26 min readEpisode 132: Is My Dental Practice Ready for Medical Billing?

Carrie Webber, Owner, The Jameson Group

Below, we’ve compiled some of the key points discussed in the Jameson Files Episode 132. To enjoy the full conversation between our very own Carrie Webber and Laurie Owens, you can watch on YouTube or listen to the podcast on iTunes, Google Play, or Spotify.

Carrie Webber:
Welcome to the Jameson Files. I’m your host, Carrie Webber. Thank you for being with us once again for another fantastic episode, with an amazing guest. We want to continue to bring you great information, excellent guests and resources and tools that help you grow and thrive in your ideal dental journey.

I am so happy to have a phenomenal guest with us today, who’s going to talk about a very popular topic: medical billing. Laurie Owens is the director of medical billing for Devdent and has been teaching, coaching, lecturing, and training on medical billing for about 18 years. And so what we want to dive into right now in this episode is the question of, is your practice ready for medical billing? But first, Laurie, I would love to have you share a little bit about your dental story. How did you end up where you are today as such a premier instructor in the dental field?

Laurie’s Springboard Into Medical Billing

Laurie Owens:
So I started out working for Dr. Michael Cohen and, as most people know, Dr. Cohen is the epitome of continuing education. So within two weeks of being hired, and with no dental experience, I  was going to a CE course on bacteremia. And I sat next to our hygienist, Elizabeth, and said, “If we’re making people sick, how can this be considered dental?” And she said, “That’s a good question. I don’t know.” And that was my launch pad to saying, “Why are we billing dental insurance when it really has to do with somebody’s health?”

We were a perio office and doing lots of oral surgeries. And I said, “I think this is something important, and I really want to figure out how this might apply to what we do. So the doctors, of course, being such a busy office, said, basically, “That’s fine, but we can’t have you do it during work hours because we’re extremely busy.” 

Now, mind you, I did dental insurance, treatment plans, answering phones, meeting with pay—the whole gambit. So I totally understood, and I took it on myself to learn at home. I paid a guy a hundred dollars to look at my faxed claims. I faxed him the claim, they were fictitious patients, and he would fax back corrections. And so that’s how I started, by wanting to make sure I was doing things right. 

So I became a certified professional biller with the APC. A lot of people think, “Oh, well, it’s just the oral cavity.” It’s not; it’s the whole body. When you learn and you get credentialed, you have to learn the whole body. If I needed to, I could do a retina detachment right now, or spinal fusion. 

I wanted to make sure our offices were doing things right and legal. That was the whole reason behind any credentialing I’ve obtained. I want to make sure that what I’m doing and teaching is proper. And I also bill for six offices myself, because I’m not going to teach something that I won’t do.

Some Examples of the Need for Medical Billing

I don’t want you to think that everybody who walks through your doors is a medical billing case. But there are things that we come across in dentistry, and it could be something that you could help them with, like a cancer patient who might be in remission having an adverse effect to their antineoplastic or auto-immune medications. So you think about that, what are they going to do? They might lose all their teeth because it’s just the way that medication runs its course.

And I also have a bonus daughter because of dentistry. Her dad would ride on our church bus, and one day he called me and said he had a toothache. And this was when I was brand new to dentistry. I said, “Well, you need to go to the dentist.” And he said, “But I don’t have dental insurance.” And I said, “But if it hurts, it’s worse than you think. And so you need to go to the dentist.” He said, “But if I pay a dentist, then I’ve taken food out of my daughter’s mouth.” And I’m like, “But I don’t know what else to tell you. Go to the dentist.”

Well, that Saturday came and went, and I didn’t hear from him Sunday morning. Then his daughter called me and said, “Can you come to the emergency room?” So my husband and I went, and when we got there, he was in the ICU at the emergency room. And I knew he was dead. He had an infection that went into his ear and went into his brain and turned septic and shut down his organs that quick. 

Now not every case is going to be that quick, but when you have an infection, don’t you think that could be an emergency? And so I kicked myself, thinking, “Had I known then what I know now I could have helped.” And my husband walked her down the aisle, but that doesn’t take the place of her dad. 

So I, it’s a constant reminder of why I do what I do. I want no one else to walk into somebody’s office that doesn’t have dental insurance that you say you can’t help.

Carrie Webber:
Your story truly is a testament to you choosing a very specific lane that you are passionate about. You are genuinely interested in being a continuous student of this, and the dental community is better for it because you are such a great expert in this realm. So let’s dive in and talk about medical billing. Maybe some have tried before, but it didn’t work so well. Others may be trying right now, or they’re considering it. When do they know if it’s right for them?

How do you know if medical billing is right for your practice?

Number One: Ask Your Coach

Laurie Owens:
Well I was thinking about the title of this podcast, and I love it because it’s really relevant. So, my number one has always been, “Does your coach think you’re ready? Because as a consulting office, we always had a consultant, no matter what. And it was dependent upon where the doctors wanted to focus the practice. As outside eyes, they are going to be the number one guide on whether you’re ready. And if you don’t have a coach, it’s going to be really hard to figure that out because you don’t have somebody looking at it with an objective perspective.

So number one, if your coach feels you’re ready, then you’re ready. And if they don’t, let’s figure out what you need to work on outside of medical billing, because medical billing isn’t like a funnel of money coming in. That’s not the purpose. If your main purpose is just to make millions of dollars, that’s fine, but that’s not what medical billing is for. The question is, “Are you able to maximize benefits in order to get the patient healthier?”

If you start looking at it on that plane, the money comes, but it’s not the other way around. If you’re looking at the money, then your notes aren’t going to be right, your focus isn’t going to be right, and the medical necessity is not going to be right. And so that’s why I say you need outside eyes looking at your practice. It’s the best way to find out if you’re ready for medical billing.

Number Two: Have Enough Staff

My number two is going to be: make sure you’re fully staffed. Don’t walk into medical billing shorthanded, because it’s going to truly end up being a failure. Your staff is going to be frustrated because now they’re not only doing multiple jobs, but you’re incorporating new verbiage into their diction. And if you’re not fully staffed, it’s not a good time to attempt medical billing, because you’re only going to create frustration instead of education. And so a lot of doctors will come to the course, get excited, and then go back and say, “Okay, team, start medical billing right now. And they haven’t given their team anything to learn from. You can’t throw your team into that, as much as your heart might want to do medical billing.

So wait until you’re fully staffed, and you can help train your team. That is going to be the most important thing. It’s a team effort, not a solo endeavor. When we went into it as a practice, it was because the team did what I needed them to do. The doctors knew what I needed to look for. It wasn’t that every person was a medical bill. And that was important. If you were to try to do a solo venture, you’re going to be frustrated, and you’re going to stop.

The other difficult thing is that you might’ve had a trained team member that had full focus on medical billing, but now that team member’s gone, and you’re expecting the team to do the same things as if that other team member was there, without any education or training, and that’s not fair. You’re basically setting them up to fail. It’s literally a recipe for disaster. So if you’re not fully staffed, it’s okay to not move forward with medical billing. 

Number Three: Prepare for Growth

But my number three, and you’re going to like this one, Carrie, is you gotta be prepared for growth. And I’m not saying you ought to hire unless the necessity is there, but you do have to plan for growth. A lot of people have asked us over the years, how did you market this? How did you market medical billing for dentistry? We never did. But we boomed. And so we planned for growth. We purchased the suite next to us. We purchased a whole new admin section so that we could answer the phone calls that came in daily, saying, :I hear you bill medical insurance.” 

So if you’re not prepared for the growth, you need to be selective and careful ,because if you’re you have no space to grow, where are you going to put all these new patients that hear that you bill medical insurance? They’re not going to leave you good reviews when you can’t get them in for two months. It doesn’t work. Prepare for the growth, because with medical billing, I guarantee you, you will start getting more phone calls just because your patients are going to be talking about it.

Carrie Webber:
Well, I bet, you see a lot of practices that are bursting at the seams already but want more new patients. But then they have more new patients coming in every month than they can successfully care for in an ideal way. And so do you have conversations with practices who want to do this, and you say, “Where? How?”

Laurie Owens:
Oh yes. Whenever I do an onsite with the team, I say, “Okay, so where would you put another admin member? Where would you put them?” And if they don’t have any idea, I’m going to say, “Then I don’t want you to move forward full force, because what happens when you are successful and other people start to come in on your patient’s recommendation?

I’ll give you an example. We had a patient take a stack of our cards and hand them out at work because we were able to get him $12,000 for his treatment. So we’ve got 12 new patients from that one patient. And we did no advertising! So again, you have to be prepared to grow, find new operatories, find new team members, and don’t let it get to the point that your other team members are pulling their hair out because they just don’t have time.

When they don’t have time to even eat, there’s a problem, right? Cause you know, hangry dental assistants and hygienists are not very nice…and I don’t blame them. So, I used to cook for our team when I knew we were having a super busy day. I would cook for them so that they could run to the lunch room, grab something, and eat it on the go, because we all know how hectic and chaotic it can get. So again, be prepared for that growth. Cause it, it could really be the downfall of your medical billing if you don’t have enough time.

Carrie Webber:
What I love about that, before we move onto the next one, is how you’re really piggybacking on all of your recommendations in such an ideal way. Yes, we want you to be planning for growth, but you need to be doing intentional strategic planning in an educated and thoughtful way, so that you can grow and have the places and spaces and people at the right time for that growth. Instead of throwing hope against a wall and just praying that it sticks, we have intentionally planned for the future and for the vision of incorporating this into our practices. 

Laurie Owens:
Absolutely. It is monumental. We all want to hire when we feel like we’re really busy, but yet we don’t move the appropriate people into that position because we haven’t properly evaluated our team and our needs. I had a team that didn’t even realize they had one person who already had the medical background needed. Because they didn’t find out about their team. She would have been the perfect person, and yet she got discouraged and quit. So that can be frustrating. You need to know your team, and you need a coach. They see qualities in your team members that you might not see. And I want to emphasize that having a coach doesn’t mean you’re a weak practice owner. It actually means you are a very strong practice owner because you want the best for your team. 

Number Four: Continuing Education

And that leads to my number four: take a course. I’ll tell you, the two day courses that I do—I’m funny. I make this silly, basic, boring subject as fun as I possibly can because I know it can be dry and boring, but without the education, you’re in trouble. If you were to ask me what my ideal scenario would be, it is that the office took a course, that they brought me onsite to train the team. I’m not a coach for dental billing, dental insurance. I’m none of that. 

But listen, I’ve had people find me on YouTube lately. I’ll get a call saying, “Hey, I watched your YouTube video.” And these are not doctors! They’re customers. They’re your patients that are seeing my presentation. And so, where else better can I guide them to than an office that’s been trained? Do you think I’m going to send them to an office that says, “I want to do that someday”? That’s not going to help either of you.

So take a course. Get the education. 

When you take a course of mine, you get an email of every resource you could possibly think of. And you can edit it to your practice. But if you don’t take a course, it’s very difficult to help you. I have you bring your own cases, bring your scenarios, bring your chart, your treatment notes. I don’t need to know your patient’s name. I don’t want you to bring your patient’s names, but I want you to bring what you deal with on a daily basis, because then I can guide you to, how could we code this? One of the things I find that frustrates dentists the most and what they say to me the most is “I tried it before.” Oh, really? What codes did you use? Well, I don’t know.

Well, I can guarantee you that’s probably why it didn’t work. Everything’s paid based on the diagnosis code. So if you have the wrong code first, they’re not going to pay you. If it’s a code that you cannot use as a primary diagnosis, it’s going to get denied. So why would they pay you when it’s not a billable primary diagnosis? 

Think of it this way, Carrie, your patient calls you in pain, the doctor finds an infection, and now you’re going to lose that tooth. Now flip it. We code it the other way. We have a partial loss of teeth due to infection and pain. So we have to think of our stories backwards. What are you treating, and why is it necessary to treat it? And that’s where a lot of doctors get lost in that shuffle. 

Taking a course helps guide you to the primary diagnosis code for that service. Even with trauma, if you code a trauma case with how it happened before you tell what happened, they’re going to deny your case. So if you’re not going to tell them that it’s fractured first, telling them how it happened is not going to make a difference. They have to have what happened before they have why it happened. I hope that makes sense.

Carrie Webber:
Oh, that’s a perfect way to explain that and to pivot the mindset that helps people be more successful at this. And you know, like you said, you’ve talked to doctors that have said they tried this once and it didn’t work. And I feel like you could insert 70 other things about their practice into that statement, because that’s the story of getting outside your comfort zone and changing. It could be patient financing, it could be incorporating some new type of technology. But when it stretches that comfort zone, we tend to give it up. You know, when you have that first one that doesn’t work like you thought it would, you snap right back to what you’re most comfortable with instead of exploring how to do this better.

How do you practice medical billing at your dental office?

Learn the Right Verbiage

Laurie Owens:
And you want to be everything, right? But you cannot say, “We’ll bill medical, they’ll cover it all.” You will never hear me say that in a course. You have financial agreements based on what you know their dental insurance covers. So if you have a conversation with your patient, you say, “And as a courtesy we’ll bill your medical insurance to maximize any benefit we’re able to obtain.” 

Did I promise you a dollar? Did I promise you 50 cents? No, but I told you we would do our best to maximize a benefit. You cannot promise something you don’t know. So I always say “under promise, over deliver.” I would rather you tell them nothing than to be grasping at straws that you don’t know. So make your financial agreement based on what you do know, which is what the dental would cover.

And I tell all my students, your goal is not to get them a zero copay or a zero payment. That is not the goal. The goal is to reduce their out of pocket cost from what it would be if you were billing dental only, and to have the practice write off less. That should never make a difference in your AR; it should always make a difference in what you’re doing to provide a service for your patients. 

Get the Whole Team on Board in Their Understanding

I was just at an office in Minneapolis. The first day I met with the team, we reviewed a whole bunch of stuff. The next day I stayed and listened to their new patient consults. And their notes were, their hygiene notes from three months ago to now? I was blown away, because once the whole team knows what we are looking for and what verbiage can be used, it makes all the difference in the world. 

We never say, Oh, this is a dental case. Or this is a medical case. All of our notes were written as if it could be a medical case, because we don’t have to make different notes for medical and dental. You can make them all the same, so if you need to use them for medical, you’ve already got medically necessary notes. 

So I’m just saying, it makes the difference when you take a course and get the education. You don’t even realize how bad they were until they make such dramatic improvements. So I always tell teams to, a month after I’m there, all read each other’s notes to say, “What could we do and how could we word this to make this sound medically necessary, because it’s a medical case?” If we can make sure that it’s in the forefront of our minds, that what we’re doing is helping these patients, the notes work. 

In the last five years, before doctors went and retired on me, I did not write a letter of medical necessity at all, because the notes said everything. It was amazing. I sent the notes off to medical, and they approved it based on the team’s notes, not Laurie’s notes. I loved that. And I always made sure to share with the team what they were able to do, because it’s their success, not just mine.

Stop and think about what happens after you file that medical billing paperwork.

So my last one: you’ve got to decide how you’re going to do this. There are ways outside of only your office. I’ll tell you that the hardest part for me was not filing a claim. I could file a claim probably in my sleep. It’s the follow-up. A patient walks in and says, Carrie, what’s going on with my medical claim? And you say, “Um, if I have free time in a couple of weeks, as long as I don’t have double doctors, I’ll call.” That was the worst thing for me as a medical biller. I felt horrible. Remember, I was doing dental insurance, medical insurance, treatment plans, conferences, and everything under the sun. And I didn’t have time. And I felt horrible. So you need to be able to follow up.

If you’re going to look at a third party, number one, we wrote a software for dentistry, so you can put your dental code in, and it tells you how it is processed into medical. We also guide you to the diagnosis code. And that’s all really cool, but more importantly, we do all the follow up for you. So if your patient walks in and says, “Laurie, what’s going on with that medical claim?” I can log in and say, “The biller’s called on this date. This is what happened. And they’re scheduled to call again on this date.” I wanted offices to look smart. I want them to say, “I know what’s going on.” So whoever you choose as a third party vendor, like I said, I wish I was more of a sales person, but I’m not. I just want you to find what’s best for your office.

For us at Devdent, it’s not a matter of “we’re the best. You have to find what’s best for your office. But make sure that they’re doing the follow up and giving you some due dates, because patients want to know that you’re on top of it. And if you have to respond, like I had to respond, “I don’t know. Let me find a day in a couple of weeks.” I hated that. 

And if you have a dedicated person that can handle this for you, by all means, do it yourself. But remember you gotta be able to track it. They have to be good at organization. They need to be able to tell the doctors what’s going on with these claims and what’s outstanding, what’s been paid, things like that. 

What Laurie and Devdent Have to Offer

We have a filter on our software that, if your doctor said, “Hey, what claims have we gotten paid for medical?” you could filter out only the paid claims and print that out from the doctor. Or so that he can see all the claims that you submitted, all that have been paid, and what is pending or denied. So you can actually see everything. And that is the important thing—it has to work for you. So when you start looking for a third party vendor, make sure you know what your ideal looks like. Do you want somebody to do your follow-up for you? Do you want somebody to help you with those pre-authorizations? Do you want coaching? So make sure they’re going to check off all your boxes, because I really think that’s important. 

I’m crazy enough that I give people my cell phone number. And it’s intentional. It’s intentional because I’ve been in your shoes. If you have a question, I tell you to text me, because I can even answer a text on a plane. And if you have a question, it’s important enough that I’m going to answer you, because you wouldn’t have texted me had you not thought it was important, right? I answer every email before I go to sleep. Why? Because if it was me, I’d want an answer as soon as possible. And I tell people, if I’m teaching all day, just know I will answer you by nighttime, because I’ve been there. If you took a course with me, I’ll be there to support you, however you want to do it. 

And in my courses, Carrie, I don’t just talk about our software. I talk about how to fill out a form. I talk about the web portals that you could use to file the claim, because you have to find out what’s good for your practice. Not what’s good for Laurie. So figure out if you can have a dedicated staff person do this or if a third-party vendor makes better sense to you. 

And here’s another thing, we’re not going to be getting into your software. There’s a big difference between us and some other medical billing softwares. We don’t interface with your softwares. We don’t take your checks for you. We don’t even correspond. All the correspondence is going to come to your office. But if you got a letter saying, “We want more information,” all you do is scan it and upload it to that patient’s claim. We take it from there. So again, we cannot take your place. We don’t want to take your place. We should just be your billing company. We should be the ones that provide the information, but you are the point of contact. We are your support and that’s what we want to be. 

So those are the things that I think are important in looking at medical billing for dentistry, Carrie. And if people want to watch, there are on-demand webinars on our website that are free, so you can see if we’re right for you. There’s also a demo of the software that you can play just on demand. You don’t have to contact anybody. Nobody’s going to hound you to be a customer. It has to be what’s right for your practice, not what’s right for us. 

Carrie Webber:
So, Laurie, how do they find you? How do they find more information about you?

Laurie Owens:
You can email me at [email protected]. I’m not going to give my cell phone number out here, but if you need me and you need to contact me, I want to make sure that you have access. One of the big things, Carrie, that’s coming up is that people are having to file their third extractions to medical before dental. So, that being the case, I’m going to email Jameson a sample of a third extraction claim form so that if Jameson can handle it, you can email Carrie and get it from her. And that way you’ll have a sample of what extractions of thirds look like. It’s not hard. There’s only one or two codes. If they’re completely in the bone and they’re embedded, and if they’re partial, bony, or surgical extraction, they’re impacted. Diagnosis-wise, it doesn’t vary from that, so I’ll send that to Carrie and you can go to Jameson Management and they can email that to you and you can make contact that way. 

Summing It Up

Carrie Webber:
Thank you so much, Laurie. So for all of us that have been listening and learning from Laurie today, remember:

  • Work with your coach to determine the right time. Timing can be everything for successful implementation of medical billing. 
  • Make sure you have the right team members in place. 
  • Prepare for the growth in an intentional way, strategically planning for it to all be successful as you grow through this added service and courtesy for your patients. 
  • Give your team the opportunity to be trained and you yourself take a course. Do this from an educated standpoint of what your true needs are and what you need to take care of first. And those courses like Laurie provides are the most important first step in getting prepared for incorporating medical billing into your practice. 
  • Then make sure that you are following up and following through and that you have a plan for successful implementation. And follow-up whether that’s through processes in your own practice or through partnering with a group, like Laurie has shared, to help you be successful in the continuation of this service in your practice. 

We wish you success in medical billing and making that a part of your day-to-day dental lives. 

So, Laurie, thank you so much for being with us, such great information, so much that you’re bringing to the table. I do encourage our community to visit devdent.com and learn more about Laurie and about those courses and take those first steps into successfully implementing medical billing into your practice. Laurie, thank you so much, my friend.

Laurie Owens:
Thank you, Carrie. Thanks to all.

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