The Dental Billing Podcast

Debunking Dental Billing and Hygiene Myths with Patricia Mooradian, RDH - Part 4

• Ericka Aguilar • Season 9 • Episode 4

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What if you could reignite your passion for your job and drastically improve patient outcomes at the same time? Tune in to hear the inspiring story of Trish, a dental hygienist who transformed her career from burnout to joy. Trish reveals her journey of mastering periodontal care, saliva testing, and insurance coding, and how these skills not only reignited her love for her work but also elevated the quality of care in her practice. Find out why chart prepping days in advance became her secret weapon for accurate coding and effective treatment.

Unlock the secrets of effective communication in dental billing as Trish debunks myths and shares her personal experiences. Discover why proper coding, including the updated 2024 claim form and box 39A, is crucial for avoiding claim denials and ensuring smooth processing. This episode underscores the power of perseverance and self-advocacy in achieving job satisfaction and better patient care. 

Navigate the complexities of patient communication and insurance education with us. We discuss tackling patient resistance to treatments, the significance of unified messaging within dental teams, and the impact of insurance myths on patient care. Additionally, we delve into international billing challenges and connect our listeners with experts for further insights. Don’t miss this episode packed with actionable tips to enhance both patient trust and practice revenue.

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:

Okay, let me pull up Trish's. So, trish, while I pull up your questions, we're of I hate hygiene, I love hygiene, I hate hygiene, I want to quit, I want to find another job.

Speaker 2:

And it all came down to basically me like just doing bloody proffies all day long and then just like burning out and like not being on the same page as the doctor, and basically I got to a point that I was just like, okay, I need to do something about this. And actually what happened was I started to like learn more things. So I started to take more courses to learn more about Perio, because I felt very like, even though we learned stuff in school, I felt like still uncomfortable about explaining things because you learn it so long ago. And then you just like get over it and you're like let me get back into it. So we started doing like saliva testing in the office, just incorporating slowly, little things, and I was like, oh, this is like way more fun now, like I'm doing something else other than just like doing a pro fee after a pro fee, right, and just wanting to clock out and see you later. So then, over time, I just started to like really enjoy my job.

Speaker 2:

And then, basically, covid came. And then, after COVID came, they were like, ok, everybody, we're going to go into working commission now. And we were like, oh, we're going to make no money, we're going to have to like push treatment on patients Like, oh, no. Actually, one of our hygienists actually was like peace, I'm done, I'm not doing this. So I was like you know what, let's, let's try this, let's see what's going to, what's the worst that can happen, right, else I'm like, let's bring it on, you know.

Speaker 2:

So I started working commission and I started to notice that like I was making more money and I was like, oh, this is nice, you know. And so then I started to like really start studying insurance codes, like literally reading the CDT book, like line by line, and highlighting it to make sure I was doing the right thing, and also so I can make myself some more money, make the patient happy, healthier and make the practice more money. Why not, right? So, like my numbers just kept going up and up and up and I was just like, ooh, like you know, I think it's a known fact that the more like if you have money, at the end you're going to work harder to, like you know, do your job, which, honestly, I wasn't doing my job before, but I was not educated on that stuff. No one thought me. No, you know what I mean. How was I supposed to know?

Speaker 2:

I basically got thrown into this and I was like, okay, now I have to learn. So I learned it and then I just started like just studying the insurance left and right and like, perio, like what else can we incorporate into the office to make more production? I just got so into it, like so into it, and then I basically tripled my income. Now I work less love hygiene. Now, like I love going into work. I used to like literally go to work and like Amy you might not know this, but like I used to like sometimes sit in the parking lot and I would just like I was like I'm going to have an anxiety attack because Amy used to work with me at my current practice that I'm in and basically all this happened. Like I've been at this practice for 12 years and all this happened here. So like hated it to like love it, which is wildly insane. A lot of hygienists think that they have to leave, go somewhere else, but it's really like a mindset thing, it's like learning as you go or whatever.

Speaker 1:

I'm going on a tangent here that being said, I mean I appreciate everything you just shared. Let me ask you then, because it kind of goes right into what you're talking about right now so there might be some burnt out hygienists right Watching us right now and what steps can the hygienist take to help their office make sure that they're checking proper dental information before the patient arrives?

Speaker 2:

Yeah, so I think chart prepping, how does?

Speaker 1:

that help you Like with your, with you know, with your hygienist.

Speaker 2:

So chart prepping is key, right? You don't want to be like just I used to know hygienists that would just like jump in like the day of, without looking at their schedule and not knowing, like, what's happening. Like how I have so much anxiety doing that, like I need to know what I'm doing that day. What happened to the peri chart last time? What was on the note last time? Like just what was coded last time? Sometimes I catch people coding things wrong, like it was a peri-humanus, peri-humanus. Now someone did a prophy and I'm like, why? And it was like the doctor that did the cleaning. I'm like, oh great, no offense, doctors, if there's any, I don't do fillings. So anyways, just basically like looking through everything, and I always like to start three days before. So three days before I'm chart prepping, and then the two days before I'm checking again, and then the day before I'm checking again, because things change Patients come in and out. I want to make sure I go up to the front desk and ask way before the day of unless they were put in the day of, when was the last FMX? When was? Like?

Speaker 2:

I do my own research because I want to make sure that there's coverage and not only are they eligible, but are they eligible, meaning are they due for a prophy today? How often can they have a prophy? So, like the whole like frequency thing, you know, sometimes patients will be in the chair and I'm like they just like we're here, like blah, blah, blah, like are they going to get coverage? I want to make sure that they can get coverage before and with our office, like we've had so much turnover and it's always like something new and people, new people, and they're not checking things. So I feel like I always have to do my homework and I feel like that's not just me. I'm sure there's a lot of other practices like that and we have a breakdown, but sometimes it's there, sometimes it's not there, sometimes it's wrong. Oh, that might not be accurate. I'm like so what am I supposed to go by? And then there's days when patients get just thrown into the schedule and I'm just like I have nothing, they don't tell me anything, oh, we didn't have time. So what are you supposed to do then? Right, it's just like a frustration for me still to this day that like things don't get checked on time, but then again throwing a patient in right before, like you might not know, you do what you can, whatever, but anyways going off there.

Speaker 2:

So yeah, just basically chart prepping and looking into everything and doing your own homework, you know, and if that, if we don't have something from, maybe sometimes I don't go by what patients say, but like I'll ask them, even though they don't know. Usually it's like well, what happened last time? Did you have period? Did you have a deep cleaning, whatever? Like you know, ask them a little bit to get to know what they know. And then look at the ledger, maybe been there. And then I know that I won't take like a full mouth x-ray FMX. If I know, like if I can see the breakdown and I see the insurance, like I do my own little thing and then like if I can't get confirmation from the front desk, I don't do it, unless the patient's like okay, do it, but most times they're going to be like no, I don't want to do it.

Speaker 1:

Okay, so are you. So you're saying you are more insurance driven, so you will go based on what is covered by the insurance plan.

Speaker 2:

For like x-rays, but not saying like I wouldn't do like a peri maintenance when they're peri maintenance, not saying that, no, no, no we talked about that.

Speaker 1:

We actually we talked about that this morning. You had an experience that pertaining to perio maintenance, and I think we talked about what to do when insurance only wants to pay for a pro fee. So what do you suggest that a hygienist does when you are documenting for what you're doing a perio maintenance but the office is billing for the benefit?

Speaker 2:

Yeah, and that's like really frustrating Cause. Like I said, this happened the other day, so not to point fingers, but like, yeah, like it still happens to this day. I'm trying not to do that. Yeah, it's just, it's hard, it's frustrating. You know, like you do your thing Literally.

Speaker 2:

This patient actually it was, this is like my whole like myth thing is that basically a new patient coming into a practice let's say they're basically perio, they had scaling somewhere else and they come into our office and I'm like okay, they're a perio maintenance patient, we need to send the insurance information so that we can post that. Or it's like a new insurance, you know a new insurance, and then you have to send out the new information and someone at the front desk changed the code, didn't even tell me, just changed it, and I was like, oh, like, and then it was funny because it happened. And then I'm like, wait, did I mess up? And I changed it again. And then they changed it again on me and I was like the clinical provider and while someone told me I should do it this way, so I'm going to do it this way, and it's like what do you do when that person is your boss? Do you know what I mean?

Speaker 1:

And that goes back to what the point of this webinar right is to debunk these myths and that's why I talked about that at the beginning of the webinar. You know, billing for benefit is called fraud and all parties involved you specifically with the license, you being the license holder and the provider. They are putting you at risk and the point of a good biller is to not only maximize on every penny owed to the practice right but also to protect our provider's license right. And so when I bill to benefit, when I see that your documentation says peri-maintenance and I bill for a prophy, I just put you in harm's way, and not only myself as the biller. Because, again, ignorance is no excuse to the law, right? You can't say that you didn't know any better because the law expects you to know your stuff. Like, if you're going to sit behind a chair, a desk and claim to be the you know all powerful biller, knowledgeable biller, slash office manager and you are doing things like billing to benefit. I strongly suggest you educate yourself, because that is not the way to go and I am going to.

Speaker 1:

I know Jessica had just chimed in here. It's so true. It goes back again and I think this is what we're talking about is like we just need a standard of care in place. We just need somebody to tell the office like from the back office to the front office, to scheduling, we all need to know, like, how this all plays out right In terms of when my hygienist does a perio maintenance. We don't change it to a prophy right that has to come from the higher ups, because you're right, trish, like what do you do when it's your boss? What do you do when you know better but they are not complying with regulation? I mean, that really puts you in a tight spot. So, with that being said, I'm going to move on to the next question here. What do you think is the biggest mistake hygienists and offices make when it comes to billing hygiene procedures?

Speaker 2:

I think that, in general speaking, for me as a hygienist is hygienists need to be more aware of things and go out there and study it. If you need to study it, find a mentor, because if we don't stand up as hygienists and do the things that we're supposed to do the right way for our patients, for our practice, things will not change Right. So it just like, uh to Sina said that you know, we all have to do it. It's not just one office that does it, it's everyone. The whole fricking country needs to do it, so that we are all on the same page, and then it can be more common knowledge instead of like, ah, did you hear about that? Did you there? This, this information is like just insanely needed everywhere. It's like I want to spread this love everywhere, like I've said before, because, oh my god, if, like, if I was to guess, I would to guess 80 of practices don't know this information. I don't know, like I feel like that's what it is, because that's, I teach courses for hygienists and no one like really knows the nitty-gritties of like, the little insurance stuff. Some, yeah, but there's always questions. It's like always questions. So, like I said, I think it's just knowledge. I always said this like knowledge is power. So the more knowledge you know as a hygienist or whoever you are in the practice you know, the better you can try to educate the people in the office so that they might open their ears. And you know, recognize that. And if you can go higher up and talk to those people that might listen to you more, then do it, which that's what I did.

Speaker 2:

When that whole thing happened with me. I went out. I was like nope, this is not going to work for me, let me go up. So I have, thank God, the place that I work with. I have amazing people up top who like listen and are open ears and maybe it was a miscommunication to begin with, whatever. Anyways, I got what I wanted. So just don't stop, just keep going.

Speaker 2:

Get like, if you know what's right from wrong, like, just keep going the right way. Plus, when you go the right way, at the end of the day, your job is going to be so much easier. When you code out right, because you're not doing that pro female style all day long and just job becomes boring. It's boring doing profis all day. You want to do other stuff. It's so much more fun and it's better for the patient, obviously. But your job won't be like you know.

Speaker 2:

I honestly, the way I work now and making sure all I'm coding right and everything I love going to work Like I love it, love it and I never thought I would love hygiene again after I was burnt out and I was like I'm just done with this. I love it and it's like, if I can, if I can go from hating this job to like pro-female, to like doing other stuff and being into it Like I would wish that for every hygienist, because I do truly think that, like hygienists, we like, we love our patients. We came into this field because we love healthcare and science and the more you get into it, I feel like your job will just be better and you'll help everyone.

Speaker 1:

I love that. Thank you for sharing that. All right, so we're going to. We have about nine minutes left for the webinar. Probably. Let's keep this next myth area, going over your myth. I want you to debunk this, because this is the myth you put in. You can't post a perio maintenance if the patient does not have history of perio treatment. And we're talking about new patients, so new patient comes to the office, we're going to start with perio maintenance, and you have had pushback about that. Okay, so talk to us about this myth?

Speaker 2:

Yeah, so it was basically a patient that came, came in recently that I spoke to you about, cause I was like, oh, it was the patient that came in, she was actually in her thirties, okay, and she had just had scaling somewhere else. Came into our office. I'm like, okay, she's definitely peri-op maintenance, she's a new patient with, I believe, new insurance. So then it's like no, we have to code out a prophy because we don't have any information. And I'm like, no, no, no, no, like do you see, I wanted to show the person at the front desk like, do you see these x-rays? You know? Like no, and she had deep pockets to the point that I was like deep, like you need to see perio, I want you to see our periodontist, you're probably going to need osseous. Like I don't know what happened there. I don't have all the information, information.

Speaker 2:

I was really concerned about this patient. And then this patient gets quoted out a prophy. And then that's when I went up to you and I was like, oh, what do I do? You know? And Erica has all the answers.

Speaker 1:

It's so true. On a side note, trish is texting me like throughout the day, sometimes like we're going back and forth. She's like, okay, how do I code this? Or how do I, what do we need to build this? Or like, what, what, what, what are the things for this? And and I'm just like, oh my gosh, like get, get me in front of that team, please. I'm kidding, I'm kidding, but she's not.

Speaker 2:

We all need help, we all need help.

Speaker 1:

So I mean, I agree with that. And I had a perio office one time call me and said, hey, all of our new patients, their perio maintenance is being denied. And I and I said, well, are you just? Are you putting the history of SRP on the claim Like that's all that is required? It's a very simple fix.

Speaker 2:

Can you talk about that form 39A, is it?

Speaker 1:

So it's a new claim form, the 2024 claim form, and it's boxed. I believe and don't quote me on this it is box 39A, which was added this year, so it's where we no longer place a narrative in the remark section. The ADA has updated the claim form and I'm not sure if it's 39A, don't quote me but there is a new section where you will insert the history, the date of SRP history, there, so you don't have to write a remark anymore. So for those of you that are and I'm pretty sure most of the people watching are still on the 2019 or 2012 claim form, because in our free coding and billing analysis we will tell you which claim form you're currently using and you are jeopardizing payment processing by using an old claim form, because the insurance companies have updated their electronic adjudication systems to recognize the new claim form now and so if you're submitting an old claim form, it could miss information and it could cause denials and delays and all of that stuff. So we're already dealing with enough. Just use the 2024 claim form. If it's not available to you, reach out to your practice management software, have them make it your default so that you know 100% of the time you are using that.

Speaker 1:

It is 39A. It is All right, I did remember. Thank you, tess. I always get nervous. I know there was a couple of updates to the 2024 plan form. That was a biggie, so make sure that you are using that. When you're submitting new peri-maintenance claims and needing to include the history of SRP, that's all you need is to ask the patient when did you have a deep cleaning? Because that's usually what they understand deep cleaning right. Because if you ask when did you have scaling and root planning, they're going to be like what.

Speaker 1:

Yeah. So when did you have a deep cleaning? And they're going to say, oh yeah, I did that on this day or this month or whatever, and then you're just going to put that into the new section 39A on the new claim form and you're good to go. So that that is okay. We'll get to that in a second.

Speaker 2:

I'll get to your guys' questions in a second Also, can I just say something really quick? I think you said this to me earlier too is it's like we, we do all this, but like really, we need to educate the patient on their benefits, right? Like I've heard a lot of times, it's like, oh, the patient needs to know their information. Like it's not our job to know their like. No, no, I hear this all the time.

Speaker 1:

That's very patient-centric. I love that.

Speaker 2:

So then, like just basically okay, this patient's going to be pari-maintenance. Now they had scaling. Are we telling them there might be a copay? Are we telling them all this stuff, or are they just randomly going to come in? And then that's when it starts. It starts with wait, I have to pay now. Like no one told me this before, and that's where it starts. And that's when the front desk might be like oh, and then they like downgrade the code and make the patient happy, like you know what I mean. Like I feel like that's where it starts. So if we are very like into the patient, educating them from the beginning all the way through, and even if that's the hygienist starting it and then the front desk talking about it, and like the doctor talking about it and everyone's talking about it, so we're all on the same, page.

Speaker 1:

You know what I'm saying. Yeah, it starts. You mentioned it starts. You mentioned that earlier. You, trish, and I, are very big on audio messaging and so we'll send each other like four minute messages, like we have full-on conversations through audio messaging and I don't know why we just don't pick up the phone, but I think it's because we're doing other things.

Speaker 1:

Yeah, this morning we were talking about what to do when a patient says I don't, I just want to do a prophy, I don't want to do peri-maintenance, I don't want to do. When a patient says I don't, I just want to do a prophy, I don't want to do peri-maintenance, I don't want to do a deep cleaning, and I find that to be more of an issue within the system. Right, like we are not properly educating our patients around their insurance, we're not properly educating them. When we're treatment coordinating, we're not having the right conversations, and when patients are saying things like this, that is more of a symptom of a bigger problem. That's not you don't want to just fix it with this patient.

Speaker 1:

It's a symptom of a bigger problem and we need to identify that. So, paying attention to patterns right, like the responses and I'm not going to get into this but the responses that we're receiving while we're coordinating with the patients you know I need to think about it or they're not. We don't have high case acceptance, for whatever reason. We need to identify those patterns, but this is a biggie. If you are hearing this in your office, then we need to have a different type of conversation outside of billing. There needs to be a conversation about something else that I'm not going to get into.

Speaker 2:

All right, so, and then real quick I think Jennifer mentioned that, sorry make sure everybody's on the same page, because if you're not on the same page you lose trust of the patient, and then they pick up on that.

Speaker 1:

Yeah, okay. So we are at the end of our webinar here today and I just wanted to go through really quick and see if there are any questions that I need to. Courtney says so to finish the myth of perio maintenance without history, of SRP and submitting to the insurance, because most patients do not remember or do not tell you because they don't want to pay for perio maintenance. Again, I think that that conversation is a symptom of something bigger going on. We're not having the right conversations with our patients. If that's what's happening, and certainly if the patient's not appreciating the type of cleaning that they need, that also means that they are not accepting responsibility for their oral health, their oral hygiene habits, and we need to have those a different type of conversation with our patients. And, like Trish said, you know we all need to be on the same page about what our standard of care is in the practice.

Speaker 1:

I know we in a practice that I was partner in in Carson, california, in between Compton and Long Beach, and for those of you in the country that don't know, compton and Long Beach are low income areas and we were right smack in the middle of that, our standard of care and we were predominantly a Medicaid office. Our standard of care was laser, lapt, laser assisted karyotherapy, with all SRPs. We did not care what insurance you had. It never came up in the conversation and we fiercely backed up our doctor's standard of care about laser with SRPs and once in a while, because the entire team was on the same page the hygienist to the assistant, to the doctor, to the treatment coordinator. We were all on the same page, sending the same message. We rarely got pushback, were all on the same page, sending the same message. We rarely got pushback. So it's, I believe, in making sure that you are all on the same page with regards to standard of care.

Speaker 1:

Don't believe the the myths that are out there. There are a lot of myths that can be debunked. Utilize the power of the insurance commissioner. It is so important that we are reporting these behaviors to the insurance commissioner so that we can have nationwide change. I mean Tessina is proof that we can have nationwide change and monitor your perio performance. I mean again, take advantage of the free coding and billing analysis that we offer. We will talk about perio performance and we will also share with you the blind spots that we see. So I mean and this is just numbers there, it's numbers, don't lie and if you're looking to improve, we would love to help you do that. Through this coding and billing analysis. It's helped a lot of offices increase collections. Just with you know this 30 minute Zoom meeting that we spend with you. So, with that being said, any final words.

Speaker 4:

Jen, I guess I would just say focus on the patient. Make sure that not all of your conversations are about insurance, but giving value to the treatment that you provide to the patient, focusing on their health. I know we have to have these insurance conversations, but make sure that you are not saying to a patient we can't do that because of insurance. Let the provider do that.

Speaker 5:

Estenette final words. I don't know. So many good things, things. You guys really hit on everything. This was so much fun. I'm so glad I got to do this with you guys. Yeah, file those complaints, file those appeals. If it feels wrong, if it feels illegal it probably is and don't take no for an answer. Love that.

Speaker 3:

Amy. It kind of answers a question that somebody had said about how do I do something challenge? Somebody said they're a new patient. They said they might. They might have had a scaling in the past. And how was I supposed to know that? Challenge your front desk is what they did, their breakdown. They should have got their history too. So challenge, challenge, challenge, that's good. Oh, that that actually answers.

Speaker 1:

I think it was courtney courtney. Yeah, I'm sorry, courtney, I I agree. Yeah, that's right when, when we were getting, yeah, burial maintenance or SRP history.

Speaker 3:

And challenge challenge, challenge.

Speaker 1:

One of the things that I find in tests. We've talked about this before. I find that when we get, when individuals get, breakdowns, we'll get frequency limitations, but they don't get history. And I don't know why, because I've said this for years frequency and history are sisters and they don't go anywhere without each other. So if you're getting frequency, you have to ask about history. So just wanted to put that out there. Thank you for bringing that up, amy Trish. Any last words Be amazing as you are.

Speaker 2:

Be just, you know, just ask for what you want and you know, just be an advocate for. Be just, you know, just ask for what you want and you know, just be an advocate for yourself. Because you know, if you don't stand up for yourself, if you don't ask for what you want, if you don't try to do the right thing, it's not going to happen. Like, you have to step up and you have to be that leader and the end of the day you will not enjoy your job if you're not like that.

Speaker 1:

Don, you will not enjoy your job.

Speaker 2:

if you're not like that, don't take no for like for an answer. Challenge. Love it All that stuff. So yeah, okay. Well, with that being said, I guess we're going to. We are those a private question here talking about? Where can someone learn about insurance billing in Canada?

Speaker 1:

I think the question is what are the next steps to going to go commission and about insurance billing in Canada. Well, you know, I don't know Canada system. I know, I know this. I know it's different because we had a study club reach out that wanted to invite me to their study club, but the factor, the fact that I don't know that the Canadian billing system was a big hard no for me to attend that study. So I don't know.

Speaker 1:

I am looking into learning Canada's system. My goal is to learn Canada and I already I'm doing the out of country stuff for Mexico, working with one office out there learning how to bill. But it's Mexico, uses our codes here in the US and it's just learning how to do out of country billing, which it's different and I'll share more about that later. But yeah, I think for all of you that have messaged us questions, I'll make sure that the question gets forwarded to the right person and you will have a conversation with that person. I'll connect Rose, I will connect you with Trish so you guys can talk about that how to go commission and maybe Trish can share some ideas on how to do that in your office. So if you guys don't have any more questions. I guess we will close it out and thank you everybody for attending today's webinar. Thank you, thank you, bye.

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