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Direct contracting is a potential solution, according to Walmart and other companies, and part of the overall value-based-care movement. Because doctors who participate in most of Walmart’s programs get paid a total rate for patient care, they are incentivized to do what will help patients get better, including, in some cases, not ordering any procedures at all, or holding off on a procedure until a patient is a better candidate.
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Basic Health Program People with dental insurance commonly have what’s described as “100-80-50” coverage, meaning it pays 100 percent of the cost of routine preventive and diagnostic care, such as checkups and cleanings; covers 80 percent for fillings, root canals and other basic procedures; and 50 percent for crowns, bridges and major procedures, Ireland says.
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A Dentist’s, Denturist’s or dental practice’s failure to comply with the current ADA coding convention, including but not limited to upcoding, the overutilization of certain codes, and/or the misrepresentation of services (e.g., unbundling).
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