MME: Avoiding the Insurance Pitfall | How to Comprehensively Understand Your Contracts | Laura Radloff

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Show Notes

How essential IS understanding insurance contracts in the dental field? Join us in this Monday Morning Episode as Laura Radloff and I delve into this critical aspect of your dental practice. We underscore the necessity for dentists not just to skim but attentively read through the terms of contracts to sidestep potential pitfalls such as insurance fraud. Laura shares from her vast wealth of experience some common mistakes dental practices make and drives home the essentiality of proper billing practices.

In the second half of our discourse, we explore the incredible advantages of utilizing Oryx software for billing purposes. We put a spotlight on the tremendous support provided by the Oryx team. The takeaway of this episode revamps the importance of thorough understanding and transparent communication in dealing with claims and operating a successful dental practice.

What You'll Learn in This Episode:

  • Why understanding insurance contracts is vital in the dental field
  • The common errors dental practices fall prey to and how to avoid them
  • The indispensable role of diligent billing practices
  • The remarkable benefits of implementing Oryx software for your billing
  • The exceptional backing provided by the Oryx team in managing claims

Dive into this episode now to learn what you may be missing in your insurance contracts!


Oryx: an all-in-one cloud-based dental software created by dentists for dentists.
Patient engagement, clinical, and practice management software that helps your dental practice grow without compromise. Visit Oryx today for a special TDM offer! (Just click or copy and paste the link here)

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Episode Transcript (Auto-Generated - Please Excuse Errors)

Michael: Hey, Laura. So talk to us. What's one piece of advice you can give us this Monday morning.

Laura: So one piece of advice is. Really to make sure that you understand your contract with any, uh, your, any insurance company that you have chosen to contract with. There are a lot of rules that come with those contracts, and if you've chosen to be in network with a certain insurance company, they may have specific rules that you have to follow, such as you have to bill certain procedures out, even if they're not going to be covered.

So you just want to make sure that you really understand your contract before you start committing insurance fraud. And it's little things like, You may have a certain procedure that's not covered by that insurance, and you may choose not to bill out that to that insurance company, because you've decided since it's not going to be covered, we're not going to bill it out anyway.

But if your contract says that you should still be billing it out, you still need to make the insurance company aware that you did that procedure, even if you don't think you're going to get covered for it.

Michael: Okay, no, that's interesting. That's interesting. And then. You said understand your contract. Are some contracts difficult to understand?

Laura: They just vary. They vary a lot based on carrier and state. And especially once you start to get federal plans, it's more just making sure that you do read the fine print. Uh, some states say that you can't charge a patient if it's not covered. and some carriers say the same thing. So it's really just making sure you, You don't go outside of those lines and making sure that you are billing correctly, not only to your patient, but to the insurance company too.

Michael: In your experience, Laura, like what is the most difficult company? I guess you feel like you've worked with when it comes to like, Oh my God, this is all in the contract. Are you serious? Kind of thing.

Laura: I wish I could just say there's only one. I feel like every company is going to have their own quirks. and each one of them is going to have their own guidelines.

I just ran across a policy the other day that said, if you try to bill out the buildup the same day as your crown, then it won't get covered. And they told you in the contract, you should bill out the buildup separately, um, on the prep date and then your crown on the seat date. Because they're already telling you it's not going to be covered, but it was so fine print and it was way deep in the contract.

understanding that from the beginning, it's not very common that you would see that. So it's just making sure you understand you would hate to bill that out and then not get paid just because you billed it on the wrong day.

Michael: Yeah. How often does that happen? I mean, so real quick, if you can let us know, you're with Oryx, right?

their billing department or how does that work?

Laura: Yeah, so I am with Oryx. I actually come from a lot of other software background where I've used a bunch of different softwares throughout my almost 20 years in the dental field. And Oryx is my favorite. So when I was working with Oryx, I reached out to Oryx and I told them how much I absolutely love their company and how much I would love to be a part of their company.

So, now I am in, in charge of the outsourced billing department. So we actually helped newly converted offices with the conversion process. Um, and we allow additional trainings in regards to insurance. And billing. And then also we help with those services, especially for startups.

They're not a hundred percent aware of all of the ins and outs of insurance. So we're able to help guide them at least through the beginning phases to make sure that they're off on the right start.

Michael: Yeah. So then how often does that happen? Especially when it comes to, I guess, transitioning from a software to another software or like, where are you seeing the most common mistakes?

Laura: The most common errors is, I would say, a sense of if it's not going to be covered, I don't have to bill it anyway, or trying to charge additionally due to a downgrade or a fee that may not be exactly what's needed. billable. I know sometimes ortho cases, if you're contracted with an insurance company for an ortho case, you have to go by their contracted rate, but Invisalign has a flat fee that they charge no matter how, you know, just to get the case going.

So some offices have found that they want to try to charge that additional fee and some states and some insurance companies say too bad, it's all inclusive. Just because you picked Invisalign instead of brackets doesn't mean we're going to give you more money. So it's making sure that you understand that piece.

the biggest thing that we run into is just thinking that we can step outside of those contract guidelines. and not necessarily defining it as fraud. It's still considered a form of fraud if you're withholding information, if you're falsifying the information, submitting under a different provider just because they have different network statuses.

Things like that can all be considered forms of insurance fraud. So just being careful. Last thing you want is to go have huge fines, get your license revoked, or have your business shut down because of insurance fraud.

Michael: Yeah. Have you seen that happen? Like where somebody really didn't read the fine print and it just went downhill from there?

Laura: Yeah, unfortunately I haven't personally experienced it, but I've gone to continuing education courses where they've talked about the Somebody else, the business owner versus the dentist. And the business owner was doing billing out things a certain way. And then the owner, the business had to shut down.

Michael: So then what would be the difference here? Laura, like if, if I were to say, okay, I have listened to this episode, I'm going to make sure my team reads the fine print compared to having like. Outsourcing it, your team, Oryx or you, right. I'm going to read the fine print. What would be the difference in those two?

Laura: So there are a lot of credentialing companies that will help make sure that as you're getting credentialed, they can read that contract for you, so it's more just making sure that maybe whoever's helping you with your credentialing understands what your expectations are too, so that they don't sign you up for something that goes against the way that you want to run your business.

personally, I've been in the dental field for 20 years, but that doesn't necessarily mean that I know all the ins and out of every insurance company too. Since it is so specific to state and carrier, it's really important that you understand it within, yourself versus even relying on someone else to do it for you, because then you're also holding yourself and your team accountable for what's happening in your office too.

So as much as I would love to say, I'm a professional, I will read it for you and tell you all the things with my magic cape. at the end of the day, it's your license and it's your practice that's on the line. So making sure that whoever's doing your billing for you is doing it the way that aligns with your contract.

And. How you want your business ran.

Michael: Okay. Interesting. So then does this come with like, let's just say we decide to go with Oryx. Does it come with Oryx, this service or? The extra how does that work?

Laura: It would be something if you have questions, we would definitely be able to review with you. We're more focused on making sure that you get paid.

So we want to make sure that those claims, there's nothing holding them up from getting sent out that you've got all the necessary attachments documentation to be able to support the claim. And then we do catch some of those things like, Hey, I remember this insurance plan said you can't bill out the buildup and the crown on the same day.

Do you still want to, because That's how you do it, or do you want to align with how the plan does it? So we do catch those things as the claims are going out, but it's more just making sure on the front end that you understand how that's coming in too.

Michael: Yeah. That's so nice that Oryx does that, the claims, you know what I mean, for, for practice.

I feel like it takes off a lot of the front office, I guess you can say like their time and you know what I mean.

Laura: Oh yeah, it's huge because personally if I have a team member that I'm paying to be in office with me that's going to be patient facing, I want them to be patient facing, talk to them about their treatment plans, get them into the schedule.

I don't need them hiding behind closed doors talking to insurance companies, but I also want to get paid. So making, putting that on someone else, especially someone who's versed in the software and has a lot of insurance experience, we've got phenomenal team that's all there to support and make sure that those claims are going out and getting paid.

Michael: Yeah. Is it pretty difficult to learn for the team? Oryx?

Laura: we offer a lot of support. It's not that it's difficult, honestly. Like I said, I I've worked with open dental, Dentrix, EagleSoft, SoftDent, Dentrix Ascend, Dentrix Enterprise, iDental, I've worked with a large number of dental softwares and I found it.

Like with any software, there's definitely a learning curve, but once you really get into it, it has so many neat hidden features and neat things, and they're constantly evolving. I guarantee you, you tell Dentrix you want to change the way that they have something set up and they'll laugh at you. Oryx, we really try to consider how are our users using it and can we make it better as much as we can all the time.

Michael: Yeah, that's so true. I see that in the Facebook group, like the Oryx users, Facebook group, like somebody will be like, Hey, Hey, Rania, can we do this or can we do that? And working on it. We'll implement it. You know what I mean? And they're on it. So

Laura: yeah, we have developer meetings all the time. Like we're still as big as we are.

We're still small, right? We're still connecting with each other regularly to make sure, Hey, this is something that our front end user saw that we might be able to improve. Is it something we can implement? if it's only one person that wanted it, then it may not be the top of our list, but being just vocal about things that we could possibly do to improve helps too.

But I also think it's got a really strong base. So, while some people may see that there's areas to improve, it's got a lot of really great things already integrated into it. That helped me when I'm doing aging or when I'm doing the insurance stuff, this is my go to it's the fastest one to work out of.

It's got the most detail. I find less errors once I'm using the software correctly. it's just phenomenal in my opinion Might be a little biased but

Michael: No, that's awesome. And then what's one final piece of advice you can give us when it comes to claims and practice ownership

Laura: Um, there's no such thing as too much information You'd much rather have 15 photos a big strong narrative and x rays right before the procedure versus later Finding out that you needed that x ray narrative or photo and not have it

Michael: So there's never enough information.

Interesting. Awesome. Thank you so much for your time. I appreciate it. But if anybody had questions or concerns or anything like that, where can they find you?

Laura: If you're already an Oryx user, then you can put in a help ticket and they'll make sure that you're directed to the right department. I do specialize in billing and insurance, but we have a whole bunch of trainers that may be able to help with any other areas.

And then if you're on our Facebook group too, you'll be able to keep posted on how often our webinars are happening and what topics are coming up, or put in suggestions for future, future requests or other webinars that you want to see. So.

Michael: Nice. Awesome. So that's going to be in the show notes below.

And Lauren, thank you so much for being with me on this Monday morning episode.

Laura: Great to chat with you, Michael.