September 2003 Newsletter

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Receive this newsletter electronically

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ADA Fights Insurance Abuse Against Dentists

(ADA) and two of its member dentists are suing some of the nation’s largest insurers under the federal Racketeer Influenced and Corrupt Organization Act (RICO) and supporting state laws for insurance abuses against dentists contracted under the insurers’ managed-care plans. Defendants named in the lawsuit are CIGNA Corporation, CIGNA Dental Health, Inc.; MetLife, Inc.; Metropolitan Life Insurance Company; Connecticut General Life Insurance Company; and Mutual of Omaha Insurance Company. The class-action lawsuit, filed May 19 in the U.S. District Court, Southern District of Florida in Miami, charges the defendants with illegally paying their in-network dental providers less than their charges for provided dental services and with late payments in states with prompt-pay statutes. Specific charges in the complaint include the defendants’ secret use of cost-based or other actuarial criteria unrelated to a covered procedure or service to approve or deny claims. The defendants also are charged with downcoding (changing the procedure code to a less expensive code) and bundling (combining codes of two or more performed procedures into one billed procedure) to deprive plaintiffs of fees owed to them for covered services. Further, they allegedly intentionally engaged in delaying payments to dentists, including the use of automated programs that suspend claims before actual processing and used their economic power and market dominance to coerce plaintiffs to accept these abusive practices and to unilaterally amend contracts with dental providers. The complaint also alleges the defendants engaged in a conspiracy to undertake these abuses with third parties, including other managed care and dental insurance companies, trade organizations and vendors. “We are disturbed by these practices and intend to pursue vigorously all of our legal remedies for the benefit of our members and their patients,” said ADA President T. Howard Jones, D.M.D. The plaintiffs seek an injunction to prohibit the insurers from continuing to engage in the alleged abusive behaviors and awarding of compensatory and punitive damages. “The conduct that we have found with reference to the defendants in this lawsuit is pervasive, unfair to patients and the profession, and, I believe, illegal” said Peter Sfikas, ADA chief counsel. “These are matters that should be brought to the attention of the federal courts and rectified there.”

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Department of Membership
DUES NEWS
In order to more closely align our dues collection practices with the ADA’s constitution and bylaws, the NJDA will institute new dues payment options in 2004 designed to afford our members maximum payment flexibility and convenience.
Each member will have to select a payment option at the time of first payment for the 2004 membership year. As always, the first invoice for 2004 will be delivered in November 2003 and will present the following payment options.

PAYMENT IN FULL – payment must be made in one lump sum.
• One-time payment in full by check or credit card is due by January 15, 2004
• Any partial payments made by check will be returned to the member
INSTALLMENT PLANS – payments may be made by credit card only. Members’ cards will automatically be charged on a monthly basis as described below. Each monthly charge will include a $5.00 service fee. Checks received for installment plan payments will be returned to the member.

OPTION A – TWO (2) EQUAL CREDIT CARD PAYMENTS
• First payment - January 15, 2004
• Second payment - March 31, 2004
OPTION B – SIX (6) CREDIT CARD PAYMENTS
• Payments must be completed by June 30, 2004
• If a member elects to begin payment in November, December or January, the member’s credit card will automatically be charged one sixth (1/6) of his or her total dues each month for six months
• If a member elects to begin payment in February, March or April, the member’s credit card will be charged two sixths (2/6) of the total dues in that month (February), three sixths (3/6) of the total dues in that month (March) or four sixths (4/6) of the total dues in that month (April) and one sixth (1/6) every month thereafter until June 2004
IF YOU HAVE ANY QUESTIONS OR CONCERNS ON THIS MATTER, PLEASE CONTACT THE NJDA MEMBERSHIP DEPARTMENT AT 800-831-6532

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MCDS Welcomes New JFK and RWJ Residents

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NJDA NOTEWORTHY NEWS

STATE BOARD OF DENTISTRY REPORT
The last State Board of Dentistry meeting was held on June 13th in Atlantic City during the NJDA Annual Session. The discussion at the meeting focused on the proposed enteral sedation regulation.
REPORT OF TASK FORCES
Task Force on Amalgam & Wastewater
The State Department of Environmental Protection published a “draft of a draft” of an overall State plan and that in this 110-page draft, dentistry was mentioned in one line, which referred to mercury in amalgam. The Task Force thought it should respond to this draft. Mr. Art Meisel and the legislative arm of NJDA advised that a response would be premature at this time. Drs. Graham and Giantomas will be attending a meeting at the ADA in August on “Train-the-Trainer” on amalgam wastewater management. Dr. Frank Graham put out a request to the Board for an additional three people to be added to his Task Force on Amalgam and Wastewater. He urged the Trustees to go back to their component to see if any members (with scientific research background) were interested.
Task Force to Deal with the Dental Hygienist and Dental Assistant Shortage
Dr. Maxine Feinberg reported that the Task Force met with Burlington County College to discuss its dental auxiliary programs. They have a state of the art program planned, starting with 48 positions and may also hold weekend programs and add an assistant program. Dr. Feinberg added that Judy Zirkle, RDH, President of the NJ Assistants Association, runs a very good assistant program and may start a hygiene program. She was very pleased to report that Dr. Gene Sherwin was appointed to the planning board for the Burlington program and NJDA added him to NJDA’s Task Force.
Task Force on NJ Dental I.D. Team
They are creating specific pathways to membership, working together on funding requirements going into the future, training, etc. It was requested that prior to September 2003, the Task Force present a time frame and agenda to the Board.
CHALLENGE of RULES of THE BOARD
Dr. Riva requested, after explaining his position on the matter, rescinding an April 16th Board of Trustees motion adopted by the Board to amend the Rules of the Board. While serving on the Board of Trustees or any councils of the New Jersey Dental Association (“NJDA”) a person shall not express opposition to or espouse a position inconsistent with one set forth by the NJDA before any legislative or regulatory body or with the news media. After some discussion, a motion was made to set up a small committee of the Board to review this policy.
ANNUAL SESSION & EVENTS
2,525 attended NJDA’s Annual Session vs. 1,985 last year; we sold five more booths and we had 115 dental students and residents attend. Next year we plan to expand with invitations to the Specialty Groups. In terms of revenues, we are ahead of last year; however, the bills from the Taj have not come in to date. The next NJDA event is the Golf Outing, scheduled for August 20th.
MEMBERSHIP
ADA Grassroots Initiative: NJDA has chosen three target groups as a pilot project to see if it makes a difference in recruiting membership. The three groups are: UMDNJ Faculty, New Dentist (1-5 years out of school) and the Female dentist. NJDA’s dues collection policy has been amended. There will be two choices: payment in full or 2 different credit card only installment plans(payment must be completed by June 30 of each year). If payment in full has not been made by July 10th, the dentist will be dropped July 11th. In addition to this, the telemarketing campaign has begun for members who have not paid their 2003 dues. Conversion to the ADA tripartite management system will begin on July 21, 2003 and the dues collecting process for 2004 will reflect ADA policy.
Also, we are mailing congratulation cards to NJDS graduates with a mail back card, hoping to recruit more students. To date, we already have a 30% response.
PEER REVIEW/DENTAL BENEFITS
The annual Peer Review Training Workshop has been scheduled for November 5, 2003 and announced that the new chairman on Peer Review is Dr. Richard J. Angowski (Monmouth-Ocean). On the dental benefits side, some plans are beginning to change their policies to be consistent with CDT-4 code descriptors (which, in some cases will preclude “bundling practices”) but other policy limitations may be applied. Other carriers most likely will wait until the October 16th implementation deadline for the HIPAA standard format and code sets.
GOVERNMENTAL AFFAIRS
Funding of the Medicaid dental program for adults has been fully reinstated in both the Senate and Assembly versions of the budget. Mr. Schulz also reported on the new “collection of benefits” legislation that would provide some relief to dentists who are not eligible to receive direct payment from dental plans due to participation status or other policy limitations. This is not an Assignment of Benefits bill. As currently written, the bill would enable dentists to enter into written agreements with patients to sign over the benefit payment to the dentist within ten days of receipt. Patients who do not sign over the benefit within thirty days would be guilty of a criminal offense and liable to the dentist for the full amount of payment as well as the dentist’s attorney’s fees and other costs incurred to enforce the agreement. After some discussion, the Board voted to support this bill.
COMMUNICATIONS
The board was updated on the progress of the new NJDA Website that will provide more information for both the public and members. We are in the third stage of the redesign (taking out the old and migrating what we will keep). We plan to go live on July 21st. Eric Elmore has been in touch with component editors and program chairs to ensure two way dialogue between the components and Association and to share information. Since joining NJDA, he has initiated two press conferences in Trenton and submitted seven features in either print, TV or radio. Going forward, he will be working on the membership packet, student initiatives and the member directory in print form and CD ROM form.
REPORT OF OFFICERS
PRESIDENT-ELECT’S REPORT – Dr. Frank J. Graham
Dr. Frank Graham reported that he attended the Special Olympics opening ceremony and accepted an award on the behalf of NJDA. He also conveyed Special Olympic’s appreciation for our support and that we were able to contribute $12,700 to Special Olympics of New Jersey as a result of the NJDA Silent Auction in Atlantic City.
TREASURER’S REPORT – Dr. Robert A. Hersh
Dr. Hersh reported that UMDNJ has made a request for financial support with its building fund. Dr. LoMonaco distributed a proposal for Funding of The NJDA Reception Hall in the new Oral Health Pavilion at UMDNJ – New Jersey Dental School. A motion was made, seconded and unanimously ADOPTED by the Board (Vote #2 BT-03-6-24) to pledge $50,000 to the UMDNJ – New Jersey Dental School Building Fund to pay out over five (5) years in five (5) equal payments. This will go to the House of Delegates for approval as part of the budgetary process.
EXECUTIVE DIRECTOR & LEGAL COUNSEL’S REPORT – Mr. Arthur Meisel
The first draft of the 2004 Budget was sent to the Finance and Investment Committee.The Committee will review it, make revisions and that draft will go out to the Board and the Budget Hearing Committee which meets at the Board of Trustees meeting August 13th. The August 13th meeting is also a combined Board meeting with the ADA Delegates and Alternate Delegates. At this meeting the candidates for the 2004 ADA President-Elect will make their presentations and we will be taking them to dinner that evening. There will be a Board Retreat, scheduled for November 15-16, 2003 in Princeton at the Nassau Inn.
NJDA’s appeal regarding the “dental decision” proposal is pending. Delta Dental has filed a brief as a friend of the court. We will file a response. In addition to that, we should be receiving the brief of the State, probably by next week; we then have 10 days in which to respond.
NEW BUSINESS
Our endorsed plan for worker’s compensation, the Dodson Group, was purchased by Meadowbrook Insurance Group. Meadowbrook submitted a proposal identical to Dodson with 3% of the annual premium being paid back to the Association and our contacts remain the same. Meadowbrook will now be endorsed.
Foundation of UMDNJ
The Board elected Dr. Carmine LoMonaco as the NJDA representative to the UMDNJ Foundation.

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ANNUAL MCDS CROSSWORD FOR THE DENTALY CHALLENGED
Only a sick mind could come up with a Dental Society Puzzle, let alone a fifth installment. Attempt it at your own risk. I get feedback every year that it’s either too easy or too hard. This one is just bizarre. Good luck. – Mitch

PUZZLE QUESTIONS

Across

1. We deliver it in our (non-ortho) offices every day.
6. Social event at an anesthesiologists convention or suburban street fest?
12. Now defunct HBO show.
13. Where a certain tilted piece of real estate is located?
14. You’ll find a scrub nurse here.
16. Teens beginning entry about a secret crush.
20. --- and Tuck.
21. Popular class II board lesion.
22. Egotists main concern.
24. What a dyslexic sees when he gets out of the airport terminal?
26. Fitting a stainless steel crown in a skimpy bathing suit?
31.---- lang syne
32. First three letters of franchise Yougurt shop or expression from Aretha Franklin’s ‘Respect’.
33. Vicodin option.
34. Speilberg hit.
35. Improve/change for the better
36. Granny Actress from Beverly Hillbilly’s initial’s.
38. Oscar – LaRenta
39. Latin American capital.
44. Melancholy feeling after benzocaine administration?
49. there’s a means to it.
50. morning abbreviation
51. much more than occasionally.
52. crowns done by an artic dentist?
55. bonding armamentarium
57. gym class or MCDS oral surgeon initials?
59. bloody Thursday night NBC show.
61. member of the ‘culture club’?
65. Harry’s been called this.
67. Show about the social lives of four metropolitan prosthodontists?
71. what we’d all like our crowns to do? Or a college in New York.
72. --- GMA resin.
73. Abbreviation for organization that gives out the “Grammys”.
74. position of molar that needs uprighting.
76. When pluralized, found in Switzerland.
77. What you hear when you can’t get a radio station in tune?
79. Hydrocolloid Machine Manufacturer.
80. Presidential Initials.
81. New Baseball Club of Orthodontists just added to the league?

Down

1. What they may have called a gap-toothed English Royal?
2. Mined matter.
3. RPD holder.
4. --- Supply
5. Timothy Leary obsession.
6. --- Arthur.
7. Army Duty.
8. ATM requirement.
9. I call it -- - --- it.
10. White Water Rafting Nemesis.
11. Star Wars character.
15. dental resident or volleyball player responsibility
17. American or Billy.
18. Presidential Initials
19. What you may call the moment when your roundhouse fits perfectly.
23. It may be put out to catch a murderer on the run.
25. Letters on a tic-tac-toe board.
27. Two vowels.
28. Movie from two summers ago, ----, where’s my ---?
29. A forensic specialist might make it.
30. ----- Metal.
37. Great snorkeling spots.
39. – Cool J.
40. Eric of Monty Python fame.
41. Theater item.
42. Alphabet sequence.
43. What you might do if someone went into anaphylaxis?
45. Yoko ---.
46. It can be widened in a dental office.
47. Ugandan Madman.
48. A supererupted molar or a meddling mother-in-law can do this?
53. Endodontists finish line.
54. Dental Chair manufacturer.
56. ____ Axton.
58. Famous Chef Julia.
60. Dentist request to patient.
61. RPD Major Connector Option.
62. He went ---- - way.
63. Your backyard chair or DO restoration can be made of it.
64. It goes with the word peach or stop.
65. Tangled Up in Blue singer/songwriter.
66. RX Dosage.
68. Impregum Manufacturer.
69. Chris Rock SNL Character.
70. New Television show recording technology.
72. Old Michael Jackson Album.
75. ‘Explosive’ Cable channel.
78. First Met Manager or John Tesh’s wife’s Initials.