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Episode : Your Billing Playbook

Podcast Description

Josh Smith, co-founder of Dental ClaimSupport, is here to tell you what’s going on in the dental billing world (and even makes it sound exciting)! Josh and Kiera go through a slew of topics, including biggest mistakes dental practices are making with billing, what to do about crowns and buildups, best clearinghouses, tips for insurance verification, and so, so much more.

About Josh: 

Josh Smith attended the University of Georgia and graduated from UGA’s Terry College of Business in 2009. After college, he quickly joined a dental group out of Savannah, GA. He focused his skills on dental billing and management, and rapidly moved out into the field to manage dental offices.

With the combined expertise of billing and management, Josh and his two other co-founders birthed Dental ClaimSupport in 2012. Since then, DCS has been an industry leading dental billing firm that eliminates insurance strain and ensures dentists collect what they produce.

Josh resides in Savannah with his wife and two daughters. He enjoys all sports and is an avid fan of the UGA Bulldogs. He loves fishing and golfing and is always good for the occasional dad joke.

Episode resources:

Learn more about Dental ClaimSupport

Read Josh’s book, Ultimate Guide to Dental Billing and Reporting

Get in touch with Josh directly: [email protected],  

Reach out to Kiera

Subscribe to The Dental A-Team podcast

Become Dental A-Team Platinum!

Review the podcast on iTunes


0:00:05.8 Kiera Dent: Hey everyone, welcome to the Dental A Team Podcast. I’m your host, Kiera Dent, and I have this crazy idea that maybe I could combine a doctor and a team member’s perspective, because let’s face it, dentistry can be a challenging profession with those two perspectives. I’ve been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner and I have a team of traveling consultants where we have traveled to over 165 different offices, coaching teams. Yup, we don’t just understand you, we are you. Our mission is to positively impact the world of dental, and I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress and create A Teams. Welcome to the Dental A Team Podcast.


0:00:51.6 KD: Hello, Dental A Team listeners, this is Kiera and you guys, I am so jazzed to bring on a guest with us today, it’s on all the things that I absolutely hate doing, so I’m super excited he’s passionate about it, and I’m sure a lot of you working in offices probably feel similarly to me, all things billing. So I’m super, super jazzed to bring Josh from Dental ClaimSupport onto the podcast today. He has so much background in it, he is talking about coordination of benefits, if you don’t know what that is, hey, me too. I never knew what coordination of benefits were… All things billing. So I’m super jazzed to welcome Josh to the show. How are you, Josh?

0:01:26.6 Josh: Good, good, thanks for having me.

0:01:27.9 KD: Absolutely. So Josh, I have to know, do you enjoy doing activities, ’cause most of the time billers are unique humans, so just kinda tell me some of the fun things you like to do since you love billing. [chuckle]

0:01:39.9 Josh: Yes, yes, I do. Outside of the office and being a dental nerd, play a lot of golf, I do a lot of fishing, I’m in the Savannah, Georgia area, so fishing is kinda second nature to us people over here, but yeah, play a lot of golf, play with my two little girls, big Braves fans, so that’s coming out with the World Series, and so… Yeah, outside of dental, a lot of outdoor activities.

0:02:03.6 KD: Okay, good. Because, you know that it takes a special personality to love billing, and it was not me. I’m a people person, I love to go out, I love to just be hanging out with people and talking all day long and billing, I was like, Oh, I gotta go lock myself in a room. I became good at billing, but it wasn’t my favorite thing. So kind of tell us, how did you get into the billing world? Give our listeners a little background on you and how you fell in love with billing, ’cause most people hate it. So tell us how you got there.

0:02:32.6 Josh: I get why people hate it, completely, it’s not like I love it every single day. That being said, I graduated with a real estate degree from the University of Georgia. This was 2009…

0:02:41.9 KD: Guys, cool. He’s got a lot of cred right here, I promise, it’s okay.

0:02:43.6 Josh: Doesn’t everybody have that kinda thing, like when they get out of… People get into dental for other reasons, it’s not like you have to be a dentist. But I came out the market crash ’cause I was so brilliant and I got a degree in real estate. That being said, I had to find something and out of the Savannah area, there was a small group, and they had a centralized billing location, a co-owner with Dental ClaimSupport, which is our company actually got me the job. We had to figure something out, and I had a little bit of an insurance background from taking some business courses, but what we’ve really figured out was that there was a need, we streamlined the dental billing process with the group that we worked with out of Savannah, there was eight offices and they all did the billing differently, so we realized like, Underneath the same umbrella, why is everybody doing the billing differently? We figured out there was a need to streamline it.

0:03:30.2 Josh: Once we streamlined it, we looked at it as a game, like, I’m gonna talk to Bob wherever Bob is, with whatever insurance company, I’ve got to fight Bob for this claim, and it became a chess match, and when it boiled down to it, we were like, This is real people’s money, let’s get it in for them, let’s try to have fun with it and look at it as a repetitious kind of job, but we realized that there was a lot of money to be made, and I stand to keep a lot of money in patients’ pockets. Then after working with this company, we realized, Hey, if they all did the billing differently, then it’s probably done differently throughout the United States, and that kinda was the impetus for creating Dental ClaimSupport.

0:04:08.7 KD: Interesting, very cool. So real estate chatty man. You love being with people, see this business side of it. #Thatswhyyourehere. Got it. I have to make these connections, ’cause I’m like, You know, most people with billing, so talk to us… I’m actually excited. I would love you to almost just kind of give a lot of your playbook almost, of what are some of the things that offices can do, what are some of the pitfalls you see commonly. I know right now, a big hot topic is getting build-ups paid on crowns, which really just chassed me because working in dentistry I’m like, Hello, there’s really no way to do a crown without a build-up, and they’re like, Oh, it’s just like one fee. Jerks. I feel like it’s so wrong. So kind of just like roll us through, I’d love to hear any of the tips or tricks that you’ve learned through billing for so many offices. I know Credentialing is a hot topic, you can take it. People ask me all the time, Kiera will you credential and I’m like, Absolutely not. I will not do that for you, it’s not hard, it’s just tedious, but let’s talk about some of the things that you guys run into that are some tips that can really help our listeners.

0:05:11.1 Josh: For sure. One thing we see is there’s not a dedicated person in every office that’s really in charge and held accountable for the whole dental billing process, so a patient calls and makes an appointment all the way to that claim being sent, processed by the insurance and then paid, and then you post it into the software, which removes it from the insurance agent report, it’s not an open claim anymore. That’s the full process. So you see the kink in that chain sometimes as it relates to data entry, that’s kind of one of the first things, everything needs to be correct. Then insurance verification. Was that done correctly? And then what clearing house are you using? That middle man that gets the actual claim to the correct insurance company, then of course, after it’s processed and paid, was it posted correctly? And you actually brought up a great point with crowns and build-ups. We see that a lot too. Now, there’s a lot of insurance companies, they’re all different with their fun fine print. I always make a joke the insurance company is the biggest building you see in any city it’s because they… Why? Because they withhold payment.

0:06:09.3 Josh: Either way with a build-up… Quick little pro-tip, is a lot of times they just need a seat date. It’ll say it’s inclusive procedure, an insurance company out there that does that is Cigna and it’s not… They just need a seat date. All you have to do is call them and be like, Hey, Josh Smith’s crown was seated on January 2nd. They’re like, Okay, great, we’ll pay it, and they send you whatever that fee associated with it is going to be.

0:06:33.4 Josh: Sometimes they just need an additional appeal and you have to appeal it. A lot of insurance companies know that people don’t want to deal with it. They’ll just take the money for the crown and be like, “Sorry patient, they didn’t pay it,” when really, if you just take two seconds out of your day and appeal it, their 95% of bills are gonna be overturned if you just take the time and send it. It’s a fact, we do it all the time, we create templates, it’s not the same amount or it’s not the same wording on every template, we fill it out independently to each patient, whatever their circumstance was and what was going on with the treatment. But you can have a template ready to where you’re not reinventing the wheel every time you send an appeal.

0:07:13.7 Josh: So as it relates to that and little things, data entry, take your time, make sure that you’re putting in the insurance information in the right way, and the patient demographic, because if you don’t put that in the right way, you’re just creating more work down the road, on a claim that would have just gotten to the insurance and paid. Insurance verification, do it 48 hours or two days out, that way, if you have a surprise patient that calls or walk in, you have time to do the insurance verification then, and you’re always staying ahead of the curve, and as long as that data entry is correct and the insurance verification is done correctly, and you have a pretty good clearinghouse, there’s some good ones out there, right? The Vyne Trellises of the world.

0:07:53.2 KD: Tell me your favorite clearinghouses.

0:07:55.0 Josh: I love Vyne Trellis. I think they do a very good job. They work with any software you got out there as far as your practice management software. Another one is Dental Exchange. Everybody’s a little different, but really, your Vyne Trellises of the world, your Dental Exchange, they can do a really good job. There’s other clearinghouses that run through the dental software such as Dentrix or Eaglesoft, your Henry Schein and Patterson products, but really, it’s okay to have a bridge clearinghouse such as the Vyne Trellis and the Dental Exchanges of the world, because you can work so easily through them. And that’s another pro-tip. If you’re sending… Send claims every morning, don’t send them after the day is finished for that day of patients. Make sure that your hygienist and your doctor provider go through and they make sure that what was done in the chair is exactly what’s on that day sheet.

0:08:44.2 Josh: And then send them all the next morning and then fix any validation errors or rejections immediately, and then, because these claims will show up on your insurance agent report 30 days later when you run that report, no doubt, so might as well just fix it and then fix it in the dental software because when the patient comes back for that recall appointment, you’re not gonna have that problem. It’s not gonna be a rejected claim through the clearinghouse because you’ve already fixed it and you’re proactive. That word comes up a lot, right? Proactive, be proactive and be efficient and you’re gonna knock out dental billing.

0:09:12.7 KD: I love that you talked about it and I love that you made it into a system. I’m big on systems, that’s what we teach all the time, but I think so many people… There are a lot of hands in the pot, when it comes to billing, and so, I agree. Do clean entry at the beginning. I had an office and I was just shocked that $2 million in AR, and I looked at that, and then I started just asking questions like, “Tell me your process.” And they’re like, “Oh we don’t ever check our claims before we submit them. That takes too much time.” And I said, “I’m sorry, what? $2 million worth of time,” just asking randomly, because I think we often think like, “Oh, this takes so much time,” but like you said, if we fix it at the beginning, we make it clean at the beginning, it actually saves us so much time later down the road.

0:09:57.1 KD: So I’m gonna just go into insurance verification. What are your tips? Because I have another office that I was chatting with, and she told me, it literally takes her all day long to do insurance verification. And I said, “I’m sorry, what?” There’s tips. I have some tips, but I preach to the choir. So Josh, what are some tips that you have to make insurance verification very quick? Because when I did it, it was not a lengthy… Again it’s like an hour or two hours, I guess it does take some time, but at the same time, you can be very efficient with insurance verification. So what are some of the things you’ve found that can clean that up?

0:10:34.1 Josh: Absolutely. In a book we just came out with, Ultimate Guide to Dental Billing and Reporting, insurance verification is the third step in this eight-step process of getting these claims paid. There are some easy pro tips. One, do it 48 hours out or two business days out, that really gives you time to make sure things have been done the right way, emergency walk-in appointments, things like that. Also, get a full breakdown of benefits on every single one of your patients. Full breakdown is gonna be your 180-50, what their coverage percentages are? Waiting periods, exclusions, clauses, stuff like that, you really need to understand.

0:11:07.0 Josh: The other thing, group all of your patients by insurance for effective and being efficient. Everybody with the same group number will have the same breakdown of benefits. So I don’t know what the trendy grocery store in your area is, but we have Krogers and Publixes, and everybody has their Trader Joe’s and whatnot. If you see somebody coming in with that group number and that employer, they’re going to have the same full breakdown of benefits. So what does that tell you? You do not need to get a full breakdown on the phone or through the web portal, you can just find out if they’re active and they have effective insurance, and then you can see if they’ve used any other benefits and you’re golden.

0:11:43.7 KD: Amen, Josh.

0:11:44.3 Josh: Yes.

0:11:44.4 KD: I’m gonna just say preach on, preach on, because guys, this is so true. Don’t waste time. And so, I had a team member tell me, she’s like, “Kiera, it just takes me too long to go check that. I’d rather just pull it from the website.” And I said, “Why don’t we just do a time. I’ll race you. I’ll check to see if it’s hard to even verify it and you go verify.” Because I think it’s just like that small step of like you said, group them together, they all come in with the same group number, it’s the same benefit breakdown, you just have to check their eligibility and what they’ve used. Preach on Josh. Keep going.

0:12:14.6 Josh: I mean, the last one is a family. If say, Josh Smith and Kelly Smith, my wife, we come in or whatever, they all have the same… If I have the insurance, I’m the subscriber, they have the same breakdown of benefits, so you don’t need to do a full breakdown for every one of my 12 children, should I have 12 children, it’s they all have the same breakdown. So again, there are ways to speed up the process. And guess what? Once you finish and you’ve gotten a full breakdown, and say you get them re-scheduled for a filling of that same patient that you’ve already done the full break down, they’re coming back in two weeks, do you need another full breakdown? No. You just need to make sure that they’re active. So on every single schedule every day, how many full breakdowns do you already have? And then how many new patients or how many are patients with new insurance? Those are the people you’re gonna need to do a full breakdown on again, and then you go through that same process of grouping it by the same insurance, right? Making sure that if they’re on… If they have the same group number, you’re good to go. Yeah, you just need to figure out eligibility and whatnot.

0:13:11.5 Josh: I think a rule of thumb is it should take one person, two hours to verify 45 to 50 people, and I stand by that because I have trained multiple people and I’ve done it myself. Again, I’m one person that, “Hey, I’ve done this”, so I know that it can be done 45 to 50 people for two hours. That leaves you six other hours in a dental office to focus on everything else that needs to be done in a dental office, there’s so many things, but insurance verification should not take up your day. And there are other companies coming out there right now.

0:13:42.7 Josh: Vyne Trellis has their insurance verification program. It still needs to be done in-house. I am a huge component of “Don’t outsource your insurance verification” because if you do, you are not able to explain insurance to a patient if you’ve had somebody else verify it and put it all down for you. Now, I get why people do it, such as the person that was in the predicament that you mentioned earlier, and it can be time-consuming, but you can take these necessary little pro tips and make sure that you can do it in-house, then you have that… Your staff in-house can explain insurance to their patients, and that’s when patients fall in love with you, is when they trust you and they know that they can lean on you to answer those difficult questions ’cause they don’t understand their insurance. How many people come in to an office and go, “I’ve got Delta Dental Insurance.”? You’re like, “Which state?” [laughter] “You need to break that down for me.”

0:14:29.9 KD: I love that. So, Josh, you mentioned that you have eight steps in the billing process. You have a book, it’s super great educational, love it. Kinda walk us through what those eight steps are because I feel like so many… We have a lot of doctors who listen to the podcast, shout out to you guys, a lot of team members, and I will say that I feel like billing in the dental world is kind of like grandma’s chicken for Thanksgiving or your turkey for Thanksgiving. And I’m like, “I don’t really know how we did this or why we did it, but I was told you do this, this and this”, but then you finally get the internet, welcome to our lifetime, and it’s like, “Actually, that was completely wrong, grandma, I should never have been doing this”, but it was passed down from generation to generation to generation. And the first person just made it up, and that’s what I literally feel happens with billing. It’s someone taught them something… Nobody really knows this whole process. So what is your process, ’cause you’ve been doing this, you’re the gurus, you’re the experts? What’s the eight-step process to successful billing?

0:15:24.2 Josh: Absolutely. First of all, I love analogies. I’ve never heard of Dental billing compared to a turkey before…

0:15:28.5 KD: You’re welcome.

0:15:29.1 Josh: Pretty solid, I might have to start using that. Very timely too, with November coming up.

0:15:35.6 KD: Yeah.

0:15:36.2 Josh: So again, appointment-made, data entry into the software, insurance verification, claim is created and batched. That is not the same as sent, you have to go over what exactly was done in the chair. The next following morning, send all the claims to your clearinghouse, work through your clearinghouse to fix validation errors and rejections, and then insurance gets the claim from the clearinghouse, they process the claim and send you payment via a virtual credit card, which I can’t stand, and we can talk about that if y’all want…

0:16:08.9 KD: Same.

0:16:09.7 Josh: Don’t pay merchant fees for virtual credit cards, and they don’t come any quicker than checks, whatever. But either way, claim is paid, either check, virtual credit card, or EFT, which is obviously the way to go depending on the insurance, and then you post it to the software and posting needs to be done, of course, accurately. And then I’ll always say this is not necessarily a step in the process, but if a claim doesn’t pay, you know, we went through that, that was a quick eight-step process…

0:16:30.7 KD: I like it.

0:16:31.8 Josh: And everybody got it, but if it doesn’t pay, where is it? It’s on your insurance aging report. You cannot lose sight of your insurance aging report, you said earlier, $2 million outstanding in insurance AR or just full AR… Those are claims that just haven’t been looked at or paid, and they’re not, trust me, they’re not gonna work and research themselves, you have to do that.

0:16:51.4 KD: You don’t say? Insurance isn’t gonna email me and say, “By the way, it’s been 30 days. Where are you at? Agreed. They’re gonna hope you forget.

0:16:57.4 Josh: I love to get a phone call from an insurer, “Hey, by the way, you have this outstanding claim you haven’t appealed”

0:17:01.7 KD: “Would you like us to pay it for you? We just need this”

0:17:02.7 Josh: Yeah, that would be funny.

0:17:04.0 KD: I love it. Well, and I think… Okay, so you brought up a few pieces that I like to dive into. I love the eight-step process, and then I’m gonna say… I’m gonna put a loop on the end of that of like, those are how you get this paid, but then you’ve also gotta work that AR list, work your unsent claims list, work all those different pieces because that all falls into it as well. But I am curious because a lot of offices talk about… I’m glad you brought up these credit cards because I’ve been out of the dental “office office” and I went into an office and they showed me this and they are like, Kiera, do you think we should sign up for this? And I was like,”Hard pass, h-e-double hockey sticks, no. Absolutely not.” I’m like, “They’re gonna charge you a percentage. Brilliant job on the insurance company, kudos to you guys for being so impressively gross. But do not do this. So talk to me about… ” And my reason for it is, like you said, you don’t get paid any faster and they’re taking a percentage from you… For doing what?

0:18:00.2 Josh: Nothing.

0:18:02.0 KD: Sending you the payment that they owe you? Jerks. I feel very, very adamant on this. But talk to me about EFTs, ’cause a lot of people get very scared to do EFTs because it’s not the same thing of having the insurance actually paying through, and so what happens is they’re not getting those paper checks, they’re not seeing it come through and people get stuck on actually tracking it and posting, because the money’s in the bank account, and they’re scared that they’re not gonna link up, like bank account won’t match software. So that’s a question that I’ve seen come up quite a few times.


0:18:33.3 KD: Hey, Dental A-Team listeners. How has your 2021 been? Is it the year that you always imagined it being? Was it awesome, or was it maybe not your best year, or was it a great year that you know you could enhance? Anyway, as we are looking back on 2021, if it’s been a year where you think you could ramp it up or you wanna take your practice to the next level, or you yourself wanna go to the next level, reach out, we’d love to help you in Dental A-Team Platinum we see massive success with all of our platinum practices, typically a 10-30% increase in revenue, reduction of stress, and reduction in overhead. We focus on teams, top-to-bottom, system development and implementation top-to-bottom, and making sure you’re business savvy all the way around. Guys, it is a season to make a change. You are always one decision away from a completely different life. Be sure to reach out guys, [email protected], and I can’t wait to see you and your practice next year.


0:19:29.2 Josh: Yeah, EFTs, huge topic there’s a few good things to know about EFTs. One, you have to retrieve them as you just said, and then you post them into your dental software. I see a lot of insurance agent reports that are inflated because claims have actually paid and deposited into a doctor’s bank account, but the biller hasn’t retrieved and posted the payment. This can be bad for a dentist because they think they have a lot more coming in than they really do ’cause they’ve already been paid for it, so that’s first and foremost. If you know that you’ve signed up with EFTs for an insurance company, I would say, check these Mondays, Wednesdays and Fridays, whatever the case is I’m not a component of going to 16 different websites every day to post EFTs. That kind takes me… Another thing is a dental biller’s schedule, make a schedule and follow it. And again, post your EFTs Monday, Wednesday and Friday, and post your insurance checks on Tuesdays and Thursdays. Trust me, you do not need to post the Blue Cross shield federal check for $15 on Thursday because it came to your mailbox, it doesn’t need to happen. But you did mention out of sight, out of mind, it is difficult because there’s a tangible thing about a check that, people love.

0:20:34.0 Josh: You’re looking at it, it says $5000 on it, you’re like, “Hell yeah, this is great. This is going into my bank account today”, an EFT is the same thing. It just comes quicker. It’s the same thing. So… And also, there are big payers in your area and there are small payers. I’m not saying get on EFTs because you see one Humana patient a month that you need to get EFTs, because you don’t wanna go to the Humana website every other day for a full month to see if something’s hit. Not everybody has access to the bank account, some doctors don’t wanna give their biller access to the bank accounts.

0:21:08.9 KD: Yes, that is the issue, they’re stressed.

0:21:10.5 Josh: Yeah, they don’t know that anything hit, so that’s why I talk about the schedule of go to the websites two to three times a week. And then your big payers, yes… Your Cignas, your Deltas, your Metlifes, United Concordias, Guardians, all of these people or insurance companies have done a good job of really making their EFTs very easy to access. You can print them out and you can have that tangible EOB in front of you if you’re a biller that likes that when you’re posting payments and you’re taking notes and stuff like that.

0:21:37.3 Josh: And also back to the virtual credit card. A lot of times you get $5000 or $6000 checks, don’t take a 2% hit on $6000 because you just didn’t call and opt out of a virtual credit card, which you can do, you can call the insurance company and opt out. There’s also sites that have been developed here, gosh it, I wish I can do it off the top of my tongue, but you can call in and basically opt out of all of your providers and multiple insurance companies at the same time. They’re going to keep opting you in automatically, which is so annoying, so annoying that they do that.

0:22:12.9 KD: Its dirty.

0:22:13.5 KD: ‘Cause you didn’t call to do it, but you can opt out of those. And, if you wanna go ahead and run the card, you can, and then you can still opt out for future payments, but I would advise everybody to do that. But yeah, you brought up a great thing with the EFTs, do it for big payers in your area, but you’ve got to retrieve these EFTs from the website and post them.

0:22:29.7 KD: I love that. Okay, Josh, I’m gonna pick your brain on one last hot topic right now…

0:22:34.7 Josh: Go for it.

0:22:35.4 KD: We wrap up. It’s fun that you are this passionate about billing guys, if you have questions or you need help reach out to them for sure. So last question is, a lot of people… COVID has been great, and it has really changed, I feel insurances, in the fact that so many offices right now are dropping dental insurance plans, because I feel like they got yuckier after after COVID. I’ve heard some dirty tricks these insurance companies are doing, so people wanting to drop insurances, do you suggest that they do that or are you still seeing that they’re paying as much and it’s just becoming a little bit more of a hustle ’cause a lot of my offices are saying, “I wanna drop out, I wanna go fee for a service, I’m sick of jumping through the hoops of insurance.” What are your thoughts on that?

0:23:17.6 Josh: I hate to say, it depends on the situation, but sometimes it does. If you’re a new doctor and you need patients, the best way to get patients to go and network. You don’t have to sell yourself and your soul to insurance companies. Don’t go and network with the world… I can’t stand when doctors do that. I see multiple dentists that are absolutely crushing it, and they’re not in network with anybody. They still submit claims on behalf of their patients, they assign benefits to their office, and what I mean by assigning benefits is the insurance company pays the office, not the patient. Therefore, they’re still doing the whole insurance billing process for the patient yet, but their reimbursement’s higher, ’cause at a network, you get paid more…

0:23:56.1 KD: Totally.

0:23:57.1 KD: It’s just the way the world… But again, if you’ve got big payers in your area, and we talked about the grocery store, say your next to a big Academy Sports, and they all have the same insurance and these people are coming to you. It’s okay to be in network with those, but don’t be in network with everybody. There’s also umbrella networks and grid networks that I think you’re probably aware of, and a lot of listeners are, it encompasses a bunch of different insurance companies at once, but a lot of times they all have… You can negotiate a higher fee schedule for an umbrella. Good ones out there, Dental Advocacy Group is a very good one, Carrington also has a very good one as well. This is where you can get in network with a few to more than a handful of insurance companies without doing the annoying leg work of credentialing each and every single doctor with each and every single insurance company.

0:24:42.1 KD: To that point Josh, I wanted to ask real quick, what is your suggestion on umbrella companies and how to answer the question of, “Do you accept my insurance?” Because an umbrella company, you’re in network with a bunch, “in network,” and so a lot of front office gets scared of these umbrella ones because they’re like, “I don’t know how to answer this question because I might be or I might not.” So do you have a suggestion of what to say for those umbrella companies?

0:25:02.2 Josh: Well, one, the umbrella should be able to tell you who encompasses the umbrella, who is underneath that umbrella… You should have a list, have a sticky in front of you. I have multiple offices that’s done that. It’s like, well, we accept the grid network fee schedule where there’s Star Mount insurance or random insurance, that we actually go underneath the United Concordia fee schedule or whatever the case might be.

0:25:23.5 KD: Sure.

0:25:24.3 KD: If you have a list in front of you, you can tell a patient that calls if you’re in network or not, that’s what you brought up though, is huge with, do you accept my insurance? Sometimes, I’ve heard billers say, “oh, we don’t”, and it’s just because they’re out of network and it’s like, “yes, you do, you still accept the insurance, you’re just not in network with the insurance.” There’s a lot of stuff thrown around or terminology thrown around in dental because you learned it from the person before you, just like you said earlier, but yeah, have a list in front of you. That umbrella network will tell you the list of insurance companies that are underneath their network, therefore if somebody calls, you can tell them if you are in network and accept their insurance company.

0:26:03.0 KD: That’s brilliant. Okay, last question, I said last time last time, but I’m going…

0:26:06.4 Josh: Keep going shoot.

0:26:07.7 KD: To bring more. It’s great. What are some companies you’ve found that if an office wants to negotiate fee schedules, get higher reimbursement? What do you suggest people do? Do you recommend they outsource it to a company, do you work with you guys… Can they do it on their own? How can people negotiate to get higher fee schedules?

0:26:23.8 Josh: You can do it on your own, negotiating fee schedules is becoming a dying breed. There are people that might want you to disagree with me, but I see it across the board, that’s why these grid networks and umbrellas have been created. Delta Dental simply will go up on their fees every couple of years. It’s… You can negotiate all day, they’re not budging. It depends on the size of the insurance company too. If you have got a small insurance company, maybe not a mom and pop shop or something… Absolutely, you can negotiate with them, but even like your signets who have gotten bigger and guardians who have gotten bigger, they’re very difficult to negotiate with. And that’s when you probably wanna maybe look into the umbrella networks. It’s always worth a shot. I will tell you this, and yes, you can do it yourself. It is simply calling and saying, “hey, I’m on this fee schedule. A lot changed in my area. Can we talk about a fee increase.” Give them a list of your most used codes and they might go up a dollar or two here and there, but over the course of a year, if you’re charging an extra two or three dollars for certain procedures, it’s worth a 30-minute phone call. Again, kinda don’t be lazy about it, but big companies, far less likely to negotiate with you. Smaller ones, yes, a little bit more likely, and yes, you can do it yourself.

0:27:34.4 KD: Shoot. Alright, Josh, that was fun. It was a rapid fire billing 101.

0:27:37.2 Josh: Yes, it was. [laughter]

0:27:39.0 KD: And I Loved it. I love it so much because you actually are someone fun to talk to about billing. So Josh, tell me a little bit about what dental claim support does. So if people are wanting to reach out to you guys specifically, I think that some outsourcing is one of my favorite things, especially with billing, I think it’s pretty cut and dry, and a lot of it can be outsourced. So what are some things that you guys do specifically if people wanna connect with you?

0:28:00.9 Josh: Yeah. So, outsourcing become a lot more accepted nowadays, and I get it, a dentist like, “whoa, I need to know what’s going on, I need to know what’s going on.” But what you get with it is freedom to focus on your patients and for your dental team to actually focus on your patients and insurance verification, presenting treatment, things like that. But what we do is most outsourced dental billing companies, we stick to our bread and butter. I can’t speak for everybody. Everybody’s different, but we make sure claims are sent accurately. We post every payment that comes in and we work every single outstanding claim. We take over after you have created a claim and when a patient leaves, you basically never have to worry about it, and so if you work that first part, I guess the life cycle of a patient will handle the life cycle of a claim. And that eight-step process that I was talking about earlier, so again, and good outsourced dental billing companies also offer that education and training. And we have our 10, 15 minute one-offs of, “hey, this is where we’re seeing deficiencies. I really think you guys can work on this right here. We’re seeing issues with this clearing house.” Let me suggest this one. There’s different things that outsourced dental billing companies can do, and that’s what we do. We also do credentialing for offices.

0:29:13.2 KD: We’ve been doing that for years, as well, so there’s a bunch of different avenues that you can use an outsourced dental billing company for.

0:29:21.0 Josh: For sure. I love that. And I love that you keep the things in-house that should be in-house, so that way the office knows you guys take it over. Do you guys do collections? So if a patient gets to collections, are you calling those patients are you guys just sending statements does that fall back onto the practice?

0:29:34.7 Josh: We batch statements, and we also preach the zero balance system, so I would be a hypocrite if I said, “Hey, let’s set up part of our company doing patient balances because I don’t believe in that. I don’t think patients should actually have a balance if you run your dental bill, if you run your office the right way, you should have collected from the patient upfront. If you’ve done insurance verification the right way and you send the claim off, insurance will pay exactly what they should do where that patient has a zero balance. Therefore I always… We don’t do the patient portion. I know they’re billing companies out there that do, but I’m just a firm believer that collect upfront. How many times you go to the doctor’s… Any doctor’s office, right? And you’re paying a copay, you know exactly what you’re paying, you pull that credit card out, it shouldn’t be any different at a dental office.

0:30:16.6 KD: For sure, and I know a lot of offices that are fee-for-service, they get nervous about pre-collecting. I have a thought process on those pre-collecting… Again, Josh, I’ve just got all these questions that I’m just dying to know your take on. I suggest for fee-for-service offices when they are billing on that patient’s behalf, I don’t know what your take is, I always had at least a 10% drop, so if it’s normally 100%, say they’re gonna collect 90%, if it’s 80, say It’s gonna collect 70, 50 drop down to 40. That’s been my take, but I am not in your world, do you have a better suggestion of what to collect from those patients when you’re out of network and it’s harder to get those breakdowns for those patients because you are out of network?

0:30:51.9 Josh: No, what you’re saying is exactly what I would tell them, especially if the payment is gonna be sent to the office, you pretty much want it to be.

0:30:58.9 KD: Sure.

0:31:00.6 Josh: That’s a really good rule of thumb that you said. But after that, you can actually track it.

0:31:03.2 KD: Yes.

0:31:03.2 Josh: If you post by procedure and you know that $50 is paid for a $55 procedure, you know the next time the patient comes in they collect $5 from you.

0:31:12.0 KD: Correct.

0:31:12.8 Josh: And this is updating coverage books, is what that’s called, or coverage tables, whatever you wanna call them, depending on the software. And you’ll know exactly what they collect the next time the patient comes in, and then patient education. Be upfront with them, “hey, we’re out of network.” They legitimately don’t tell me what they’re gonna be paid… What they’re gonna pay for any procedure because I’m an outer network doctor, but we’re gonna do our best to estimate it. You’re probably going to get a statement from us, and then the next time you come in, we’re gonna know what’s gonna be paid for, especially your recall…

0:31:40.8 KD: For sure.

0:31:43.3 Josh: Your bitewings eval and cleaning and what not, crowns and stuff can get a little sticky ’cause they’re not having those done every single six months probably.

0:31:48.7 KD: Sure, sure.

0:31:49.8 Josh: With that being said, update your coverage booklets, and then that patient, you’ll know exactly what to cover or collect from the next time…

0:31:55.4 KD: Gosh, Josh, so much. So much info. So guys, check it out. Josh you guys have a couple of books. What books do you guys have because that asap billing process, I think would be a great resource for a lot of offices. How can they find it and where can they get that.

0:32:08.4 Josh: Yeah, it’s on our website, dentalclaimsupport.com, or you can buy it on Amazon and there’s an e-book. Get some nice charts and stuff like in color if you like all that, but that being said, there’s Ultimate Guide to Dental Billing and Reporting. We have the Profitable Guide to Coordination of Benefits. Everybody’s fun, exhilarating topic. With that being said, it’s written by one of our favorite people, Dilaine Gloege. And then we have a Profitable Medicare for dentist, the Guide to Profitable Medicare for dentist ’cause that is becoming a more and more problematic issue in offices, and that was written by Glenda Hood. And she is with dental claim support as well. Those last two books will be published within the next month, so look out for those, but the ultimate guide is available on our website, dentalclaimsupport.com and at Amazon.

0:32:54.0 KD: And Josh, you’re sending me signed copies of all those, right? Just because.

0:32:57.4 Josh: Yes, I am.

0:32:58.0 KD: Yeah, exactly. Thanks.

0:33:00.4 Josh: Nice, nice, beautiful letters in it for you.

0:33:01.1 KD: [chuckle] Thanks. Awesome. Well, Josh, this was such a fun podcast. I love it. Guys, reach out, Josh, if they wanna connect with you. I know you mentioned dentalclaimsupport.com. Any way that they could connect with you if they’ve got more questions want to start utilizing you guys, or they’ve got just questions in general on billing?

0:33:15.5 Josh: Yeah, I’m reachable, [email protected]. It’s… We are a family-owned and operated. We keep it pretty simple, and I wanna hear from everybody. And especially if they’re coming off the A-Team Podcast, we’ll offer you guys something so give us a call if you’re up for that, or if you just wanna talk. We’re all about education here, or better ways to do stuff. But, yeah, that, or just go to dentalsupport.com and you can book a call with our sales rep, or any way that we can answer any questions for you.

0:33:42.6 KD: Cool, Josh it’s been so fun. Thanks for making me not dislike billing. I hope everybody else took some good notes. I feel like you guys we rapid fired over so many different topics gave you a smattering of them, which was kind of fun. It really… Let’s just pull in our thanksgiving theme here. We had all the different servings and sides today until they built and build up.

0:34:00.3 Josh: I’m starving.

0:34:02.3 KD: But Josh, thank you, thank you for your time today, and thanks for what you guys are doing, and thanks for making billing not terrible. I love that you broke it down into processes and systems and offices. Billing does not have to be terrible. It can really be a simple process. You can get paid. I love that you go after the build-ups, the crown seat, that’s my favorite one actually, which just makes me giggle. We need another crown seat and I’m like, “You know that’s not even an ABA code, but It’s cool. It’s cool.” I got you insurance company. That was a quick one. [laughter] So Josh, thank you again for being on our podcast, I super appreciate it.

0:34:33.6 Josh: Thank you very much, I appreciate everybody.

0:34:35.5 KD: Absolutely. Alright guys, thank you so much for listening, and I’ll catch you next time on the dental A-Team Podcast.


0:34:42.3 KD: And that wraps it up for another episode of The Dental A-Team Podcast. Thank you so much for listening and we’ll talk to you next time.

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