The Dental Billing Podcast

How to Manage Daily Dental Billing Tasks

• Ericka Aguilar • Season 10 • Episode 4

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This episode highlights the essential components of a streamlined and effective daily workflow for dental billing professionals. Emphasizing critical reporting, compliance, and continuous education, we aim to empower new and experienced billers alike.

• Overview of the Dental Billing Mastery Course 
• Importance of establishing a daily rhythm in billing 
• Running Procedures Not Attached and Claims Not Sent reports 
• Verifying clinical documentation and quality attachments 
• Role of the clearinghouse in claims submission 
• Timely follow-up procedures for older claims 
• Monthly reporting and reconciliation tasks 
• Importance of understanding compliance regulations 
• Continuous professional education for successful billing practices

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 and see how Fortune Billing Solutions may help you.

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:

Welcome back to another episode of the Dental Billing Podcast. I am your host, erika Aguilar, and in today's episode, I thought I would take you into our Dental Billing Mastery Course In week 11, we are talking about the workflow, the daily workflow process that we use inside of Fortune Billing Solutions, so that I can give my newbie billers an idea of what a daily drumbeat or rhythm looks like, so that they can start billing as they get ready to wrap up their course. Friends, I also want to mention that when I launched this course, I never imagined that we would have 376 students actively working through the course. We are about halfway done and we continue to meet live every Monday and every week. We just continue to go deeper and deeper into the weeds of dental billing and in this week, we're going to talk about how to develop your billing workflow process. Now, keep in mind, this is just giving them an idea of how to get started. I'm sure they're going to develop their own processes along their journey of dental billing, but I wanted to take you on the inside as we kick off 2025 in week 11. Okay, I think we're good to go ahead and get started.

Speaker 1:

So today's class was held live and we did go over the dental billing workflow that you see in front of you. However, when I recorded the class today with students who attended in the live class, I had the wrong content up. I'm working on that training. It's not next week, because next week we're going to go over payment posting workflows. Today we're going to talk about the dental billing workflow that we use inside of Fortune Billing Solutions, which is the company that I own and we do dental billing for offices all over the country. Before I continue, I am going to put my phone back on. Do Not Disturb. All right, let's go ahead and get started. All right, let's go ahead and get started.

Speaker 1:

So, as I mentioned, this is the bones to the workflow that we use as billers inside Fortune Billing, and it's a very specific and intentional workflow that we use so that things don't slip through the cracks. We use so that things don't slip through the cracks and as we go through it, I'm going to explain why we created the steps in this sequence and how it works for us inside of Fortune Billing. Now, those of you that are new to dental billing, this is going to give you the framework that you need to start getting into a groove or a rhythm in your billing, daily tasks. So this is what we use as our rhythm and hopefully this helps those of you out that are looking for some type of where to start, where's the messy middle and where's the end. So that's what we're going to go through today and if you have any questions you guys know there has been since I launched this course we now have 376 students enrolled and actively taking this course and you guys know that I can take a couple days to get back to you, but I get back to everybody. So if you have any questions, my students are my priority in my day-to-day work, so please do not hesitate to reach out to me. So please do not hesitate to reach out to me.

Speaker 1:

Okay, with that being said, let's talk about the first report that we run before we actually start billing. That report is labeled procedures, not attached, and this can be called something different in every software, and I would encourage you to figure out what it is called in your software. We are predominantly working with open dental and Dentrix. We have some offices that are on EagleSoft, softdent, you name it. We probably work with it or have worked with it, but for the most part, I'm going to say that most of the softwares are going to call it something along the lines of procedures not attached.

Speaker 1:

This report is, in my opinion, one of the most valuable reports that we can run as billers, because it's kind of like that report that catches everything that slips through the cracks. So we always start with running a procedures not attached report. Even though we run this report every single day, it is still something that we do on a daily, sometimes twice a day, because things shift around right, like team members go in, make adjustments to the treatment that was posted or charged out to the patient's account. We just want to make sure that we're not missing anything. Sometimes treatment is added that maybe the clinical team forgot to document for. So now that treatment has been added but it's not attached to a claim. So we want to make sure that we run that report first, and that's going to get again help us to catch all of the things that can fall in between the cracks.

Speaker 1:

The second report that we like to run is the claims not sent report because, as the procedures not attached allows us to catch the procedures that might slip through the cracks and not make it onto a claim form, the claims not sent report does the same for the times when we create a claim and simply forget to press send. It happens right Like we work so hard to put a clean claim together and everyone here at this point in the course should understand what a clean claim looks like. And that is going to be making sure that the demographic information is correct, the insurance company is correct, the payer ID, all of the information needed to get this claim over to the insurance company so that the insurance company can make a quick decision as to pay or deny. That is a clean claim. Sometimes we spend so much time on a clean claim that we forget to press send. I've done it. I know that most of my experienced billers have done it and that's why there are reports that we can use to catch those oversights.

Speaker 1:

So procedures not attached is going to catch all of those individual procedures that may not have made it onto a claim but should have. An example of that would be let's say that the patient had five fillings done and we posted four of them and somebody forgot to post the fifth filling and it's not caught or it's added later. Or I bill four of them and forget to put the fifth one on the claim form. It's going to get caught in the procedures not attached report and the claims not sent report. We just talked about that. It is to verify that all claims from prior days have been sent and you can also use this to address any claims in the queue that have incomplete information.

Speaker 1:

Maybe we created a claim and we did not send it because we don't have clinical documentation backing up what's on the claim form yet. If anybody has listened to my podcast or you guys have been in this course now with me for the past 11 weeks going on 12 weeks, you guys know that I'm a stickler about clinical documentation. The golden rule in billing is if it is not documented, it did not happen. So we have to make sure that we are creating claims but not sending them unless we have clinical documentation that backs up your claim right, backs up the codes that you were claiming we did and serviced the patient with those procedures with proper clinical documentation. So now that we have run our two main reports, we are going to start working off of our procedures not attached report Typically what you're going to find when you run this report, because we run it at the beginning of the billing session and at the end of the billing session.

Speaker 1:

Because we run it at the beginning of the billing session and at the end of the billing session, because we run it so frequently, your procedures not attached report should be free and clear, with the exception of the day that is outstanding. Usually for us as a third-party billing entity, we're billing for the previous day or the same day, but later that evening. So the procedures not attached report is really the main report that we use to start and kick off our billing process. So we will go to the schedule, verify that the procedures in that appointment match what is being charged out to the patient's account or to the patient's ledger, and then, once we know that everything matches, then we are going to go over to the clinical notes and verify that the clinical notes support what is being charged out and essentially going to be placed on a claim form. So at that point once and I just want to kind of touch base on attachments for a second I am a huge advocate that billing starts in the back and what I mean is x-rays, intraorals, perio charts, caries, assessments all of those things happen on the clinical side and when we're talking about verifying attachments and making sure that we have what we need in order to put a clean claim together, one that is providing sufficient evidence proving dental necessity, so that, in the event the insurance company decides to unethically deny our patient's benefits, we have a fighting chance with the evidence that we're providing to the insurance company, right. So when we go and we verify attachments, we are verifying quality, right.

Speaker 1:

Obviously, we have to know which x-ray reflects the correct tooth number. We have to know how to read that x-ray well enough to know if it's providing sufficient evidence proving dental necessity. And we also have to make sure that our clinical teams understand what we need as billers in order to submit a claim that's going to get paid, right. So if the x-rays are blurry but the treatment is already done, the question then becomes what do we do? I get that question all the time the SRPs are done and we have x-rays that are three years old, what do we do? Well, in that case, I mean, you can retake the x-rays because they're probably still gonna reflect the bone loss, but it's really important that we get what we need prior to the treatment being rendered, because it's all about the diagnosis right. Diagnosis and prognosis are everything to any biller a medical biller, a dental biller, ophthalmology it's all about diagnosis and prognosis. So we want to make sure that we are providing the right type of attachment. So please make sure, as you grow into your billing position, please make sure that you understand you are the catch-all to the practice. You are the last stop. The interaction between the provider, whether it's the dentist or the hygienist, and the patient. That's done and over with, and our job is to now get our providers paid right.

Speaker 1:

So when you see that the clinical team is giving you poor attachments blurry x-rays, foreshortened x-rays, elongated x-rays, just bad x-rays altogether you have to say something. As a third-party billing company, we are an extension of the team. We don't work directly in the office, but we are a part of the team and as a part of the team, it's our job to hold each other accountable, especially when it comes to playing with the money right. How many times and for those of you that are new, you're going to experience this how many times have you seen a patient for SRPs and we get an incomplete perio chart? Excuse me, we get an incomplete perio chart and there's no bleeding sites indicated on the perio chart. There's no clinical attachment loss indicated mobility nothing other than perio depths, pocket depths.

Speaker 1:

That's not sufficient evidence proving dental necessity for SRPs. No wonder why it was denied. You gave the insurance company a reason to deny it. So we have to, in essence, stop giving the insurance companies reasons to deny. We need to get on the other side of the fence and make sure that we are providing clean claims. We are ensuring that everything on the claim form, all codes on the claim form, are backed up with clinical documentation that includes a diagnosis and a prognosis. We really want to emphasize that in our clinical documentation and we also want to make sure that if we are utilizing the power of intraoral photos because in my opinion, intraoral photos have better, give a better reflection as to what's going on in the mouth sometimes than an x-ray or sometimes both the power of both. But intraoral photos are awesome and I think that every office needs to use those as a part of the exam, diagnosis, because it just again provides that sufficient evidence proving dental necessity.

Speaker 1:

So what you want to do, what we encourage our billers to do, is not only verify that we have the right attachment, but also take a look at that, at the quality of the attachments. Are you getting quality attachments consistently? Are you getting poor attachments consistently? And if that is the case, that is 100% gonna affect our ability to get these claims paid in a timely manner, because we don't have the evidence to prove why we did what we did right, or the insurance company just can't see it and we don't want to give them an excuse. We don't want to give them that reason to not see what we saw in the exam, what the doctor saw, what the hygienist saw in the exam. So be very mindful of that when you are verifying your attachments. Please also take note and determine whether or not we need to do a training with the clinical team. I have done that several times with several clients and it improves our ability as billers to get claims paid faster with better quality x-rays, better quality intraorals. Sometimes offices are not doing taking intraoral photos at all, but then they start and everything just improves with regards to the billing cycle, because now we're able to prove that this treatment was necessary and we are giving sufficient evidence and now we're getting paid quicker. So very, very important You're not just there to make sure that we have the right attachment, you're also verifying the quality of the attachment and if there is no quality of the attachment and if there is no quality, then we have to do a training with the team. That's all in a day's work.

Speaker 1:

As a biller, our job, as the catch-all to the practice, is not to just code treatment. Our job goes well beyond that and in some cases, if your office were to go through an audit, the insurance company is going to go directly to the biller. They're going to consider the biller, the quality control right. They're going to go to the biller and refer to the biller as the compliance officer. So, with that being said, I would definitely take that position and make sure that we are compliant, submitting compliant x-rays to the insurance company so we can get paid All right. So now we're ready to create the claim and submit it.

Speaker 1:

So let's go back through the process here. You've run your procedures, not attached report, and, as I mentioned, your procedures not attached report should consist of maybe the previous day's treatment there might be a couple of other odd dates here and there from things that were adjusted or added but your procedures, not attached report, is the main report that you're working off of. Then we have our claims not sent report. Usually a lot of the billers at Fortune will create claims, put them in queue but not send them, and make a little note as to why they haven't sent this claim, and they will continue to follow up on why that claim has not been sent. I can honestly tell you, 100% of the time the reason that our billers will not send a claim is because the clinical documentation is incomplete or just non-existent.

Speaker 1:

And the reason that we're such sticklers about clinical documentation being done essentially boils down to the fact that we take our doctor's license very serious. We're very protective of our doctor's license because without our doctor's license our doctors we don't have a job. There's nothing to bill if there's no license to bill for. So we want to make sure that we are protecting our doctor's license at all costs and ensuring that we're compliant, and compliance in my world has always translated to higher reimbursement. So, keeping that in mind, we want to make sure that we are doing our very best to protect it. And then we have from the procedures not attached report we are going to move on to the clinical documentation and from the clinical documentation we are going to Then we are going to okay. So it looks like we're screen sharing again. I don't know why sometimes it will pause my screen and I'm not sure why it does that on its own, but I'm glad we are up and running again, okay. So you have give me one second. I think my computer is going rogue here. Okay, might be time for a new laptop. All right, so from the clinical documentation being verified now you are verifying your attachments that everything is of quality and we're ready to submit.

Speaker 1:

We are going to generate a claim and then submit it through the clearinghouse. So let's talk about the purpose of a clearinghouse. The purpose of a clearinghouse is to do two things right, twofold. First thing is to ensure that we have proper conversion of the 2024 claim form properly converted to the electronic 837, I forget what letter it is at the end, d, j, something like that but it's the electronic formatted version of our actual claim form. Because what the clearinghouse does is it takes the information from the claim form and then puts it into an electronic format that the insurance companies are prepared to receive. So that's how they read your claim. They are not actually receiving an actual claim form, they're receiving the electronic version, and that's the purpose of the clearinghouse so that the clearinghouse can then convert it and send it over in a format that the insurance companies recognize and process their claims through that format. So the other reason for the clearinghouse is the clearinghouse is going to. It stores all of what we refer to as the oh my gosh.

Speaker 1:

Attachment rules. So every insurance company has different attachment rules. Some insurance companies want an FMX for certain procedures, while others are okay with bite wings. Those are attachment rules and clearinghouses know all of the attachment rules for the most part and they will flag your claim before you send it over and they'll say, hey, hey, this requires a narrative. I noticed that you don't have a narrative here. Did you want to submit without a narrative? I noticed that you don't have a narrative here. Did you want to submit without a narrative? And you can bypass that. But it's probably best practice to listen to the attachment rules unless you know. You know for a fact that this insurance company doesn't need that particular attachment, then you could go ahead and bypass that. So that's the purpose of the clearinghouse.

Speaker 1:

You always want to make sure before you're done with your day, after you've sent all of your claims through the clearinghouse over to the insurance company. Some clearinghouses can take 15 minutes, 30 minutes, to generate a report that tells you which claims were accepted and which claims were rejected. I always encourage our billers to not wait until the following day. I always encourage our billers to just give it that 15-minute grace period. While the clearinghouse is sending everything over, they're communicating directly with the insurance companies. You'll get a report that says accepted or rejected. I do recommend doing that before you close out your day. That way, we're not one day behind. There's not one day lag in following up on anything that was rejected.

Speaker 1:

Now, with that being said, I do want to talk about a caveat. A part of what we do at Fortune Billing for our clients is we also focus on old insurance claims that have just been sitting in the insurance account receivable report and what we want to do is really go after any of that old money that's just been sitting there. Now, with that being said, the reason I'm saying that is to say this Sometimes, when we're doing our insurance claim cleanup process, we go directly to the portals. That's our first go-to. When we're talking about cleaning up old insurance AR, we go to each insurance portal first and do what we refer to as discovery work. We want to know, first and foremost was this claim received by the insurance company Because we did not receive a rejection from the clearinghouse. Okay, so remember I was talking about running that rejection, that report that tells you if the claims were accepted or rejected through the clearinghouse.

Speaker 1:

What we have found as we clean up old insurance claims is that more than half of the time these claims are sitting in the insurance account receivable report because they were never received by the insurance company for whatever reason. Lately, what we're seeing is we're seeing no diagnosis code and we're also seeing old claim format. Just not ever. It doesn't even make it through the front door of the insurance company because it just doesn't fit. The formatting is so off because we're using an old claim form. The insurance company doesn't even know how to allow the claim to come in. So using an old claim can definitely be a means to rejection or denial.

Speaker 1:

But my point here is this Even though I am telling you to run a report that tells you accepted or rejected, don't always assume that accepted means received. I'm going to repeat that Don't assume that accepted means received. It just means that they didn't receive, that the clearinghouse didn't receive an official rejection notice. But sometimes that doesn't always mean that the claim was received. So this is what we do.

Speaker 1:

We use Fridays as our follow-up day. We call it follow-up Friday because the fortune is in the follow-up, always, always, always. So as we are following up with our claims, what we do, we check on any claim that is greater than $1,000 and we verify through the insurance portal that the claim was actually received by the insurance company, even though we didn't receive a signal from the clearinghouse that the claim was rejected. Remember, accepted doesn't always mean received the extra mile and you have to verify that the insurance did in fact receive that claim, because I can't tell you how many times we've had large claims and anticipated insurance checks to come to the practice and they don't come for, and ever never because nobody's following up on that claim to determine that the insurance company never even knew it existed. It's sitting in our insurance account receivable report because we created the claim, we sent it through the clearinghouse, we did not receive a rejection from the clearinghouse not receive a rejection from the clearinghouse, yet when we went to the insurance portal, the insurance company never received the claim.

Speaker 1:

So we make it a point on Fridays to follow up on all large claims. Sometimes we're able to follow up on all the claims sent, depending on the volume for a particular practice. But when we have offices that are collecting $500,000 to $600,000 a month in insurance money, we really just try and get to the larger claims to ensure that that money doesn't just sit on AR, but actually we get it off of the books and into the doctor's bank account. That's very important. So that's why we call it follow-up Friday and that's what we do. So once you have um, once you have submitted and, and you're following up on Fridays and you're ready to close out actually not let's exclude follow-up Friday we're still talking about the day-to-day. So now we're still doing the billing for the day. We're going to rerun the procedures not attached report just to check up on our work, just to make sure that you didn't miss anything before you close out your end of day.

Speaker 1:

All right, so now we're going to go to step eight. We have an end of day email that summarizes how our billing went for the day, and we have a section in that email that's referred to as unresolved claims, and these are typically going to be the claims that maybe we created but we couldn't send because we're waiting for clinical notes or we're waiting for attachments, and so we're going to include that in the end-of-day email. Whether you are using a third party or you are the individual handling the billing, I do strongly recommend creating an end of day summary as to how the billing went, so that the doctor, the office manager, you yourself hold yourself accountable. But, more importantly, you know there's a paper trail of how things are going and I really enjoy having that paper trail personally so that in the event you know I'm ever accused of not sending a claim, I can go back and say no, I created the claim. But if you look at, this dates this email. I did request the mail, I did request the XYZ. So I do like the idea of whether or not you decide to be a third party billing company or you're going to be an in-house biller, create your end of day summary and send it to the office manager or send it to the owner. I mean, it really really does help and I will tell you right off the bat, most doctors don't read their end of day summary, fyi.

Speaker 1:

All right, let's talk about monthly tasks that we do. Now, this is not going to apply because I'm not going to go through what we send over to our bookkeeper at the end of the first working day of each month, our billers are required to send a final report with proof of insurance collections. Usually it's going to be like the deposit slips with Dentrix will tell you how much insurance money was collected for the practice and that's what the bookkeeper will invoice the client based off of the insurance collections. I believe Open Dental it's just going to be a day sheet and it'll tell you what your insurance collections were for that month. So it's really important that we get that information so that we can get everyone invoiced and get the billers paid. With most dental billing companies, you're going to find that they are going to pay you a percentage of the invoice and you're going to receive the majority of the invoice, where the company will receive a small percentage because and rightfully so the billers are doing all the work and the company is predominantly absorbing the liability, which is why they are able to obtain I'm sorry, retain a small portion of the total invoice. So we want to make sure that you are reconciling and posting payments accurately. Once we are done submitting all claims, then we can move into posting payments.

Speaker 1:

We're not going to talk about posting payments in this training. We are going to talk about that in next week's live training. We're going to go through the step-by-step process that we use when we are posting payments. But I will tell you in my experience, if you've ever worked with someone who is posting payments but has never done billing and does not understand the billing process, they don't understand how to verify if an EOB is accurate, because most EOBs have inaccuracies in them. Most EOBs have inaccuracies in them. And if you are going based solely on the EOB the explanation of benefits then your office is in trouble, because the first thing that we want to do and I will be very brief here the first thing that we want to do before we verify anything else is to first verify that the math is mathing on the EOB and that the EOB is accurate, and I will go into the details of that next week.

Speaker 1:

But it's really important that we understand we don't just look at an EOB, post the payment according to the EOB, create the adjustment or the write-off based on what the EOB. Post the payment according to the EOB. Create the adjustment or the write-off based on what the EOB says. Sometimes the EOB is not right. Actually, most of the time it's not right and we actually have to do some homework before we can determine if this payment is even accurate. So we'll talk about that a lot more in next week's training. So we'll talk about that a lot more in next week's training.

Speaker 1:

But super, super important to verify the accuracy of adjustments, write-offs and patient balances when you are posting payments. And if you've never done billing before you, my friend, have no business posting a payment. Okay, here are a couple of other things that I find, as billers, we need to verify and once again, just like we are verifying the quality of attachments, we are also verifying the quality of eligibility and benefits right. One of the main sources of the mess when we're talking about insurance AR messiness is the fact that it started with a weak breakdown of benefits and that weak breakdown of benefits was never entered into the practice management software, management software. Therefore, all treatment plans that are being recorded during an exam are coming out incorrectly or we're having to manually override, manually calculate way like operating like an office out of the 90s, where you know we're having to pull out our calculators, get the breakdown, pull up a fee schedule and now we are treatment coordinating like we are from living in the 90s again. It is so important that we know how to utilize the power of our practice management software so that our treatment plans are coming out accurately and we are not undercharging or overcharging the patient. We know how to apply the deductible properly. All of those things are so important. Yet I can tell you firsthand firsthand that people that have been in the game doing dental billing for 20 plus years are still calculating their deductibles incorrectly. So it's really important that you know how to verify.

Speaker 1:

Again. You're the catch-all, you're the biller, you are the detective, you are the one that's going to catch all of the things and verifying that eligibility and benefits are being done properly and entered into your software correctly. That is a part of your job as a biller. You are not just here to do data entry work. You are here to do so much more than that. You're here to verify compliance. You're the anti-fraud officer, you are the coding officer. You're the clinical documentation officer, you are the eligibility and benefits officer. You are the denial management officer. You are so much more than just entering a code into the system Understanding your codes. That's just one area. That is not all areas. That's just one very important area. But there's so much more to billing than just knowing your codes right.

Speaker 1:

All right, so now we're going to talk about tracking denied and outstanding claims. It is important that, as a biller, we are monitoring and tracking the patterns that our office is receiving from insurance companies. And I'm not going to get into all of this because we are going to have an entire course on denial management. I'm going to go into that in even greater detail than we already have. I'm going to go into that in even greater detail than we already have, but it is important that you know how to use Excel and you can create a basic spreadsheet outlining the insurance name, the denial, the reason for the denial I'm sorry the procedure, the reason for the denial and any other information you feel is important to document so that we can report a pattern of abuse to the insurance commissioner if necessary.

Speaker 1:

Okay, so denial management is going to start with you keeping track of anything that gets denied. And remember, denials are not a reflection of whether or not you put a clean claim together. You're going through this course. You're going to put together a clean claim, because that's what we talk about, right? So I know that you are going to have a clean claim. However, that does not mean that clean claim means paid claim, because, as we spoke about in a couple of classes previous, I told you that sometimes denials are based on budget and not on clinical merit. So the sooner we understand that maybe that denial had nothing to do with how clean of a claim you put together, but more to do with the fact that they ran out of money for that, let's say, quarter. Now we know how to fight fire with fire. So, with that being said, very important that you track those patterns of denial. So, so, so important. So denial management biggie as a biller, all right.

Speaker 1:

And now we're going to talk about compliance, and this I'm going to briefly cover. What I mean by compliance as a dental biller. There are state and federal laws that we need to understand and we also need to understand how to apply these laws into our billing practices. As a dental biller, we need to understand our state's non-covered service laws. How can we proceed and balance out a patient's account, audit that patient's account, if we don't understand what our state law says about balance billing that patient? Maybe there's a service that was not covered, but in your state, even though it's a non-covered service, you are still obligated to charge the contracted rate, whereas in another state, if it's not covered, you can charge your full UCR fee, but that is going to be up to your state's non-covered service laws. There's also the federal law of the HITECH Act of 2009. And this is going to help us.

Speaker 1:

When the patient wants to self-pay for a service and does not want to disclose that they paid for that service, they don't want to disclose this to the insurance company. Let's just use the simplest example here. Say, a patient needs four perio maintenance cleanings per year, but the insurance company will only cover two. But the insurance company will only cover two Because the patient is signing a consent form under the HITECH Act of 2009 that basically says I'm paying for these other two cleanings and I don't want you to disclose that to my insurance company. I'm gonna pay for it. I have the right to pay for it. It's called their right to self-pay for their own healthcare services and they have the right to pay for it. It's called their right to self-pay for their own health care services and they have the right under the HITECH Act to also not disclose everything that is done. So because this is a federal law, this is going to trump the PPO contract if you are a PPO provider and I'm going to get into more detail in a couple of trainings from now but just to give you an idea of the depth of knowledge you need to have to be a good biller goes beyond just coding treatment.

Speaker 1:

I really want that to sink in to everybody the 376 people who are taking this course and I'm sure there's more than that out there. Let's be real, I want that to sink in. You need to understand how to apply federal and state laws to your patient's accounts. Okay, and we're going to talk about that in a future training. Just give me a couple trainings. I want to make my way through how to post payments properly, and then we're going to get into the state and federal laws and how to navigate through all of that stuff laws and how to navigate through all of that stuff which, by the way, continue to create more and more wins for dental practices, for providers. Legislation is really coming down hard on insurance companies to provide us, whether or not they are a fully insured plan or a federal plan or a self-funded plan, and that matters in getting us paid faster because if there is a dispute that arises with a claim more likely a denial that we don't agree with. If we understand whether or not this plan is fully insured or self-funded, then it makes it easier for us to know which governing entity we should approach first in order to expedite the resolution of the dispute. So really, really important stuff happening through legislation coming down, but what that's going to translate to is insurance companies scrutinizing our claims. So really, really important that we understand how to navigate through all of that. And, finally, we encourage all of our billers to update their knowledge annually. I really am emphasizing the incorporation of diagnosis codes and keeping up to date with any clearinghouse updates.

Speaker 1:

I like to go to my local dental boards California Dental Board, local TRICARE Dental Society, local TRICARE society dental society. I go to any local dental society, my state's dental board, and I look for updates so that I can share that information. I will first sometimes even run it by an attorney, a dental attorney. I have someone here in Southern California who I've been going to for many, many years and she will tell me sometimes I'll run a PowerPoint by her and say is this, does this look okay? Is this legitimate? Is this in sync with? Am I saying anything misguiding? Is this misinformation? And so far, knock on wood. She's always said that things have been on the up and up.

Speaker 1:

It's really important that the information I give is accurate and sometimes I get a little nervous because these state laws and these federal laws continue to update and change, and just having it run by an attorney helps me feel a little more confident as I present it to all of you. Run by an attorney helps me feel a little more confident as I present it to all of you, but you know it's your job as a dental biller to stay on the up and up with all the changes that are happening, so make sure that you do that. I'm going to post a copy of our workflow process into your learning platform and you can use this as your workflow. Feel free to adjust it If you see that there's anything that we can add and do better. I would love to get your feedback for those of you that are experienced dental billers, but I appreciate your time. Thank you so much for spending this. I think we're about an hour now with me and I'll see you in the next training.

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Ericka Aguilar

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