Dental’s Enhanced Benefits Program is customized at the individual level by offering additional benefits to persons who have specific health conditions (diabetes, pregnancy, high–risk cardiac conditions, suppressed immune systems, kidney failure or dialysis, and cancer, chemotherapy and/or radiation).

Not all Delta Dental groups offer the Enhanced Benefits Program. And even for those that do, patients must be signed up to receive the extra benefits. Fortunately, it is easy for the patient or their dentist to enroll in the program. Once enrolled, the patient is immediately eligible for the extra benefits.

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Claim Reporting Tips
Avoid Claim Processing Delays — Do Not Report Tooth Numbers with Periapical Radiographs
Including a tooth number when reporting periapical radiographs (procedures D0220 and D0230) causes a delay in the processing of your claim. Do not include tooth numbers when reporting periapical radiographs.

My Claim is Denied Requesting Documentation
The most common procedures denied for lack of documentation include core build-up and surgical extraction.

If you are experiencing claim denials due to lack of documentation for a core build-up (procedure codes D2950/D6973), please familiarize yourself with the reporting guidelines and attachment requirements.

• Only report code D2950/D6973 when it is necessary to retain the crown and there is extensive (50% or greater) loss of coronal tooth structure from caries or fracture, and there is not a 2mm collar of sound tooth structure remaining around the gingival portion of the tooth preparation to retain the crown. Anything less is deemed a filler and is part of the crown procedure.
• Include a current radiograph and narrative if it is not evident on the radiograph.

If you are experiencing claim denials due to lack of documentation for procedure code D7210, first, be sure you are reporting the correct procedure.

D7210 — surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth. Includes cutting of gingiva and bone, removal of tooth structure, minor smoothing of socket bone and closure.

• Include the diagnosis and clinical rationale demonstrating surgical necessity or a copy of the patient’s treatment record that is tooth specific and describes the procedures necessary to remove the tooth.

My Radiographs are Not Being Returned
In 2008, Delta Dental of Iowa began disposing of radiographs received unless a postage paid envelope was included. If you submit radiographs to Delta Dental and you would like the radiograph returned to your office, you must include a self-addressed, stamped envelope with sufficient postage.

Other important radiograph tips:

• Most dental offices currently submit copies of radiographs/attachments to support designated claims requiring documentation and/or attachments. The Current Dental Terminology (CDT 2009/2010, page 7) also recommends submitting copies versus originals.
• Current attachment guidelines are found on the Dentist Connection on Delta Dental’s website under Download Forms.
• When radiographs are needed, please only send copies — no originals. Be sure to properly identify and date the copy of the image.

If you do not currently have the capability of sending scanned radiographs or other electronic attachments and would like information about National Electronic Attachment Inc.’s (NEA) FastAttach^TM software, please contact NEA at 800-782-5150 ext. 2 or visit www.welcometonea.com to learn more. This software lets dental offices submit claims electronically to send digitized radiographs and attachments in support of their electronic claims.

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New Claims Mailing Address Starting in April
Delta Dental is in the process of building a new facility located in Urbandale and is expected to move later in 2010. Due to the facility move, Delta Dental’s PO boxes and physical address will be changing. Beginning in April, Delta Dental will start using the following Johnston claims address:

	Description	Old Address	New Address
Claims	Address that dentist office sends claims, radiographs and attachments to.	PO Box 919 Ankeny, IA 50021	PO Box 9000 Johnston, IA 50131-9000

Most of the Delta Dental PO Boxes will be transitioned prior to the physical move into the new facility to ensure a smooth transition. Please make note of the new claims address; we will be sending offices notices during this change.

The Dentist Office Manual has been updated with the new claims address and is available for download or print on Delta Dental’s Dentist Connection.

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2010 IDA Annual Session
Delta Dental of Iowa will host a booth at the 148^th Iowa Dental Association Annual Session. The meeting will be held April 30 — May 2, 2010, at the Marriott Hotel and Conference Center in Coralville. Please stop by the Delta Dental booth during exhibit hours to visit with the Professional Relations team. They would be pleased to answer your questions or discuss any concerns you may have. There will also be informative handouts and fun promotional items for you and your office staff. We look forward to seeing you there!

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