Agd house of Delegates (hod) Policy Manual



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Organizational Marketing


GUIDELINES
Public Affairs Guidelines

Advocacy Guidelines



ACADEMY OF GENERAL DENTISTRY
Announcement of Credentials to The Public: A Position Paper
EXECUTIVE SUMMARY
The purpose of the “Credential and Dental Marketing: A Position Paper” (Position Paper) is to set forth to dental regulating bodies of each state (i.e., state dental boards), the reasons that the Academy of General Dentistry (AGD) believes that general dentists should be permitted to advertise credentials earned by meeting rigorous requirements imposed by professional organizations whose educational programs may not be subject to a formal accreditation process.

Professional organizations, as discussed herein and in the Position Paper, are limited to those that award credentials for dentists who have met rigorous requirements in continuing education through targeted PACE or CERP approved coursework, comprehensive examinations, and longevity in dental practice as verified by sustained organizational membership.
Professional credentials awarded by these professional organizations recognize the achievement of proficiency in areas of dentistry outside the nine specialties identified by the American Dental Association (ADA).
Proficiency is “the level of knowledge, skills, and values attained when a particular activity is accomplished in more complex situations, with repeated quality, and with a more efficient utilization of time,”2 and signifies a higher standard than competency.
Patient care and protection is the ultimate goal of the AGD, and public awareness of dentists’ proficiencies through advertising of credentials earned by meeting rigorous requirements imposed by professional organizations shall assist patients in selecting the appropriate dentists for their specific needs, while restrictions to advertising of these credentials may falsely depreciate their value to the public and may obstruct the patients’ ability to make independent, unbiased and fully informed health care decisions.

The sole purpose of this Position Paper is to set forth before state dental regulating bodies (i.e., state dental boards), the AGD position provided herein on credential and dental marketing.


2 Commission on Dental Accreditation (CODA), Accreditation Standards for Advanced Education Programs in General Dentistry, 1998. Cited section excerpted from definition provided for “Proficient.”

Coordination of Benefits Guidelines



1. When a patient has coverage under two or more dental plans, the coverage from those plans should be coordinated so that the patient receives the maximum allowable benefit from each plan. The aggregate benefit should be more than that offered by any of the plans individually, but not such that the patient receives more than the total charges for the dental services received.
2. In determining order of payment for benefits, the following rules should apply:
a. The plan covering the patient other than as a dependent is the primary plan.
b. When both plans cover the patient as a dependent child, the plan of the parent whose birthday occurs first in a calendar year should be considered as primary.
c. When a determination cannot be made in accordance with the above, the plan that has covered the patient for the longer time should be considered primary.
d. When one of the plans is a medical plan and the other is a dental plan, and a determination cannot be made in accordance with the above, the medical plan should be considered as primary.
3. In coordinating benefits with a dental plan which contractually reduces the fees for services which participating dentists accept as payment in full, the following rules should apply:
a. When the reduced fee plan is primary and treatment is provided by a participating dentist, the reduced fee is that dentist's full fee. The secondary plan should pay the lesser of: its allowed benefit or the difference between the primary plan's benefit and the reduced fee.
b. When the reduced fee plan is primary and treatment is provided by a non participating dentist, the reduced fee plan should provide its allowed amount for non participating dentists and the secondary plan should pay the lesser of: its allowed benefit for the service or the difference between the primary plan benefits and the dentist's full fee.
c. When a full fee plan is primary and a reduced fee plan is secondary, the full fee plan should provide its allowed amount for the service and the secondary plan should pay the lesser of: its allowed benefit for the service or the difference between the primary plan benefits and the dentist's full fee.
4. In coordinating benefits between an indemnity and a capitation dental plan, the following rules should apply:
a. When the capitation plan is primary, the capitation payments to the treating dentist remain the capitation plan's usual benefits. The indemnity plan should pay benefits for the patient's surcharges or copayments up to the indemnity plan's allowable benefit.
b. When the indemnity plan is primary, and treatment is received from a capitation participating doctor, the indemnity plan should pay its allowable benefits. The capitation payments to the dentist are the secondary coverage since they constitute benefits up to the capitation plan's allowable amount.
c. When the indemnity plan is primary, and treatment is received from a non capitation participating dentist, the indemnity plan should pay its allowable benefits. The capitation plan will pay benefits, in keeping with the capitation plan's allowed amount for treatment by non participating dentists.
d. No dental plan should contractually direct a dentist to charge a secondary carrier for more than the amount which would be charged to the patient absent secondary coverage.
5. Third party payers, representing self funded as well as insured plans, should be urged to adopt the above guidelines as an industry wide standard for coordination of benefits.
6. Constituent societies are encouraged to seek enactment of legislation that would require all policies and contracts that provide benefits for dental care to use these rules to determine coordination of benefits.
And be it further
Resolved, that third party payers, representing self funded as well as insured plans, should be urged to adopt these guidelines as an industry wide standard for coordination of benefits, and be it further
Resolved, that constituent societies are encouraged to seek enactment of legislation that would require all policies and contracts that provide benefits for dental care to use these rules to determine coordination of benefits.'"

Adopted HOD 7/93

Dental Care Policy Guidelines

The Academy of General Dentistry notes an increased interest by the general public on all levels in dental care programs both private and government sponsored. In keeping with the general outlook and purposes of the Academy, it is necessary to promulgate certain policy guidelines which will assist the profession and allied agencies involved in the maintenance and improvement of high quality dental care.


The objectives and purposes are:
1. To promote the science and art of dentistry and the betterment of the public health, encourage oral research, and to preserve the rights and freedom of the dentist and the patient.
2. To preserve the right of the general practitioner to engage in dental procedures for which he/she is qualified by training and experience.
3. To provide and guide continuing education programs and study group activity for general practitioners and to encourage and assist practicing dentists to participate in such program toward continuing education competence.
4. To provide effective representation for the general practitioner in all matters of interest to the profession and the public it serves.
5. To maintain an active organization of general practitioners of dentistry.
6. To motivate and assist young men and women in preparing, qualifying and establishing themselves in the general practice of dentistry.
7. To promote uniform methods of reporting treatment contemplated and rendered.
8. To affirm that the prime responsibility of total dental health care rests with the general practitioner.
In fulfilling these goals, the Academy supports the following principles as its policy on dental care programs:
1. Any government dental health program which has as its principal requirements that:
a. All drinking waters be fluoridated as needed.
b. Concepts and programs of preventive dentistry be taught and implemented for children in schools, and a program for adult preventive care be instituted both in the dental office and community service clinics.
c. A massive effort be undertaken to discover the cause and cure of dental disease.
2. The right of the general practitioner to practice all phases of dentistry must be preserved in every state.
3. The doctor patient relationship must be maintained without interference by a fiscal intermediary.
4. The Academy supports a prepayment evaluation mechanism that establishes a working liaison with insurance carriers and other fiscal agents for the review of prepayment programs. The Academy supports only those prepaid dental programs which meet the standards of the American Dental Association, or its equivalent. The Academy is opposed to any program which denies the right of the dentist to preform any services for which he/she is licensed and qualified to perform or one which limits the patient in his/her freedom of choice of a dentist.
5. Wherever and whenever the Academy finds discrimination in third party programs involving the general practitioner and/or patients, it will make every effort to correct the problem. Failing to do so, the Academy will then seek relief through the American Dental Association or its equivalent or through appropriate legal channels.
6. Legislative contracts should be established and maintained from the individual member up through the state and national levels to assist general practitioners and the community in programs involving health legislation.
7. Every constituent of the Academy shall have an active dental care committee which will report on an annual basis to the AGD National Dental Care Committee for proper coordination and development of programs on a nationwide basis.
8. The Academy supports a pluralistic system of dental prepayment including private insurance carriers, service corporations, private payment by patients and limited government payment.
9. The AGD endorses and supports co insurance in addition to those programs offering total or paid in full coverage.
10. An acceptable fee for any dental care service is that amount which is mutually agreeable to both the patient and the dentist, based on all factors involved in the treatment. Any fee established by a third party (for example, that called usual and customary) is to be regarded as an indemnification toward the fee agreed by the dentist and the patient.
11. The plan must not involve the dentist as a contractual party nor shall the plan publish a list of participating dentists.
12. The Academy supports the view that the public has the right to have access to comprehensive dental care. However, the Academy opposes any government health program which would use public funds to provide dental care for persons who are financially able to pay for dental services. Current medicaid programs should be expanded to include more comprehensive dental care.
13. The Academy should be represented in all agencies of the American Dental Association or its equivalent which deal with dental care programs. The Academy wishes to cooperate in every possible effort not only on behalf of the general practitioner, but also on behalf of the total profession and the public.
14. The American Dental Association should be encouraged to review dental insurers' plans to make certain the coverage provided is presented accurately to the patient.
Adopted GA 2/72

Revised HOD 11/74



Amended HOD 7/77
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