In this episode, Crystal May, from Devdent, details some of the essential tips and tricks around medical billing and how it can help your patients afford the care you recommend! At Devdent (Developing Dentistry,) their mission is to take the headaches out of medical billing, claims, and any appeals along the way. Crystal shows that with proper billing procedures using medical, a $10,000 treatment could be much more obtainable and affordable for your patients. She notes that it is less about "what" you are doing, but "why" you are doing it, to qualify for medical billing. If a patient's tooth is missing, and that is the reason why they are unable to chew, the procedure might qualify for medical billing!
Follow Crystal and Michael's conversation here to learn more about how your practice could utilize medical billing!
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Red, white, and blue card (Medicare)
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Michael: Hey Crystal, so talk to us about medical and dental billing. How can we utilize this, or what advice or suggestions can you give us that will help us with doing medical and dental billing?
Crystal: Absolutely. So medical billing is quite a bit different than dental billing. a lot of people are scared of it.
They're intimidated. Maybe they've heard horror stories even that it takes forever to get paid or it's not worth the energy. And really my mission is just to explain to dentists how it is not as complicated as it sounds, and it's certainly worth the effort. So we get thousands and thousands of dollars of reimbursement from medical insurance for dental services. Many dentists don't even know that it's a possibility to bill medical for dental. Treatment, So when you think of an implant or a bone graft, you might be thinking, well, dental insurance might cover a little bit of that, or there might be that $1,500 per year max benefit available. But what if we could tap into their medical benefits?
So when you start talking about, especially larger procedures, if your patient portion is more than $5,000, we know that dental insurance doesn't make a very big impact in that patient portion, They're still gonna be spending at least $3,500 out of pocket after they use all their dental. So the combination of adding medical billing to your dental practice allows your patients to be able to afford the care that you recommend.
Taking a large treatment, 5, 10, 20, $50,000, and we can get medical insurance to pay sometimes a hundred percent of those procedures. So it's really about. Identifying the medical necessity. So you see a patient and you're trying to figure out which insurance should I build? Should I build their medical, should I build their dental?
What? What are my options? And so what we do is we teach Dennis how to find the medical correlation. So when I teach about medical billing, I use the statement a lot. It's not about the what you're doing, it's about the why you're doing it. So if you can prove that there's a medical correlation to your dental, So let's say again, an implant, for example, if you can't chew because of that missing tooth, then that's a medical condition and we can actually build medical for that.
Or what if you've lost that tooth for a medical reason? So maybe you took a medication that caused dry mouth. So now all of a sudden you had acid erosion and just all this enamel was gone because of this severe dry mouth. Well, we can prove the medical insurance that you are losing that tooth because of a medical condition.
So it's just about the why can we tie back something that's going on inside of the mouth to the rest of the body or something in the rest of the body that's affecting the oral cav.
Michael: So then once we identify the dental necessities and we decide, okay, we're gonna bill medical, right? Which sounds beautiful.
Like, we're like, we wanna bill medical. Where do we go from there?
Crystal: Wonderful question. So it all starts with the insurance card. So it doesn't matter how perfect the medical necessity is, you've got this patient that desperately needs this treatment and you can prove that it's directly related to an a medical condition.
If the insurance policy doesn't offer dental treatment for any reason. There's nothing we can do. So sometimes our best doesn't trump the payer. Okay? So the medical insurance determines coverage. Also, remember your patient chose that plan. A lot of times we get really like emotional about how we wanna help our patient more.
And darn it, this silly medical insurance won't do much, but remember, Your patient chose that plan, so they're paying a lower premium to have a higher deductible or less coverage. So, you know, we can't own that. We just have to say to them, unfortunately, the plan that you've chosen doesn't have medical benefits available.
Also, let's say Medicare, so everyone knows who, what Medicare is, right? It's, it's generally thought of as a, as a 65 or older plan. . Medicare's changed a lot over the last decade, and we are getting some coverage for dental treatment through medical, red, white, and blue insurance cards.
They're actually paying dental offices, but you have to sign the right paperwork. You have to be participating. So you look at the card. If it's a red, white, and blue card and you're not participating, you simply hand the card back to the patient and say, unfortunately. This plan won't pay anything here at our office, but let's say it's a good plan.
You get a card and you're like, Ooh, I know that one. I think they might cover benefits at this office. You then start with the verification of benefit. So we reach out to the insurance company and we ask them for details. What's the deductible? Are there any plan limitations? Does this plan cover dental treatment for these scenarios?
Maybe you're treating sleep in your practice. Well, medical billing for sleep appliances, by far the most common procedure that we bill. So you ask specifically, do they cover sleep appliances? What that end of that call? we give back to our clients a summary of coverage and we'll actually say, yay, ur nay, this plan makes sense, or this plan doesn't.
Assuming it makes sense to Bill Medical. Because we've called the payer, we verified there are benefits available for these services. Now the next thing is to talk to the patient. You give them their treatment plan with all their treatment options and with all their payment options. That's gonna include potentially dental, right? Because we're still gonna build dental for class two fillings. We're still gonna build dental sometimes for the crown or restoration. Some plans only cover the implant under medical. So we're still working very closely to maximize all of the. Insurance benefits, medical and dental. And then assuming the patient wants to proceed, most of these procedures I'm talking about do require pre-auth.
So we would actually then start the process of getting authorization to, to treat this patient. Um, and if that's approved, which we're averaging about 75 to 80% approvals on pre-auth. So it's a good high. As long as it's approved, then you complete treatment and you submit the claim the same day you finish the treatment.
So it's really not that much different than what we do in dental, with the exception of, most dental team members are not familiar with these insurance cards, so they have to learn how to look at them and read them.
Michael: Gotcha. Okay, because I was gonna ask you, why aren't people doing it more then? Well, it's
Crystal: not easy. Okay. So I don't wanna make it sound like, oh my gosh. Like all you do is take a copy of the insurance card and you've got a gold ticket, right? That's not it. . You have to code it correctly. You have to have the right documentation, you have to have the right submission tools. So most of our dental practice management softwares do not include enough information on medical to even use them. when customers come to me all the time, they're using any number of the large practice management companies and they're saying, well, they say they have medical. But if you read the fine print, it's very limited. They might allow you to print out a claim, but these claims to medical have to go electronically. So one of the things that causes a little bit of an obstacle is do you have a submission tool? Do you have a way to get these claims to these medical payers? Not dental, but these medical payers electronically? So I think that's one of the obstacle. But I'd say more often than not, the biggest thing is, is dentists and dental team members don't even know that they can bill medical.
It's not even so much they've tried it and struggled. It's just their, their minds are blown when I show the potential.
Michael: So then what submission tool should we have or would you recommend, or how did that work?
Crystal: Well, so there's a couple of different options. Some the, the manual way and the less expensive way is to go to some of the, uh, payer portals.
So you could go to Blue Cross Blue Shield, for example, and you can manually submit a claim directly to them. So that does get you your electronic submission. But it doesn't provide you tracking or any automation. It's very manual. Um, the option that we provide is actually a software solution. So Dev Den offers a system called Imagine Billing, and we are a cloud-based medical billing software built specifically for dentistry.
So all of our clients are dental, and everything in the software is directly related to something under the dental category. So with our solution, We have the clearinghouse connections and all the electronic communications to kind of take the technology piece out of the equation for the customer.
So if I was front office right now and I'm, and let's just say there's a implant, right? That needs to be done and you're like, okay, we're gonna check that out, and stuff like that. And then you realize, okay, there is a necessity. It does, you know, the whole body is affected and things like that. I'm new, but I know dental billing, right?
But if I have dev. I can just use that and then it like kind of scans it out.
Crystal: Pretty much, so we built a cross code tool so you can go put a patient's entire dental treatment plan. So there's c d T codes into our software. It cross codes as it to medical forward for you. And then it also adds the diagnosis conditions that are required.
So it, it really takes the coding component entirely out of it, which is a lot of fear. The dentists aren't necessarily scared about the coding because generally speaking, that falls on an office administrator of some kind, right? Mm-hmm. . So when I talk to them, they're always like, oh my gosh, how will I know what codes to use and how do I do this Crystal?
I don't even know these acronyms. And so what we've done is just take away a lot of that. We've just allowed them to stick in their dental codes. So you use your C D T code, we cross it for you. We show you what documentation is required. And then part of our training program as a new customer is we teach them how to read those insurance cards.
We teach them exactly what to look for. We go over case presentation and how to present estimations to their patient because you know, you now have to explain to the patient their medical benefits and if it's scary and new to you. now you don't feel like the smartest person in the room anymore, and we don't like that feeling.
So we wanna make sure that our, our office admins are always the smartest person in the room when it comes to their medical insurance benefits. and then we offer, um, a lot of coaching on your clinical documentation. So, many dentists haven't looked at their clinical notes in a very long time, so they use auto notes.
There's just sentences that are just click, click, click and prefilled out. Unfortunately, medical, I. Spends a lot more time and attention when looking at clinical notes than dental, so we have to do a little better job. So we teach our clients exactly what documentation they need and how to incorporate it into their everyday dental process.
Michael: So then typically crystal, when someone signs on how much do they see an increase in like their collections or product?
Crystal: so across the board, we have 80% success rate on all of our claims submission. That's including the worst claims out there. The best claims out there. 80% is our average approval rate.
But what we're finding is patients are accepting treatment. At a faster rate because they can now afford the treatment. Imagine you had a $10,000 treatment plan and you got presented $1,500 from dental, and you were gonna owe the $8,500 difference. Now imagine I present that same $10,000 treatment plan, but I explained to you that you have to meet your $3,000 deductible and then you have a hundred percent coverage.
So now that treatment plan costs the patient $3,000 instead of 85. We all know that there are far more patients who would be willing to pay 3000 than nearly 9,000. So that's the story we tell. That's the, the, the purpose of medical billing is to help patients access the care that they need. So historically, we're seeing about a 20% case acceptance increase with cases over 5,000.
So if you're a $5,000 case and we can decrease patient portion, at least 20% more of those patients are proceeding with treat. .
Michael: And then what headaches can we encounter with.
Crystal: You're dealing with insurance, ? it's just the insurance companies. It's nothing else. The, the conversations with patients is quite easy.
They're just excited. They're just really feel great that their dentist is willing to go above and beyond to help them get more, more access to PA care. Right. They're, that's what they care about. Even when deductibles are in play, even if the patient gets no actual payment from the insurance company.
There's gratitude for helping them access their deductible in these medical benefits. But so that's not the obstacle. Never the patient, uh, it's never the coding. We can teach the coding. It's, it's just one plus one equals two, right? Mm-hmm. , it's not challenging. but it's the insurance payers. One minute one payer says this.
And literally the next claim, we call back and we'll get a different response. So the quality of representatives that are answering the phone are, are quite low. They haven't been well trained, they're not very familiar. So you get really inaccurate information will literally be told, yes, we'll pay for this.
And so we submit the claim with an approval number and they'll deny saying We changed our mind. So then we have to appeal it. Now again, a huge benefit of working with a company like DevNet is we do all of that follow up. So when you submit a claim through our system, we're responsible for it all the way through the process.
So we are the ones on the phone with the insurance companies arguing these approved prs or these denials and things like that. So I would say the first initial obstacle is just understanding the I. Knowing which plans pay what and why. And then I think the forever frustration is that we're just dealing with insurance companies and they are not in the industry of wanting to pay claims.
Their goal is to slow down and reject claims as quickly as possible.
Michael: Yeah, retain that money too.
Crystal: Yeah, that's their job, right? So we're kinda going against, against a big force in that sense. The good thing is, is there's a lot of rules and regulations. Insurance companies cannot just choose not to pay. And so when we know all the proper paths to take and all the right words to say, and all of the right, you know, if you will, threats to make.
They finally process our claims. So we do have some tools in our, our toolbox to help us make those go faster. But I would say to anyone who's getting into medical billing or is considering it just, just pre-prepared for the first few months to be exceptionally frustrating, these medical payers will not recognize you.
They won't recognize your M P I and tax ID numbers. There's gonna be a slight delay. Usually if you can get past the first 90 days, if you can just stay with it. Be diligent. Follow our program. By the end of 90 days, you've pretty much got a system in place that's working. .
Michael: so Dent is a program or is it like a software that I can utilize forever?
Crystal: dent is an education and distribution company. So Dent stands for developing dentistry. We just are here to pri find solutions that help dentists improve their practices and improve patient care. So that's our mission, is to just provide tools and solutions for dentistry. One of the tools we provide is Imagine Software.
So Imagine is a cloud-based software that handles these cross codings and handles all of this documentation. And behind that is a third party billing company. So we actually facilitate the entire billing process for our clients.
Michael: Okay. Awesome. Awesome, crystal, I appreciate your time and if anyone has further questions, you can find her on the Dental Marketer Society Facebook group, or where can they reach out to you? So
Crystal: you can always find email@example.com. We've got some awesome resources, re recorded webinars, tutorials, demos, everything you could possibly want to see. We have some awesome programs going. You can check out our Facebook page and you'll see success stories and just a whole program we've got specifically to different types of dentistry.
And then if you want to reach out directly, you can reach firstname.lastname@example.org.
Michael: Awesome. So guys, that's all gonna be in the show notes below. And Crystal, thank you for being with me on this Monday morning marketing episode. Thanks for having me.