Top 5 Dental Insurance Questions Webinar with Laura Hatch and Teresa Duncan

Top 5 Dental Insurance Questions Webinar with Laura Hatch and Teresa Duncan

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It’s December 4th 5th I’m not sure what day
it is I know it’s December and if you work in dental it’s a crazy time of the
year so we’re super excited to have everybody here welcome to our second
webinar we’ve done this month on insurance because insurance is
everyone’s favorite topic especially this time of the year and I’m super
excited to be here with Teresa Duncan from Odyssey Management if you don’t
know me my name is Laura hatch and I am the founder and owner of Front Office Rocks
and I’ve asked Teresa to join us today because we’re gonna talk about top 5
insurance questions so Teresa thank you for joining us today on our webinar I
appreciate you having me on I love what you’re doing and I love that you’re
getting out and telling people the stuff they need to do now like what they need
to know now so this is really timely because insurance is all getting ready
to turn over next year so good job exactly thank you so I have to tell
everybody a little story I started Front Office Rocks kind of about five
years ago I started at an organization called AADOM which is the American
Association of dental office management I went and saw some amazing speakers
there and Teresa Duncan was one of the first speakers that I saw I don’t like
anything about insurance I hate dental codes I hate dealing with
insurance I like customer service I like systems I like communication and I went
to listen to Teresa and I thought this is going to be so boring it wasn’t it was amazing and she is my go-to guru person comes
to insurance so I started stalking her the first time I saw her speak now
become really good friends and it worked together so I’m and she’s my go-to
person if anybody asks me insurance question it’s over my head I go to
Teresa so thank you so much for being my my guru can you tell us a little bit
about you and what you do in Odyssey management sure no I didn’t even know
you were like stalking me so I’ve been an office manager for about 20 years but
I started out in pretty much every other position manager so I I cut my teeth on
being an assistant on being a receptionist then went on to manage her
and then just decided I want to be out there helping and educating you know
what that feels like so it’s been really good I started consulting I started
speaking and then realize maybe the consulting is not
exactly what I need to do there’s so many good consultants out there I sweet
spot is educating and getting the word out and sharing what’s happening with
insurance and management and I think I found my niche I’m super happy with what
I’m doing so I’ve kinda everywhere if you ever need to find out what’s going
on with insurance I’m pretty much everywhere so you people can find me
yeah exactly and just so everybody knows if you’re planning on going to Yankee
Theresa and I are actually going to be speaking together yes about you know
cross-training assistants front and back and how the front and back worked well
together so I’m working it was kind of a happy accident Laura because it was
supposed to be you and Kevin Henry and Kevin his daughter’s turning 21 and of
course she wanted to spend it with him and so you know when he said Theresa do
you mind speaking with Laura I’m like oh that’s so hard I don’t know how I’m
gonna do that yeah get outta here we don’t need to get out exactly we’re
gonna have a lot of fun for sure so you mentioned that you love this insurance
stuff and you just mentioned to me earlier I wanna make sure everybody
knows they we’re gonna get to put your contact information at the end but you
have a newsletter that you put out right you just acted maybe one you said right
yeah we came out yesterday so my newsletters I don’t put them out every
month because they’re just so there’s a lot I try to write a lot so yeah I just
dropped yesterday and certainly feel free to go to my website check it out
it’s on Facebook it’s linked on Facebook and LinkedIn and all of that kind of
stuff so it’s easy to find and if not just email me and I’ll send you the
direct link perfect great I also want to do another little plug for you and have
you know this every time I speak I give this away this is a book that Teresa
wrote and it’s called moving your patients to us easy insurance
discussions and like I said early on when I started with Front Office Rocks
I personally don’t like the insurance game I don’t like playing it I don’t
like to talk to patients about it and when she wrote this book I thought of
it’s gonna be boring insurance stuff this is an amazing book this book it
ties what I do in train with what Teresa knows about insurance and how to get
your patients to accept dentistry with that insurance discussion I recommend
every dental office when I speak I give one away and I recommend every office
have everybody on the team read this because you know when the dentist tells
the patient they need something they leave they look at the dental
assistant or the hygienist or somebody else on the team not just the front
office needs to understand how to have these insurance discussions so a little
plug for your book if you haven’t done it how can they get a hold of the book a
copy of your book it’s on my website and it’s also linked on my facebook under
products so if you hit shop on my Facebook page you can you can find that
but yeah on my website you could there’s a direct link to it my my big caricature
face pops up so you should be able to see it if you’re watching it not
watching it live we’ll have all our contact information
since I’m plugging your book I’ll plug my book too absolutely
this is a good book for 2019 a book club for your office yes this is step away
from the drill and I wrote this for dentists to understand what should be
happening in the front office to get the front office and the doctor connected
because we understand most of our doctors don’t understand how to run the
front office so that’s the end of our commercials that’s a good book everybody
should have it I love it because it is it’s really high-level and I like that
it’s not just your basic you have to run a report it’s more level than that I
love it thank you I think this is a good combination
everybody should get this for your Christmas yes this yes the way today is
going to work we just wanted to introduce ourselves and you know a lot
of times we hear these webinars you don’t see the faces behind the voices so
we want to introduce yourself this way for those of you that are live on this
webinar with us there’s a chat function that you can click on too and somebody’s
already put a chat in there that says love that book I think they’re talking
about your books so we’re super excited about that let’s see am i Suzanne
what I’m gonna do is I’m gonna monitor the chat wall Theresa is talking today
and I will jump in with questions and stuff you have so please put in
questions along the way if it’s on the topic she’s talking about I’ll jump in
and make sure we get it answered if there’s something a little bit kind of
off in one you know just something special for your office or doesn’t
follow today’s topics we either Theresa and I will reach out to you about that
so make sure this is active we want to try to get as much knowledge from
Teresa as possible in the time together so Theresa if you want to go ahead and
and share your screen with the PowerPoint we have and we’ll never know
let’s do that okay all right and so what I count on you to let me know let them
know or let me know that it’s going alright yep I will if it’s not moving or
something I’ll jump in so okay sounds good so video there are two just said oh
you want me to do that yes how do I stop it let’s see here okay
alright so when Laura messaged me she said give me your top five dental
insurance questions and I was like oh my gosh like you know it’s not five I have
like a million every time I speak and and it really just kind of goes to the
whole environment where just insurance is becoming more and more hard to work
with there’s a lot more confusion out there and then added to it is a constant
flow of new people coming in who don’t understand insurance and so they’re
they’re struggling to learn the customer service which Laura does such a good job
with they’re struggling to learn the marketing they’re struggling to learn
even how to talk to patients and then we throw on these insurance issues it’s
kinda it’s a bad it’s kind of a bad soup that’s out there and so hopefully if you
have somebody in your office that is brand new to insurance and doesn’t quite
understand it what I would love for you to do is just do a full stop give them a
book to read either my book honestly I would love for you to look get Charles a
split Charles Blair’s administration with confidence the coding with
confidence is great but the administration with confidence is a
really good book to have get the ad a companion guide basically this there
needs to be like an immersion into insurance because it’s such a huge part
of your office so let’s move on to the top five insurance questions here
because I’m gonna actually jump in on that because you and I agree on that a
hundred percent we um I do some basic insurance training on my core courses
I’m for an office rocks and what we have to understand is that when it comes to
patient care customer service talking with our patients a lot of times we get
into that insurance discussion and if you get somebody new who’s not confident
not trained you know case acceptance is so important and making sure we’re
quoting correctly and that we’re talking to patients correctly so don’t just
throw a new person to the Wolves help them out there’s enough resources out
there like you said Charles Blair you me get the training that these new
employees need because in the long run it’s going to backfire on you and your
patience in your in your care if you’re not training your employees correctly so
I 100% agree with you well and just just to illustrate that point Laura I was I
shared this in my I’ve been sharing it lately because it happened actually at a
Dom I was giving them beginners insurance course which I give almost
every year at a table so if you need that we’re gonna be there at that
meeting that’s that American Association of dental office management so it was a
beginning course couple weeks before the course I get a question via email and
the lady says or the girl I should say it’s a girl says are you gonna go over
what a deductible is and I Wow this girl is in charge of collecting money and
doing the finances so I called the girl I emailed her back and said of course
I’ll definitely go over that but I called her because Laura I can’t know
two weeks like letting this person not never did so I called her we explained
it I explained it she understood it but her story was she was hired it’s a new
dentist office she was hired you know money’s not flown so they pretty much
went with somebody who’s brand-new with no experience and here she is presenting
treatment plans and filing claims and she needed a lot more help than just
what’s a deductible but she’s she’s on her good path now she is she’s learning
but yeah and I’m sure you run into that all the time it’s kind of super scary I
think doctors just assume there’s this level of knowledge out there and that’s
not not true no identity to signed up for for an office talks on a Sunday and
he lied about it with me and he had just let go of his office manager and this
office manager was the only person in the practice who knew anything about the
insurances because and so here he is owning a business that he didn’t even
understand you know how the majority of it works so that we yeah we add the
training into it okay so let’s get started on the hot topic yeah you were
saying you get this question a lot too and I get this question a lot so 4346
was a new cone kind of burst out onto the scene we’re getting used to it now
because it’s been around but what this is basically is it’s not a difficult pro
fee that’s the number one thing that we need to get across so the issue with
4346 which is scaling in the presence of generalized moderate or severe gingival
inflammation i would like to call out the word generalized
generalized means its present throughout the mouth localized means it’s in one or
two areas right so generalizes throughout the mouth so that’s the first
criteria that’s got to be met moderate or severe inflammation is the other
criteria that has to be met and in order for you to see that there’s an
evaluation that needs to be done so you can’t just spot inflammation across the
room and it works although Laura as dental people we can
spot it across the room however we need to do an evaluation and it has to say
either moderate or severe it’s got to be throughout the whole mouth so the issue
with this code is that there’s a lot of offices out there who just kind of threw
this in the mix and said okay well if 4355 doesn’t fit which is debridement
and let’s use 4346 if they’re not quite ready for a scaling and root planing
then let’s use 4346 which is not really the intent so if you have a patient who
has a lot of puffy gums they’re bleeding but they don’t have any bone loss that
means that they don’t have a lot of pockets so if they don’t have a lot of
bone loss and their gums are just puffy and itchy could be that they haven’t
come in awhile could be that they stretched and stretch they started
taking new medication that caused their gums to be inflamed and that happens all
the time it could be that they’re pregnant because pregnancy does cause
and some women on gingival hyperplasia which is basically huge puffy gums there
there’s a couple reasons why you would have what looks like a disease but it’s
not a disease it’s just puffiness so in inflammation so this is not code that
you can pretty much just throw into the system and have it apply across the
board it’s it’s very specific now the issue that I get at the issue I hear all
the time is that okay they’re not paying it as a 4346 and what that means is it’s
a little bit different than a pro fee it’s not quite a perio maintenance it’s
not quite on the same level as a 43:55 when I charge a 4346 it’s not paid at
the fee that I assess it’s paid it’s downgraded to a 1 1 1 OH
so there are certain plans that will pay a 4346 100 percent some plants will pay
for it at 80% after deductible what I
see most often though is that its downgraded to one one one oh and paid at
the percent of preventative percent that’s pretty much what we can expect
for now when we have a new code there’s just not enough data for us to for the
insurance companies to figure out what to do with that code so it’s going to be
like this for a while and until some studies and data come across so my
advice to you is to assume that 4346 is going to be downgraded to a 1-1 100 and
if it’s not then good surprise cherry on top but if you have a 43 46 and it gets
downgraded to a 1 1 1 know according to your PPO contract if there’s a fee for
43 46 that’s the that’s 50 you should be allowed to charge just cuz it’s
downgrade it doesn’t mean that you write it off it’s very similar this is the
exact same situation as a composite being downgraded to a silver filling so
Laura I gave your readers the the actual complete description of the code from
the code book because and I highlighted what I think has to be in the
documentation for it to work if you feel strongly that the 4346 should be paid at
a higher level you can always appeal but I can just tell you in my in my
experience it has not been successful to appeal it but they will let you at least
charge up to the 43 46 is this around the same lines as what you get the
questions in your courses yeah for sure and I actually have a
couple of questions for you just for I mean I’m like I said this is not my
forte okay so I’m just gonna be a new user like some of these people listening
I’m sure sorry how often does the 88 come up with new
codes because I remember this being the big talk last year oh we’re gonna be
able to get paid more and it’s a new code how often and then I noticed that
it a da comes up with one thing but that doesn’t mean the insurances keep up with
it or pay on it can you talk that’s a really good question actually because
what a lot of people don’t understand is that just because we have a new code
doesn’t mean that they’re gonna be paid for it so I always always push that out
and you know every year I give a coding update webinar and I can send your
readers the link I think it’s January 7th or 8th that’s um and it’s basically
just we’re gonna go over the new codes and I always say in this webinar you
will not necessarily get paid just because there’s a new
for example we have new codes for next year we’re gonna have for copying
records I mean who’s gonna pay for that new basement we have a code for it so
the a da is comprised the code maintenance committee is comprised of a
couple different organization which are the specialty organizations Hospital
Association Center for Medicare services CMS the government that’s the government
the deltas and a lot of the other insurance companies so there’s a lot of
players at the table so they meet every year you can submit a request for a new
code if you go to the CDT page on the ADA website you’ll you’ll see it you can
request a new code but you have to be really good with the documentation on it
so so then they sit around and they debate it and they decide whether or not
it’s going to go through 4346 is a great code because it does fill a gap however
I know it’s been hailed as like the second coming of coding and it’s just
it’s not that useful code but it’s definitely not the most fun code to deal
with because of the downgrade so speaking of that now talking about
implementing it conversationally with patients between I’m sure the hygienists
love this code doctors or I mean I saw everybody talking about it but then we
also have to make sure we have that conversation with the patient so do you
have recommendations of like how we explain this saying you know this is why
is it is it kind of like because well I get frustrated with is when we tell a
patient they need to have you know a pareo maintenance and then the insurance
that says do it as a pro fee and now we’re arguing with the insurance about
what we actually did versus you know what they’re telling us to code with so
do you have any recommend sure yeah and same thing with 4910 you can tweak it
you can tweak the 4910 conversation but let’s talk about 4346 so it all starts
clinically and the doctor will say you know I hate to tell you this mrs. Jones
but you’re you’ve got a lot of inflammation and I really want to take
care of that first before we move forward with figuring out how your gums
how healthy your gums are and if we need to address that with other work what we
need to do today is a different code than what we normally would bill for for
cleaning so I don’t want to bore you with all of the the details on that but
you know I know you plan to come in here today and have the cleaning done
I need to do a different procedure because of the inflammation so I’m not
saying you know I feel like we I’m not saying here’s what we’re gonna do is
gonna cost you a lot more I’m really tying it back to the condition I see in
the mouth because that’s hard to argue with right I mean the person’s got
inflammation so you know based on what I see going on in your mouth I wish that I
could do what we had scheduled today but I need to I need to Zig a little bit
because they’re what you have calls for something different gene a front we’ll
talk to you about the fact that you know it may not be covered the same as a
regular cleaning appointment a normal cleaning appointment but she’ll work out
the numbers with you on that it’s not going to be a huge amount out-of-pocket
and in my experience some insurance companies even cover it completely so
I’m always if a doctor or a clinical team member is going to talk about
insurance I always want them to say it shouldn’t be a huge out-of-pocket they
will make sure upfront but I I do believe you need this and you need this
procedure so I’m never going to say though that everything is covered a
hundred percent that’s the number one take away from that
exactly and that’s where I think I train it’s important that the console staff is
comfortable with having those discussions because if they avoid that
been a patient and just assumes they’re getting a pro fee and then they’re upset
later at the front office because we didn’t have we didn’t have that
discussion about this once you have a 4346 if they down great can you do a pro
fee after or know is this supporti yeah you can do whatever you want to you can
do a pro few right afters in many cases that’s the appropriate code because the
inflammations gone down and now you can actually do full prophy but because of
the patient’s benefit limitation you mean if it’s every six months then
obviously that necklace gonna be out of pocket if it’s – per year then you’re
gonna have to make sure that the next one that you do six months down the road
is going to be collected from the patient so yes so you can do whatever
you want to it’s just the fact that you’ve got to make sure the patient
knows the benefit limitations exist and it’s an oh by the way your insurance is
not going to you know blah blah blah I don’t want you to put the fear of God
and I’m just basically let’s see how your benefits work with it but we plan
to do this okay and it’s not a you know in the past I’ve heard once a 42 nine
ten once a pareo maintenance always a
pyramid and pareo maintenance that’s not the case with 4346
this can or one time only and then never again right well one time only and well
I don’t know maybe three years from now they’ve got another set of medications
going again or they’re pregnant again but but in your situation when you’re
talking about like this one visit for an evaluation yeah it should be just a one
time I can’t imagine that they’re gonna come back in and need it you’re gonna
want to move them at some point to some sort of surgical intervention yeah got
it okay wonderful that’s great hey one last thing I guess do you see the
insurance companies moving towards pain sure that’s like do they keep up with
the new codes over time once they see enough codes getting submitted oh for
sure yeah we saw that with we saw that with forty three forty or forty three
eighty one which is the arrests and it’s not arresting but it’s the antimicrobial
we saw that a lot so a lot of plans have picked up paying on that a lot of plans
picking up on paying for adult fluoride whereas before it was not covered so
yeah I think I mean they take a look at utilization they take a look at what the
employers want that’s really what’s first and foremost unfortunately what I
have seen with this code and hearing from offices there’s not a lot of
pushback on this code which is going to affect how the insurance companies to
say whether or not they’re gonna pay for it but let’s go back even further I
think there’s not a lot of pushback on this code because I still hear a lot of
offices and don’t use this code they don’t want to use this code or they
don’t even know about this guy yep okay yeah push them the higher
chance we got alright great so that I think that’s a great great explanation
for that what’s our next top five oh boy radiographs radiographs radiographs so
and I kind of just was in a goofy mood bitewings FMX the CBC T oh my because those
are the questions that I typically hear all the time there are so many
restrictions now on radiographs and I’m saying radio brass I know when we talk
to our patients we say x-rays a lot but I just want to share I got dinged one
time by a doctor because he said they’re not x-rays they’re radiographs x-rays
are the beams that are made that use we used to make the radiographs and he was
very very set on that so I almost feel like I got scolded that day so I kind of
I say radiographs now that’s because I used to say the word staff
when I talk about the team and staff as an infection team and I was like oh and
so now every time I see the word staff I’m like change it to team I know I’m
senior but yeah but being called out on that in the middle of the class was like
oh that was a young speaker you know I was like oh my gosh like melting into
the floor but anyways so radiographs what we see a lot now are bite wings
being restricted to once every 24 months which is not you know used to be once
that once every year we’re seeing a lot of once every 24 months FMX is of course
we’ve noticed have been going up to six times five years sixty months that has
been around for a while I don’t see a lot of three years
I keep hearing also from plans that plans that were I’m sorry from insurance
coordinators that plans that were FM x three years four years now all of a
sudden our FM expert for five years so we’re starting to see that CB CT you
know I just want to address there’s always these Facebook groups are great
and I love that we shared is sometimes there’s information on these groups that
isn’t quite accurate the CDC Ts I hear people put in there do
CDC T’s get covered and there’s always a string of no no no no no and that’s
that’s not accurate there are definitely some payers who pay CDC t and I’m not
talking medical MetLife has been paying CB CT films for a long time so I mean I
used to do implant coordination I used to treat I used to teach implant
coordination for the I COI and even back then they were paying CBC teams about
ten years ago so I there’s still their benefits for CB CT now do I see that
increasing no I don’t I’m in effect I just attended an insurance industry
class where they said there’s a high the rate of CBC T is rising but the payment
has been steady for a while so until we hear kind of an uproar from employers or
until it becomes known as the standard of care which I don’t see that happening
for regular visits then we’re that’s still going to be a fringe benefit but
it’s definitely reimbursable so I don’t throw the baby out with the bathwater
they’re a couple of things here that aren’t specifically to coding but I just
wanted to point out one of them is you mentioned be careful in groups and I
follow a ton of social media groups that we’re all
there’s so many of them it’s almost too many yes be careful who you listen to
especially when it comes to coding when it comes to patient I I get a lot of the
questions about you know patients mad how do we handle this balance and some
of the people and some of the doctors out there it’s like they’re not really
necessarily I don’t know I just be careful who you listen to you especially
when it comes to coding make sure you listen to somebody like Charles Blair or
like you Teresa or people who know what they’re talking about it’s a little
scary I mean some of it and honestly if I were to go in and correct
everyone are gently correct everyone I would do nothing because I would prana
that’s how much information is out there that’s that’s not exactly correct and I
mean god bless the people wanting to help I get that and I appreciate that
but hmm you know all right so let’s talk about what do you say to a patient who
you know once just do what insurance says but your office would prefer that a
full set of radiographs is taken every three years because that’s what your
doctor thinks is appropriate this patient meets that criteria they’ve got
a mouthful of you know old fillings old crowns or whatever every waiting every
five years is tough on this type of adult situation so you know every three
years is really what your doctor wants and in some cases we have some patients
who have just rampant issues maybe it’s two years so change it as you need to
here’s some herbage for you you know your plan provides benefits for a full
set every five years but what we found is that many patients need this more
often than that so five years is great for patients who’ve never had a cavity
or they’re young but in your situation we’ve worked with your before you’ve had
cavities you’ve had crowns and I don’t think you want to wait for us to catch
it down the road so I’d like to catch it sooner my preference is three years so
and and what I just did was I explained I acknowledged the objection but I
explained why it was specific to them and that is really hard to argue with
because honestly what what patient is going to sit there and say well you know
we’ll just deal with it when we get it to it so if somebody definitely has a
issue with payment maybe they’re on a fixed income they absolutely cannot
afford it then I don’t think that we need to be so harsh on them people have
their Rees but for the most part you have patients
who just see that it’s covered every five years and in their mind that’s all
they can do they don’t think past the limitation they just assume that must be
the rule I so and here’s another another follow-up to this is all there your
insurance is not going to chip in for these images of your back teeth I’m
talking about bike lanes we need to see them to see what’s going on between the
teeth and I’ve watched doctors you know really nailed this conversation where
they basically put their fists together and they like like you’re you know kind
of a like a boxer you put your fists together and then you ask a patient can
you see in between my fists because that’s really the size of the teeth what
I’m looking in the mouth I can’t see in between there without those x-rays and
patients you know they’re they they don’t realize how thick teeth are
honestly so you can show them that and I think x-rays are great to show them on
the screen but when was the last time any of you pulled out like one of those
models the 3d models of the tooth so that they can except see just how thick
those are I mean we can’t see it visually so so don’t be afraid of the
limitations with radiographs but I will say from the ground level this is
becoming a huge pain point because these are the small little bits that we have
to send statements for we have to chase patients for this so yeah and a lot of
this a lot of this is a philosophy change in the practice so if you’re if
you’re running a practice based off of what only what the insurance will do
then you’re gonna it’s going to be a lot harder but if you’re running a practice
or your doctor has the philosophy of we doing what’s best for the patient then
you get books like you know Teresa’s book and in my information to help you
with the verbal skills because like you voiced it reso is perfect and somebody
asked about getting a copy of this this is gonna be recorded this webinar it’ll
be on YouTube you guys can refer back to it later and of course I’m sure you have
all of this in your books and more things and then we have a questions on
documentation is there a particular notation to submit for a CD CT or do you
document why patients are refusing x-rays do you have thoughts on that type
stuff yeah so there’s two questions there so that the CB CT there needs to
be a diagnosis for why and this is actually for already guess we there’s it
needs to be a diagnosis for why you need the CB CT and
it could be because your implant you know you’re doing some planning or you
need to see the structures because of you know whatever surgery you’re
planning on doing so always have a diagnosis and a reason and then you have
to make sure you’ve got the right code is it a 2d image 3d image as it
reconstructed is a real imited field is it’ll you know big field so you have to
make sure that that’s all and I apologize there was something when
you’re going on with my dog did you hear that that was awful is in the background
learning about Cody Griffin is a very good insurance coordinator by now he’s
heard enough webinars so yes so make sure that you have the reasons and then
also who read it because you know who reads it is different than who takes it
a lot of times so I always make sure that you have the person who read it and
then what you found off of it a lot of times we don’t even write what our
findings are so have all of that documented and then the last question
what wasn’t again because that was a different location every fuses x-rays
yes yes so the patient refuses x-ray so there’s two reasons a patient refuses
the x-rays one is that they have maybe read something and they’re really
nervous about it or two they are they actually are very scared in the
radiation because maybe they’re going through chemotherapy or something like
that section two I totally get I understand section one is really all
about educating them on that so if they if they come in and they don’t want
x-rays taken you know may I ask what what is the reason and if they give you
one of those reasons where they saw you know the view talking about it or
whatever you know actually radiation is very low you actually get more radiation
walking around outside than you do with our radiographs and we get our media our
machines calibrated I you know it’s very low we have the collar I mean you can
kind of tell them all about that and then what I always say is there is it’s
really really hard for the doctor to really get a good look at everything
without those radiographs so honestly he or she may feel that they can’t do a
good job with your evaluation today without those radiographs we may have to
do an incomplete evaluation which means we can’t give you a true picture of
what’s going on in your mouth and because honestly I’m not I’m not staring
them that’s the consequence it’s true that’s that’s absolutely
consequence so I have worked with two types of doctors one type of doctor will
give them one free pass and just you know beg them basically to take white
wings and then I have worked with other doctors that just say you know I’m sorry
that maybe you need to find a different office I just can’t do that and when the
patient sees how dedicated you are to that maybe they change their mind as I
age I am now firmly in camp number two if a patient comes in basically asked to
tie your hands tie your doctors hands and doing a diagnosis basically asking
you to do a diagnosis without an explorer and a scaler you know like what
am I doing here so I would I actually would not even bring that patient in as
a person as a patient record I agree with that and I should talk about that
in my book too because your doctor needs to be on the same page and it helps with
the line in the sand so in order for everybody we have questions coming in
but some are a little bit more specific about different things so I want to make
sure everybody listening to this live we will make sure these questions get to
Teresa so make sure them for you specifically but since we have five
things halfway through I’m gonna let Teresa get going on number three and
what I’ll do too is I’ll probably do a video I’m answering all of the questions
and we can we can both share that on our site so okay so help my buildups never
get paid I know so this is what I hear all the time build ups are getting
harder and harder to get paid I’m giving you here the criteria that you’re going
to need in your doctor’s notes to get paid that doesn’t mean that your doctor
makes stuff up obviously but the criteria for buildups is really dr. born
Christian is so well-respected he can’t he basically came up with this and then
a lot of the plans looked at it and said okay that’s our criteria so run this by
your doctor and see if your doctor can change the notes to incorporate this
information if that’s present most of the time your doctor is fulfilling these
recognized requirements they’re just not putting it in the notes now the reason
why I wanted in the notes is that you insurance coordinator can then grab it
and put it into your narrative or if you’re an insurance Corre that just a
screenshots of the clinical record and that’s what you send
with your narrative at least it’s sitting right in there in your narrative
so how many millimeters were removed that’s super important any recurrent
decay that was removed that’s super important um periapical and bitewing is
definitely needed if you’ve gotten mms better but bitewing is really what i can
use interaural images are just so needed right now and I’ll tell you why there’s
a couple insurance companies who have changed their policy now and if you’re
in network this is a big pain because you’re pretty much forced to do this
they have changed their policy now to require an intro image prior to the bill
being placed so the doctor has drilled out all the decay before they prepped
for the build-up stop taking intro image after the build at this place stop take
a picture of the build-up that is actually in place before the prep now
there’s two questions I get for this number one is why what the heck and now
the big answer honestly is fraud so crown bill’s have been easily claimed
and pretty much really hard to prove that they’re actually there because you
know you have to destroy a crown to show that it’s there second is there are many
doctors out there who are billing crown billed us with every crown and so it’s
again it’s a very highly fraudulent code so couple tips on buildups what I would
love for you to do is build for the buildup if it gets denied hold on to
that because you’ve got a document Control Number they’re the claim ID
number same thing document Control Number a claim ID number I want you to
either call or write an appeal with the date that the crown was seated and a lot
of times your insurance companies will pay for it once the crown is seated so
what a lot of offices do which I’m and this isn’t even one of the questions but
I’ll just bring it up here what a lot of offices do is they hold the build up in
the crown together and build it all on the seat date which honestly just
doesn’t make a lot of sense to me i bill from most of my build ups and crowns on
the prep date unless I know for sure that the seat date is what they’re going
to require the example is Delta so a lot of you are sending in the build up on
the prep day and then holding on to the crown
on the seat date and then it just becomes kind of a big mess according to
the insurance company so they have policies written where the build-up is
allowed but the crown has to have been done so if there is no seat dates
submitted with the build up then it’s gonna look like the crown wasn’t done
and that’s and it’s not necessarily somebody sitting there you know coming
up with little crazy ways to not pay you this is written into their their
processing policies where not even anybody looks at it it’s just kind of an
automatic denial in many cases because there’s a buildup being submitted with
no seat paid so in your narratives if there is a seat date already go ahead
and put in that seat date if you haven’t seated the crown I would submit the
build-up if it comes it back tonight then you’re gonna resubmit with a seat
date or you can hold on to both and submit them both with the seat date and
make sure your narrative says build up and crown performed build up was done on
this day see data sustained so build ups are very very confusing and I definitely
can tell I haven’t even looked at the questions but I can just being a Swami
here I can tell that there are more on questions on this because this this can
take up a good half hour of a lecture for sure you know it’s funny to say that
there’s no questions at this point I think maybe you could wait were you you
know the questions that people are going to ask
that’s excellent yeah good but if you do have a question don’t be afraid to put
it in there because I definitely want to make sure you get this straight because
build ups are expensive it’s a hard ride off to take and I just don’t I don’t
want you to have to do that I think your images are a huge thing no matter what I
mean I recommend taking pictures all the time along the way because it’s better
to have it than not you can’t it’s tough though because there’s a lot of I agree
with you it’s tough though because there’s a lot of doctors who have had a
clinical flow going for years you know they’ve been doing the same thing for
years of doing it well and all of a sudden because of documentation they’ve
got to stop their flow and introduce you know an intraoral image and it’s just
it’s it’s tough but if this is what needs to be done for you to get paid I I
want you to get paid so you know a little bit
we actually trained our dental assistants for that and so for each
procedure that we want certain things the insurance coordinators we have like
a check sheet for the assistance so that they is not because they’re a little bit
more in tune with what we need especially if they’re somewhat cross
trained versus the dentist who’s been doing at the same way so have the
conversation with other people on the team to not just the doctor excellent
excellent okay so here’s a here’s a common
complaint that I mean obviously Laura you’ve got this down in your office but
I think other offices I mean we hear it all the time I clinical doesn’t give me
what I need so I wanted to just give you a couple tips and I’m not going to tell
you what you need obviously you know what you need from clinical what I want
to give you tips on is how do you talk to your clinical team about it so it
doesn’t sound like you’re just a broken record I know from being a manager for
years that you know definitely there are some assistants who just tuned me out I
get it sometimes I’m saying the same thing so I always I want you to think
about it in a different way I’m not gonna stop back there and say you know I
could have had this paid if I’d have just had that x-ray that I told you I’ve
been wanting you know for years what I’m going to do is kind of attack this a
little bit more proactively I’m going to insist during regular team meetings that
we go over insurance changes there may not be a lot of insurance changes but
you know what there’s probably going to be a lot of insurance changes and part
of any regular team meeting your monthly meeting I guarantee you that some of
your team members are going to have questions about insurance or they heard
something funky and they want to run it by you but you know we’re busy all day
and they may not they may not remember it I’m not saying having insurance
focused meeting what I’m saying is maybe make an insurance quarter like 15
minutes of insurance any questions on it here’s what I’m seeing and during that
time you’re going to reinforce so this is a this is a regular reinforcement
this isn’t a ad hoc or something goes wrong and you jump up from your chair
and you make sure you write a memo and you put you post-it notes everywhere you
know that’s that’s managing that’s reactionary managing right this is us
being proactive so in my meeting I’m going to say you know insurance changes
a lot I want to give you regular updates on documentation requirements and go
over it again not don’t make it a lecture but just say you know I’ve
noticed that white wings are with buildups I’m having
trouble getting them paid so if you guys could keep up I’m taking radiographs and
taking intro are images that would really help example is this one and
bring it up when a doctor sees patients name and the actual work wasn’t
reimbursed or it was you’re still struggling to get reimbursed so what
you’ve just done is put a face on a problem so anytime I’ve been in a
meeting and been you know listening in when I when I did full service
consulting I would listen in once the doctor heard that it was a patient and
they would stop and they would because they remember they did all the work
and now I said they’re going to want to help you get that paid and it’s going to
it’s gonna stick with them a lot of times we at the front kind of speak in
generalities like oh I’m having a hard time getting this pain I’m having a hard
time getting this pain try using a patient’s name and see if that kind of
brings the point home a little bit a little trick there another another point
of conversation is saying you know if we’re not able to get paid the patients
become disappointed now what I mean by that is if we’re not able to get paid
we’re not gonna get paid we’re not gonna get bonuses and salaries and all that
kind of stuff so that’s really what I’m saying but what I need the clinical team
members to hear is that this directly affects affects our patient care anytime
as a manager and this Israeli management information here anytime as a manager I
needed to have a correction with my team I never made it personal I never said
you know Kim you never did this or Jean you never did this I always said when
this wasn’t done it affected how the patients were treated patients weren’t
able to get the services that he needed because they were waiting for this this
and this patients become disappointed so I always bring it back to the patients
because really that is that is what it’s all about so I try to tweak your
language on that because clinical you need clinical so it doesn’t do anyone
any good to butt heads with clinical and then doctors support is essential so if
you have a doctor who’s just not supporting you on all of this it might
be worth it to have a private come to Jesus meeting with your doctor and let
them know and not saying you don’t ever kortnee that’s not what I’m saying I’m
saying it’s really hard to get what I need I would appreciate it if you gave
me more support or I would appreciate it if you reiterated what I was saying
there’s all sorts of ways to go about it but it is frustrating when you get a
claim denied and you don’t get what you want with the claim but again try not to
be reactionary let’s try to be proactive about it and now and that’s really great
advice I actually have a couple to add to that because I love this this whole
thing between the front in the back and working together I think is key one is
in the Huddle’s in the morning that’s a great time to remind the doctor the
assistant make sure you get an image of this make sure you get an x-ray and they
can jot it down I mean when we’re in the huddle that’s you know they might not be
thinking about insurance as much as we do but when the morning we say we make
sure we need this one thing that’s a good time to remind them the other thing
is to have a regular meeting with your doctor not just when you have problems
but maybe once a week once a month to just sit down and talk about insurance
salutely yeah patient issues patients upset about balances patients that
aren’t doing treatment like having a real conversation because many times our
doctors just assume patients accept treatment insurance pays they’re good to
go and if they actually see that things
aren’t being paid or patients aren’t doing the treatment that will and like
you said put a name to it I love that I think that’s great yeah and then lastly
just an addition it’s coming from back office rocks we’re actually adding
clinical training to the back office sure to front office rocks it’s back
office rocks it’s not clinical training in the sense of how to how to assist but
it’s training like what you know how the front can work with the back better how
we can offer better customer service and one of the videos I’m doing is how
important it is to understand what we need for insurance so that the
assistance and the hygienists can hear from an outside perspective how the
person is you know from here that we get this
information so reach out to resources like Teresa and myself to help you if
you’re not getting what you need in your practice yeah you know a very
interesting trend that I’m seeing is assistants are becoming insurance
coordinators and I think that’s honestly one of the best career paths for them
because having clinical knowledge I mean I was a good insurance I was a good
insurance coordinator because I had a good
clinical background that makes a huge difference
few of our best schedulers in our practice where our doctor schedulers
were assistants that moved up because they know what the doctor how much time
they need they knew what needed to happen and they understood the flow of
the back so I agree to have a cross trained is a great thing to have mm-hmm
all right so this is the last one this is this is usually like an hour now our
class and and and I gave a whole class at last aid on the more advanced level
class was participation and how to evaluate and you were in the back of the
class I appreciated you stopped me in but it was basically we ran a whole
bunch of numbers we took a look at it so I’m gonna give you the quick and dirty
answers to the most common questions I get about this and I there’s probably
three emails a day I get on these these with these questions so should I get out
of network and my answer is it depends I mean it has to be you can’t say yes no
it has to be intense so I always ask a couple things and I and this is
rhetorically I need you to go and look at the numbers and I need you to to make
the decisions but who is your biggest carrier that makes it it’s usually Delta
but let’s just take Delta out of the equation who’s your biggest carrier
other than Delta how much of your revenue would you lose yes you love if
you got out of that Network and the answer to this is not as much as you
think a lot of people think because it’s say 30% of your practice you’re going to
lose 30% of your practice that’s not the case yes you’re going to lose patients
but there’s gonna be a lot of patients that stay and then if you really have
your act together your customer service together those patients are going to
come back so and people go in and out of plans all the time so sudden death
sentence but you do need to know because you have to make arrangements for
possible loss of income and there are gonna be some tough times which carrier
could you chop off I always look at when I ran my numbers I always look at who is
my least profitable carrier so I have to know my procedure codes right so my top
twenty or thirty procedure codes I’m gonna run them I’m gonna see what my top
procedures are and then I’m gonna take a look at what did my insurance company
pay for those top procedures and compared to what other carriers pay
least profitable is not always the one that stands out to you you you may be
thinking that the most time-consuming is your worst carrier so let’s just Acme
insurance Acme insurance Jeana front is forever writing appeals to Acme
insurance Lee you think Acme is the worst
Acme may actually pay pretty decently but beta insurance over here is the fee
schedule is terrible and you have a large employer group coming in and so
you’re actually losing more money on that my quaint with all of this is you
don’t know until you look so I always look at the numbers what is the least
profitable and then I always do an emotional check with my front office
what’s the most time-consuming the time-consuming piece is important
because there is a cost to labor so you have to think about that if say if gene
is doing nothing but acne appeals acne needs to go if gene the third of her day
is acne appeals well you know that’s probably in line with a lot of the other
carriers but you would know that by running the numbers what’s your biggest
write-off percentage you know it kills me but I’m seeing right off percentage
is getting closer to 50% across the board
I know a lot of offices that negotiate can get better than that but it’s it’s
getting pretty bad out there now what’s your biggest referral source now this is
something that I’ll or I know you have a ton of videos on this on how to increase
referrals and talk to patients and increase your customer service when you
look at your biggest referral sources I want you to keep in mind the 3 out of 10
rule your top 10 refers are going to be full of insurance companies and patients
right if out of the top 10 if at least 3 are not patients you’re upside-down I
even it breaks my heart to say 3 because I would love for only 3 to be insurance
companies but I just know in today’s day and age most of your referral sources
are going to be insurance companies because that’s what you sign up for
right so they should be delivering at least that’s the trade-off they market
for you and they should be sending in patients to you and you give them a
discount but if you don’t have any patients in your top 3 something’s wrong
you’re not paying attention to patients you’re not building that
that day debate that fan base of you know adoring fans that are sending you
more and more patients then go down to the next set so that the numbers 10
through 20 if you see any patients in there they’re referring to you let’s do
something special for those so all of the patients that are referring to you
in your top 20 refers list they should get something special they should get a
thank you they should mean this is this is marketing 101 and I know you’ve got
stuff like on this so and then Laura’s got a really good resource on there you
want to talk about that Laura you’re out in there because it’s funny you and I
get the same questions even though we kind of talk about different areas at
the front but I get that question all the time so I love doing choices saying
about evaluating the insurances and she I was in your class it was great you had
reports out people were looking at their numbers they were shocked by their
numbers what I speak on I kind of follow what you have there but also now how do
we talk to patients like you said some patients will leave and some will leave
and come back and how do we tell the patient’s we’re getting out of network
what verbal skills how do we train our team you definitely want to roleplay
with your team before you drop an insurance so I have a resource there
that’s listed on the bottom if you go to that website we can send you out of
getting out of network a white paper about the steps that I followed because
I used to be in one in office we were in nine insurance plans and we dropped out
of everything up to Delta premier so I’ve been through it I know what it’s
like and so I’ve got a weight paper for anybody who wants it there you go so and
then and of course the other question that I get and I’m starting to get this
more which is a little bit concerning last month or so I’ve gotten this
question a lot should I go in network yeah and the answer is it depends if you
don’t if you you have to run your numbers because if your largest carrier
is one you want to go and network with and that’s that’s not a smart move
because what you basically is giving a huge cut right off the top you want to
take a look at your employers run how many run your employer list who are your
biggest employers in your practice and then find out who the biggest employers
are in your area and I was just talking to somebody yesterday about this if you
have for example Boeing is in your area you can Google
Boeing Dental 2018 PDF and if you google again I’ll say that so Boeing name a
company dental plan 2018 PDF PDF is of course the the form that’s gonna pop up
a lot of times the large employer groups those are those are out there those are
out there for you to read so you can do it that’s my little sneak tip there so
you can you can find out who the big people are in your area and also the
Chamber of Commerce can tell you who the big employer groups are in your area
don’t just go signing up because you hear you might get a good fee schedule
or the doctor down the street started accepting something making a reactionary
decision on participation is probably the worst thing you can do in this
environment is so critical to your revenue to make a good thought-out
logical decision sure sure I agree with that 100% and there are companies out
there I’m sure you refer to something I refer to something who can help you
do your homework I actually met it was a sad story I met a dentist who decided he
needed to go in network and he went in network with his biggest insurance plan
and he’s now losing I think he said he wrote off you know 40% more than he did
the year before and it was the worst decision he ever made and he’s looking
at this now so this is sad yeah this is not plus especially now maybe you can
speak to this for a minute or two it’s right more and more groups are like
umbrella organizations for different insurance plans where you’re you belong
to one but now you’re in a network of insurances and you don’t really know
that if you don’t do your header homework ahead of time mm-hmm fine
that’s growing more and more oh yeah that’s that’s actually what we’re gonna
be with or that’s what we’re gonna be dealing with in the future is you’re
gonna sign up it’s actually going to simplify wishes this has come around
about five years ago it would be nice to sign with one and be part of many what
problems the problem became people were signing up with one and thinking they
were with one so there’s a lot of offices now that when they are signing
up they’re aware that it’s an umbrella plan a lease network and that’s actually
I think that’s okay because you can get a pretty decent B there’s some that are
the pits and some that are really good and again this is really important if
you go on Facebook and you ask what are good networks to be in and people give
you all their information it’s regional people it’s not you know who
gets a good one from kiha over here is not going to get it from from them on
this side on this coast so it cannot be these blanket answers these generalized
answers that people give out I really just do your do your due diligence call
call the Dental Society go to a general office meeting go to your local Eitan
chapter ask around and find out what your what is the going rate in your area
and and understand to that your dentist get advice many times from other
dentists and other dentists and not as much about insurance as the other one so
yes for homework if your the insurance person and get the facts and present it
to your doctor and go over the numbers don’t just assume when they come back
from a course that you know we need to sign up for whatever plan so one other
question I have for you and this just came to pot for me are we still seeing
that Delta premier is going to go away because I know that was a big discussion
over the last year or two so it’s funny because because Delta is I mean in many
states premier is go is going away but I can’t tell you how many Delta reps or
you know when I speak around the country they’ll come up to me and they’ll tell
me no and that’s in this state it’s not going away like Virginia I always
thought it was going away in the Virginia reps you know told me they
reassure me it’s not going away so I get a lot of reassurances that it’s not
going away but I also hear from the ground that you know it’s getting
tougher and tougher to get a premier Network so again this is gonna be
regional I can’t make a prediction I’ve actually been reached out to by
people who have instructed me that they are definitely not getting rid this is
not just reps any people in Delta so I don’t think I can say is a blanket world
and it’s gonna be gone but I think it’s gonna be harder and harder to get that
premier level yeah and so this is where you and I work
really well together and for anybody listening no matter what happens with
insurance if it gets bigger better worse whatever you’ve got it up your customer
service game you’ve got to understand it you got to know how to talk to patients
about it but I mean patients are expecting more now even if you are in
network for their insurance they’re expecting more so not only should you
balance your time with understanding insurance and write-offs and all that
but you should also balance your time making sure that you’re doing training
with your team on verbal skills and customer service because that’s really
what patients are looking for what and you were absolutely right we flew
through this hour you told me that it was gonna just feel like that and it did
so real quick and I know we’ll go on to the closing slide I have a podcast and
yes Laura is gonna be on it and it’s called nobody told me that so there’s a
couple different episodes I called out here that I think would be really good
for your audience the bullying and why it sucks our friend Kevin Henry we
talked about that and it was a pretty laid bare episode I was surprised by the
feedback on that so I think that that’s something that is really a touchy
subject out there if that’s the situation that you’re in you might want
to check that out non coverage services I talked about and then Laura this is
your webinar I’ll let you wrap up right well I appreciate wheat for those that
we didn’t get to your specific questions we are going to make sure that Theresa
handles those questions for you if you didn’t watch this live if you
find us on you YouTube you know here’s our contact information Theresa and I
both are very similar in the fact that we are just out to help dental front
office rockstars we understand what you guys are up against we were in the
trenches with you and we want to be a resource for you so there’s Teresa’s
contact information there’s my contact information we both are speaking
nationally around the country we’re both at Yankee together coming up in 2018 so
please reach out to us we really want to help you guys we want to be a resource
for you follow us on all our social media we post up Theresa you just
mentioned early on you have your newsletter that’s out there and
available to them right yep so we’re always posting stuff to help you guys
and we want to be you know your resource to go to so Theresa any final words for
anybody listening today or anything that you want to close up with just you know
insurance is not something you learn once and you’re done it changes so often
so at least once a year take it take an insurance update class whether it’s with
me whether it’s just were Shelburne where Charles Blair just somebody some
take a class once a year at least and then my January coding update webinar
I’ll put that on my social media as well sign up for that so you know what’s
coming down the pike for next year and we would love to have you back – Teresa
would you come back and do some more webinars with me are you kidding me any
time right so oh please real neat comments
let us know what you want to talk about you know I’m focused I’m teaching the
basics in the front office when it comes to insurance and Teresa is my go-to
insurance guru so together we can can be a resource for you so let us know what
you want to hear we wish you guys all for those listening
to it live a happy December happy holidays and have fun with those
insurance questions thank you everyone for joining us and we will make sure we
retouch any questions that come our way Thank You Teresa have a have a nice
holiday you too all right thanks everybody have a great day

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