Michael Kanellis, DDS, MS ADEA BFACA Mid Year Meeting October 17, 2014
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1 Michael Kanellis, DDS, MS ADEA BFACA Mid Year Meeting October 17, 2014
2 Michael Kanellis, DDS, MS ADEA BFACA Mid Year Meeting October 17, 2014
3 Implemented May 1, ,000+ low-income adults not eligible for Medicaid Comprehensive dental benefits Unique program design based on earned benefits and personal responsibility The only earned benefits program of its type in the nation
4 Designed to address concerns about Medicaid Administered by Private Insurance (Delta Dental) Higher reimbursement rates Promotes personal responsibility by patients Incentives to patients: more benefits if they return for preventive visits Incentives for dentists: bonus paid out based on percent of patients receiving oral health risk assessment
5 Previsor online oral health risk assessment Caries risk Periodontal risk Oral cancer risk Dentists get paid to do risk assessment Eligible for additional bonus payment Dentists get paid to provide oral health education
6 Three tiers of benefits Patients earn next tier of benefits by returning for a recall within 6-12 months No Co-Pay No Deductible No Annual Maximum
7 CORE Diagnostic Exams X-rays Preventive Cleanings Emergency Extractions Oral Surgery Stabilization ENHANCED All Core, plus: Restorative Root canals Non-surgical perio Oral Surgery Etc. ENHANCED + All Core, plus: All Enhanced, plus: Tooth replacement Gum Surgery
8 Core Benefits (tier 1) Emergency Care Diagnostic and Preventive Care Stabilization Services Enhanced Benefits (tier 2) Enhanced Plus Benefits (tier 3)
9 Opportunity for the College of Dentistry Potential increase in patients seeking care Student clinics annual procedural requirements for dental students Scaling and Root Planing 640 Root Canals 560 CU/CL 160 RPD 160 FPD 80
10 Challenge How to train and monitor 300+ providers regarding the unique aspects of the Dental Wellness Plan program Eligibility and tiers of treatment Documentation requirements
11 Three levels of Providers Faculty Practice (~80) 100% intramural practice Resident Clinics (~50) Advanced training program in all specialties Dental Student Clinics (~240) 80 students per class D2 Clinics Operative (free clinic) and Preventive D3 Clinics Clerkship Model D4 Clinics Comprehensive Care Model Kirkwood Dental Hygiene Program (~24)
12 Restorations covered If caries extends > 50% of the way to the pulp Written and radiographic/photographic documentation and attachments required Dentures and interim partials covered If provider documents basic human functions that are being restored Root canals covered If comprehensive exam has been done by general dentist
13 If patient starts treatment before enrolled in Dental Wellness Plan (i.e. cast partial denture) Then becomes enrolled in Dental Wellness Plan prior to insertion We cannot legally bill the patient for the partial denture, and the Dental Wellness Plan will not pay because it is a third tier benefit that the patient has not yet earned
14 Patients cannot pay out of pocket for treatment that is covered in another tier Restorations of teeth when caries is not encroaching on pulp Can be treated at NC in D2 Operative Patients can pay out of pocket for nevercovered services Bleaching 3 month prophy
15 Patient can pay out-of-pocket Bleaching Cosmetic Dentistry Replacement of unsightly restorations Diastema closure Implants Be sure to document and inform There is a consent form for never covered benefits
16 Provider Training (March-April 2014) Mandatory provider training Faculty, Residents, Students, Hygienists, Assistants, Front line staff
17 Primary education about dental wellness plan benefits occurs at comprehensive exam appointment by provider
18 Awareness of insurance coverage Familiarity with DWP coverage by tier Clear and specific documentation in patient record Treatment meets specific criteria Appropriate attachments Be aware what tier patient is in before scheduling next appointment Be aware of program limitations
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23 This year (2014) 67,884 Last year (2013) 67, DWP 4,713
24 Faculty 1, % Residents % Predocs 2, % Total 4, %
25 Change Visits Procedures
26 Questions?
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