Will that Be “Paper” or “Electrons?”

[By Darrell K. Pruitt; DDS]

What is the mission of the American Dental Association? Is it the ADA’s obligation to keep failing dental insurance companies afloat – regardless of how much it raises the cost of providing dental care in the nation? Even necessary fee increases limit access. And so, what can the ADA possibly be thinking?

ADA News Online 

Recently, an article written by Arlene Furlong was posted on the ADA News Online with the title, “ADA studies scanning – Paper claim filers may benefit from sending scanned, printed radiographic images.”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3319

Of Possible Benefit 

The title promises that paper claim filers may benefit from scanned radiographic images. Do you know who definitely will benefit if radiographs don’t have to be returned to dentists? Two Dental insurance companies who were quoted in the article: American Health Insurance Plans [AHIP] and Delta Dental Plans Association [DDPA]. See: “Such a ‘Sleazy’ Company”.

https://healthcarefinancials.wordpress.com/2008/09/19/%E2%80%9Csuch-a-sleazy-company%E2%80%9D/

Outline of Arlene Furlong’s Article:

THE PROBLEM

“Dentists and their office staff report frustration in trying to keep track of varying policies.”

THE CAUSE

“Third-party payers continue to use different criteria to determine when images are needed to support claims adjudication, and if and how those radiographs will be returned to dentists.”

THE QUALIFIED SOLUTION

“Dentists who use digital radiography and file electronic claims can easily submit images electronically.”

THE COST

“Standard images, including single periapical films, panorex films and full-mouth films were scanned on four different scanners priced between $99 and $299.”

In addition, in order for a dentist to legally transmit digital patient information contained in one scanned periapical radiograph, one must be a HIPAA-covered entity. Furlong failed to mention the HIPAA liability that is not a problem with paper. It happens often when she writes articles as a favor to eHR stakeholders.

ADA CONCLUSION

Dr. Jeffrey Sameroff, a member of the ADA Councils on Dental Practice and Dental Benefit Programs (CDP) says:

“We still recommend dentists file electronic claims, but this option might be the next best thing for dentists who still submit on paper.”

THE QUALIFICATION

“Delta Dental Plans Association [DDPA} members told the councils that printed images from scanned radiographs would be adequate for initial claim review.”

Blue Cross Blue Shield Association and the National Association of Dental Plans [NADP] did not respond.

Ambiguous

The ambiguity and non-committal is obviously the reason that in spite of Dr. Sameroff’s enthusiasm, Furlong can only promise that it may or may not benefit ADA members to follow the advice in her article – but that we should nevertheless do it anyway just to get along with everyone. [The issue of whether the method of sending insurance companies radiographs affects dental care for patients is not addressed].

My Critique

This means that even after buying a scanner, Delta Dental can capriciously make the dentist still send the originals anyway. How good is that investment? Does it provide hope of a return, or does it encourage stakeholders to delay payments to dentists and pocket the interest? When insurance consultants question my ability to properly diagnose dental problems without actually meeting my patients, I will always mail them original radiographs that I expect to be returned because I think it should cost the insurance company a token amount of money to demand information from me.  Who cares if the US Post Office pockets some profit.  Postal workers need jobs too.

Unfettered

Without some sort of restraint, why should Delta Dental stop second-guessing me if delaying payment costs them nothing – even when I am expected to provide for free whatever they request to help their clients receive the benefit that Delta owes them?

What exactly is the mission of the ADA?

I would be a very foolish businessman to fall for this transparent trick – perpetrated by the ADA Councils on Dental Practice and Dental Benefit Programs (CDP). Of course, I’m not new in the neighborhood. I recall a similar article from May 9, 2006 by Arlene Furlong that most ADA members either never read or don’t remember. Its optimistic title is “It’s time to apply for a national provider identifier.” http://www.ada.org/prof/resources/topics/npi.asp

Selling Points

In order to persuade members to “volunteer” for the NPI, Furlong provided three selling points. As you can see for yourself, they are as laughable as Dr. Jeffrey Sameroff’s comments:

1. Providers, including dentists, will not have to maintain multiple, arbitrary identifiers required by dental plans, nor remember which number to use with which plan.

2. Electronic claims function more efficiently by introducing another element of standardization to processing.

3. It contains no vital intelligence about the provider’s name, location, specialty, patients or qualifications.

Rationalization

And so, to think that the best of Furlong’s three rationalizations – for “volunteering” – for an NPI number! The very best reason she gives for ADA members to trustingly expose their businesses’ proprietary information as FOIA – disclosable data – data which would otherwise be considered Constitutionally-protected private business information – is so that dental office managers will not have to remember numerous numbers.

DDPA 

What will sleazy dental insurance companies like Delta Dental do with the FOIA-disclosable information that ADA members are tricked into allowing them to manipulate?  Delta Dental, with the help of Arlene Furlong and the CDP, will determine American dentists’ reputations and pay scales according to their proprietary algorithms which will always seem to favor Delta Dental’s profitability and not their clients’ welfare.  It is called “P4P,” or Pay-for-Performance and it is part of George Bush’s mandate for healthcare reform.

Assessment

The CDP, a rogue collection of ambitious stakeholders, not practicing dentists, has expensive solutions that are desperately reaching for non-problems to solve. For every dollar I must raise my fees for even good ideas, a child in my neighborhood goes to bed with a toothache. Shouldn’t the ADA be more concerned about access to care than insurance companies’ postage expense?

Conclusion

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Filed under: Health Insurance, Health Law & Policy, Information Technology, Op-Editorials, Practice Management | Tagged: ADA, EHRs, EMRs, HIT | 31 Comments »