As the number of third-party payers rolling out provider rating programs increase, the ADA Council on Dental Benefit Programs is advising dentists to be proactive about speaking up when they believe the ratings don’t accurately measure the quality of care provided.
Kevin Dens, D.D.S, chair of the council, said that third-party payers using rating systems displaying “quality scores” for dentists within their provider directories are doing so to differentiate themselves in the market with employers and other marketplace consumers. Medicaid programs are also placing similar requirements on managed care entities.
“Some provider rating systems say they represent ‘quality’ when they don’t actually represent an agreed-upon and science-based definition of quality. Don’t be afraid to appeal the grades,” Dr. Dens said. “It is always best to reach out directly with your provider-relations representative whenever there are any concerns about how the third-party payer may be calculating their ratings. Remember to keep a paper trail by communicating by email, if at all possible.”