Let’s face it, the insurance-based dental care system is broken. It’s difficult for dentists to grant the care their patients need because the insurance companies control everything— access, pricing, payment and treatment. Dental membership plans put control back into the hands of dentists and enable them to provide their patients with the care they need without the hassles including deductibles, pre-approvals, payment processing delays, claim denials, annual maximums and the coordination of benefits. With membership plans, practices can improve patient access to care while improving their bottom line.
While dental membership plans are the perfect solution to the battle of working in an insurance-controlled system, many dentists and their staff are confused with compliance and licensing requirements. There’s worry over what dentists must do to stay compliant with state and federal regulations.
Membership plans must be compliant with regulations including HIPAA, federal anti-kickback laws, federal physician self-referral laws, federal consumer protection laws, FTC laws and state healthcare and dentistry laws. These laws can vary by state and require implementation of a variety of features including disclosures, consents, data security infrastructure, support processes and payment terms.
If your practice already has an in-house dental membership plan in place, or you're looking to implement one yourself, here’s 5 tips to be sure you're protecting your practice and your patients.
1. Know your state laws and regulations
Check with your state board of dentistry and make sure you understand the requirements.
2. Properly structure your plan
Make sure that what you're offering through your dental membership plan isn't too good to be true and doesn't violate any anti-kickback laws or other regulations.
3. Consider your patient’s privacy
HIPAA and state privacy laws will require you to properly manage your patients' protected health information (PHI). Make sure that you have an appropriate system in place to ensure that PHI is kept secure.
4. Build a plan for payments and renewals
Decide how you'll be collecting payments and have a system in place for renewals. You'll also need to decide if processing payments will be owned by you or a third party.
5. Confirm you're disclosing properly
Properly disclose prices, payment terms, limitations, and exclusions associated with the membership plan to patients.
Simplify Compliance and Membership Management with Kleer
Kleer has completed a detailed legal review of state and federal regulations and has built features into the platform for compliance and continuously monitors state and federal guidelines to ensure our platform remains up to date. Not only does Kleer simplify compliance, it also eliminates the time consuming processes of managing a membership plan with features such as automated enrollment, renewals, payment processing, payment posting to PMS, and more.
Protect your practice and gain the confidence that comes from knowing you’re offering a premium coverage solution for your patients. Get started with Kleer.