A New Normal for Patients, Procedure Billing and Profits

Kelsey CreehanFeatured News

By Krysten Garduno
From the Spring/Summer 2020 Journal of the Colorado Dental Association

Dentists are facing many challenges in the wake of the novel Coronavirus. The gradual reopening of our offices causes us to reflect on some important topics that could be causing headaches for practice owners across the country. As Colorado providers, we must ensure that we are creating a safe environment for our patients, filling our schedule with quality production, and finding solutions for the rising cost of personal protective equipment.

Promoting a safe and comfortable environment for patients is of the utmost importance for Colorado dentists. Beginning with appointment confirmation calls, we are now tasked with utilizing a patient pre-screening questionnaire to allow patients safely into our offices. These questions should cover the patient’s recent travel events, symptoms, and contact with anyone infected with Coronavirus. While on the phone with the patient, it’s also best to have your front administration inform the patient on what they can expect when they enter your office, whether that be mandatory masks and/or temperature checks while checking in. It is important to limit the number of people in your practice, and a great way to do that is to ask your patients to please leave children, spouses, and friends at home. Other best practices for the reception area are to remove any non-essential items like magazines, brochures, and drink stations, and to have a team member wipe down the waiting room often.

Filling your schedule may be another challenge you are facing. With the recommended 50% reduction in patient volume, longer times to sterilize between visits, and a modified patient check-in system, providers will undoubtedly see a decrease in production with any schedule. A strategy to increase production within these guidelines is to simply extend your office hours to later in the evening and possibly working Saturdays in the interim. If there is a challenge getting patients on the schedule, you should create some lists to help prioritize who to schedule. The most obvious list to pursue would be all patients who had to be cancelled due to COVID-19 closures. The second list would include approved pre-authorizations for treatment that was diagnosed from January through March 2020. The third option would be to create a list of your three-to-five most profitable codes. To determine which codes to focus on, take your revenue minus the cost. Once you have these codes, create a list of patients you have seen in the past six-to-eight months with these codes that have not been completed to use as a production list. Many dental software programs can generate these types of reports to help fill your schedule.

Right now, there is plenty of confusion with recommended PPE. However, what should not be confusing is how to bill insurance providers for this. The ADA has petitioned and stated that “Third party benefit programs should either (1) adjust the maximum allowable fees for all procedures or (2) allow a standard fee per date of service per patient to accommodate the rising costs of PPE. Not doing so is deemed an automatic reduction in reimbursement rates.” Prior to these changes taking effect, some insurers are accepting code D1999 if used to bill for PPE, while others are offering a flat reimbursement per claim submitted. For example, Delta Dental of Colorado is providing $8/claim for DOS between 05/01/2020 and 07/31/2020.

More insurance companies are releasing this information daily so it’s difficult to put a blanket statement to it at this time. The best practice is to ask your patient’s plan if they are considering coverage for PPE or the D1999 code when verifying insurances. If an insurance company denies coverage for PPE, typically this code can be billed to the patient, with showing caution for your state Medicaid plans.

One thing we do know for sure is that our world has changed. We are coming out of a global pandemic to a new climate for dental providers that can be challenging to navigate. The one constant that has not changed is our focus on providing quality treatment to our patients while building a thriving business. We can all band together, use our resources wisely, and create a collaborative environment for dentists across Colorado.


Krysten Garduno is the dental billing manager for Avitus Dental and has been on the frontlines of practice management and dental billing for Colorado dentists for 10 years. Contact her at kgarduno@avitusgroup.com or 303-557-7774.