Episode 71: Expensive Dental Billing Blunders with Ericka Aguilar and Jennifer Lyman, RDH

Unlock the secrets to error-free dental billing with insights from our esteemed guest, Jennifer Lyman, a seasoned hygiene coach and expert in the field. Join us as we uncover the common pitfalls that even experienced dental billers face and how to sidestep them for smoother operations and compliance. From the importance of keeping up with the American Dental Association’s annual coding updates to understanding the nuances of the CDT codes, we gear you up with the knowledge to eliminate costly errors and maximize your practice’s performance. Discover why the debridement code is often misunderstood and how getting it right can enhance your periodontal outcomes.

In this enlightening episode, we delve into the art of meticulous dental billing practices and the critical role of accurate clinical documentation. We emphasize the necessity of understanding Explanation of Benefits (EOBs) and balancing accounts daily to safeguard your practice’s financial health. With Jennifer, we explore the risks of over-relying on templates and the essential need for patient-specific details to prevent fraud allegations and claim denials. By the end of our discussion, you'll have actionable strategies to revolutionize your billing processes and ensure your documentation is as precise as your dental work.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
ericka@dentalbillingdoneright.com

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Chapters

• 0:00 Dental Billing Blunders Discussion
• 15:06 Efficient Dental Billing Practices
• 27:10 Proper Clinical Documentation for Dental Billing

Transcript

Speaker 1: 0:00

Hi friends, welcome back to another episode of the Dental Billing Podcast. I'm your host, Erika Aguilar, and I am pumped about this episode. I have the pleasure of a returning guest, Jennifer Lyman, who happens to be on our team as our hygiene coach. Jen is a very seasoned hygienist slash dental biller, and we often have conversations around perio performance and everything related to hygiene and billing. But today we're going to be talking about dental billing blunders that we see in our clients' offices. Now, Jen and I both own our own dental billing companies and we often get together to talk about some of the common issues that we see happening internally as we onboard new clients. We have taken the liberty of documenting some of these billing blunders and we want to share them with you here today in part. One of dental billing blunders that we see. So, without further ado, let's get on with the show. Jennifer Lyman, welcome back to the Dental Billing Podcast. We have not been on the podcast for a minute.

Speaker 2: 1:28

I know it seems like a while. Life has been crazy it has been so crazy.

Speaker 1: 1:34

I have so many things I want to talk about with the updates to my business and you've got a lot going on in yours. We just haven't had a chance to get together and talk about doing a podcast. So I'm happy that we're here and I'm happy to be back. I think that today's podcast is as a result of all of the things that we vent to each other about, right, and I don't mean vent as in talking about, and I don't mean as in talking about, but I mean venting as in. We wish we could help more by training more people. But we're only one person, right, like we're only individuals, and we see patterns of billing errors, billing blunders. That's why the episode is called dental billing blunders, and the purpose of today's episode is to really bring them to light and then talk about why they should not or should be doing some of the things that we're going to talk about and this episode may turn into a part two depending on how much we get to go through. But my goodness, friends, there's so many things that we see.

Speaker 1: 2:49

Jen has her own billing company. I have a different billing company, but we collaborate with a lot of clients and I will sometimes outsource and, jen, will you know, we reciprocate and we just work really well together and we are very like-minded in how we believe billing should be done, which is obviously. We're big on compliance regulations and understanding state laws as they apply to each individual state, right? So, coming from the perspective of owning two billing companies, we're going to talk about what we see and the stuff that we wish we could help offices more with. So we're going to try and do that with this podcast, so we're going to get into it.

Speaker 1: 3:40

Yeah, let's just get into it, jen, we had a little briefing before I pressed record and we were talking about some of the topics that we prepared. I think, for me, the biggest blunder that I see is experienced individuals not keeping up with coding changes. And I'm not talking about just the additions to the codes, the CDT codes. I'm talking about the definitions, because sometimes the code is not changed, but it is revised in how it is described. Right, because the purpose of these codes is to describe. As you always say, jen, you always tell your clients you know this code more accurately describes what you did.

Speaker 2: 4:35

Right and make sure you're using the right ones.

Speaker 1: 4:38

Yeah, and so staying up to date with the revisions is so important. So three things happen every year, friends. The American Dental Association's coding committee updates the codes annually, and there's three things that happen, and I'm sure there's a lot more, but I'm going to mention the top three that I know of. They delete codes that are no longer, they no longer feel are applicable to dental billing, and that's probably done through a utilization report of some sort. Then they add codes and then they revise, and the revisions include changes in how that code is intended to be used. So in my opinion, jen, I feel like experienced billers are not keeping up with these revisions, and I know this because, through the billing company, we get to see the good, the bad, the ugly right.

Speaker 2: 5:38

Yeah, I mean, we see that all the time and we'll ask them. You know well, what does your coding book say?

Speaker 1: 5:43

You're like, oh, I need that time and we'll ask them you know well what does your coding book say. You're like oh, I need that. Or you ask them do you have a?

Speaker 2: 5:51

copy of the coding book and they're like oh yeah, like 2019 or something. Yeah, you have a current CDT coding book friends.

Speaker 1: 5:59

That is so vital. I think that's one of the blunders that a lot of offices make is not buying, not investing in keeping up with the new codes. Get that book every year 2025, I believe, is going to be out, or it's already out and or I know you can order it. I'm not sure exactly.

Speaker 2: 6:20

Yes, preorder.

Speaker 1: 6:22

So, friends, go to the American Dental Association's website, go get your book, and you can also get it on Amazon. There's no excuse, it's not super expensive and it's an investment. I promise you will not regret updating your knowledge um the coding book, but that's the biggest one that I see. I get asked questions, like I was asked something the other day about debridement. It's not common knowledge on how to utilize that code and it's very. It surprises me every time when I hear someone who's been doing billing for 10 plus years and they say you know how do we use debridement? Or we do these assessments of their billing department and we see that they've only done three debridements in the past 18 months and their perio performance is super low. So that's my first right. So, jen, I'll let you take the stage now, like tell, talk to us about some of the blunders that you see.

Speaker 2: 7:30

Yeah, well, I'm going to start from the very beginning of the billing cycle, which is incorrect verification of benefits. Now, this is the one that we see often when we work with some other companies, or maybe the office has multiple companies in there, you know, helping them out, which I think is great. Verification companies are so needed, but we really need to make sure that that information in there is correct Base. It changes the entire billing cycle. If that's not correct, it's being sent to the wrong payer. The correct payer never received it.

Speaker 2: 8:06

Now we're spending hours on follow-up, not paying attention to the termination date or the effective date, and then when we follow up on these, they're like yeah, we never received it. Oh, that's because we had the wrong verification of benefits in there. So make sure that you have a system for that and that you verify and have reference numbers to everything that you get from that insurance rep, because sometimes, too, we can go back and say, hey, well, we verified benefits and let's just say this for example, fluoride was covered based on this reference number, and I've gotten claims overturned because of correct verification of benefits. So you have to make sure that you get that information and you have a reference point to refer back to.

Speaker 1: 9:22

And to add to your point about follow-up, to rework a claim depending on the amount of time that's put in. I did some research and it can cost an office anywhere from $25 to $150 in productivity to rework a claim. And if you put that into perspective of you know a simple payer ID being incorrect and we're having to rework a pro fee claim and we're having to rework a prophy claim, sometimes you're spending more time and productivity reworking that claim than we're actually getting reimbursed. So we have to make sure that these little bits of information are accurate and I think also, jen, to add to your point, get this information put into your practice. Management software Correct.

Speaker 1: 10:20

Use your software the way it's intended to be used. Don't do workarounds. These workarounds kill, kill productivity. You think you're, you think you're moving right along and you're moving quicker, but you're not using the software the way it's intended to be used and we're just creating a mess on the back end. I know that you know Open Dental really well, jen, so I want to. I want to point something out. One of the areas in Open Dental that I often see overlooked and just kind of left on its own is when you open up the benefits section where you put in, say, for example, how much the patient used for the year right. So say, mid-year, we've got a new patient. They've used half their annual maximum. I see that area overlooked. And then the treatment plan. The software thinks that the patient still has, say, $2,000, when they only had $1,000 remaining. Nobody bothered to put that in the system. And now we have a nightmare, not only with how we presented treatment, but we're going to have some denied claims.

Speaker 2: 11:32

Yeah, yeah, there's that in the subscriber. I see that so often in open dental too, because you can just add it and it automatically says self and a lot of people won't change it to dependent or spouse or whatnot. And then we get claims paid for the subscriber when it's the wrong one and billers need to be able to catch that and know this is a dependent of the subscriber and be able to change that ahead of time, because then it's I mean, probably double your 150 mark that you had mentioned earlier because now you're overturning, you're sending a refund, you're changing frequencies and then billing it out under the correct patient. So verification is huge. We cannot overlook it and it's really, really important to spend your time there, especially for new patients.

Speaker 1: 12:21

Let me ask you a question, in your opinion, because I believe that the biller is the catch-all. We are that person, we're the detectives, we're the compliance officers, we are the catch-all to everything. So when a claim is sent out under the subscriber and it should have been as a dependent, where do you place the blame there? I mean, obviously we not blame, as in like we want to point the finger at anybody, but in, in your opinion, who should have caught that.

Speaker 2: 12:54

I think initially it should have been the verifier, because that is when the information gets put in. You know if you're putting it in incorrectly, the biller should catch it. Yes, I believe that, but I don't know that they should be to blame for that, because we put a lot of trust in our office. Right, like, everyone has their lane that they are supposed to master. The doctor is clinical, the hygienist is youist is the oral health specialist, biller is the biller, front office scheduler. That's all on them, right? So verification, if that is your sole job, should be on you, I believe, and then the biller should, yes, catch those mistakes. But we have so many other things that we're trying to focus on and we put a lot of trust in our verifiers, so that that's just my personal opinion, though.

Speaker 1: 13:46

I just did a tick tock yesterday and you guys, I'm not the dancing type of tick tocker, you're never going to catch me doing any of that stuff, but I like to do TikTok, I like to do like educational shorts, things like that, and I just did one yesterday on clean claims and the definition of clean claims. You know the definition of clean claims is defined by Medicare as giving the, the insurance company, the proper information to pay a claim or deny a claim quickly, right. So they want to be able to just have the right information. So I think if our billers understand the concept of clean claims, we have to understand that that has nothing to do with coding. It has everything to do with making sure that the demographic information, which includes subscriber relationship, right, like self-dependent spouse, other. So I think, ultimately, I feel that when that type of incorrect billing happens, I agree the biller should not be blamed for that, but they should have caught it he or she should have caught it right, Absolutely.

Speaker 1: 15:06

I feel like we're not as thorough. And I say this, friends, not because I'm trying to make anybody feel bad, or you know. I want to emphasize this is what we are seeing. We are seeing claims from that are getting paid to the wrong person in the family because we're trying to move too fast, right? So I think there's a saying that I live by and it's fast is slow and slow is fast. So you know, the faster you try and go, the more mistakes you make. So that makes it slow and I guess we should add expensive. Yeah, yeah, right. And then slow is fast because now you're dotting your I's and you're crossing your T's and we're going to get it submitted the right way the first time. So fast is slow, slow is fast.

Speaker 2: 16:03

Yes, I love that.

Speaker 1: 16:06

Yeah, okay, jen, what's your next point, cause you got some good points here.

Speaker 2: 16:10

Yeah Well, your slowest fast kind of goes into the next one too. So mine is how to read an EOB. It seems to be so complicated for some and then I just kind of I I'm very confused why it's so complicated. You know we do a lot of cleanup work and we'll go in and post a payment and then we go back several years to make sure that the account has been audited correctly. And in a lot of scenarios the EOB is attached.

Speaker 2: 16:49

I'm an open dental fan so the EOB is sometimes attached not always, so I have to go find that. But if it is attached I'll check what you know. I'll check what was the insurance payment, what was the patient responsibility. Does that match what we have in our software? And a lot of times it does not. So my biggest blunder is not posting a payment correctly based on what the EOB is telling you. So lining up the payment, the insurance payment and the patient responsibility, and then adjusting the write-off accordingly. I see too many people just put in the write-off based off of the discount and then the patient responsibility doesn't match that. So patient responsibility, insurance payment, is way more important than what we're writing off.

Speaker 1: 17:36

Oh yeah, definitely, and if I can, just add to that.

Speaker 1: 17:42

it's understanding the difference between a bulk payment and an individual payment, because, friends, believe it or not, for those of you that know the difference, I have interacted with billers, experienced billers, who have never done a bulk payment, and it's vital that you understand the difference between the two and that you are in fact, again using the software the way it is intended to be used, because how can you balance out properly if you're not entering a $10,000 payment that came in one check for multiple patients? That's a bulk payment. We have to know how to do that in your software.

Speaker 2: 18:32

Yeah, that's so important, I don't even know. I mean, balancing could even be one of our points, Erica. Are you know? Are you balancing at the end of the day, pulling your daily payments, balancing your credit card transactions, balancing your insurance card transactions, balancing your production, so you can know what your collections versus production ratios are? All of those KPIs are so important to track the health of a practice. But balancing your insurance checks, like you should be balancing the deposit. I even had a couple offices years ago that only put on the total dollar amount on their deposit slip.

Speaker 1: 19:10

I said so how do you?

Speaker 2: 19:11

know what checks were deposited Right right, and they were like oh, we can always go back in the and I was like, no, actually you can't. Sometimes those get deleted out of your bank account years later. So now we're trying to clean up and make sure that these have been cleared and they can't find the check. So balance your days. Do an itemized deposit slip every day and make sure that it balances your software. Your fiscal checks or your EFT should balance into your software.

Speaker 1: 19:39

Oh, absolutely that's that's so important.

Speaker 2: 19:42

I'm a big fan.

Speaker 1: 19:43

I mean, this is probably going away from billing blunders, but I I like. When I was running offices, I liked each of my providers to get their own day sheet at the end of the day, Um you know all the hygienists, all the you know associates, the doc, the main doctor, would receive their day sheet at the end of the day so that they could also check it for accuracy. But I mean, that's that's a topic way off of billing blenders, kind of it's like a whole ecosystem that we could talk about forever.

Speaker 1: 20:17

You know just kind of it's like a whole ecosystem that we could talk about forever, yeah, so so again, you know, I think, I think for sure this is going to turn into a part two, but I also think that you know there's so many moving parts to the billing cycle and I think a biggie, and I know I keep hitting on this one, but I want to emphasize and I feel like recently I've just come across a lot of offices that are very resistant to moving away from their workarounds and their life is harder because of it. You know offices that don't want to attach a fee schedule to that patient's account. Attach a fee schedule to that patient's account. They, you know there's just so many things that we're doing that are making our lives harder because we don't want to utilize the software the way it's intended to be used and some of those examples for me that cause billing blunders when you know you are a contracted provider but you don't want to attach that fee schedule to the patient's account.

Speaker 2: 21:24

It's a recipe for disaster. With credits, it's a recipe for disaster.

Speaker 1: 21:29

And then and then what ends up happening is the biller is trying to post this payment and make appropriate adjustments, Nothing's adding up, and it or it just takes a lot longer in productivity to get that payment to be to match, and the patient will end up overpaying too.

Speaker 1: 21:49

Yes, yes, always a hundred percent. We are finding that the patient is overpaying and it's important that we are making sure that these little things on the front end of the billing cycle or the revenue cycle are accurate, because they just pile up in the end and then we end up with really messy AR and then we're kind of pulling our hair out going how did this happen? And because my company does, I feel like we really focus on AR cleanup when we are working through AR cleanup and you know this, jen, this is one of your favorite things to do.

Speaker 2: 22:32

I do love AR.

Speaker 1: 22:33

You love AR and we see the patterns right. Love AR and we see the patterns right Like the patterns start to emerge and then you're able to see, you're able to tell the doctor why or how this AR nightmare took life in the first place.

Speaker 2: 22:50

Mm-hmm.

Speaker 1: 22:51

You know. So yeah, I definitely think understanding how to read an EOB is so important. What about adjustment, jen? You know we've seen a lot. I think a lot of individuals will just post a payment and move on.

Speaker 2: 23:09

Yeah, yeah, they don't ever look at the backlog, the account ledger. You know what the patient has paid. Has that been applied correctly to the services? It just gets so messy when you don't know what you're doing posting a payment and it can be something for as simple as like a prophy examine fluoride and x-rays, and if you don't apply the payment correctly it is going to be a nightmare to clean up later, especially in certain softwares. Eagle soft is that way where you can't edit it later. Once you post that payment it's in there unless you delete it and re-add it back in. So it's so important to know what you're doing and to make sure that everything lines up.

Speaker 1: 23:48

Right, right. And that's why we're big fans of itemizing the payments and not posting the payments as one whole payment for that.

Speaker 2: 23:56

EOB? Yeah, because everything's going to be overpaid and then you have a reporting nightmare. Another thing with AR as you're bringing this up, it makes me think about it. But as we're going through AR and you've seen this too a lot with me but we're going through and the insurance has asked for notes, let's say, and we go back and it's several months ago and we're like, okay, we're just going to go find the note. Oh, there's no note.

Speaker 2: 24:28

That's another thing that I feel like is a huge billing blunder is that we don't verify the services rendered based on the account ledger and the progress notes or the clinical notes. So documentation I know you talk about this a lot too, erica documentation, documentation, documentation. If we do not have the accurate representation of what was done clinically that day, you know we're third-party billers. So we look at the account. We say, okay, they billed out prophy, bite wings and exam. Let's go look at the note. Oh, that's interesting. The notes say peril, maintenance, exam and bite wings.

Speaker 2: 24:59

Now we're delaying the claim, now we're double checking, now we're frustrating the office. So I say that your documentation, your auto notes need to be correct, but you need to make sure that you're editing those auto notes. Do not leave the prompts in your notes, because you know I'm a hygienist too, so I know this whole side of it too. I know I can be pressed for time, but it's so important and I always say you know that very first line of your documentation, have all of the billable procedures on that line so that it's very easy to go back in. You can look at the you know detailed notes later and the diagnosis and everything but what we're going to build should be at that very top line.

Speaker 1: 25:41

I'm going to dive a little deeper on that. I had the pleasure of sharing the stage at the beginning of the year with Dr Roy Shelburne and for those of you that have not heard my episode with Dr Shelburne, I would suggest that you go back and listen to it. He went to prison for $17,000 because the clinical notes didn't match what was billed out, and when you're talking about compliance and fraud, talking about compliance and fraud, they don't care about the amount. So, as you're you know, you're talking about clinical notes, jen, and you're talking about filling it out. Don't leave it up to chance that, for you know, that claim gets overlooked and we forget to put clinical notes in at a later date because they don't care about the amount. They care about you matching up what was documented clinically and what was placed on the claim form.

Speaker 1: 26:51

So it's so important that, as a biller, you understand this is a part of our professional etiquette as billers right, we have to act compliantly, in alignment with regulations and with the law. When we bill something that does not have matching clinical notes, you have committed fraud, and I know that that sounds extreme, but it is the case. So you know, routing slips do not replace clinical notes. I've heard that. I've heard billers tell me I have a routing slip that I go off of and I just bill based on the routing slip and then I go back and check if his clinical notes oh boy yeah, and that, in my opinion, you're leaving yourself open to liability, and I want to make sure that everybody understands it is not just the doctor who is going to be held responsible.

Speaker 2: 28:05

Yeah.

Speaker 1: 28:06

They are indicting and I know now I'm going way extreme, but it's the reality of what's happening is that they are indicting the biller as well. Well, they're indicting the whole staff. But you have to be careful with that, because they will not accept ignorance as an excuse. As Roy says. Dr Shelburne says ignorance is no excuse to the law. So we have to be very careful with clinical documentation and those templates that you talk about, jen. Those templates are scary. For me, what I see and I'm sure you see it too in your company is that they're copying and pasting and copying and pasting and they're not putting the individual's BP. We're not putting how many carps of Lido or carbocaine were used. We're not putting, like those, those patients specific details that take it, take it out of just this template. But now we've added that patient specific information that makes it more appropriate for that patient, right?

Speaker 2: 29:20

Yeah, yeah, you have to have those patient identifiers in there. You can't have an auto note that says you know checked patient health history, no new changes, like you can't have those. You need ones that say you know health history and then you leave it open and then you fill in the blanks with that specific patient experience and what you had to do that day. Diagnosis should never be the same you know those things unless it's a healthy patient. As far as hiking goes, diagnosis should never be the same you know those things unless it's a healthy patient. As far as hiking goes, diagnosis should never be the same. It's they have gingivitis localized and you know the upper right, whatever that may be. But we need to make sure that it's patient specific and those prompts are there for a reason, so don't cancel out of them.

Speaker 1: 30:02

They're there to save you. Yeah, you know like use it as it's appropriate you know, to make the billing cycle a lot easier. That's why these templates were created in the first place.

Speaker 2: 30:23

Yeah, cause we're all busy. We get it, but use it as it's intended to be used. Don't use it as a crutch yeah exactly, exactly.

Speaker 1: 30:28

All right, so we have so much that we could cover. I knew this was going to turn into a part two. I was like this is going to turn into a part two. We've touched on maybe four of the things we talked about.

Speaker 2: 30:42

You want to do one more.

Speaker 2: 30:45

Yeah, let's do one more.

Speaker 2: 30:47

My next one is not attaching accurate diagnosis codes, particularly, in my case, for perio procedures.

Speaker 2: 30:54

So gingivitis, you know, chronic perio, acute perio, whatever that diagnosis code is medical diagnosis code, not just a descriptor in the progress notes or not having a perio chart in there, or an incorrect, or a copy and pasted perio chart in there. I've had several conversations this week, I feel like, from offices that are starting to implement 4346, which is fantastic and I'm starting to bill it and see it paid but we're missing a crucial component, which is the period chart. And a lot of times they'll have the period chart in there but they won't have the bleeding points. And for me to bill a gingivitis cleaning without bleeding points is what you're saying, Erica. This is fraud. If we can't show that this was needed medically as necessary for this patient, the insurance company is one either going to downgrade it to a prophy because we don't have accurate evidence of it, or they're just not going to pay it because we don't have the correct information. So gingivitis diagnosis code and period chart, please, please, please and per your chart.

Speaker 1: 32:10

Please, please, please. And that's where these preconceived notions of around you, you know they just downgrade 43, 46 to a prophy anyways. Well, to that I ask when somebody you know reaches out to me and says you know, we build that code but it gets downgraded to a prophy, yeah, a hundred percent of the time I will look at that perio chart. I will first ask can you send me the copy, a copy of the perio chart that you submitted with 4346, and they will send it to me? And there's no bleeding sites? Yeah, so of course they're going to downgrade it to a prophy. You're lucky.

Speaker 1: 32:41

They downgraded it and didn't deny it, right? Yeah, exactly. Factor piece of information that's needed for a gingivitis cleaning is going to be the patient has bleeding in 30% or more of the mouth. So if we're not indicating that anywhere outside of the clinical notes because usually I don't see that the hygienist or the doctors that are doing the 43-46 are indicating what percentage of the mouth had bleeding, what's more representative in the perio chart, right? So if we don't have that in the perio chart and we're not putting it in the clinical notes, the insurance company is going to downgrade that, if you're lucky.

Speaker 1: 33:43

And you know I go into these Facebook forums and I'm in all the billing groups and I'm you know I'm there to just kind of get an idea of what people are talking about and I see a lot of bashing on the insurance companies. And don't get me wrong, friends, I don't like them either. However, I do also want to say that it's not the insurance company's fault completely that they are denying so rampantly. We're giving them an out when we submit incomplete perio charts or an x-ray that's blurry or a cone cut or you know like. We are giving them an excuse. So when we talk about clean claims, I'm talking about making sure that you have your package buttoned up to the T. It's a clean claim proving dental necessity and dental or medical necessity, and we have those diagnosis codes on the claim. We have strong narratives that get to the point. They're not two pages long, because I've seen those too.

Speaker 2: 34:58

Yeah, they don't need a novel.

Speaker 1: 35:00

Those are appeals. You're a two pager. Get to the point with your narrative and make sure that you have attachments that are proving dental or medical necessity, sometimes both. As long as those benefits are available to the patient, there's no reason for the insurance company to deny your claim. Your claim, however, they could still deny even though you've sent them a nice, clean claim. There's still a chance of denial for so many reasons that I don't want to get into here, but we can definitely go into it further in part two.

Speaker 1: 35:40

But I think, jen, honestly, that perio chart and the implementation of 43-46, I think a lot of teams need to understand it's not just a matter of slapping the code onto a claim form. There's other things that need to happen, both from an auditing standpoint. The clinical notes need to be written a certain way so that we compliantly bill for that service, and then we need to prove sufficient dental evidence proving that that procedure, dental or medical evidence proving that that procedure was necessary. And as long as we're doing those two things in conjunction with each other, I think that you know we're going to have a smoother billing process. But you know we can't control how insurance companies treat us, and they do tend to do some things that we don't like, but you know, we have to do our part and not give them an excuse to deny.

Speaker 2: 36:44

Yeah, Give them all of the information that they could possibly need, but that does include you know correct processes and systems to make sure that that is done beforehand.

Speaker 1: 36:54

Oh yeah, Is there anything that you want to share? Any, any information, any advice you want to give before we close out this episode? This has been so much fun.

Speaker 2: 37:07

I feel like this is like our normal conversations. I think the biggest thing for me is as a biller. You know we need to hold the insurance companies accountable for what they promise to their clients and their patients that we serve. You know these patients pay a pretty penny for their premiums every month. They expect the benefits. You know we get the benefits. We tell them it's going to be. You know it's going to be under their insurance benefit. You know estimated under that and then when they deny it, we're like, okay, they denied it, Like let's look further into that, let's hold them accountable to that. You know, as we're billing, more 4346 coding and that's coming out more, more insurance companies are starting to pay it because we're seeing that trend and more offices are seeing the need for it in their practices. So my biggest thing is you know verification of benefits, get that, hold the insurance company accountable for that and try to get you know as much money for the patient as you can and for the doctor.

Speaker 1: 38:14

Yeah, Advocate advocate for your patients.

Speaker 1: 38:17

Friends, it's all about advocating, and when you get a denial, it's our responsibility, unless you have a financial policy that says otherwise. But I think overall we have a responsibility to fight for the patient's benefits because they don't know how to. And, as an advocate for the patient, the benefit for the practice is that our doctor gets paid, and that's ultimately what we want to happen is we want to get our doctors paid. We want to get them paid, uh, quickly. We, we want to make sure that there's no financial burden, because there's now, you know, there's no cash flow issues. We're making sure that the insurance company is paying promptly. I can talk so much more about that. I'll go ahead and close out. Friends, I hope you guys enjoyed this episode with Jen and I, we're going to do a part two. Stay tuned, jen. It's always a pleasure to have you on the podcast and forward to the next one with you.

Speaker 2: 39:27

All right Sounds good. I'm looking forward to it.