Health care reform, criminal prosecution for health care fraud, and an analysis of why some codes are reviewed more than others are a few of the topics to be explored at the National Dental Benefits Conference 2012 on Sept. 14 at the ADA Headquarters.

Sponsored by the ADA Council on Dental Benefit Programs, the conference offers an opportunity for dentists to hear from recognized experts on dental benefits issues. Dentists who attend will receive up to seven continuing education credits. 
 
The one-day conference opens at 7 a.m. with breakfast and ends at 5 p.m. For more information, please visit ADA.org/benefitsconference.

Program highlights include:

• The Role of Dental Consultants in Dental Benefit Administration—Dr. Gary Colangelo, a certified dental consultant, will assess the roles and responsibilities of dental consultants in the operation of dental plans, ethical issues in dental consulting and how practicing dentists and organized dentistry can interact with dental consultants who have dental plan administrative responsibilities.
• Criminal Prosecution, the Ultimate Claims Review—Dr. Roy Shelburne, who went to prison in 2008 and was released in 2010, will discuss ways to protect practices and to prevent what happened to him from happening to other dentists.  Dr. Shelburne will discuss how dentists and practices can protect themselves in the event of a board complaint, insurance audit, malpractice claim or criminal complaint.
• Payers and Quality Improvement Initiatives—Dr. Robert Compton will discuss how one dental plan administrator responded to changing market demands related to the Children’s Health Insurance Plan Reauthorization Act of 2009 programs, Medicaid and the ADA’s Dental Quality Alliance measures and created a program that both achieves improvement in quality of care as well as innovative approaches to provider compensation.
• The Impact of Health Care Reform on Health Systems, Dental Insurance Companies and Dental Consumers—Ben Wright, chief financial officer and vice president of strategic initiatives for AmeriBen, a full-service third-party administrator with 50 years of administration experience, will discuss how important provisions of health care reform have significant impact on health systems, dental insurance companies, distribution and eventually consumers. He will discuss the establishment of state exchanges, minimum loss ratios and bundled payment reform.
• Contracts, Coding and Claims—Dr. Charles Hoffman, member of the ADA’s Council on Dental Benefit Programs, will engage participants in a presentation and discussion of key issues in dental benefit plans.  This presentation will cover non-participating dentist issues with third-party carriers, contractual issues, payer cost containment methods, preventing and resolving errors and common claim denials.
• Using Claims Review Protocols to Establish a Value Proposition to Client Groups—Dr. Gary Dougan, national dental director for MetLife, and Dr. Brian Fitzgibbons, manager of consulting dentists for MetLife, will describe commonly used internal claims adjudication principles and guidelines.  Common codes subject to auto-adjudication, manual claim review by dental consultants and why certain codes are reviewed more than others will be discussed.  Also on the docket: changes in plan design available to meet client group’s needs, communication with dentists regarding identified claims submission patterns, and common claims review practices.