Everything a Dental Practice Needs

Dentists are licensed by each state's board of dentistry, sometimes called the board of dental examiners. Requirements differ by state, but every candidate must meet three basic requirements: education, a written examination and a clinical assessment. All U.S. licensing jurisdictions require the Integrated National Board Dental Examination (INBDE), which replaced the National Board Dental Examination Parts I and II. Most state boards rely on third-party testing agencies to administer the clinical assessment, and which assessments a board accepts varies by state. Dentists who already hold a license can often get one in a new state by credentials.

The Dentist and Dental Hygienist Compact adds another path. A compact privilege is the legal authorization to practice in a remote member state where you are not licensed. To be eligible you need an unencumbered license in a participating state, graduation from a CODA-accredited dental program, a passing National Board result, a completed clinical assessment, a background check, the remote state's jurisprudence requirement and the fees. You keep your home state license and its continuing education. In the remote state you work within that state's scope of practice, and you still need its specialty license, sedation permit or other permits where its law requires them. The compact's current status is shown below.

Dentists who prescribe, administer or dispense controlled substances, for example for pain after extractions or for sedation, need a DEA registration. DEA requires that all of a state's licensing requirements be met before it registers you in that state, and a dentist who practices in more than one state needs a separate DEA registration in each. A separate registration is also required for each principal place of business or professional practice where controlled substances are dispensed. An office where a dentist registered elsewhere in the same state only prescribes, and neither administers nor dispenses controlled substances nor keeps a supply there, does not need its own registration, so a group whose offices keep sedation drugs on hand has to plan registrations by location. DEA also requires registrants to meet a training requirement when they apply or renew.

Where your state requires its own controlled substance registration, it has to be in place before DEA will register you there. We sequence the state and federal registrations, file each one and track every renewal.

Each dental benefit plan credentials each dentist before that dentist is in network. PPO, DHMO and Medicaid dental plans each have their own application, documents and timeline, and each needs your state license, DEA registration if you hold one, malpractice coverage, NPI and work history. Joining a plan is a business decision as much as a clinical one, since the contract sets your fees for that plan's patients.

We help you decide which plans to join, complete and submit every application, follow up until each one is approved, link each new associate to the group, and re-credential on schedule. Before you sign, our contracts team can review a plan's fee schedule and terms with you.

The CDT Code, maintained by the American Dental Association's Code Maintenance Committee, is the HIPAA standard code set for dental procedures. Both CDT and ICD codes are HIPAA standards on electronic dental claims, and ICD-10-CM is the only diagnosis code set that may be used on claims to dental benefit plans when a diagnosis code is needed. Claims must use the CDT version in effect on the date of service, and the code set is updated every year, so codes have to be checked against the right year. CDT contains no fees; your fees and each plan's allowances come from you and your contracts.

We code each claim from the clinical note, attach the narratives and images a plan's policy requires, submit electronically, post every payment and follow up on what is denied or underpaid.

Medicare excludes most dental care, meaning services for the care, treatment, filling, removal or replacement of teeth. The exclusion does not apply when dental services are inextricably linked to the clinical success of another Medicare-covered service, and Medicare can then pay under Part A and Part B. CMS gives examples such as dental exams and treatment before an organ transplant, cardiac valve replacement or certain cancer treatments, reconstruction of the dental ridge done at the same time as surgery to remove a tumor, and stabilizing teeth while reducing a jaw fracture. The medical and dental providers must coordinate care, and that coordination must be documented in the medical record.

These claims carry the KX modifier and an ICD-10 diagnosis code on the dental claim, and submitting one certifies that the service is inextricably linked to a covered medical service. A dentist who bills Medicare for these services needs Medicare enrollment first. We set up that enrollment, decide with you which services go to a dental plan and which to medical coverage, and bill each one with the documentation it needs.

Medicare covers a custom fabricated mandibular advancement appliance, billed under HCPCS code E0486, when four criteria are met: an in-person clinical evaluation by the treating practitioner before the sleep test, a Medicare-covered sleep test that meets the apnea thresholds in the coverage policy, an order from the treating practitioner after reviewing the sleep test report, and a licensed dentist (DDS or DMD) who provides and bills for the device. The policy denies a prefabricated appliance (E0485) as not reasonable and necessary in every case.

Under the coverage policy the treating practitioner is an MD, DO, nurse practitioner, clinical nurse specialist or physician assistant, never a dentist, so the evaluation, the sleep test order and the appliance order all come from the patient's medical practitioner. CMS treats a dentist furnishing an appliance prescribed by another practitioner as acting solely as a DMEPOS supplier, which means DMEPOS supplier enrollment, the supplier standards and, according to CMS, the $50,000 surety bond, because the exception for practitioners furnishing items to their own patients as part of their professional service does not apply. We prepare the DMEPOS enrollment, keep the bond and supplier standards in order, and bill each appliance claim with the order, sleep test and proof of delivery.

Medicaid must cover dental services for every enrolled child through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Adult dental coverage is a state choice, with no federal minimum, so what Medicaid pays for adults varies widely from state to state. Separate CHIP programs must cover dental services necessary to prevent disease and promote oral health.

We enroll your practice and each dentist with your state program and its plans, and bill with each program's rules on prior approval and frequency.

A dental practice that sends claims electronically is a HIPAA covered entity. The Security Rule requires an accurate and thorough assessment of the risks to the electronic patient information you hold, from the practice management system to digital radiography and intraoral cameras, and a security awareness and training program for everyone on your team. We run the risk assessment, write your policies and Notice of Privacy Practices, train staff and collect business associate agreements from your software, imaging and billing vendors.

Infection prevention is a separate set of standards. The CDC's summary of infection prevention practices for dental settings applies to every dental setting, rests on Standard Precautions and includes a checklist for evaluating compliance; it calls out breakdowns such as failing to heat sterilize handpieces between patients and failing to spore test sterilizers. Your state board may set its own requirements as well.