WHEN IT RAINS, IT POURS / ICD -10 DENTAL CODING
Insurance companies, powered by their medical insurer counterparts, and government, are deepening their requirements for classification and reporting. The motive is obvious - more control of what is diagnosed and therefore treated. They realize they can better “manage what they measure.”
With greater diagnostic and treatment coding, the more particulate the codes, the more data can be accumulated. Baselines, trends, standards of care, comparison of dentists, possibly best practices (what they see as best practices), become much more readily available.
There is no law preventing insurance companies from sharing their data of their network dentists and with other 3rd parties. Eventually “big data” will arise which will allow insurance companies increasing strength in determining reimbursements. Also, they will be able to generate EPOs, Exclusive Provider Neworks, closed panel networks of dentists who align best to their data.
Besides the incredible impact of capital investments, explosive growth of managed group practice, ever increasing student debt, ever decreasing access, increasing cost for practice operations and equipment, shift to employer-insurance axis of power, suppliers branching into consulting services, now we have the tremendous increase in coding by insurance companies that will not only increase time and money spent, but also lead to more power for the insurance companies.
Since 9 out of 10 dentists take some form of dental plan, and the cost of ‘doing business’ with insurance companies will increase with this new coding, once again it appears that group practices will have a strategic advantage over solo practice. Managed groups will be able to generate in their resource center departments that do nothing but insurance transactions that can handle a much higher volume of transactions at much less cost per transaction.
In a typical solo practice, one administrator is focused on receivables, but they often have many other duties as well. With an increase in workload due to an increase in coding, it would require a solo practice to make another hire raising the total cost of doing business. Whereas in a managed group practice, this cost would be shared by many since one person is servicing multiple providers.
When we look at all the forces that are gaining strength by 3rd parties, suppliers, government, competition, Big Data, and larger and larger DSOs, solo practices are sailing into the wind and the wind is getting stronger. Whereas managed group practices are sailing with the wind at their backs and they are unfurling their main and their jibs, picking up speed.
Here are some resource on ICD-10 Coding
http://www.ada.org/~/media/ADA/Member%20Center/FIles/ICD_Requirement_in_dental_claims.ashx
http://www.ada.org/en/member-center/member-benefits/practice-resources/dental-informatics/standard-terminologies-and-codes/faq-icd-10-cm
[Chris - white out Jerry's writing and attache document to eNL. ?