Dental Facilities
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Myers and Stauffer offers a comprehensive suite of dental provider services, including policy and contract evaluation, rate setting, fiscal projections, data analysis, and utilization management. Whether services are delivered in a fee-for-service (FFS) or managed care environment, we have developed monitoring and reporting methodologies to provide important dental trends and findings information to state agencies, including meaningful summaries of payment analyses, service delivery analyses, member analyses, provider analyses, and claim statistics.

We provide the following services:

Rate Setting and Reimbursement

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Tim Guerrant, CPA
member
tguerrant@mslc.com

317.846.9521

We believe dental fees should be a reflection of the health care policy and/or quality objectives of the program. Data analytics and dashboards are provided to demonstrate how current and proposed fees compare to other programs and various percentiles of dental charges. We assist clients with everything from stakeholder engagement and data collection to socialization, implementation, and on-going maintenance. Our services include:

  • Stakeholder engagement.
  • Policy and benefit analysis.
  • Rate adequacy studies.
  • Charge coverage analysis.
  • Data collection.
  • Fee schedule rate development and maintenance.
  • Fiscal analyses.
  • Implementation assistance.
  • Socialization planning.

Medicaid Financing and Reporting

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Jared Duzan, CFE
Principal
jduzan@mslc.com

317.846.9521

Health care reform, payment transformation, and alternative payment models offer unique opportunities to infuse equity and accountability into reimbursement, while aligning reimbursement to program policies. Contact Myers and Stauffer’s consulting team to discuss how we can provide financing and reporting assistance for your dental program.

Benefit/Program Integrity

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Ryan Farrell, CFE
Principal
rfarrell@mslc.com

512.342.0800

We have extensive experience performing reviews of dental providers. Our work includes performing data analytics to identify potentially aberrant billing patterns, as well as detailed medical record reviews to ensure compliance with state and federal policies and national coding guidelines. Our library of algorithms allows us to efficiently perform detailed peer comparisons by provider type and specialty, isolate claims that exceed service limitations, and identify instances of dental unbundling. We perform both limited- and full-scope reviews of dental provider records to ensure compliance with documentation and coding standards, as well as to ensure dental professionals are practicing within their approved scope. Our program integrity services include:

  • Claims analysis.
  • Post-pay claims audits – clinical and financial.
  • Pre-pay claims audits – clinical and financial.
  • Medicaid recovery audit contractor (RAC) services.
  • Software modules for surveillance and utilization review subsystem (SURS),
    fraud and abuse detection services (FADS), and case tracking.
  • Provider compliance.
  • Payment system processing accuracy.
  • Fraud, waste, and abuse detection (FWAD) litigation support.
  • Electronic health record (EHR) incentive payment audits and consulting.

Managed Care Oversight and Compliance

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Mike Johnson, CPA, CFE
Member
mjohnson@mslc.com
404.524.0775

Dental services delivered in a managed care environment can sometimes create unique challenges. This service delivery model typically requires an additional layer of oversight due to the manner in which most managed care plans delegate dental services to a third party vendor. Analyzing the administrative and medical loss payments is challenging, yet necessary, to ensure that the appropriate safeguards are in place for network adequacy and access to services. Our managed care team has experienced these issues firsthand. We have successfully on-boarded managed care plans and conducted on-going operational reviews. We offer a comprehensive portfolio of managed care oversight and compliance services, which can be applied generally to all provider categories, but also to dental services. These services include:

  • Encounter data reconciliation and validation.
  • Financial audits, performance audits, and program effectiveness audits.
  • Network adequacy assessments and member access compliance.
  • Readiness reviews.
  • Claims payment and denial assessments, accuracy, and timeliness.
  • Medical record review.
  • Grievance and appeals analysis.
  • Contract compliance.
  • Other provider-specific issue review and resolution activities.