The Dental Billing Podcast

Debunking Dental Billing and Hygiene Myths with Tessina Bullock of Verus Insurance Verification- Part 2

• Ericka Aguilar • Season 9 • Episode 2

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Unlock the secrets behind insurance claim denials and empower your practice with actionable insights from Tessina, the president of Veris Insurance Verification. Learn why some offices are more frequently targeted for denials and how to avoid this costly pitfall by optimizing your insurance verification processes. Tessina’s hands-on experience in training, consulting, and coaching offers invaluable strategies to ensure all forms are accurately completed and entered into your software systems, minimizing the risk of random denials and boosting your office’s efficiency.

Discover the power of collective action in advocating for patient rights against insurance company misconduct. We delve into a compelling case study involving UnitedHealthcare, where coordinated complaints from multiple offices sparked significant nationwide policy changes. Understand the critical differences between self-funded and fully insured plans, and get expert advice on filing effective complaints with the insurance commissioner. Tessina emphasizes the far-reaching impact of even a single report, showing how your voice can contribute to industry-wide improvements.

In our final segment, we dispel the myth that healthcare providers are beyond challenge and highlight the importance of proper coding and billing practices. By advocating for thorough insurance verification and detailed patient intake processes, Tessina shows how to create clean claims and prevent revenue loss. Stay informed on the ever-evolving landscape of insurance codes and payment policies, particularly for dental procedures, and ensure your practice remains vigilant to avoid unnecessary denials. Tune in to empower your office staff and patients, fostering a culture of proactive healthcare management.

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:

We're going to move on to Tessina. Tessina is the president of Veris Insurance Verification. And, tessina, why don't you tell us a little bit about what you do and how you serve your?

Speaker 2:

clients. I do a lot of things. I dabble quite a bit All the things I do. So I love training and consulting and teaching all that fun coaching stuff Super fun, I do. So. I love training and consulting and teaching all that fun coaching stuff Super fun. I do some fee negotiations, and that is super fun too.

Speaker 2:

I started a business called Varus that you mentioned. This is at the heart of, like the basics that I think of things that are getting missed. As I'm doing these coachings and these trainings, I can always lead back to like well, what did you have on your breakdown form? And they don't have it. Or they have the form but it's not always filled out all the way. They just don't have time and they have so much else to do.

Speaker 2:

So you know, you see a need, you fill a need right. So we started the insurance verification company, found a reasonable price for it at only $15 an hour, and our team goes in as if they're working for the office, but they work remotely from home and it's completely customized to what the office wants to be done, how their form wants to be done, how they want it entered into their software. I go in and give my expert level, recommendations and suggestions, but otherwise it's just customized to what they want. So, instead of having this big form that only has three things filled out, now you have your big form completely filled out and everything's entered in the software, ready to go, so that when that patient comes in you know how to handle it, you know how to educate them, cause that's a big part of the whole process, right?

Speaker 1:

It's like an educational yeah. It's really kicked off with a really good breakdown of benefits and I can concur with you on the fact that we're not asking the right questions on the breakdown in most cases. You know, I think you really have to analyze and look at what codes are we using on a regular basis? You know what? What are our denial trends Like? We really need to customize that. So I appreciate what you do for the clients that we have, and we have a lot. We have mutual clients and you know I I appreciate all that you do. All right, so I want to, I want to kick off your portion with your myth, if I can make it. So. Your myth is insurance companies randomly deny claims, but they are not. They're actually targeting.

Speaker 2:

Yes, Okay, so this is. It's loaded right. These questions, yeah, it's super loaded, so so many things. But the insurance companies what happens sometimes when we try to fight a denial or you're saying we're tracking those denials, we're looking for trends, and the reason sometimes people aren't is because the insurance company is telling the office or is telling the insurance commissioner that they randomly select claims for denial. It's part of their audit process.

Speaker 2:

And this is going back to what you talked about earlier of them getting in trouble for denying a claim on an initial submission. The way they try to get away from that is by saying oh, it's random selection. That's what our audit process is. We randomly select them. So it wasn't an automatic denial, for it wasn't a misdenial, it was our random selection process and they can get away with that sometimes if you're not careful. So if you're tracking those trends and you're paying attention and you're watching what companies are denying and how often they're denying and proving that you have that clean, valid claim, you will find and I know from working with people inside the insurance companies I won't ever say names, but I have contacts from within very high up that have explained to me this process as well. They will flag offices and that is how they choose their denials, not random selection.

Speaker 1:

Wow, that's amazing. Okay, so do insurance companies. I guess this is kind of redundant. Oh, you can move on to the next question. So how does an office get flagged for less denials rather than more denial?

Speaker 2:

Yeah. So let's talk a little bit about that flagging process and let me think this through of what? What am I saying? So a lot, right, so much, and so I just want to make sure that I don't confuse anybody here. So there's a couple of things. So I want you to know, first, that the insurance company is either going to flag you as an office that gets bullied, an office that doesn't know their processes, doesn't know their laws, doesn't know their rights, and that's how they are not randomly selecting you. They are choosing you as an office they have identified as an easy target. So that's how you're getting flagged.

Speaker 2:

One of those ways in the very beginning is putting too much documentation on your initial claims, these big, huge, long page or two page. I've seen two page narratives. That's insane to me. It's a lot. Two page narrative and all the pictures and the circling on the pictures and all those things. I'm sorry, that's funny, you've seen it right. The circles and they put an arrow and they're like this is a fracture and you know all these things. All of a sudden they're trying to educate the insurance company because we all know they're not trained in dentistry and you're like how do you not see this. Let me educate you. And that is a sign to the insurance company that you don't actually know your laws, you don't actually know what is required for submission and that first line right there, first line of defense, is where you can start getting flagged as an office who can be bullied or who can be pushed around. So that's huge.

Speaker 2:

And then the way to get flagged as an office not to be messed with I like to call it a whistleblower. You want to get flagged as a whistleblower. The way you do this is by using the insurance commissioner. So you want to file a lot of complaints with the insurance commissioner. Use it as much as possible.

Speaker 2:

My rule of thumb is one appeal, and that's because, talking with the insurance commissioner and working with them a lot, they do require that. In some cases they require it, in some cases they just really appreciate it. So you want to show proof that you did attempt to work it out with the insurance company at least once, and so you want to do that. One appeal, and again that appeal is okay to just say I've already given you everything that you need. You don't need anything else.

Speaker 2:

Process the claim or I file the complaint and if they still don't process the claim, and you go ahead and send it to the insurance commissioner, so file the claim. If it's denied, you reply saying get this paid or I report you. And then you report them. That's how you get flagged as a whistleblower and they will back off, the reason being because the insurance companies, even the insurance commissioner, is aware that they're doing this, but they can continue to do it as long as they don't get in trouble for doing it Right. So they're going to flag these offices and they're going to continue to bully the ones that they can. That saves them money and they're going to back off of the ones that are the whistleblowers. As long as those people aren't reporting them, they can continue to do it to everybody else.

Speaker 1:

And I want to. I want to bring something up because this has come up. You know, when I'm working with an office and we're in a coaching session and I'm teaching these strategies, right they are, they're saying well, I've had one doctor recently say you know what? I don't want to report to the insurance commissioner because I'm afraid of retaliation from the insurance company. And I think we again, understanding your laws is so important and it's empowering because if and I had to explain this to the doctor and later, they're okay doing this, but when you understand your laws to the extent of your rights and the protections, there are whistleblower protection laws.

Speaker 1:

I'm trying to word this For two categories. Right, there's for employees who blow the whistle on something that they feel is unethical going on with that employer. Right, that's a whistleblower. But there's also protection for healthcare providers specifically who report these behaviors to the insurance commissioner. And there has never been, as far as my research goes and I've did some extensive research there has never been a case where the insurance company was ever accused or convicted of retaliating against an office who reports these behaviors. There are instances where they get fined and they change their behaviors, but there's not an instance of retaliation from the insurance commissioners that I have seen so far. I could be wrong and I'm willing to be wrong about that, but I so far have not found that. What do you say to that Tess?

Speaker 2:

So that is a question I get all the time and I can tell you from doing this, a lot, a lot. Over the years, I have been threatened by insurance companies. When I am sending out these complaints, it never comes to fruition, right, like they're not able to own up on these threats. So I want you to think about the insurance company as a bully. What does a bully do?

Speaker 2:

Sometimes, when you start to push back, they puff up bigger, right. All of a sudden, they say back, they puff up bigger, right. All of a sudden they say you're going to try to mess with me, the big you know kahoot, right, you're like I'm going to scare you into backing down. So they're going to threaten you harder. They're going to threaten you with whatever they can think of in the sun that they don't have any way of doing any of these things. They would actually be in so much more trouble for that.

Speaker 2:

So I can tell you, let them puff up their chest. They're scared. They're doing that because they're a bully and they're afraid they're about to lose their power. So they're doing what comes naturally to them at that one last attempt to push you back into silence. And don't let them do that to you when this has happened to me. I laugh at them, I take away their power. I know that they have no right to do that and I repeat back to them are you threatening me? It's been on the phone and usually a little bit about how you took on UnitedHealthcare in the state of Utah and you actually caused change because of that.

Speaker 2:

Yeah, unitedhealthcare was going around denying all of these crowns and all these buildups every crown, every buildup, everywhere and we were sending complaints through to the insurance commissioner and it was not looking like it was going to go well. And I teamed up with a lot of offices across Utah talking with the insurance commissioner. One person submitting a complaint, one office doesn't show trend. Right, we can show the trend of what's happening in our office, but what that can look like is that our office is doing something wrong and it's not happening to any other office. We actually need all of the offices. When I talk with them, it's happening to all of them, but nobody else is reporting it but me. So I got everybody to go and report this.

Speaker 2:

And then the insurance commissioner is like okay, we see a trend. A trend is a problem. That means it's a tactic of the insurance company and it's not these 400 offices or two. I think we had 200 offices sending complaints and they're like okay, it's not, all 200 offices are making the same mistake. This is a UnitedHealthcare problem. And they did an investigation, they found them at fault, they were fined and they were told to knock it off. So our.

Speaker 1:

That's amazing.

Speaker 2:

It's the UnitedHealthcare's back at it again, but I've had three run-ins with UnitedHealthcare over the years and they were one of the ones that had given me the name testing a bullet.

Speaker 1:

They're like shaking in their boots because they're like, oh no, here we go here we go.

Speaker 1:

They don't like me very much, but they fall in line every time, so they were one of these tests because you made a couple and I'm just trying to kind of guess what the audience is thinking right now. So when you say you know if it's just one office reporting it, that's going to change behavior between that office and the insurance company, but not necessarily statewide change, Because what you did with the 200 offices was a statewide change, right, the behavior-.

Speaker 2:

It was a nationwide change.

Speaker 1:

Okay, well, there you go. So even better. So that is a different movement than the office. So you're not saying you're a single office. If you report your challenges with the insurance company, nothing's going to happen unless you get 200 offices involved. You're saying report those behaviors because it will also change the behavior in which the insurance company treats the practice individually. Yes, definitely.

Speaker 2:

So that's. There's two part system, right? Like getting flagged as a whistleblower and getting them to back off of your office so you're not reporting them. Because if all these offices are reporting them, then that goes to that second part of where the insurance commissioner can see the trend and can shut them down. They don't want the trend to be notified, so anybody who's reporting them they back off of. So they pay the claims and they will start giving you less denials because they know you're going to go straight to saying hey, commissioner, here's another one, look at what they're doing. So they don't want this trend popping up for the commissioner's office, so they're going to flag that office and back off of that office because they don't want those trends.

Speaker 2:

So I would say make sure you don't ever think like oh, I'm just one person, right, that's what you're saying. And don't think that way. You're one person in your one office and you're very, very important to getting not only your office flag but to helping and set those trends for the state or for the nation so that they can be made aware of that. Every person counts.

Speaker 1:

Okay, yeah, I love that. I love that. I saw a question that came in and it was pertaining to what you were talking about. Where can you find those laws?

Speaker 2:

Yeah, there are federal laws and there are state laws and I would make sure I used to have the link. Now I can't think about. I had the link for the federal laws. I can go over them with you, but I don't remember what the link is now. It's been so many years.

Speaker 1:

I have, I have, I have the links, um to understand and understand what you're cause. There's state and then there's federal. Yeah, so it's not just state, it has to be. You got to understand both and, and, I think before you even get into the laws. I think it would also be important for individuals to understand the difference between self-funded plans and fully insured plans, and which governing bodies they can anticipate to interact with, especially when it gets to this level, when we're incorporating the insurance commissioner, it's also important to understand that there's different governing bodies and what their?

Speaker 1:

role is pertaining to self-funded and fully insured plans, and that's a whole other webinar in of itself understanding that. So if you are a biller and you do not understand the difference between self-funded and fully insured, that's probably one of the fundamentals of billing is understanding those things, in addition to your state and federal laws, very, very important. So I would encourage you to know.

Speaker 2:

And I would say, if you're entering a claim or getting a denial and it feels illegal, it feels wrong. Trust your gut. You're probably right, it's probably illegal, it's probably wrong Anything. That is just like how can they do this? They probably can't. They probably can't and you just don't know where to turn for that protection. So go to the insurance commissioner and say how can they do this? This is wrong. And the insurance commissioner is probably going to say you're right, and they're going to make them pay it.

Speaker 1:

Yeah, so understand, not just state federal as well. Okay, so let me see what your other question is, and I think we may have already covered it, but how does an office file a complaint with the insurance commissioner, and are there details that should be pointed out? Yes, Okay.

Speaker 2:

So we've kind of been around this, but I don't know if we've said it directly. So a lot of offices are like I don't even know how to send this letter, where to send this letter. And I have this story, erica, you and I have talked about it before. I went to a seminar way back when and they said here's this letter template for you, here's the address to send it to. And I mailed it in and they called me and said what are you doing?

Speaker 1:

The insurance commissioner said what are you doing?

Speaker 2:

Yeah, the insurance commissioner's like this is not how you send a complaint, and I was like I don't know, this is what some. I paid for some seminar that told me to send it in this way. But it was great. It still got me to where I wanted to go and they were very sweet and directed me. But as I've been learning and doing this for so many years since then, I have found that that's pretty much the streamlined way is going to the website so you can Google your insurance commissioner for your state. There's a website It'll say on there somewhere Sometimes it's under consumer, but there's a website It'll say on there somewhere sometimes it's under consumer, but there's a spot somewhere that says file a complaint and you're going to click on that and follow the process. That is on the website. They walk you through the whole thing. It takes about five minutes.

Speaker 2:

As far as things to be pointed out, I like to point out the rules that they're breaking. This is not. Don't get in the mind. Change your mindset. That's what we're talking about today, right? Change your mindset.

Speaker 2:

You're not going to try to educate the commissioner on the treatment that the patient had. You're not going to try to educate and say this is what needed to be done. This is how it had to be done. You're going to point out that you provided everything to the insurance company to prove necessity and so they're not allowed to dictate treatment. They're not allowed to diagnose treatment, so they are required by law to process in good faith that what you have said needs to be done needs to be done. So all you have to do is submit your clean, valid claim showing enough evidence that it's reasonable that the treatment needed to be done. That's all. You're not gonna plead your case. So you're gonna point out if they delayed a claim. You're gonna point out if they wrongfully denied a claim when you already provided information.

Speaker 2:

I know they have some x-rays that they require to be done. It is good to give them an x-ray for those requirements. But again, if you have a narrative, then your narrative trumps the x-ray. X-rays are 2D, they don't show everything. I know some offices that have had issues with their software malfunctioning and that x-ray being deleted and you can still get that claim paid. They can't just say, because you don't have an x-ray, you can't get this paid. If you show a narrative explaining the situation and explaining what happened, that is that reasonable evidence that that treatment needed to be done. So you're going to point out those things that the insurance company is violating and how it's negatively affecting the patient and only benefiting the insurance company, right? So point those things out and then the insurance company is going to be looking at the. The insurance commissioner is going to go look at the insurance company to see why that they are denying this claim and if they have any valid reason. If not, they're going to make them pay.

Speaker 1:

Yeah, and I think, even before it gets to that point, they're just not going to want to have to deal with that.

Speaker 1:

So, as you, as you had mentioned earlier, they're just going to pay the claim because they don't want to be, they don't want to be accused of doing something wrong, right, denying benefits to a patient that had the right to receive that benefit. So, yeah, yeah, I love that Using the insurance commissioner to advocate for your patients and the byproduct of that is that the office gets paid and the other byproduct is that the insurance company stops bullying us right Like they start paying our claims because they know we are going to go through the troubles of reporting this behavior to the insurance commissioner. So I think that that is really good information. Tessana, I appreciate you know everything that you do for the dental community, the changes that you've made for all of us nationwide, continue to do that, and anything that we can do on our side to support that you know, just let us know, and if anybody has any questions, let us know and I am going to move on to our next panelist, and this is the final panelist for the insurance panel.

Speaker 1:

Then we're going to move into the hygiene panel and, amy, tell us a little bit about your career and tell us what you do.

Speaker 3:

Currently a practice manager. I work within a DOS they're on the smaller side Been in the biz and I don't want to say how many years, but 27 years started very my meager beginnings as just answering the phones when I was about 18, yeah, and just kind of working my way through um. I found I had a little knack for basically being a patient's advocate and having them understand because medical and dental are not the same, they're a different breed and I found I had made, I had a good rapport with dealing with patients on that level rather than clinical. As much as I am a perio geek, love everything to do about perio, my actual practice is periocentric. We have two general dentists but we're owned by a periodontist, two practices and I just it's like my jam.

Speaker 3:

I actually am leaning more toward getting into more of kind of what Tessa. Tessna, you're like my. I'm aiming to be like you at this point understanding more of the laws around now, because insurance companies are not out to help the patient, they're out to make money off the patient, are not out to help the patient, they're out to make money off the patient. And as long as I can help educate my patients that your insurance is great, but they're not thinking of your best interests, and that we are, and that's how I try and instill in my patients.

Speaker 1:

Okay, so let's get into that. Let's start off with your myth. I love everything you just said. It's right up our alley. I think my favorite thing you've said so far is that your practice is periocentric, and I absolutely love that. The myth that you believe is out there, and the one that you want to debunk today, is that we can't challenge our health care providers. And what do you mean by that? Your myth is challenge your healthcare provider.

Speaker 3:

When I mean by challenge, I mean, as in push for what you know is right for going forward, especially with hygienists. I see a lot of hygienists who say, well, you know, this is this, and they'll do a full workout and the doctor will come in and say well, I don't know. You can, as a hygienist, you can challenge your doctor saying I don't agree with you, let's discuss this. You know, not for the patient, obviously, but let's discuss this. And taking it a step further, you're a hygienist, you've completed your treatment, the doctor's completed treatment and of course, you go up against the insurance company. They say no, well, they have the benefit no-transcript.

Speaker 3:

A group that I worked with previously was a three-strike rule. They appealed twice. On the third, you asked for a peer-to-peer and you talk to their doctor on staff, which they have to have that doctor on staff to talk to your doctor. And the practice I'm in now is wonderful because they don't have a problem doing peer-to-peer whatsoever, even finding out that they just have doctors on staff. So if you're appealing an SRPp the doctors that they are getting to do the peer-to-peers with the hygienists it's funny how much they don't know and are not willing to come forward and say um, I sit in on these peer-to-peers and it's kind of entertaining. I'm off to the side, my hygienist can't see me, but I'm off to the side, so, and um, it's more often than not, within I don't know days, you'll get the okay going forward.

Speaker 3:

I also about the appealing and how you cannot go up against your provider. You get your patient to do it too. Once again, you've engaged with your patient. You want them to understand You're educating. But if that patient is making the phone call to the insurance company or to talking to the doctor or the hygienist directly, you know after they've seen them they're more involved, they've got more chips on the table and they're more apt to get to help you in your job as well. So it's kind of a fourfold. It's a lot of people involved, the one thing. But the more people you get involved, the faster it gets resolved and the less often it's going to happen. Yes, so I do think the challenge challenging is a scary thing to go up first, but once you get used to it and kind of empowering the people you work with and empowering your patients, the more you can get out of it.

Speaker 1:

Oh yeah, well, thank you for debunking that I mean. So the the. In a nutshell, just because it's a dentist does not mean they know better, right? So don't take no for an answer. Don't take no for an answer. Okay. So then what steps can an office take to create a clean claim before the patient even arrives to their appointment?

Speaker 3:

This kind of is telling to. When you have your patient arrive for our first appointment, my practice, my current practice, we don't do cleaning. It is a full examination with the doctor. It's full charting, it's full photos, it's full. If they need, if they don't come with an FMX, they take the FMX.

Speaker 3:

We take also a panoramic x-ray, as you know, maybe as a courtesy, we have everything on the table as well as before they've. That's for the first visit. But before they've come in, we've also researched their plan to the point where we know if they're coming in, they need SRP. Can we do arrest in that appointment too? You know, because a lot of them don't have SRPs. You can't do arrest at the same time. You have to wait for the peri-home maintenance appointment To have all that in place so you can explain to your patient as to why they need it at that time, why it's been diagnosed for their next appointment.

Speaker 3:

Having everything up front, being schooled in the policy so you can tell the hygienist, this is what you're able to do. They have the tools so they can collect the information. So once they've collected all the pertinent information, it gets attached to the claim and it's a no brainer, you hope, but more often than not having that way before they even walk through the door. And it's not just about insurance verification. It's you're verifying, but you're identifying the fine details involved. But in the long run it makes the claim go out and it's done. Your hands are washed, it's going to get paid.

Speaker 1:

Yeah, and that's what I said earlier is the insurance verification really kicks off the revenue cycle and the weaker the breakdown, the weaker the cycle. Right, we're going to leave money on the table. We're not going to, in addition to weak coding practices. You know you condense all this stuff and you know you put it all together. You condense all this stuff and you put it all together.

Speaker 1:

On average, we do a free coding and billing analysis which I want to offer to everyone and if Hernan or Ari, if you guys can post the link to receive a free coding and billing analysis into the chat, any office that wants to take advantage of this. We've identified up to about $180,000 over an 18-month period that an office left on the table because of forperio performance, hygiene performance, using incorrect codes or codes that they could use, fee schedule positioning. I mean, there's just so much about the free coding and billing analysis that identifies. But if you look at the core and I've done this thousands of times now if I look at the core as to what, why this is happening, how offices are leaving this money on the table, it always boils down to a weak breakdown of benefits, like just not asking the right questions and not using the right codes Like it's just that simple so it also goes back to.

Speaker 3:

It also goes back to if you don't have that full breakdown and things aren't going to get covered and you've done it now you're alienating your patient. Now they're not going to trust you.

Speaker 1:

Yes, absolutely so. The next question, amy, is how do you ask for those that are attending, how are they going to ask their front desk to take extra steps in this process, like, as it's mentioned here, going beyond the verification. Like, what extra steps can we take to prepare for the patient?

Speaker 3:

I have the rapport between the front desk and hygienists.

Speaker 3:

I know there's always the pushback Well, they don't have coverage for that, so you can't do it.

Speaker 3:

I have been educated along the line by some lovely group of hygienists over the years of what they want for their patients.

Speaker 3:

And if you don't understand what hygienist is telling you, you need to ask and as a hygienist, you're not going to go I need this, this and this, as long as you explain to your front desk this is why I need this.

Speaker 3:

This is going to make you look like a superstar because you're going to understand it You're going to be able to build it up, build it out or, in turn, you can school your hygienist to say well, you can do that at a prophy and a limited scale at the same time. So as long as if you're hand in hand with your hygienist and there should be a very there's no pushback involved and you've got your I's dotted and your T's crossed, everything is smooth. If you are not asking the correct questions to your front desk, you're not going to A treat your patient the way they should be as well as you're not going to make any money. So it's just the way it is yeah, yeah, you know, it's just the way it goes. But having that rapport asking all right, you're asking me for a rest, and what exactly is a rest?

Speaker 2:

and because a lot of front desk.

Speaker 3:

People don't come from that world. I've been in it so long I get a lot of it. I'm always learning. I did assist for a short time for a periodontist, but there's a lot. I'm still learning as well because I'm old. Things have changed. So as long as you're asking the correct questions and you're schooling your front desk, they're going to understand.

Speaker 3:

The exchange of information is going to be seamless and going back to that complete breakdown as well, it's up to you, the hygienist, to say I see this, you know bone loss and I don't think we're going down the right avenue.

Speaker 3:

Can you find out for me if their policy covers this or X and Y isn't adding up to me. I really you know this is really down the avenue we want to go. I have a lot in my practice. A lot of patients are elderly and we actually build in extra time to our new patient appointments and things like that for education. I have one of my hygienists she's been in the business a very long time and I hear her day in and day out very positive about that and she'll come to me and say can you look this up for me? Can you tell me what their benefit is and what she needs to do to get that benefit paid. So as long as, like I said, opening that line of conversation, that conversation is huge and don't don't take no for an answer, either like oh no, you can't do that. Ask your front desk as a hygienist, ask your front desk.

Speaker 2:

Why can't?

Speaker 3:

I do that.

Speaker 2:

And if they cannot?

Speaker 3:

answer you, then they need to give you an answer. It's a challenge. Once again, challenge the people you work with. If they're really invested in what they do and if they really like what they do, they're going to help you. And if you're making more money, then they're going to be making more money too. So just the way it works.

Speaker 1:

Yeah, I love that. Okay, so final question is and I love this question why is detailed documentation so important? Can we just like take a moment to like acknowledge that there are still those two-liner documentationers, the providers that are still doing two lines of documentation, and then expect us to magically get them reimbursed for everything they did?

Speaker 3:

Because the insurance company wants to deny. They say they don't have this, they don't have that. But if you don't give them what they anticipate, they're going to need, for instance, a scaling. I'm seeing more and more claims getting denied because it doesn't say how long they took in the appointment. This is, as of lately, one particular insurance company, so I've started. When did you clock in with this patient? When did you clock out with this patient? They need to see. Come to find out. I got a claim denied why they weren't in the chair long enough. Wow.

Speaker 1:

That was a big one for me and I was like I don't see that.

Speaker 3:

And I requested the patient's detailed breakdown from actually from the employer employer, because nobody would talk to me at MetLife. So I called the employer and said can I have a copy of their book? I want to see it in writing. That they have to be in the chair for an hour and a half for scaling, it bothered me. It was only, mind you, it was only once, two quads and there was no place. It wasn't written anywhere.

Speaker 3:

But now that I've started including that on my MetLife claims, they're going through and the more I won't say more is better Because, like you say, sometimes you do what is asked of you. You don't overindulge, because then they'll give you more reasons to deny. But push back. I had to push back on that one because I was like I've never heard this in my how many years to say you have to be in a certain in the chair, a certain time limit or time maximum for it. It was kind of ridiculous. They didn't find it. I haven't seen it coming in writing in a couple other ones though, other insurance companies, though. It's kind of like a thing now.

Speaker 1:

And I think that we need to understand that, just as the codes are being deleted, revised, additional codes, that landscape changes every year, so do and I want everybody to hear me loud and clear so do payment processing policies. So they are always changing their requirements and I'll say the two biggies that are scrutinized the most are going to be 4341 and 2950, the buildup in the SRPs because of the abuse, the utilization abuse, or at least that's going to be the latest reason why they're scrutinizing, right, I'm not saying that, that's fact. I am a firm believer that there is no such thing as a clinical denial, because I've read and done and spoken to, like Tessina, we've spoken to those individuals behind the curtain, right. So we've had the conversations with, you know, the attorneys at the insurance companies. We've had the conversations with dentist reviewers. We've had those conversations and all have informed us.

Speaker 1:

You know these denials are for cost containment purposes, like I mean, it's really not a clinical denial, maybe once these denials are for cost containment purposes, like I mean, it's really not a clinical denial, maybe once in a while, but for the most part we are not dealing with the payment processing policies. Don't stay the same. They change. So we got to stay on the up and up, okay. So thank you for sharing that, amy. I appreciate everything you have shared.

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Ericka Aguilar

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