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Pt Mgmt > Final > Flashcards

Final Flashcards

1
Q

What is a K code?

A

Dx code for a disease

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2
Q

What is SNOWDEN?

A

Dental diagnostic method

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3
Q

What is a treatment code called?

A

D code (the ones we see)

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4
Q

SNOWDENT is harmonized with???

  1. ICD 11
  2. ICD 10
  3. ICD 1
  4. ICDAS
A

ICD 10

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5
Q

First university to use Z codes? What is the Z code?

dx code, tx code, dental classification dz, dental diagnostic method

  1. University of Boston
  2. University of NY
  3. University of Toronto
  4. University of California
A

University of Toronto

Z code = dental classification of disease

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6
Q

What percentage of schools use code driven treatment?

  1. 10-20%
  2. 20-30%
  3. 30-40%
  4. 40-50%
A

42% USE IT
6% are ready to use it
24% are going to use it
28% DO NOT USE

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7
Q

Why should we move towards diagnosis driven codes?

A

To justify the treatment plan

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8
Q

What is a benefit code?

A

A code that the insurance will cover (D1354)

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9
Q

What is a billable code?

A

A treatment code (ex: OHI)

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10
Q

How many categories of services exist?

A

13

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11
Q

D0 code is

A

Diagnostic

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12
Q

Give the CDT code categories in order:

A

Diagnostic
Preventive
Restorative
Endo
Perio
Prosth, removable
Maxillofacial pros
Implant
Prosth, fixed
Maxillofacial surgery
Ortho
Sleep Apnea
Adjunctive general services

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13
Q

D5 code is

A

Prosth removable,
Maxillofacial prosth

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14
Q

D9 code is

A

Adjunct general svcs,
Sleep apnea

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15
Q

D6 code is for:

A

Implant
Prosth, fixed

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16
Q

Which D codes cover more than one treatment

A

D5, D6, D9

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17
Q

The D Code for Endo is:

D0
D1
D2
D3
D4
D5

A

D3

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18
Q

The D Code for Perio is:

D0
D1
D2
D3
D4
D5

A

D4

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19
Q

The D Code for Resto is:

D0
D1
D2
D3
D4
D5

A

D2

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20
Q

The D Code for Oral maxillofacial surgery is:

D0
D1
D2
D3
D4
D5

A

D7

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21
Q

Which of the following does not need to be filled out for insurance purposes:

Procedure date
Location
Tooth system
Tooth number
Tooth surface
Procedure code
Quantity
Description
Fee
Diagnosis Code
Remark
Missing teeth

A

Remarks,
Quantity (sometimes)

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22
Q

When signing a billing form, what dentist specific information should be filled out?

A

Signature
Date
NPI
License Number
TIN

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23
Q

Common errors related to insurance (most common are) which of the following? (do them in order):

Details, Documentation, Fee, Frequency, Process, Procedure

A

Frequency
Procedural
Documentation

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24
Q

Identify the error in this insurance code? D1110

A

D1110
6 month + 1

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25
Q

Identify the error in this insurance code? Onlay

A

MOD inlay and MOD onlay codes

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26
Q

Identify the error in this insurance code? Direct restoration MO and DO same day

A

MOD bill otherwise insurance will only pay for 1

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27
Q

Which statement is true? Which is false?

A billable code is always a benefit code.

A benefit code is always a billable code.

A

False: A billable code is always a benefit code.

True: A benefit code is always a billable code.

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28
Q

Takes the place of a regular dentist who may be on vacation or temporary leave (so that the office can function normally):

A

Locum tenens

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29
Q

Automatic pass is

infection control

A

0

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30
Q

Score that goes on your record, not transcript

A

6-9 points

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31
Q

What happens if you have any of the following infractions? What is your score?

Didn’t raise chair
Foot pedal is not placed on the base
Trash bag not tied
No hand washing
Not wearing gloves with patient
Not using proper aspiration
Not disposing of single use instruments
Not cleaning or package insturments

A

Verbal warning,
2-5 points

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32
Q

3 examples of 6-9 point infractions

A

Not recapping needles
Having food/drink
Missing mandatory trainings

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33
Q

The dx code drives _ code

A

treatment

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34
Q

Pathway to SNOWDENT?

A

ICD 10 drives SNOWMED –> SNOWMED affects –> SNOWDENT –> SNOWDENT affects –> SNOWDDS

ICD 10 to SNOWMED to SNOWDENT to SNOWDDS

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35
Q

How many points will result in an NP?

A

10+

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36
Q

Violations that result in a NP:

A

Not wearing N95
Missing N95 certification
Sharps in the trash
Not returning instruments within 24 hours.

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37
Q

Automatic NP (2)

A

Missing N95 certification
Sharps in the trash

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38
Q

Most common infractions (4)

A

1) Not purging water lines (2 min morning, 30 sec afternoon)
2) Not wearing proper eye protection
3) Patients don’t have on eye protection (wrap around)
4) Not applying protective barriers in clinic

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39
Q

If you get a red paper, this means you have

A

a sharps violation

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40
Q

3 most common accidental exposure chart reasons

A

1st Scalpel injury
2nd Burs/Piezo
3rd Needles

41
Q

When do you use the hazardous waste bins?

A

When items are soaked in blood, use the red bin only

42
Q

Other waste/clinic violations

A
  1. Sharps container full and you use trash
  2. Dirty sinks
  3. Tray adhesive sprayed outside of the box
  4. Liquid waste it the red container
  5. Teeth with amalgam not in correct container
  6. Cover the chairs and tables with big bags
  7. Take off gloves when you leave the cubicle
  8. Cannot wear gowns in elevators
  9. Must disinfect impressions before moving them
43
Q

T/F: Teeth with amalgam go to biohazard

A

False – go to amalgam container

44
Q

dental and medical practice billing differences:

Medical billing has been ____ and ____ have been captured using _____ terminology.

A

Medical billing has been standardized and causes of death have been captured using standard terminology as well. In modern dentistry, we still do not capture why a tooth is non-vital or why one is extracted

45
Q

How are ICD and SNOWMED different?

A

ICD is “sparse” and SNOWMED is enormous/lots of information

46
Q

SNOWDDS = ___ + _____

A

A combination of SNOWMED and SNOWDENT

47
Q

Dates of founding and place in order:

SNOMEDCT
SNOWDENT
ICD-10
SNOWDDS

A

1965: ICD-10
1990S: SNOWDENT
1999: SNOWMEDCT
2017: SNOWDDS

48
Q

Issues with the earlier dental classification system?

A

insufficiently subdivided, scattered code arrangement (poor organization)

49
Q

comprehensive, multilingual clinical healthcare terminology for use in the EHR describes ____

A

SNOMEDCT

50
Q

When were standardized diagnostic terminologies first used?

A

250 years ago

51
Q

What is EHR?

A

Electronic Health Record

52
Q

International Classification of Diseases (ICD) was founded in

A

1893

53
Q

Who cannot use SNOWDENT

A

The general practitioner, dental schools (must be licensed)

54
Q

Who created SNODENT? Who had led it since the early 1990s?

A

WHO: Created
ADA: Manages

55
Q

First dental classification of disease is

A

Z Code

56
Q

What is the Z Code?

A

First dental classification of disease – 1999 (UT)

57
Q

Why is SNODDS-GD not used by the ADA?

A

They want a more simple version to communicate medical codes

58
Q

Explain the study from article 2:

A

25 students from Harvard (12) and UCSF (13) who were D3 or D4 students with at least 6 months in the clinic, Axium usage and 2 years of training were monitored for their ability to properly diagnose, treatment plan based on the diagnosis and develop a logical treatment sequence

59
Q

In study 2, if the wrong diagnosis was selected, how often was the correct treatment selected?

A

81% of the time

60
Q

What are some of the concerns/weaknesses about this study?

A

@ Observer may have influenced the results
@ “think out loud” process was not used
@ limited number of participants
@ moderators themselves did not always strongly agree
@ participants were selected based on “convenience”
@ familiarity with the technology

61
Q

How many students scored poorly with the tx organization/sequence?

A

41%

62
Q

What were the two ways to enter the treatment?

A

Chart Add,
Tx Planning Module

63
Q

How should a treatment plan be organized (in 5 steps):

A
  1. Deal with the chief complaint (pain and infection first)
  2. Disease control
  3. Tooth replacement and reconstruction
  4. Esthetic/cosmetic concerns
  5. Preventive and maintenance
64
Q

Why may tx planning vary among dental students nationwide?

A

There is no teaching or development standard

65
Q

Steps in the study for tx planning (4)

A
  1. Chief complaint
  2. Dx from a comprehensive list
  3. Tx objectives
  4. Detailed tx plan
66
Q

Per the study was it easier for the students to choose the correct tx or the correct dx?

A

Choosing the correct treatment

67
Q

What to submit for a fee reduction:

A

Consultation form from original faculty, Chart info (should be updated)
Additional info (private meeting)

68
Q

What should be included for in the consultation for a fee reduction review?

A

1 - Root cause of failure

#2 - Proposed improvement

69
Q

Who can do the consultation for the fee reduction?

A

1 - original faculty

#2 - section chair
*#3 - Resto faculty + GPD/GPL

70
Q

What should be updated before submitting the fee reduction request? (6)

A

X Rays
Medical and Dental Hx
Medications
POE (eval)
Perio Signature
CRA/CAMBRA

71
Q

1 Crown/bridges

Maximum time for re-dos for the following:

#2 Intracoronal filling
#3 - Perio
#4 - Prosth

A

Crowns - 5 years
Fillings - 2 to 3 years
Perio - 1 week
Prosth - 12 months

72
Q

Can we do a fee reduction on an unsatisfied treatment case?

A

Sometimes, as a good will measure

73
Q

Put these in order for a fee reduction generation process:

Faculty approval
Provider gets info
right click to Add/edit tx form
Select mother code (with fee attached)
Run to Dr. Mong
Select fee reduction and fill out the form
Faculty initiated process

A

1 - Faculty initiated process
2 - Provider gets info
3 - Select mother code
4 - Right click to add/edit tx form
5 - Select fee reduction to fill out form
6 - Faculty approval
7 - Run it to Dr. Mong

74
Q

How long does it take to process a fee reduction request?

A

10 working days
If more information is NOT requested

75
Q

Fee reductions are only considered for ___ cases

A

completed

76
Q

If additional information is needed for a re-do, what will you discuss?

A
  • history of issue
  • faculty and provider involved in the case
  • Clinic and resident involved in the case
  • your assessment and proposed solution
77
Q

Fee reduction workflow (re-order):

Billing, Approval, Completion. Submission, Start Work

A

Submission, Approval, Start Work, Completion, Billing

78
Q

Dos and do nots of fee reduction:

A

DO: tell patient we will look into the request

DON’T: Promise the redo will be covered

DON’T: start the re-do without approval from the clinic director

79
Q

For most dental practices, an C Corp/S Corp is generally more advantageous due to its tax benefits and simpler
tax reporting. However, a C Corp/S Corp might be preferable for practices planning significant growth or seeking
substantial investment due to its flexibility in ownership and stock options.

A

S Corp,

C Corp

80
Q

Cons of a C Corp:

A

Cons:
1. Double Taxation:
(corporation pays
taxes on its income, and shareholders also pay taxes on dividends received.)
2. Tax Complexity: It’s a corporation
3. Operational Complexity: more compliance methods required

81
Q

Unlimited shareholders
Formation simplicity
Stock flexibility

A

PROS of a C Corp

82
Q

Formation compliance
Ownership restrictions

A

CONS of S Corp

Complex Formation: Forming an S Corp requires filing Form 2553 with the IRS and possibly
additional state-specific forms, making it more complex than forming a C Corp.
- Increased Scrutiny: The IRS tends to scrutinize S Corp tax filings more closely, and inaccuracies can
lead to the revocation of S Corp status.
2. Ownership Restrictions:
- Shareholder Limitations: S Corps can have no more than 100 shareholders, all of whom must be U.S.
citizens or residents. This can be restrictive compared to C Corps.
- Single Class of Stock: S Corps can only issue one type of stock, limiting flexibility in structuring
ownership and investment.

83
Q

Max # of shareholders for S Corp? C Corp?

A

100 - S Corp
unlimited - C Corp

84
Q
  • Tax benefit (avoid double taxation, tax deductions)
  • Ownership structure (limited shareholders)
    *Simplified Tax Reporting (pass through taxation)
A

PROS of S Corp

  1. Tax Benefits:
    - Avoids Double Taxation: S Corps are pass-through entities, meaning business income is reported on
    the owners’ personal tax returns, avoiding the double taxation seen with C Corps.
    - Tax Deductions: Owners can deduct up to 20% of their business income on their personal tax
    returns, potentially saving a significant amount of money.
  2. Ownership Structure:
    - Limited Shareholders: S Corps can have up to 100 shareholders, which is usually sufficient for dental
    practices that typically have a small number of owners.
  3. Simplified Tax Reporting:
    - Pass-Through Taxation: All items of income, loss, and credit from the business are reported directly
    on the owner’s individual federal income tax return, simplifying the tax process.
85
Q

What the the UCLA subsidies?

A

Apollonian
Endo
Friends and Family
Dentical

86
Q

Max Apollonian society benefit per student?
Max per patient?
What are the other rules?

A

$1500 per student
$1000 per patient over a 2 year period
D3/D4 student only
Must be tx in the general clinic
NOT in grad clinic
NOT to be used as a co-pay
NOT stackable
NOT transferrable

87
Q

When must billing approve the Apollonian subsidy?

A

Before the treatment starts

88
Q

Apollonian subsidy must be linked ____.
It is for ____ issues.
Not to be used for ___ (tx - 3)
no cash value or refund

How can you get 100% coverage?

A

linked to provider
genuine payment issues
prophy/X Ray/ lab rush fees

By being a D4

89
Q

Apollonian percent for 100%? 70%? 50%?

A

100% - D4s
70% - Endo RCT, Perio Sx, CD/RPD/implant, Resto - indirect, FPD
50% Perio SC/RP (non-surgical), resto

90
Q

Rules for the Endo subsidy:

A
  • Endo tx approved by Endo faculty
  • Tooth restorable, Resto approved
  • 50% courtesy on Endo TX
    ** pre doc** and must submit ALL crown fees before RCT is started
  • Max 2 RCT per provider, not on the same patient
  • Ineligible - if tx already started without the complete crown payment, referred to resident
91
Q

Friends and Family percent off?

A

20%

92
Q

What makes an Endo subsidy ineligible?

A

Referred to resident
Already started the RCT tx without a complete crown payment

93
Q

When does the Family and Friends discount not work?

A

Perio surgery
Oral surgery
RCT
implant
implant crown

94
Q

Eligibility for the Denti-Cal subsidy…

A

60 or older
Denti-Cal eligible during tx
$400 max per patient
covers what Denti-Cal will not

95
Q

Max amount for the Denti-Cal subsidy

A

$400

96
Q

Which is true of the Apollonian subsidy?

  1. Can be in general or grad clinic
  2. Can be used as a co-pay
  3. Not transferrable
  4. Not stackable
A

Must be tx in the general clinic
NOT in grad clinic
NOT to be used as a co-pay
NOT stackable
NOT transferrable

97
Q

Denti-Cal preauthorization is needed for which procedures?

o Cd , rpd
o Crown
o Endo
o Exams
o Extractions
o Immediate denture
o Prophylaxis/ fluoride
o Sc/ root planing
o Am, composite
o PM/ prophy

A

CD/RPD
Crown
Endo
SRP

98
Q

When are anterior and posterior crowns covered with Denti-Cal?

A

Anterior crown More than 50% tooth gone structurally

Posterior crown (or requirement): RPD, Survery crown holding RPD, opposing full COMPLETE DENTURE

Also

, Premolar : missing 1 cusp/ 3 surfaces
Molar : missing 2 cusp/ 4 surfaces 1/3, 2/4

o Part of an RPD design
* Survey crown holding RPD (must accompany RPD)
* Opposing FULL denture ** Cannot oppose RPD

99
Q

How many years before a Denti-Cal crown may be covered again?

A

over 3 years

Pt Mgmt (1 decks)

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