#877: Billing: Dealing With Denials + Old Balances

Dental A Team Podcast

Kiera educates listeners on how to install systems in the billing department that can better flow out to the clinical teams so denials and old balances can disappear once and for all.

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Transcript:

Kiera Dent (00:00.59)

Hello, Dental A Team listeners. This is Kiera and man, let's do a little billing 101 for you all today on the podcast. Who's excited for billing? How to deal with denials and old balances. How does that sound? You guys, I am not your expert biller, but you know what? We're going to have a good time with this. I know enough about billing to make me a little wild. And so I hope you guys are excited about it. I feel like let's do a quick tactical practical for you.

a few things around billing. As always, thank you for being a part of our Dental 18 podcast family. I adore you. I enjoy my time hanging out with you. I love to podcast with you and I love to give you tactical tips that you can take back to your practice and make your practice even better. As always, just share this with one person today. I ask that you guys just share it, put it in a podcast or a Facebook group, share it with a friend, send a text message to somebody, but just share it. That's how we're gonna be able to get into the hands of every single dental practice.

and truly be able to hit our mission of positively impacting the world of dentistry in the greatest way possible. So dealing with denials is super annoying and we've got some expert billers Shasta with Paragon, Sarah O 'Brien with Evolution Billing. They're incredible. And so this is just going to be kind of a high level. I also love Josh Smith with dental claim support. Be sure to tell them Dental A Team sent you if you need that, but dealing with the denials I think is really just getting into it and figuring out why are we getting these denials?

having your biller look through and what is it contacting you. I think so much of the denials is education and then putting into place a system so we don't get those denials. So calling them and researching and figuring out why are we actually getting denials on the buildup? What is it? Most of the time, the reason your buildup is being denied is because they require it to be on a seat date, not on the prep date. And if you will submit the seat date with it, you usually will get those buildups done. But calling the insurance company, finding out why was this denied? It should be covered.

And then getting the proper, the proper documentation is truly going to help. We just actually did a doctor think tank with our, our clients. We have a think tank with our doctors and I absolutely love it. I call it the let your hair down, come hang out, ask the questions. But we actually just did one on all things billing. It was one of our best attended think tanks because the doctors really don't understand what to do with it. And so how do we actually handle denials is just because they submitted denial does not mean it's a denial.

Kiera Dent (02:23.598)

What we need to do is we need to research it, we need to figure it out. And then if we're getting denied because we don't have an intraoral, we don't have an x -ray or we didn't get the correct radiographs or we didn't have the correct information within our notes, like I was talking to an office the other day and they said, we need this, all this information from the doctors on these bigger cases to get it approved. And I said, fantastic, make a note template and then update the note templates to give you everything that you need. And I think so many practices feel like that's too hard. And to me, that's being proactive on the problem rather than reactive on the -

on the flip side. The reaction side is that we got the denial. The proactive is how can I actually set this as a system within the note template that we know we're gonna fill in every time to make sure that we actually get these pieces. Other things you can do if we're missing the documentation is put an intra -oral photo as part of the deliverables that are being in the procedure. So if it's a crown or it's a filling, put X -ray, intra -oral. So it's part of what they actually have to submit that we did do those items.

and then also put it in the note template. It could be the very first pop -up when they go to put a crown in of take X -ray. Like you literally can make a pop -up on there in your note templates of reminding them to take that X -ray right before we get started. Or intra -oral, you can also have it like we took an intra -oral. Dental assistants, please, please, please, I'm gonna say this. Start your notes as soon as you start the procedure because if you go through, you already know what you're gonna do for the bulk of it.

your note pretty much done before the procedure even starts. So it's going to remind you to take the extra. It's going to remind you to take the intra oral, have the intra oral as part of your prep setup for the fillings and the crowns, knowing that we need to take those x -rays for hygienists with the SRPs, making sure you have that in there as well. But often into those note templates, it can just be simple like that or having it on the route slip, add it into the treatment plan of these are the items that we need to do. So we prevent those denials and then the billing team educate.

your clinical team. Now, with that said, billers, you're super, super, super detailed and I love you for that. Clinical teams are not usually as detailed and so oftentimes what I watch is there's a divide between the clinical team and the billing team because the billing team's like, we need all this and they make it very hard. So the clinical team's like, fine, we'll do our best, but it's going to be too hard. So coming to a middle ground of billers, what is truly the one, two, three things that you have to have?

Kiera Dent (04:40.27)

for 90 % of the claims, I understand that there will be 10 % that we need something different. What can we do that's a true system to make it easier for people as opposed to just being like nuance. For example, I was talking to an office the other day and they said, Kiera, we have to have the doctors write this whole thing. I said, not a chance. They're not gonna do it. So what could we do instead? And they're like, well, I just have to have all this information. And I said, but like break it down for me. Like, what do you really have to have? So they were telling me and I said, all right, well, like let's put that in a note template.

And they said, yeah, but like, that's not going to work because the doctor has to fill it in. And I'm like, the doctor's not going to do it. So let's find an alternative where they're not going to do it. Just like billers, like your clinical team is not going to write a huge narrative. Can you have pre -made narratives for them of, you know what the insurance is going to ask for. You do all the billing. Make a quick pre -made narrative for a crown of like, crown was replaced because of that, that, that, that, that have that as one option. Crown was replaced because.

or like initial placement of the crown or make multiple templates for it of initial placement of a crown, replacement of a crown, how old was the crown, like put that in there of the information that you need because I understand from a billers perspective that it seems so we need all these details. But the reality is most of them fall within patterns and if we can just get the quick patterns done where 90 % of our claims are being covered, amazing. But I say that's on the billers responsibility is to figure out why was it denied?

build the system so the whole team can follow through and then make sure that it's happening consistently. So don't just tell them telling does not ever work. People don't change behavior by just telling make it into a system to where it's a fail proof. Like I think about Ray Kroc with McDonald's. If he just told them like, I need you to make sure that those fries are taken out every whatever minutes. People are not going to remember to do that. So he said a buzzer that would go off constantly for him that made sure that people take the fries out of the fryer so they don't get burnt.

In practices with systems, I feel like so often we don't realize you need to build a system that doesn't require people to think. It just requires them to fill in the template and then you get everything you need. So looking with those denials, how do you handle them? It's researching the company, finding out why, fixing the note template and educating the team. But like I said, make it into patterns and make it simple for your clinical team because they're not going to sit there and write a narrative. Your doctors are not going to fill in these whole things. Build narratives as a builder.

Kiera Dent (07:00.654)

So that way your team can quickly just choose it and you get 99 % of what you need to begin with and you're not chasing it down. I think that's a really great way to deal with denials. And then I'll pivot gears real quick on how to handle old balances. So when we're looking at it, and I think these both go in the billing world is like, so that's how we deal with the denials and that's how we build a system for our team. Now on the flip side, we've got the AR, right? And so billers should be in my opinion,

Every single month going through every single account. Yes, I said every single account. And I have a lovely spreadsheet that I love for our offices that I give them of this is how you actually track every account. It's statement one, two, three. We make, when we do statements, we send it out as a text. We're not mailing statements. You can still mail, but I would definitely recommend connecting with Moolah. If you're mailing out statements, they're an incredible payment processor. Be sure to tell them Dental A Team sent you because you guys do get preferred rates with Moolah.

But what's awesome about them is like they have a whole drip campaign so statements get done. But on your billing spreadsheet, it should be statement one, two, three. We know we've called them. We've got the insurance follow up. We've got the payments. But every month your biller should be able to tell you every single account in the AR of what's going on. Because once we do that, then with these old balances, I know that you've had about three months of trying to collect on these old balances. And then if we can't, what I usually recommend is once we've gone through and the doctor sees how much.

Number one, why did we get the old balances? Like what happened to get this? And did we fix and create a system? So this never happens again, because what I hate more than anything is writing off money, but we never fixed the problem. And so it's just as leaky bucket. We write money off, but we never fix the leak in the bucket. So you've got to find a way to fix the hole in the bucket by building a system. So before I ever allow a team to write old balances off, I make them build a system to where this never happens again, because you don't want me taking the X amount of money out of your paycheck.

This is truly your paycheck by having to write off these old balances. Now I understand it could be a bill or left or different things in place, but if a bill or left, it wasn't a system. You need to have a system in place to make sure this doesn't happen. So with that, we set up a system so it doesn't happen again. We figure out what we did wrong. Maybe we didn't have timely filing on it. Well, great, let's set up an alert. This is where the spreadsheet comes into play so we know we always have timely filing on it.

Kiera Dent (09:18.254)

Maybe it was the fact that we didn't have the correct estimates in there. Amazing. All fee schedules have to go in. We have to have signed ones. We have to bill them if we don't have it coming back from insurance. We follow up with the insurance every like two weeks to make sure that we're getting all these claims paid. And so with that, once all that's done, then what we do with these old balances is I set a day and I just say, this is the bad day. Doctors, we write all this off as old debt. You can decide if you want to send them to collections. You can decide if it's old debt, but we just...

We write it off, we zero out those accounts, we can set a note so that way if the patient ever does return to the practice, they are required to pay that amount before they're able to be seen. But we literally just zero it all out. Usually I have offices work on this for three to six months before I zero it out. And then we just know, and I try to do it at a set time so I know May of this year or June or December is when we're gonna just write it all off so that way the books are truly clean.

but I'm going to try and collect every single penny because I feel like that's my job. The work was done and we owe it to our practice to collect the money and to our patients to train them that they do need to get paid. Now, sometimes if it's old, you might be able to strike some deals of like, let's do a 50 50 or like all right off 20 % of it. You pay 80 % of it. I try to strike some deals with patients just to get payments paid. You can also again work with a processor and you can make payments.

So that way the patient can pay over time on this balance if it's old and they weren't expecting it. And verbiage for that is like, hey, we were going through our accounts and we noticed that there's a balance on your account. We do need to get that paid. I can take card over the phone. I do Visa or Amex. Which do you prefer? Now they're like, I wasn't expecting this. Amazing. Let's do a couple of payments. And just have a payment process in place where they can pay it maybe over the course of three months, six months, whatever you guys choose to do.

But the goal is that we get these balances taken care of. And I'm just very confident with it. You don't need to say that, we lost a biller and we didn't know about this. I can't tell you how many times I have companies from six months ago, 12 months ago, they say, hey, we're reviewing our accounts. And we noticed that this balance was still remaining on your account. We do need to get it taken care of. We accept a credit card and we do need it paid by this date. It's like no nonsense. That's how other companies do it. So just so you know,

Kiera Dent (11:33.326)

That's what happens and they do audit their accounts quite often. It's very common. This is why there's auditing people. This is why there's accounting teams is because their job is to true up and make sure the balances are all correct. And I know we feel guilty like, well, we should have been doing this. Of course, we should have been doing it, but we didn't. Today, we know that these people owe money for work that we did do. We're not going after them for money that we didn't actually do the work for. You did the work. And so we need to get those balances cleaned up and taken care of.

So that's my recommendation. And I know I did like a really high level for you guys on denials and balances, but the goal is, I hope you guys take from everything is there's gotta be a system so that way we stop having the denials and we stop having the balances and we stop the bleeding at the top as opposed to constantly like putting water in a bucket that has an open hole at the bottom. Build the systems, make it very simple for people, have the spreadsheet, doctors have a meeting with your billers every single month.

where you review every account that we were not writing off things. I had an office that just wrote off accounts. Make it to where they can't write off accounts without your approval so you know every account that's being written off and you will A -okay that because at the end of the day you did the work and you should be paid for it. So that's like I said, a very high level. I recommended a couple of billing companies if you guys need help with that. But truly getting this set up with practices and giving doctors and teams the confidence and the know -how is what I'm obsessed with doing in Dental A Team.

That's why I love consulting because I'm able to give you the tools and the resources of what to do with these items in depth for your practice. So be sure to reach out [e-mail]. And as always, thanks for listening and I'll catch you next time on the Dental A Team podcast.