C.E. Credit Worksheet

July 2022 Continuing Education Worksheet

This worksheet provides readers an opportunity to review C.E. questions for the article “Commercial Dental Benefit Plans” before taking the C.E. test online. You must first be registered at cdapresents360.com. To take the test online, please click here. This activity counts as 0.5 of Core C.E.

1. Which of the following statements is false:

a. The first known dental plan, instigated by the International Longshoremen’s Union/Pacific Maritime Association’s desire to provide dental benefits to employees was a collaboration between California, Oregon and Washington in 1954.

b. The plan that resulted was a subsidiary of the California Dental Association and was named the California Dental Service (CDS).

c. That first plan eventually became known as Delta Dental.

d. In 1959, the Continental Casualty Company (CCC) became the first commercial insurer to offer dental insurance.

2. True or False: The Knox-Keene Act, written in 1975, established national governmental oversight for the prepaid medical and dental benefits industry.

3. In 2022, according to the National Association of Dental Plans, what percentage of dental plans utilizes the PPO model?

a. 68%

b. 72%

c. 78%

d. 86%

4. Which of these are true statements regarding PPO plans (mark all that apply)?

a. They utilize a network of contracted providers.

b. Network providers accept a discounted fee schedule in return for the referral of patients.

c. Most plans do not cover out-of-network services.

d. Often diagnostic and preventive services are fully covered.

5. Which statement about DMHO plans is false?

a. Patients must select a single, primary care dentist.

b. Dentists receive a capitated monthly rate for a predetermined set of services for each assigned patient.

c. The DMHO model does not utilize a claims-based payment model.

d. Dentists can perform and bill patients for services that are not part of the predetermined set of benefits if in their judgement the patient needs a noncovered service.

e. DMHOs are generally viewed as an affordable benefit plan by employers and employer groups.

6. Which statement about dental indemnity plans is false?

a. In 2022, just slightly over 5% of the dental policies issued were indemnity plans.

b. One of the main differences between a PPO and indemnity plan is that the indemnity plan does not use a network of providers.

c. The level of benefits offered in an indemnity plan is determined by the purchasing employer.

d. In California, indemnity plans are regulated by the California Department of Managed Healthcare.

7. True or False: The DMHO model of prepaid benefits often leads to confusion among patients about what is covered and what they must pay for, which results in billing complaints.

8. Which of the following are common frustrations with dental benefit plans (mark all that apply)?

a. Fixed copayment design in the DMHO model.

b. Stale annual maximums.

c. Difficulty updating dentists’ fee schedules.

d. Plan complexities and coverage variations require dentists and dental office staff to spend time educating patients.

e. All of the above.

9. Which of the follow statements accurately describes artificial intelligence (AI) and its use in the dental sector (mark all that apply)?

a. AI is the practice and development of automated systems and processes using computer systems to perform tasks that historically required human intervention or human intelligence.

b. All dental benefit plans use AI to address fraud, waste and abuse in the dental insurance claims process.

c. AI analysis can identify such concerns as the same duplicate radiographic or photographic images used for different patients as well as upcoding of restorative surfaces.

d. AI can expedite claim review and claim processing, with a higher level of accuracy than with the traditional or historic models of manually handling claims.

e. Newer AI applications can be used in-office to aid in the detection of soft tissue abnormalities, bone loss, calculus and caries from the various images obtained in the examination process.

f. All of the above.

10. True or False: Today’s dental benefits plan is more flexible and willing to offer and design a product based on the request of an employer group than in the earlier years, but this acceptance is dictated by the willingness of the employer groups that purchase the product to make changes to their employees’ package of dental benefits.