Documentation
What supports your chosen CDT code set(s)?
Chart documentation
True or False?
2 periapical (PA) radiographs taken of #21 and #22 would be coded as:
D0220 intraoral - PA first radiographic image #21
D0220 intraoral - PA first radiographic image #22
False! Correct coding is:
D0220 intraoral - PA first radiographic image #21
D0230 intraoral - PA each additional radiographic image #22
What is used to support allegations of fraud, abuse, or malpractice?
Weak or missing documentation
Where can you find the patient's insurance listed in axiUm?
The Patient Card
What translation service is IUSD contracted with?
Language Line
What is considered "timely and reasonable" for documenting and approving your chart entries?
24-48 hours
Patient presents to the ER clinic with complaint of throbbing pain in the UL quad. Which CDT EXAM code do you report based upon this documented presentation?
D0140 - limited oral evaluation - problem focused
Limited evaluation is problem focused on a particular dental health problem or concern presented by the patient. It is also performed and reported when the patient is referred for a specific problem.
__________ is one example of Fraud?
What form needs to be filled out at the cashier window prior to treating the patient if the services are non-covered by Medicaid or when the patient has reached their Medicaid plan maximum?
Medicaid Waiver
Which animal has the same number of teeth (32) as an adult human?
A giraffe
What is the most common audit finding when charts are reviewed?
Inadequate supporting documentation
True or False?
D1206 topical application of fluoride varnish is included in D1110 prophylaxis -adult and D1120 prophylaxis -child?
False!
ANY evaluation, radiograph, prophylaxis, fluoride, sealant, restorative or extraction service is reported separately.
Once a provider has been made aware of “Abuse” but doesn’t correct the error while ignoring the potential consequences, he or she then crosses the line into ______________ and the violation of abuse can then elevate to Fraud.
Reckless Disregard
What is the best way to contact the IUSD Insurance Group when you have questions?
Send an axiUm message
Who is the elf in Rudolph the Red Nosed Reindeer that wants to be a dentist?
Hermy the Elf
What can happen if you use unrecognized abbreviations, symbols, acronyms, or misspelled words in your charting?
Harm or unfavorable outcomes to the patient
What type of evaluation is done to determine an established patient's oral health status since their last check-up?
D0120 periodic oral evaluation - established patient
It includes an oral cancer screening & periodontal screening when indicated & interpretation of information gathered through additional diagnostic tests.
_________ states that over-coding and under-coding are equal and clear violations.
False Claims Act
True or False?
IUSD Treatment Plans take insurance company minimum and maximum payments into consideration.
False!
The IUSD Treatment Plans are an estimate.
This needs to be relayed to the patient during treatment plan discussion prior to procedures/services.
True or False? Family members are allowed to translate for the patient.
False - ONLY IUSD Certified translators may be used in place of Language Line
What must be proven in your documentation and drives the need for services rendered for each encounter?
Medical Necessity
Which CDT code is used to report a re-evaluation - post-operative office visit?
D0171
Additional services or procedures performed during the encounter should be reported separately.
What type of document is a dental record?
The dental record is a legal document
"If it isn't documented, it didn't happen"
What form must be filled out prior to the dental procedure/service/RX to confirm that the insurance company will pay for it?
Prior Authorization
When creating the treatment plan, axiUm will notify you if a PA is needed. Forms are available from the Cashier.
Fill out the form in its entirety
This animated dentist is known as Nemo's captor in "Finding Nemo"
Dr. P. Sherman