The Dental Billing Podcast

Optimizing Perio Performance Percentage & Billing with Hygiene Coach Jennifer Lyman RDH

• Ericka Aguilar • Season 8 • Episode 3

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Unlock the full potential of your dental practice with expert insights from Jennifer Lyman, our esteemed hygiene coach at Hidden Dental Profit. Together, we're cutting through the noise to bring you a comprehensive series on periodontal performance—an area too crucial to ignore. Our discussion goes beyond the surface, as we dissect perio performance percentages and their pivotal role in evaluating and enhancing the treatment of periodontal disease. We're not just crunching numbers; we're spotlighting the stark reality that many practices may be under-treating this prevalent condition. By understanding these vital statistics, dental professionals can ensure they're providing the highest standard of care for their patients.

The conversation doesn't stop at diagnosis—prepare to navigate the ins and outs of insurance reimbursements for gingivitis treatments with finesse. With Jennifer's seasoned perspective, we tackle the challenge of engaging patients in their oral health, stressing the importance of transparent communication and collaboration between the front office and hygienists. We also address the delicate balance of ethical practice and practical responses when faced with reimbursement dilemmas from companies like Delta Dental. By the end of this series, you'll be equipped with the tools and knowledge to revolutionize your hygiene and billing operations, reaffirming your commitment to patient well-being and practice profitability. Don't miss this opportunity to transform your approach to periodontal care—tune in now!

Want to connect with Jen? Send her an email:
Jen@hiddendentalprofit.com

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka or Jen? We would love the opportunity to discuss your billing questions!

Email Ericka:
ericka@dentalbillingdoneright.com

Email Jen:
jen@dentalbillingdoneright.com

Perio performance formula:

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


Want to know what your fee should be for D4346? Send Ericka an email to ericka@dentalbillingdoneright.com


Speaker 1:

Friends. Hello, this is Erika Aguilar, your host of the Dental Billing Podcast. This week, we are starting a four-part series on hygiene and billing with my good friend, jennifer Lyman. For those of you that don't know, Jennifer, she is an active hygienist, also our hygiene coach here at Hidden Dental Profit, and we're going to dive into all of the perio performance percentage numbers, how we calculate that, and we're going to continue the conversation in three more episodes, and our goal is to help you improve hygiene performance, thereby improving your perio performance percentage. Let's dive in, jen. Welcome back to the podcast.

Speaker 2:

Thank you for having me.

Speaker 1:

Yeah, this is going to be fun. We spend a lot of time talking about this topic and I just, you know, I just want to have this like behind the scenes conversation with you about what we see with regards to billing department performance, and I guess I want to let the listeners know what we see and why they need so much help. So in today's episode I'm pretty sure I'm probably going to do some type of introduction talking about it, but I really wanted to hone in on with you. Is perio performance Like? What does that mean? Why do offices need to understand when we're talking about a billing department, right? Why do offices, in your opinion, need to understand what perio performance percentage is? And then I guess a second question to that is you know what? What does it represent?

Speaker 2:

Yeah. So I think we'll go backwards here. We'll start with what is perio performance. Perio performance is taking your total number of patients and then we divide your perio patients and kind of separate your perio patients. So perio maintenance, srp, 4346 patients, all those patients get separated and we divide that by your total number of patients and that gives us your perio percentage. So that tells us how many of your total patients are in a periodontal protocol program in your office.

Speaker 2:

One thing that's super important with this is that we do include the 4346, because that is the start of a perio patient. Sometimes they can move towards SRP or then we kind of put them into perio maintenance, whatever that looks like. But it's super important that we include the 43-46 in this periodontal performance. Now why we look at that is if you look at the CDC, it says that 70% of Americans have periodontal disease. If we are treating on average I mean what we see in in our office, erica is like our offices are like five. I mean I've even seen as low as one percent um one percent of the total patients.

Speaker 2:

Yeah, yes, I know one percent of your total patients have perio. I highly doubt that like so. The cdc says 70 percent of americans have perio. That's a conservative number, I think, because that's only recorded patients, right. A lot of people go to the dentist. A lot number, I think, because that's only recorded patients, right. A lot of people don't go to the dentist. A lot of people in the US don't go to the dentist. So I think that's a conservative number at 70%. Then we see these perio performances that are at 1, 5, 15% is probably pretty average. I would say, for what we see and that tells us as a hygiene perspective, that you're only treating 15% of perio in your practice. Now, some of those things are dependent on population, your demographics, wherever you work in your area that you work in. You know if you work in Beverly Hills you're probably not going to have as much SRP as if you work in like Nebraska, but it's going to be a different thing You'd be surprised.

Speaker 1:

I've worked in Beverly. Hills and there's a lot of perio there too.

Speaker 2:

So it's true, I have treated multiple dentists actually for full, full mouth perio.

Speaker 1:

So and just so the audience understands, jen is a registered dental hygienist and she's also a biller, which is why we have her. She's one of our coaches with our billing optimization program, and you know. So if you're a new listener and you're thinking, well, who's Jen and why does she know, she kind of knows what she's talking about. She was a practicing hygienist until last year, right, jen?

Speaker 2:

Yeah, december is when I kind of went out of clinical practice. I still sub here and there because it's fun, but yeah, yeah, mostly stick to you know, coaching and helping practices increase production collections.

Speaker 1:

Yes, yes, so that when she says she's treated dentists for full mouth periods because she is a hygienist, yeah, yeah, let's just be clear there. Sorry for that, I just thought for the new listeners. Maybe they should know that you're a hygienist, yeah.

Speaker 2:

That's kind of helpful when I talk about all this, but yeah, so I think when we're looking at those perio percentage numbers, um, as a hygienist, I'm looking at how, how many patients in your practice, what percentage of patients are you treating properly? And I think when we look at ideal numbers, we're looking at 60%, which again 70 is conservative. So I think 60 is also very achievable and I think we have only had one practice, erica that was close to that, and now they're at that percentage.

Speaker 1:

Yes, they were at like 56% which is on the higher end when we initially start working with clients. I'd say, on average, most of our offices are less than 10% perio performance. In fact, I just met with dental Intel because we're potentially going to be collaborating on the reports that we give to the clients, and Dental Intel shared with me that their average client perio performance is 0.6%.

Speaker 2:

Wow, I would love to know their formula too.

Speaker 1:

Yes, absolutely yeah, I mean, we're in talks of doing something together, but the point here is that it's not just us reporting perio performance percentage as a part of the you know, the billing department, and I think that a lot of times we point that out and sometimes people get offended, and can you just talk to us a little bit about, like, what this does not represent?

Speaker 2:

Yes, yes, so this definitely does not represent the education or the ability of the hygienist. I think that's something that we make very, very clear when we're talking to clients. Right Like this is not reflective of you and your hygiene department. It's reflective of processes and systems that you don't have in the practice. That's exactly it. Yep, that's exactly what it is the whole analysis right?

Speaker 1:

Like the whole analysis that we do represents systems, the lack of systems in place, because the idea is, when you're talking about putting systems in place, it's not about training the current team, although the team could be worth the investment. I'm not saying they're not, but I'm just saying as, as a business owner and have been partner in two offices, I want systems in place that, no matter who the hygienist is, they're going to follow the same systems system that we have in place, and I want you to talk to us about that system and what that looks like. When we're implementing change into a hygiene department. What are the most common challenges? You know?

Speaker 1:

in terms of incorporating, say, 4346?.

Speaker 2:

Yeah, I think there's a couple. One has to do with timing. You know, if hygienists are already burnt out, they're exhausted, they don't have they need to implement systems and processes, but they keep getting shut down every step that they try, you're gonna have a lot of pushback there. And then if a dentist comes in and says, hey, we hired this consultant, now, with this hygienist, has been trying to change things and trying to implement things and they keep getting hit with a brick wall, they're going to be really defeated and you're not going to keep that staff member. So we really really focus on, like, staff retention. You know you want to keep the staff that you have because in this environment, this economy right now, it's very, very hard to find staff members, including hygienists, and hygienists are producers. The hygienists.

Speaker 1:

More importantly, hygienists I mean offices are really struggling to, to retain and we'll talk about that in a second. But I think, yeah, you hit the nail right on the head when you're, when you're saying, look, you know, we're not talking about just looking at codes that we can incorporate for things that we're already doing. We're talking about, you know, really a big overhaul. Like how are we scheduling, you know, overbooking our hygienist? Are we doing back-to-back SRPs? Like we don't want to, we don't want to burn our hygienists out. They're already burnt out for the most part. So talk to us a little bit more about when we talk to a hygienist about now incorporating a different type of cleaning, I think a lot of times they may get a little overwhelmed with the possibility of now we're adding a new cleaning to the decision-making. What is it tracks? So talk to us a little bit about 4346.

Speaker 2:

Yeah. So there's a lot of pressure when it comes to patients and when we're talking about diagnosing, we're talking about SRP and we're saying you have gingivitis or you have perio, now you need XYZ. Whatever that is that we determine that they need, it can be a huge barrier with time, burnout, things, that we we already feel tired, that we're like there's one more thing. Are you kidding? And I think that's what that's the pushback that we get a lot from hygienists is I'm just, I'm already so tired, I'm so spent. How in the world am I going to have another 20 minute conversation to convert this periop or this prophy patient to a periop patient?

Speaker 2:

And in that sense, we definitely want to pursue that with caution, because we don't want to push the patient. We don't want to bait and switch them by any means. We don't want to burn out our hygienist. We don't want to bait and switch them by any means. We don't want to burn out our hygienist. We don't want to overwhelm our hygienist. So there's things that we can do that take off the load from the hygienist and put it back on the patient in a way that is not pushy, in a way that is making the patient hold accountability for their own health and still making the hygienist feel like they're treating them effectively.

Speaker 2:

So you know, we, we talk about prepping the patient a lot, so there's, we're not going to go in and tell you you need to. You know, treatment plan, srps and gingivitis patient, patient, that's not going to happen. What we do is more focused on the conversation, the relationship, the trust that you have with that patient and really capitalize on that to make it easier for you to have that conversation with the patient. So, and it's not a lot more for the hygienist, you know we've talked to a few offices that they're like it really wasn't a lot and it was already things that they were doing, but now it seems so much easier, it flows so much better and they don't feel like they're pushing things and yet they're still producing twice as much during the day. So it's a huge, huge conversation to have and not a lot of hygienists are having it for 4-3-4-6. And a lot of honestly, a lot of hygienists don't even know about this code, like they've never used it For the individuals that don't know what 4346 is.

Speaker 1:

It's a gingival inflammation, is what it's defined as in the CDT book, but we call it the gingivitis cleaning or as Jen likes to refer to it. You like to refer to it as a therapeutic prophy.

Speaker 2:

Yeah, yeah. So, I agree with you.

Speaker 1:

Not a lot of hygienists even know about this code, but I love the way you describe integrating this code. Do you always? And I can say I can. I'm like a parrot, right when? When you say something, I repeat it. When, tess and I say something, I repeat it. Like I feel like I learn around you guys all the time, but you always tell the clients. You know, and I'm sure you guys can do the same with some of the things that I say like we all have our, our.

Speaker 2:

Oh yeah, I've said your things too.

Speaker 1:

Um, so like I love how you explain to the hygiene teams that you work with that the 43, 46 is a bridge, gaps the. You say it better.

Speaker 2:

Why don't you go? It bridges the gap. There we go. Not all involved patient. So it's that patient that comes in that always has gingivitis, always has inflammation, just like. What like? Why can we not get on top of it?

Speaker 1:

And there's a lot of reasons.

Speaker 2:

And that also contributes to your burnout right, like if you're constantly treating gingivitis and you're just like, why are they not getting better? That's why you don't have the right systems in place, you don't have more frequent recalls, you don't have the correct processes in place to treat this patient, so you're not totally burnt out every single time you see them and wondering why they're not getting better. So this code bridges that gap between a very healthy individual that's a prophy patient and the patient that comes in and needs SRP. We're making it more doable for hygienists and, honestly, a more appropriate code to treat patients that have gingivitis. They're not SRP, they're not healthy. Like, where do they fall? And that's why the ADA came up with this code.

Speaker 1:

So I'm thinking that there are some offices, there are some people out there thinking our patients will never go for this because there might be a copayment involved with this code and, let's be honest, sometimes there is. But when a patient has perio, we don't think twice about charging the patient their copay. We just do it. You know, when there's a copay for a filling, we just charge the patient. So what are? What do you say to individuals who are thinking to themselves right now? Our patients will never go for this.

Speaker 2:

Yeah. So that's where that prepping the patient conversation comes into play. If you get to the end of your appointment and your patient isn't convinced that they have gingivitis, that's kind of on you. So we go through systems again, you know, step one, step two, throughout the entire appointment, that say, you know, kind of put things back on the patient, we ask them questions, we involve them in the diagnosis, so then by the end of it they're like I have gingivitis, how do I treat this Right?

Speaker 2:

And that's the goal is they need to be accountable and I always say this you're not responsible for going in and brushing their teeth every day. You're not responsible for flossing their teeth every day, not responsible for their finances, so, and we can't automatically assume that they can't cover anything or can't pay for their copay. So we want to be really careful with assumptions in a practice and just tell them what they need clinically. They are the bread and butter, I swear, of a dental practice. They are my best friends, typically, because when hygienists and front office are able to work together symbiotically, it's like. It's like harmony in the practice. Yeah, it's, it's beautiful and it's a wonderful way to work, and so that takes the pressure off of the hygienist of oh, now I have to talk about money.

Speaker 2:

Dentists, if you're listening, please don't make your hygienist talk about money. Let them do clinic, clinical work and let them focus on the patient. You're able to have that conversation and the trust with the patient then. So typically, if there is pushback with the 43-46, I always say you know, I'm not really sure. All I can tell you. If they ask for a cost or whatever, I'm just gonna say I'm not sure. All I can tell you is that this is what I see today. And then I go back to the clinical information and then I say if you're concerned about that, we can have our front office come talk to you about any costs involved. But honestly, most of the time when I say that, by that point they're like oh no, it's okay, I'm gonna do it anyway right, and then we don't even have to have that conversation.

Speaker 1:

They have taken responsibility. You've done your job as a clinician, as a hygienist, you've explained what is going on in the mouth, they have accepted responsibility for it and, um, you know that the coverage is no longer a concern. Now there are going to be some patients that are still going to be insurance driven and only want to do what insurance covers, and and that's okay. And at that point I think it's up to the office to decide whether or not you know they want to keep a non-compliant patient. Um, you know, cause you do have those, keep a non-compliant patient, because you do have those very difficult non-compliant patients that just want to do what?

Speaker 1:

insurance covers, and that's a whole other conversation. I don't want to get into that right now. But I do also want to point out that there can be times when there are copayments associated with 4346. However, we are noticing on the flip side, we are also noticing that more and more insurance companies are covering 4346 as a preventive procedure. So at 100%, and talk to us a little bit about why you think that's happening.

Speaker 2:

Yeah. So I think insurance companies are starting to realize that offices are using the 4346. I think insurance companies are starting to realize that offices are using the 4346. They are recognizing that if they treat it at this point at a preventive level, they don't get to that SRP stage and then they don't have to pay more frequently for payroll maintenance and everything else. So I mean, as hygienists right, we're always looking at preventive measures that we can do this is just kind of fall in that category. Yes, they have the startup disease of fall in that category. Yes, they have the startup disease, but it's still reversible. So an insurance is starting to notice that. So they're like oh, it's still reversible, let's pay for this one, Maybe two times. You can do it twice in a year. It doesn't have to be like a one and done type of thing, but I think they're starting to recognize that and they don't want to pay down the road. So they're starting to see that 43-46 is valuable.

Speaker 2:

I will say, Erica, you and I have talked about this before, but some insurance companies and some doctors have reported that 43-46 is getting reimbursed at a lower rate than pro-fee. But when we look at the numbers and we take a look at your total numbers for in 18 months. We're looking at your average reimbursement 18 months, right, we're looking at your average reimbursement. So that can be cash paying patients, that can be other insurances that you're at a network with. All of those things factor into it too. So in total, you're still getting reimbursed more for 4346.

Speaker 2:

Absolutely, and I want to make that very clear because it is more. It's more work for the hygienist and it is more of a conversation.

Speaker 1:

So and the question then that I get, when I'm having this discussion at, say, a live event that we're hosting, and you know, I always get one or two doctors that will stand up and say but it's always Delta. Delta Dental reimburses us less for a gingivitis cleaning than for a prophy. Therefore, why would we not bill for a prophy?

Speaker 2:

Yeah, so thanks Delta Dental for encouraging.

Speaker 1:

I mean, it's almost like you're asking these doctors to commit fraud, not saying that they do.

Speaker 1:

No I mean it's hard enough with low reimbursement. And now you're saying for the office to bill for something that you know is going to get us reimbursed for less than a prophy, you know. So the question then becomes well, what do we do when that happens? And that, my friends, is when you go back to the last episode with Tessina Bullock and she talks about getting the insurance commissioner involved, and, um, you know, I have taught how to appeal claims for so many years and I learned of Tessina's technique not too long ago and I just cannot stop advocating her method Now.

Speaker 1:

I also was a big advocate for getting the insurance commissioner involved. I just took a little bit longer to get the insurance commissioner involved. I like how she cuts out the middleman and we just get straight to the point. So when these patterns start to emerge in a practice where you're trying to improve perio performance percentage, you're trying to educate your patients you know you're, you're doing all the things and then insurance comes back and says, oh, we're going to pay you less than you know a pro fee Um, then we need to start reporting those types of patterns of abuse, right insurance bullying this is a more invasive procedure and we're getting paid less for then.

Speaker 1:

Uh, what am I trying to say here? For a profi, yeah, we're not prof. So we want to get paid for the more invasive procedure. We want to get paid more for that I mean it makes sense right.

Speaker 2:

Yeah, yeah. Well, you're still treating disease. It's just not periodontal disease, it's gingivitis, but you're not treating full on disease. But at the same time it is the start of disease. So you are treating something with prophy, you're just preventing disease. So it's not apples to apples. And I think that's where insurance companies are really falling short is they're not seeing the comparison between the two. And that's where they need us to educate them and tell them why this procedure needs to get paid at a higher rate. You know, because X, y and Z and we fight them on that, and also it all comes down to and we, we you preach about this too, eric, all the time but billing what you do, you know, if you are doing a gingivitis cleaning, honestly I mean, I know it sucks, but the insurance is going to pay less, but you're doing it, so document it, bill for it correctly. And and also the on the flip side of that too, with insurance, they're going to see that, oh, the offices are billing 43, 46, a lot more at a way higher rate yeah.

Speaker 2:

and how are they going to know if we just keep pushing out profis all the time? They're going to say oh well, you know, 90 of our claims are prof, so we're going to pay at profis at a higher rate. It's just, it's all insanity to me.

Speaker 1:

It's a whole ecosystem that, and we all have to do our part, you know, for the, for the overall good, Right? So, um, Jen, I want to, I just so for the offices that have just learned about 4346, right? So they're like whoa, I didn't even know this code existed. What should they do now? What type of conversation should they have with their team? You know, like, what do you suggest they do now? Because now they're like, okay, I'm aware of this code, I have no idea what to do with it.

Speaker 1:

I know Jen said gingivitis and I heard all that. But what do I do next? And before you answer that, let me just let the audience know that this is a four part series. So we are going to be doing three more episodes on hygiene and billing and what it has to do with the billing department. So we're going to go into more detail. But what does that one action item that you would suggest an office that just learned about this code do? Most of my listeners are listening on the way into the office. Yeah, they're about to walk into their office.

Speaker 2:

In their commute.

Speaker 1:

Yeah, yeah.

Speaker 2:

Yeah. So I would say the very first thing is to read the ADA code. Book description for 4346.

Speaker 1:

Yes, yes. And if you don't have it, go buy it.

Speaker 2:

Go buy it or even just look it up online, say D4346 ADA code description, and read that and see exactly what it is that we're talking about, because that's your first step. If you don't know what you don't know right. So let's figure out what that is and then, like you said, we'll talk about 4346 a lot more, but there's a lot of kind of criteria for that that we want to go into, so where you can be compliant as well as bill correctly and document correctly. So but that would be my number one tip. So look it up, research it and know the criteria for billing.

Speaker 1:

And on that note I'm going to close out with just kind of a little prelude to our next episode. We are going to be going through walking you through how to diagnose your practice, your own numbers, and you can diagnose what your current perio performance percentage and what to do with that information. So stay with us on this four part series. Today was just an introduction to perio performance percentage with our coach, our hygiene coach, jen Jen, and if you have any questions pertaining to peri performance or anything related to hygiene and you want to connect with Jen Jen, why don't you let the listeners know how they can connect with you?

Speaker 2:

Yeah. So right now I think the best would probably be email. So that's Jen J-E-N at hidden dental profitcom.

Speaker 1:

So with that we'll close out and, yeah, we look forward to having everybody join us in the next three episodes. This is gonna be a lot of information. Share this episode with an office that you feel could benefit from this information and we'll see you in the next episode, friends.

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Ericka Aguilar

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