September 2012 Newsletter

President's Message - Dr. Constantine Simos

I hope everyone had a great summer and was able to take some time off to enjoy it with family and friends. It has been a productive season for the society as we prepare for the Centennial Celebration that will take place on Saturday October 13th. The organizing committee has planned a truly special evening to honor the Past Presidents of the Middlesex County Dental Society. I hope to see you all at the East Brunswick Hilton to celebrate this milestone.
We received great news on the statewide level on August 7th when Governor Christie signed the General Supervision Bill into law. This legislation was sponsored by NJDA and allows for the general supervision of dental hygienists on patients of record as opposed to direct supervision which is the current standard. The law will go into effect on October 7th 2012. Thanks to the tremendous efforts of our state association and our PAC, our members now have this added flexibility in delivering care to their patients. I know you have heard about the benefits of PAC many times but this time I ask you, is there any better reason than this to support NJDPAC?
I wish to congratulate our immediate- past president, Dr. Robert Ashmen for his excellent leadership last year. Like so many of our volunteers, Bob offered his time and expertise to advance the mission of the society.
Our Education Coordinator, Dr. Amit Vora, has assembled an excellent line up of speakers for our monthly meetings. Please review the schedule and mark your calendars to ensure that you will not miss any of the presentations. Of particular note is our full day course which will be offered on Wednesday April 17th, 2013. Dr. Mark Setter of Port Huron, Michigan, will present “Happier Patients-Healthier Practice”, a unique practice management seminar.
Lastly I would like to call your attention to a medical first which occurred this past March. A team of doctors led by Dr. Eduardo Rodriguez, MD DDS, at the University of Maryland Medical Center, performed the most extensive face transplant reported thus far. They grafted hard and soft tissues to restore the facial appearance and function of a gunshot victim. Dr. Rodriquez has extensive training in plastic and reconstructive surgery including microvascular reconstruction. His roots however are in dentistry, having completed his DDS at NYU and OMFS training at Montefiore Medical Center. We should be very proud to count Dr. Rodriguez as one of our colleagues.

Dental Benefits

CRP Statistics: From January 1, 2012 through March 31, 2012 a total of 33 (10 from Middlesex) complaints were submitted to NJDA. Most were against Aetna (9) for denial of claims and MetLife (5).
Guardian COB: Staff reported on a situation in which Guardian, as secondary carrier, did not pay the full patient liability after payment by the primary, even though that amount was less than it would have paid if primary. When the dental office called Guardian, the representative stated that the COB rule did not apply to dental plans. NJDA faxed the regulations to Guardian’s legal department, but no response was received. NJDA then contacted the NJ Department of Banking and Insurance (DOBI), which is investigating.
(Subsequent to the meeting, DOBI informed NJDA that Guardian acknowledged that it had not been coordinating appropriately based on the NJ regulation that was adopted ten years ago. DOBI has not decided what, if any, further action will be taken).
MetLife Payment Delays: There are on-going problems with MetLife delaying payment for entire claims if routine restorations are sent on the same claim and did not include x-rays. To date, all of the plans are self-insured and exempt from state law that forbids such practices.
MetLife: Diagnostic X-Rays (ADA Article): The council reviewed information from ADA indicating that the problem with MetLife denying claims for the diagnostic x-ray taken prior to a root canal has been resolved.
MetLife Office Assessments: Dr. Weddle reported to the council on MetLife’s Office Assessment Program, which is not related to financial audits. The review was performed by a practicing dentist from Ohio and covers issues such as quality of x-rays, patient charts, sterilization practices, etc.
According to Dr. Weddle, it was not an onerous experience, and the council believes this type of assessment could be useful for some dental offices.
Aetna and Medicare Submission Requirement: It appears that Aetna has a list of procedures (so far procedures that involve cutting) that it believes Medicare might cover under certain circumstances, so it is rejecting these claims and requiring a Medicare EOB.
This, despite a law passed in 2003 that prohibits health plans from requiring a Medicare claims determination for dental benefits that are excluded. The Medicare law has a blanket statutory exclusion for outpatient dental services that states that expenses are excluded if “in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth…” NJDA has previously contacted the ADA concerning this issue, and will request that the Director contact CMS for a ruling.
MetLife Tricare Dental Contract: The council discussed MetLife’s assumption of the Tricare dental plan for military dependents and reservists effective May 1, 2012. (United Concordia will continue to administer the Tricare plan for active duty personnel). Some enhancements are being made to the program, including incentives for pregnant women and diabetics to receive preventive care. However, the dentist contract is very specific with regard to collecting payment from plan members in the event MetLife denies the claim because it is an excluded service or deemed “not necessary”. A separate agreement must be signed by the member in advance of each such service.
“Pay Plus Solutions”: Dr. Vitale reported on a situation he experienced with a dental plan administrator for the Borough of Metuchen. Rather than receiving a check in payment of the claim he submitted, he received a voucher that had to be processed through his credit card terminal. Since credit card processing fees must be paid, dentists must “pay to get paid”. It is unclear if other options are available.
Delta Dental Individual Coverage: The council reviewed information on Delta of NJ’s entry into the individual dental insurance market. Claims administration will be provided by Delta Dental of Wisconsin.
“UC Wellness” Plan: The council reviewed, as informational, a new plan being introduced by United Concordia that covers oral health maintenance for diabetics. The new program was designed after the results of a study that showed hospitalizations decreased by 33% annually and physician visits by 13% in diabetics who treated and managed their periodontal disease over a three year period, reducing medical costs by about $1,800 per year per patient.
Horizon BCBS National Dental Network: The council discussed the letter and contract amendment from Horizon BCBS New Jersey, which was sent certified mail to participating dentists, relating to a new national BCBS dental network. It appears to be a mandatory program, since even if dentists do not sign and return the amendment, Horizon will assume they accept it unless they submit a letter to terminate as a participating dentist with Horizon.
Status of Medicaid Committee: Dr. Vitale reported to the council that the NJDA Board of Trustees approved a resolution to change the status of the Medicaid Committee from a “committee of the Board” to a subcommittee of the Council on Dental Benefit Programs. Dr. Whitman will continue as chair of the Medicaid Committee and attend future council meetings.
Report of Medicaid Chairman: Dr. Whitman reported that New Jersey is currently renegotiating the HMO contracts for Medicaid beneficiaries.
Problems have been experienced in the last two years with the HMOs denying orthodontic treatment that is a covered benefit under Medicaid. It is unclear if these HMOs will be penalized in any way by the State for not fulfilling its contract. Horizon NJ Health, one of the Medicaid HMO contractors, is beginning to reimburse pediatricians to apply fluoride varnish and refer these children to a dentist. Pediatricians receive an extra incentive payment if these children are seen by a dentist within 30 days of the referral.
Besides serving as the Medicaid committee chairman, Dr. Whitman also serves on a New Jersey Medicaid Advisory Committee, the ADA Council on Access and Prevention, and is active with the American Association of Pediatrics. As an aside, it was noted that Dr. Cliff Lisman has just filed suit against Horizon NJ Health for bundling and violating Medicaid rules.
Report of NJDA Access to Care Committee: Dr. Michael Messana, NJDA President-Elect and Chair of the NJDA Access to Care Committee, joined the council to report on the activities of the NJDA Access to Care Committee. The committee is now involved in the SmileCheck program, in which NJDA volunteers are screening third graders in schools selected by CDC. This screening is conducted in most states by the respective state’s Department of Health, but NJ has never participated.
By NJDA taking this responsibility, assisted by a $10,000 grant from Delta Dental, one of the criteria used to develop the state oral health report card would be fulfilled.
Dr. Messana also reported that Henry Schein has agreed to help NJDA develop an Access to Dental Care website, which would provide one central location for access and dental care information.
NEW BUSINESS:
Update on Legal and Regulatory Matters: Arthur Meisel briefed the council on the status of current litigation.
The next council meeting is scheduled for September 12, 2012

2012-2013 Program Labels

For those of you who download the newsletter from our web site rather than receiving it in the mail: If you would like printed labels to stick in your appointment book, we will have them available at the September meeting. If you can’t attend that meeting, you can download the document in Microsoft Word format from our web site. Go to the member section, then “General Meeting Info, then click on the Program link.

Staff Night Collage

With everyone likely to have web access at this point, a decision was made just to post the pictures on our web site. You can see the gallery of the photos taken by Dr. Maya Prabhu and Dr. Devang Modi by going to our web site: www.MCDSofNJ.org and clicking on the link on the home page. Photos from previous Staff Nights can be found in the Member section in the Archives.