Some Insurance Basics For Perio
Back to: Things Everyone Should Know
Important to Check in Red Section: SRP:
– If you are performing SRP, check the red section for notes on quad limitations and when D4910/D1110 will be considered.
– D4910/D1110/D4346 in the same year – if you are performing a mixture of these services in the same year, check the red section to see if they share frequency.
– Always bill the treatment that you perform, but let Treatment Coordinators know if there looks to be a cost of frequency issue so that they can work with INS team to prepare the patient for possible out-of-pocket cost
– Insurance does not always tell us the guidelines for SRP (daily quad limit, and healing period between SRP and D4910/D1110). If you are thinking that a patient of yours may need SRP and the benefits are not clear, let INS team know ASAP. We are always happy to call and get benefits and the sooner we know the better (I.E. While auditing or at the beginning of the appointment).
– You should always be in the clear to perform 2 quads SRP same day (after Treatment Coordinator has quoted the patient). So do not let contacting insurance about 4 quads of SRP stop you from getting a quote from the Treatment Coordinator and starting on 2 quads of SRP.
D4346 + SRP cannot be billed together – they are contradicting codes. D4346 is a lack of bone loss while SRP has GBL.
D4346 + D1110 – Share frequency
D1110 + D4910 – Share frequency
D4341 + D4342 – Share frequency
1 Quad of Localized SRP and D1110 CAN be performed together on the same day UNLESS OTHERWISE NOTED IN THE RED NOTES SECTION. (“SRP – D4910/D1110 not considered same day”)
When doing 2 or MORE quads of 4341, be sure to treat the non-SRP quadrants of the mouth as D4910, however DO NOT BILL to insurance. This will be adjusted off.
Healing Periods:
– D4910/D1110 after SRP GENERALLY has a 30-day healing period UNLESS OTHERWISE NOTED IN THE RED NOTES SECTION.
o We can schedule sooner as needed, please have FD quote out of pocket cost.
When a plan is vague:
– Some insurance companies will not give us comprehensive information. On these plans, we will have a note in the red section that usually says something along the lines of “FL/SEAL – not covered on adult. If a child is on the plan let INS team know that they will update.” Please alert INS team as needed on these patients.
Co-Pay Plans:
– When a patient has a copay plan/fee schedule (You will see this in the RED NOTES) and you notice while auditing charts please send a message in Insurance questions with the Front Desk members tagged prior to the day of appointment so that we can accurately edit the treatment plan and quote the patient.
Treatment Charged Out Incorrectly:
– Please double check ALL treatment on appointments before completing the appointment. If you did not perform a treatment or if you added treatment, please make sure this is completed when you are setting the appointment complete.
– We send claims throughout the day so any incorrect treatment charges create quite a hassle. Claims team has to send a correction to the insurance company and this can take anywhere from 30-90 days to get corrected.
– If you think you have incorrectly charged out treatment, please alert Marie/Sara in the Claims and Account Changes teams so that we can correct ASAP.
– Please make sure all claims are charged out under a Doctor’s name.