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Dental bill format for Sales

foreign [Music] let me formally introduce Teresa Duncan with over 20 years of health care experience Teresa addresses topics such as insurance coding office manager training and patient conversations she has been named one of the top 25 women in dentistry and as the author of moving your patients to yes Easy Insurance conversations as well as a contributing author to the Ada's annual CBP companion guide for podcasts nobody told me that and chew on this are valuable resources for dental leaders so please be sure to check out some of those cool resources that uh Teresa hosts so Teresa it's your turn so take it away for us this evening I am thank you so much and I am so glad to be back with you all um some of you I recognize some of the names on the participant list some of you from previous violates webinar so thank you for coming back here there are some issues with billing and coding when it comes to making sure that we have accurate Revenue right so in our very heavy Insurance world nowadays we are running into more and more stumbling blocks I'll just say that to to obtain reimbursement and it's not necessarily all the carrier it's some a little bit the employer a little bit that we have a lot of fresh faces and Dentistry doing Insurance um it's a lot of all of it and I know that there are certain plans in particular that have been um just I think a good word is problematic this year right so we'll just we'll just leave it at that my goal today is to help you code accurately so that if you were to ever need to appeal your procedures that you would be able to do it and hopefully successfully one important thing that I'll just say is that I cannot guarantee that you're going to get paid for everything um you know maybe 15 years ago I could have said listen let's do ABC and we're going to get you paid in probably 99 of the time it would have worked but it's not 15 years ago things are very different plan design is very different customer expectations patient expectations are very different and like I said before the workforce is very different so um if you've been hanging in there for a while you've been in dentistry for a long time and uh you're still hanging in there I I think it's awesome I love this industry very much and I hope that many of you stay for years to come if you're newer to Dentistry yeah it has its ups and downs but I'm hoping that you stick it out with us so with all that being said um this is an hour of laser billing and coding so it's not going to be a full like um how to get your claims paid and all of that you know lots of webinars and classes on that but let's talk about the procedures that you can uh utilize the laser for the ones that you're going to run into the most and and one let me just let me go forward here with uh with advancing the slides um one of my most common mottos that I'll say I have a lot of Teresa isms I guess you'll say um is your documentation is going to drive your revenue and so I'm going to give you a couple foundational key pieces that you need to be aware of whenever you do any uh billing so we'll we'll go over that in just a second but one um one thing that I want you to keep in the the Forefront is that your decisions clinical in nature and I'm not a clinician I'm an admin but I'm also at my heart an office manager my office manager brain is always out to protect my office it's always out to make sure my doctor you know keeps his or her license so so let's engage my manager brain for a little bit um clinical decisions are the purview of the the providers the ones with licenses the one that did all the training my job is to make sure that we can get paid for it but it also means I have to educate my providers on best practices for that and I think that that's where we have a little bit of um there's a disconnect there so a lot of times doctors will take my classes and they'll say I had no idea you needed all that documentation you know nobody told me that and so I call it my that's the name of my podcast because I hear this all the time from people nobody told me that about everything really um and so when the admin team is doing a really good job of letting the clinical team know hey I'm running into issues here um it would help if the templates could reflect this this and this and then making sure that the templates match the treatment or the clinical notes match the treatment so um I'll say this and I know it sounds harsh we just got started but I'm gonna I'm gonna say it and I hope that you take it to heart um if you are rationalizing coding like you're making the code stretch to fit what you're doing then there's a bigger issue there so the coding should be pretty straightforward and when we get into uh non-cover services and all of that we'll we'll talk about that towards the end um I'd rather you tackle it from a holistic point of view meaning the patient's benefits or the patient's benefits um you are providing treatment and let's just see if we can divorce the two okay so but keep that in mind we'll talk about this I know it's easier said than done I know I was in your shoes too so I I know I'm going to try to guide you through it as much as possible so first things first this comes as a surprise to a lot of clinicians clinical notes are actually what they're looking for as far as benefit determination so in the past you would you know you'd always hear that you know I gotta write a narrative for this Dr can you write a narrative for this um what's really nice is that you don't have to do that anymore because your clinical notes should be be complete and should tell the story of what was being done the diagnosis the prognosis what was done the materials any patient comments things like that that's what we need in our clinical notes so another teresa-ism that I talk about is that I don't want you to document to the level of your carrier so you know I have lots of handouts on insurance friendly documentation I don't want you to document to the level of the carrier that's backwards that's not shouldn't even be a consideration if you document to the level of your state board and whether or not you can keep your license if you go in front of a judge and jury that's the level I need you to document to if you're really good with that complete everything is golden you're going to be fine with insurance you're going to be able to you know pass any utilizations now does that mean you're going to get paid maybe not but you can't control all of these crazy plans that are out there and you can't control employers who don't want to spend money and get a good plan so you know we can talk about that in a little bit so make sure that you know that your clinical templates can make a huge difference in getting paid I'm kind of reminded of way back when intro are already intro photos came out and there was only a handful of you know offices that had the cameras but when we sent in intro images along with radiographs man the approval rating the benefits just started flowing because I can get a lot paid with a good clear intro image in conjunction with the radiograph and so um just keep that in mind as much documentation that could paint that picture is what I want I don't want you to send them lists and lists and photocopies of files that's that's not the way um precise to the point and comprehensive and it's possible so the other part is I want you to make sure that you put in there if the patient comes to you as a from a comprehensive or periodontal evaluation and they don't have those notes with you you want to make sure that you cover yourself that you ask the patient for that information and that they showed up to your office with no previous treatment um history and so that helps you I've been told that helps in the court of law like just that you you know you didn't take somebody else's old notes and use that you had your fresh notes there and honestly I I can't tell you I I haven't met a doctor yet that would be okay going into court with another doctor's radiographs I just I don't I wouldn't do it right and I'm not even a dentist so okay so let's let's move forward here and it's not a documentation class but I can't talk about Revenue without talking about documentation and you know in my Revenue classes actually where we talk about revenue and collections Productions adjustments and all of that you know the big fat piece of it from most offices is the insurance reimbursement and so I can talk talk about cashing checks and how to collect from patients and all of that but the doctor really has nothing to do with that piece right like I'm up front just doing my thing in the back is where I can't control what you do as far as clinical notes I can just ask so work with me on that right okay so I'll give you a couple little guidelines here so documentation the ideal time to get all that down is of course at the comprehensive or the periodontal evaluation so you know that you know if somebody comes in with sign symptoms periodontal disease it's you're you're really doing a periodontal evaluation okay so um and a lot of offices don't even bother with 180 because which is that's the code for periodontal evaluation not periodic periodontal a lot of offices don't even bother with periodontal because they say Well they're only going to you know downgrade it to a one two o or they're not going to cover it at all it's going to be you know we're gonna have to write it off um or it'll use this is my this is the one that I don't understand but let's talk it through it's going to use up one of their evaluations I know you're right so my job up front is to say um you know you have two per year your your employer chose a plan that only benefits two per year and one of those is going to be used today and that's it because there are people who are going to come in often they're a mess you know how they are they chip a tooth here implants loose here I mean you know how it is you have to charge for these limited evaluations for these periodic evaluations the fact that the patient only gets benefits for two why does that even come into play you know but I hear it also from my fellow Insurance coordinators we don't want to have arguments with patients but you know what I didn't choose those benefits so it is possible to educate a patient about their benefits with a big old smile on your face and that's what I'm here to help you with so templates are very good for these evaluations because the assistant can actually prompt you if you sort of forget where you are if you forget to record something very important what you should know about documentation is that there are guidelines that Dental Consultants the ones who review claims there are guidelines that they have to go by in order to get a claim paid for example um perio charting must be complete must be a clinical attachment lot level you've got to show you've got to show that bone loss right but here's the thing most people don't realize it's got to be usually almost always it's got to be within 12 months so you can't send them a perio chart from two years ago it might have tens all over it all right however contractually that Dental consultant cannot approve benefits for that procedure if the documentation that you provided does not meet the criteria okay and that's for in and at a network benefits so that's that's really on you to have current and acceptable documentation um definitely make sure you're recording the missing teeth in the software more and more the claim forms um you know the platforms actually pick up missing teeth in the chart and record it on the um odontogram on the the actual claim form so we want to make sure that that's accurate too because you don't want to uh bill for a crown um I'm sorry Bill for an implant but the tooth chart shows that it's still there right so that's all part of good clinical documentation and one other issue I want to talk about is radiographs so typically the same thing applies for for the probing um for I'm sorry for the period you're already like if it's very obvious that they need the work on the ready grass but the radiographs are three four five years old it doesn't make a difference it has to be current right so a lot of times doctors are saying well I can't charge for the radiograph that day they'll just deny it or disallow it and you know I I when we did didn't have digital radiography and yes that's how long I've been around I would have said okay I get you I know it's painful but we have um we have digital now so you know while you're doing a naval um an eval in hygiene or you know while you're going to um glove up or whatever just grab an x-ray I mean just just do it just grab an x-ray the sunk cost is already there Technology's there um don't beat your head against the wall for something that's really not honestly not that big of a deal now if you had hard costs involved like films and fixer and toner and all that oh my gosh I our developer and fixer I'm taking some of you back to the uh the good old days right um so the radiographs typically need to be within two years I am definitely seeing a tightening of that down to uh 12 months now here's the key with radiographs very easy so some of you who are like really experienced clinicians and you're practicing it like this really high level so you're gonna kind of go what is she talking about I'm not talking to you I'm talking about I'm talking to people who just haven't learned yet that radiographs need to be they need to be um of diagnostic quality so if you've got cone Cuts if you've got overlap if you've got open bite if I mean if the the um what is the exposure is just off that radiograph is not of diagnostic quality and quite frankly the insurance carrier is going to be like well how did they even make a diagnosis off of this so and then you have to ask yourself if I take this image with this really bad open bite into a court of law for an endo case how good are my chances how good do you feel about that so we have to I'm going to start a campaign we have to be better with our radiographs you have to stop whomever in your office is doing lazy radiographs and get them better at it they have to be better it's not just the benefits that are going to depend on you know getting paid um if you ever go to court that's going to reflect on you so my job as a manager protect the office so that and that means protecting you so will I talk to any hygienist or assistant that's having issues with that oh yeah definitely definitely because it's um but I'll tell you what it's much more strong in nature and tone coming from you because you are the clinician I mean in cases like that when it's a clinical I guess um guidance it's always going to be better coming from you not for me so let's move on here okay um I I'm starting off with perio you know Joe and I were talking about this earlier the the fact is the most amount of questions I get in my coding classes Circle they're they're around either um Crown buildups secondary insurance or perio and Perry depending on you know the area and which carrier is dominant you can see I can tell which one's going to be more um more discussed in the class uh so let's just talk about perio one thing I want you to do and this will increase your Revenue because what's going to happen is you're going to have some level of consist consistency your team is going to get calibrated on what they expect to have when I as the insurance going to go to submit your claim I know that these pieces of information are going to be in that chart because that's what we've all agreed to the one thing that is harder to agree on is the path of the patient through perio it's hard when you have um hygienists with different um styles you have doctors that are aggressive some not aggressive um conservative I mean it's just it's up to in each individual dentist and hygienist has their own style that that's it but and they'll find you know a good place for them but sometimes you have such a mismatch it's really hard on the whole team because patients will tend to settle with who they want to go with right and we don't want that we want we want um everybody to be calibrated across the board um I will just let's just touch on this I I want you to have a meeting with your team first doctors I would do this with your hygienist your hygiene team talk about this trace the patient through the office if they have periodontal issues okay so where where do we go from at all of these places and you can do flow charts I mean there's lots of stuff out there I think adha may have something like that my friend Rachel wall she has lots of resources inspired hygiene for this so she's I know she's got something like this but at which point do do you Zig and other people's Zach so identify that and then the other piece of it is when you get some sort of consistency right you're going to have a team meeting and bring in your manager beforehand so he or she isn't blindsided you're gonna have a team meeting and this is what the expected path is for patients in your office everybody knows the assistant knows everybody that's scheduling the insurance coordinator knows and so you have a really good protocol in place for perio do you revisit it sure because technology and all of that maybe maybe there's just lasers everywhere and you start adapting lasers into your day-to-day on even more than you already are so there's just lots to do with this I recommend doing this once a year and then that way everybody is reminded of um how important this is but also we definitely have a lot of new people coming in and I'm gonna guess that you're going to have at least one new person at least one new person within a 12-month period so it's always good to catch up with them um and and also people come from other offices and sometimes they do things really well in other offices and so you can benefit from that but you're not going to benefit unless you don't ask all right so I'm sorry unless you ask not Donuts unless you ask okay so let's move on here um one thing that biolays customers have been able to um really sink their teeth into is the fact that they have protocols all put in place for them so this is the repair um peria protocol Dr Lau does a great job coming up with these so the the codes that you see on there are not Dr laus he's he kind of just said hey take this and and give the codes out and I I did so you have these um I do want to say though that the um the fourth bullet point on the presearcher phase I need to go back and change that because new for 2023 starting in 2023 I'm going to have new codes in there because intraal images is now replaced with different codes so um and I you know what everything changes right so okay so I went through the protocol and gave you all of the codes that you would need for that if you were to utilize this protocol so I hope that that helps one other thing I want you to know is that for most of the procedures I'm going to go over here there's a there's clinical protocols already in place and so uh the the website has all of those so if you're wondering like what's the protocol for you know frenectomy and and you know clinical crown lengthening hop on over to the website or email you know or throw something in the chat and hit up Joe and he'll figure out a way to get it to you um there's lots of resources on the website for that uh this is suggested documentation again from biolays on you know what to do for laser use message I'm not going to go through each one because we'll be here all night I just want to point this out down here the laser setting I don't know if you can see that but the um the laser setting bullet down at the very bottom there so when I see this my manager brain just goes I have no idea what that is and what I was really lucky I had a doctor when I said um I really have no idea what you're talking about he would stop and he would explain the procedures and I I have to give it to him he's the reason why I understand a lot of clinical situations and why I love really Dentistry so much so when I see something like this that makes me kind of go what is that there's got to be other people that feel the same way so I'm going to challenge you dentists and hygienist to talk to your team you know pull up a at a team meeting it doesn't have to be the focus of it I mean an hour of lasers is not something that a new assistant is going to want to listen to but little Snippets you know hey this is what this means and then this template and this is why we need wavelengths and all that kind of stuff I mean a new person coming in is going to be like wavelengths what's that about learning about what the laser can do is super cool so um don't forget that don't forget the new new people really don't understand like everything that's going on so take the time not just with lasers things like root canals why are you doing this why on the upper are you sending them out because that that hidden Canal is going to catch you you know you're worried about that little things like that make your team stronger and they're able to discuss things more confidently with your with your uh patients and and you will see that that makes a huge difference so the other so let's just keep going with Perry and then we're going to go into other stuff um the AAP uh has new periodontal guidelines I'm hoping I'm hoping that most of you have seen this by now and if you have a hygienist in your office I'm hoping that this has been the topic of conversation if you have a hygienist in your office and you go back and you say hey what's this about new staging and Grading and they look at you with a Blank Stare um you know two years ago I would have said oh you need to send her here or send him over here to learn about it listen to this podcast we're about ready to start implementing it like as standard of care um and there's really no excuse for any hygienist I don't I don't care if they took off during all of covet there's no reason why um anybody involved with perio has not heard of the staging and the grading so with you for some reason just got somebody who doesn't have that information you're going to go to AAP perio.org and look that up now the handout that will make available to you is going to have these two and the next one um on in full pages so I did the handout with the PDF of the slides and then these are actually in full pages so that you can print them out and use them in a team meeting or go to perry.org and go to that section and you can print them out because I just took them from there um fantastic uh information to go over and also you'll start to see where the holes are in the clinical information so I did a whole series I've been doing by early's webinars for a while and one of the things that I love is that the participants are always like okay well that's great but what about this and it's good because it keeps me on my toes so I was talking about staging and Grading oh gosh it's got to be last year and uh somebody messaged me and said well that's nice but what do we do with our templates because you're telling me I need templates and I said all right well let me give you some templates then so feel free to take these insert them into your templates for anything perio so that you have this in your notes and you can rely on it so I did I ran this by a lawyer that I talked to all the time and he was like yeah that's good so I got the stamp of approval there so feel free um to use that the most important part is that when the patient comes in you're assessing what stage they are their perio disease and then as you treat them and as they progress through you know over time you're assessing how the disease path and and whether or not it's accelerating or or you're treating it you're keeping it at Bay and that's the grading okay so that's the important thing definitely definitely worth a lunch and learn so let's talk about SRP I want you guys to get paid for SRP but I will tell you it's getting harder and harder nowadays those two images I've been using them for probably 10 plus years because I can't find better ones that illustrate it better than this like these are the same teeth and with my internal image I can get that you know they were able to get this baby this is a doctor out in Colorado they were able to get that paid because the radiographs look at it bone loss but it's not but but look at the intro image oh my goodness so that being said I hope that that drives him the point that internal images are wonderful and I want you to use them so let's put a pin in the first bullet point I'll come back to that in a second typically SRP um you have a 24 or 36 month frequency limitation always always is going to require period chart and the most comprehensive radiographs that you've got so fmx is good Hannah not so much Pano just is not really a diagnostic quality uh oh got something on my throat is not really of diagnostic quality as it pertains to perio so you will take typically not you will typically get a request for fmx four bite Wings bite Wing series that that can help too um but clinical attachment loss is what they're looking for on the perio um charting and then also on the radiographs okay so I also would love for you to get in the habit of noting seat and dismissal time you know there's a lot I used to not see this but now I'm seeing it in some of the clinical guidelines for insurance carriers because I'm that person that reads them and enjoys them I'm starting to see that they're actually making recommendations like one quad of Dentistry should take about 30 to 45 minutes which is you don't you haven't really seen that before and the reason why whenever I see something new I always ask myself why what what would they what is that for is that Paving the way for something well there are offices out there that definitely abuse 43 41 4342 I mean that's fraud unfortunately is a fact of life and so I think I know what's happening is that fraud fraud investigations have been centering in on easy codes to look in their chart and see if their things are bad right and this is one of them so I just am a fan of noting when they exceeded them and when they were dismissed from the chair um every uh attorney that I talked to about this and I would say not all of them I would say the four that I talked to about this we're fine with this they actually liked this if you do any kind of sedation this is going to be what you have anyway so why not just add it into your chart right um and then that way and I'll honestly if you bring on an associate you're going to see that the seat and dismissal time pretty big right new associate coming out you know how it is they're very slow um two years later have them look at their seat and you know seat and dismissal times it's pretty cool to see that they really have gotten so fast and efficient but going back to Insurance it may come up in an audit and so just you know it just added to your templates so the first bullet point I told you I was going to come back to it and this this really applies to all of what I'm going to talk about today tonight I want you to involve the patient ahead of time by having conversations with them firm firm and friendly conversations with them about their coverage and so what I typically will say especially for SRP is I'm going to try my hardest to get this paid Mrs Smith I'm going to send it in lots of documentation I'll go ahead and send it in um I have found that there has been a lot I'm dealing with a lot more denials in regards to scaling and route planning and now I'm not lying on that in my experience I have had that I hear many of you have had that and you probably have seen that so if you if you are not experiencing that don't say that obviously I don't want you to lie but I'm gonna guess that most of you have this situation all right so I'm going to say to them you know I I just know that I've been having some issues with them and I what I will do is I will appeal it now if I have to call you Mrs Smith that means that I have exhausted all of my options so if I put up the bat signal and I have to call you that means I really need your help I will likely need you to go to HR and have them call the Carrier and maybe um step in for me A lot of times patients will say um well call me before then you know I can help before then and then some patients will say sure whatever but when I do put up the bat signal it's not a surprise to them and I you when I started doing this when I started prepping them that I might need their help the um I would get calls back I would get emails back because before then it was like oh you said you're going to get it paid so get it paid you know how it is so I always enlist the patient's help um when it comes to getting paid and this can apply to not just SRP but to other things so let's talk about some of the periodontal Clauses that you're going to see out there and these uh these two dogs just cracked me up I kind of feel like uh the white dog has some gum disease and the breath is kicking right and the black dog is like oh my gosh don't come near me now um and and we know that our the our admin team um I'm gonna guess is probably just as good a diagnosing perio as you are because we get the breath right when they walk in so it's always fun to uh I used to say I'm you know Mrs Jones is ready um you want me to bring her back and I would say and by the way I'm going to put 10 down that she's got like six millimeter Pockets you know so we would have some fun with it and let's be honest demonstrate sometimes you've got to have fun right okay so here are some common periodontal Clauses now these are what are called benefit limitations you have a Cost Containment measure so listen to what I'm saying your plan has a Cost Containment measure your plan has a clause your plan does not allow benefits for this your plan you hear what I'm saying your plan has a cost restriction um in place what I'm saying here is that these are not Clauses that we came up with these are causes that carriers came up with and I'll tell you carriers you know I work with them a lot too I work with Ada and carriers and they'll tell me we'd be happy to carry and cover all of that but the premium on that plan is going to be astronomical right so there's got to be some give and take and I want you to look at it from a business point of view so with that being said everything that I list on here I'm not going to go through each one of them but you will see here these are these are clauses I come across quite often there is nothing none not one of those bullet points is rooted in any kind of clinical data studies anything they're all strictly Cost Containment measures benefit limitations Clauses or cost Clauses you know things like that like you will you will use these terms start using these terms more and more don't say well Insurance didn't pay or oh they didn't pay and we can't do this and we you know they they won't pay us for that that's not the way it might be true but that's not the way what I want you to say is um your employer has selected your employer's plan your employer chose a plan that has Cost Containment measures like this I'm going to try to get it paid but I may run into a Cost Containment measure that your employer has selected do you see the difference so and and if there's any carriers listening I don't think I'm saying anything out of line because this is exactly what the employer selected so I'm being what I call Trans transparent try to be very transparent in all things and this especially because put yourself on the other side as a patient I want to know if I could have chosen a better plan or if the plan I have what the limitations are so that I can plan for it you know um that lots of people have hsas that they can tap into okay so that's a whole different conversation but I just want you to see all of that in there that we kind of accept as clinical guidelines and I see this all the time offices will use these as their clinical guidelines well we only scheduled two quads in one day we only schedule it's always two weeks between appointments it's always one week between appointments it's always we see them three months plus one day these are all because you got used to these being guidelines but they're not they're just Cost Containment measures you Doctor clinically you do you do what you think is best for the patient all right and then let the benefit chips fall where they may benefits are great because it gets people in the door lots of studies on that right people with Benefits come in much more than people without benefits that's not even contested but that doesn't mean that those benefits once they walk in the door that those benefits become your ten commandments so let's not do that all right so uh let's move into gingivectomies um and I was joking I was joking with Joe on this because um there's some bad stock images out there right so and I just found this this is one that was for a gingivectomy and I was like well I guess that that kind of counts that the lots of soft tissue there it's just funny um so for gingivectomies um one thing that you should know and and what I did I structured with these um slides is I I'm talking about the different procedures that you could do but I am also giving you what I see is the most common documentation um requirements in all of these provider benefits are I'm sorry the um processing names so there are people out there that love reading this kind of stuff I have a small group of people that um I really adore because they like looking at the stuff and we kind of share I know delan's on the Call Shout Out Delane I just she's my coding uh sister so here's the thing I read those so that you don't have to okay I read those so you don't have to so that what I'm doing is I'm I'm taking the most conservative um clause and I'm applying it here okay so someplace fans might just require you know um four millimeters of attachment loss whatever but I'm giving you what I see the most so that you can at least be prepared for what's out there now if I'm seeing in all of the documentation so follow me here if I'm seeing all the documentation for gingivectomies I'm looking at all these different requirements MetLife United Healthcare Emeritus whatever they all say five to eight millimeters attachment loss is commonly required will I go to my template and make sure that there's a how many millimeters of attachment loss is there so not just the perio charge is going to show it but I'm going to put on there you know there's in certain Pockets there's you know eight millimeters here six millimeters here I'm going to put that in the clinical template because that will remind me to write something about it and I'm speaking as a clinician um which I'm not but you know what I mean so I'm going to use that to have that note in there and if it doesn't apply then I'm just going to backspace delete that out of the template okay so but I'd rather have it in there so it prompts me so definitely you will see and I know this doesn't make a lot of sense to me and again it's a Cost Containment measure not necessarily a clinical guideline most of the plans are going to reimburse if it's done on a different date as the crown prep and um you know I I have doctors doctors are funny I I just love you all but you'll you'll come up to me and you'll go why why and I don't know why but I feel your pain so okay so let's keep moving um you know so uh anatomical Crown exposure okay so and crown lengthening right so um I thought it'd be fun to show you a picture of this uh paleo caveman they dug up um 14 000 years old and I'm thinking wow look at that crown lengthening and uh all of that it's gosh it'd be so much easier if there wasn't all that soft tissue in the way so I thought that would give you a little bit of a chuckle so okay so let's talk about um blue crown exposure here so typically of course not reimburse on the same day as a restorative procedure and I I can hear that I mean there's some healing that goes on but honestly they're not going to reimburse it anyways I don't see this reimbursed hardly I really just don't um and I look for it all the time it's kind of like the white whale if I see it I'm going to be oh I gotta get that I got to find out which policy and spread the word but I just don't see it so that's where you're going to let the patient know you know in my experience we don't get this covered very often uh we're gonna try but we just don't get this covered very often and let them know that you're going to do everything you can but you're already priming the pump that they're going to expect that it's not going to be a covered service okay so just prepare uh the patient so and transparency transparency transparency transparency I'm just gonna I hope that you you get that from my conversations with you tonight so clinical crowd lengthening okay well so again I went and read a whole bunch of manuals and um the most common was must include alveolar bone recontouring so when I see that in most manuals am I gonna adjust my template to say alveolar bone recontouring and then a line you know so that you can describe you know where and then any other clinical notes you want to put and again if it doesn't work then you're just going to take that out so um I I have a really good friend who's a periodontist manages a periodontist office Beverly and she her templates are huge and by the time they get done they're just you know they delete what they don't need I'd rather have that than have to sit and type up every single one um templates are godsend okay so um evidence of the Decay you know that extends below or near the alveolar Crest make sure that you note that internal images your radiographs are all going to help um this is hit or miss so I I typically it's probably 50 50. I mean I know that's a scientific term right 50 50. and my appeals on crown lengthening I will say you know I used to be 100 on most appeals I'm not gonna lie um it's harder now so I would say for clinical crown lengthening it's a lot harder for me and and if if the patient is already prepped for it I'll do one appeal and then you know it's I'm not going to waste my time on that so I'm just going to prep the patient you'll notice in some of the codes that I'm going to go over that you have this little medical billing Circle uh when I have that up there I will tell you um that what that means is that it's a possibility that you could build this to Medical but I will say I am not a medical billing expert I'm I'm terrible at it um you would you would absolutely get audited if I taught you how to do medical billing so you don't want me to do it but I do have people at the end I'll put on the uh on a slide of who you can call to help you because I just would not be the one so let's go back to Dental so the necessary documentation obviously is it includes whether or not bone was augmented or removed that is the that's the core of it okay so we need to make sure that that's involved now the period the charting the period charting and the radiographs you know this is where um bite wings and fmx um you know vertical vitamins and fmx really really do well here so I I actually um get a lot of claims paid when I've got like extra x-rays if that makes any sense so um and of course the intraoral images one thing that I'll tell you I didn't mention this was scaling and root planing is uh I learned this from a very uh one of my very oldest clients um the treatment coordinator was amazing and what she would do is they would the hygienist would probe you know get the perio charting done and you know pockets and all the kinds of bleeding that's when she would whip out the integral image or intraal camera and she took pictures of bleeding spots bleeding spots all over the place and it was great because I they we could send them into the insurance carry but it was really great from a um from a patient education point of view because when the gums were healthy tightened back up and they didn't bleed like that it was a great comparison point so uh you know I'm telling you internal images I love them okay so then I see this a lot too Crystal bone level should be greater than two millimeters below this the um sentin enamel Junction you know what I'm talking about Sentinel and animals I I think I probably have it um here's something that's very interesting um sometimes even with 4910s getting 49 tens paid uh and they're going to ask you for a history of previous perio um treatment the SRP or the osteosurgery and sometimes the patient doesn't bring that in and that's why it's important to note you know patient came in with no records it's an estimate so they do usually request you know when when they had this work done and I can tell you with confidence that when you put in the notes patient states that she had scans she had this procedure done well over five years ago or patients states that Crown is over 12 years old that's all they need to make the benefit to termination um on that criteria they don't expect you to have exact dates unless that patient you know was in your office or the the charts right in front of you so um definitely patient statements are so important to have ask them how old the these things are ask them how long it's been since and just make sure that that goes in there I will tell you that having an assistant that understands this is super helpful some of the best documentation I've seen it's because the assistant was on his or her game and it's fantastic the one thing about osteosurgery I'll tell you is that um a lot of times you know you want to go straight to osteosurgery you want to skip scaling and replaying because it just needs to go there there are benefit plans out there that will not provide benefits if they did not go through that step of traditional SRP so in that situation you know that's it is what it is you know the patient's responsible for it it's a bummer it's a bummer but the patient's responsible for it you could do two things you could ask them for the alternate benefit of the scaling and route planning code that does not mean that you're changing the code you're still submitting your 4260s 61s but you're saying can we at least have the alternate benefit of the scaling and route planning code it'll be much much less and maybe you don't get it but I've had a couple successful appeals using that criteria that's a new use of alternate benefit for me and it's been I've been surprised that I've been able to get that that covered so I love it um the other piece of this is that it gives you another opportunity to say to the patient I you know I really thought this was going to be covered too I'm surprised I'm just as surprised as you are your employer unfortunately chose a plan that just doesn't cover that or you know chose a plan that was restrictive in this area that I'm sorry I'm really sorry and that's really all you need to do don't go tripping over yourself to give discounts you know or courtesies don't don't do that you did the work and it cost you money to provide that work okay so let's talk about laser bacterial reduction lbr I get this all the time but there's no code to describe it so we have to use our 49.99 um typically if you're in network they're going to bundle it up and tell you that you can't charge for it if you're at a network you're like whatever I'm still going to charge for it uh that's the beauty of being at a network but I realize many of you um aren't out of network in fact most of you are in networks and so um I know that we have to be conscious uh very conscious of this because uh you might charge for it and then have to write that off and that just that hurts you know you're as speaking from an admin who's had to do that and help people do that I don't like writing off I want you to get paid lots of payment um and that really hurts but it is what it is within in network um contract and so and I know some of you are like but what about the form hold on so we'll get to that in a second um most of the carriers have really deemed lasers to still be investigational in nature that was those are some of the terms that I see and it's not you know the documentations there are the studies are there you see it with your own eyes you use it in your practice um it's just you know if you feel strongly like like I do that the manuals are not up to date with this type of thing talk to your patient just say you know what the insurance carriers do not feel that these are you know ready for prime time they still call them investigational meanwhile there's tons of laser companies out there I have a company that's great this laser is fantastic and I see the results I would say that to them because why not they're not going to hear it from anyone else they're going to hear it from you nobody's going to stop them in the street and say Hey you know how your insurance doesn't cover lasers well you know that's wrong nobody's going to do that you have to do that so I'm going to urge you to just be a little bit more open about the benefits that people have don't slam them because patients typically do not have control over the benefits that they have the employer picks it but being Insurance friendly and translating to patients what benefits mean that's how you're going to keep people coming back trust me on this I've worked with tons of offices that do that so uh your frenectomies you know we had the 7960 was our catch-all and that went away and now we have more granular more specific codes there is um some documentation some some clinical guidelines on this on the website I mentioned that there's a you know the protocols and so go look for that um if you are billing to Medical the one thing that I've heard over and over again from um usually is pediatric practices that are building medical they will tell me um that if they have these key phrases on here interferes with proper Oral Care or interferes with the seating of a prosthetic that's not gonna be a kid but causes issues with speech or mastication um you're going to get some coverage now an adult obviously you're going to get some coverage but medical billing um learn how to do it before you do it okay it's it's not for the faint of heart it's not easy I'll tell you it's not easy so uh proceed with caution okay so what I want to tell you about is that there is an evaluation code that to me is like so criminally underused and I want to talk to you about it d0171 some of you were like what is this code I've never heard of it it's been around for a couple years it's just that we fall into habits right so you've done all these procedures that I went through I kind of ran through them right you probably brought a few back for a reveal so let's talk about your scaling and replaying you probably brought them back um to do another perio charting and another assessment and you were like what can I charge this you know what is this 171 is the perfect code for that do did you have um a pretty heavy extraction um and and lots of you know cutting and all that and you want to bring them back in just to make sure everything is okay 171 is that any time that you had a post-operative visit from a procedure 171 is appropriate does it eat up an evaluation code yeah it does and so we just tell the patient but that's what's going to happen and collect and so you know try to try to do you know do this whole thing what would Teresa do Teresa would smile and say I'm sorry you've already used your two evals that your employer allows so unfortunately this one's going to be out of pocket it will be sixty dollars and then I'm gonna smile how do you want to take care of that that's how you do it you do it confidently and you do it with a smile and your patients actually are just going to fall in line most of most of them I can't promise you they all will you all know who's not going to fall in line um but I want you to explore using 171 more because I'm gonna guess that you provide lots of look-see evaluations where it's just a no charge and uh boy are you losing money because you're disposables your PPE it's all different now you're overhead everything's different now covid and this recession everything is different so uh one thing that I I find very interesting so let me just tackle the big one biopsy and excisions typically not going to be reimbursed medical billing is where you're going to get some some traction there um hemostasis I I'm this is fascinating to me honestly and I just think this is something that I would share with the rest of your team lasers are great at stopping blood flow so sometimes you know you will be we talked about this earlier Joe and I in our pregame um you know if you're doing a crown and you've got a bleeding spot it just won't stop you know pull out your laser um you know stop that bleeding and and your reps you know your reps and your clinical guides your doctors that you um work with with violas they'll tell you this you'll figure out when you know you could do it but from an admin point of view or from a new clinical person you know your assistant a lot of times that doesn't make sense to us until we see it it's super cool right so that's what I'm talking about explain why you do what you do now anytime that you do that and you're like oh I should bill for that well you could it's going to be a 999 code um and 999 codes are useless let's be honest so we submit it there's a fee attached to it and then we end up not you know it's not going to get paid so any 999 codes are just they're tough they're tough um but it's typically included with the procedure and I just think honestly it's it's going to help you be a better clinician I know when I was an assistant I don't know how many times we sat there and just waited for a spot to stop bleeding stop bleeding so this would have been much better right so and then you know troughing around crowns all that kind of stuff is perfect so at any rate see I get excited about this stuff right I'm not a clemension so typically denied this is my list of yeah good luck this is my good luck list um you're typically not going to see this however medical I should have my little um Circle here medical is very commonly um billed to for for these procedures so let me get to because I know this is going to be the biggest oh gosh we're at 8 54. um this is going to be the biggest question that I get so hopefully I can answer most of them right here can they just sign a form so you want to do laser disinfection you want to um charge an upgrade you want to utilize different materials um and you just say well can I just have them sign a form so if you're at a network you don't worry about this okay so I'm speaking to my in-network people can they just sign a form so a lot of times yeah they can sign the form um but you've got to check your carrier contract because sometimes the form means nothing and that's because of the contract you sign you signed and agreed to that right so um unfortunately you're kind of you're stuck right what about this form that everybody talks about where you can it's a hippo right to restrict disclosure form and what it is is you have it have them sign it and you don't submit to the carrier the patient agrees that you're not going to submit to the carrier they're going to pay in full so Hazard here so I yes there is such a form um it applies to that day and it applies to all services on that day you can't pick or choose the problem is the patient has to pay in full for the day Services no payment plans or anything like that it negates that whole thing it's part of HIPAA okay so I don't make up the rules unfortunately I have to translate them for you and and tell you about them um and this is what this is what gets me it can be revoked at any time and I countless horror stories you can imagine I hear all of the the horsters I never hear that oh man I had all my claims paid today I don't get those stories um I've heard the horror stories and been on some calls um where the the carrier has said you know Mrs Jones you you signed a form and so all you have to do is revoke it and that counts and the patient's like so if I revoke it I don't have to pay anything yeah you don't have to pay anything and by the way they actually have to give you money back because you shouldn't have paid anything that is a terrible phone call to listen to it was painful um and I've heard that a couple times and I hear countless stories about it so I understand that there is that form available um Rick garofalo's site practice mechanic um go there and look for the Do Not Bill insurance form and read the instructions so that you know what you're getting into um there's also uh on there's lots of resources on his site the handout that I made available in a PDF um this actually if you click on it on your computer it's going to be hyperlinked I hyperlinked a bunch of different stuff for you so that being said and um let me just say that there are definitely schools of thought out there where well we'll just create a dummy code um you know just our own internal code and um they won't be covered by insurance and so they won't send it into insurance and they won't recognize it and whatever or we just do an internal code and um don't submit it to Insurance the patient will never know any different it's a non-covered service so we should get paid for that I hear this a lot and I it never ends well so I'm just going to say buyer beware when you hear any kind of advice on the internet let's be honest um just yeah be careful all right so I've been I've consulted with a couple on strategy calls I've had a couple strategy calls with people who've been burned by this so that being said your documentation as always is going to drive your Revenue please remember that because that's super important and then I want you to take this sheet home and this is new we didn't have this last year during the bilays um webinar series that I I did um I'm I'm adding this in because I'm I'm realizing with all the new people coming into Dentistry that it's tough for them to say what comes naturally to some of us Old-Timers so I want you to get in the habit of saying using these terms and just Try It Out Try It Out Try It Out um you know role play everybody hates role play but I tell you what role play is great because you can once you get the initial laughter out of the way and the awkwardness you do start improving on the verbal skills so just remember the tone in all of these your plan doesn't provide benefits for your employer selected a plan that does not have benefit fits for that procedure I'm going to do everything I can to obtain benefits but I have found that with your plan in particular I'm having issues or I never am able to get benefits paid I am happy to talk to your employer if they're interested so that I can help him or her take a better plan why not right so um take this slide and use it in a a another huddle you know like a morning huddle whenever you huddle or use it in a team meeting and just kind of practice on each other I I hope that you utilize everything that I've given you today because that's that's what I want so some other resources for you my book yes is moving your patients to yes you can find on the website or Amazon my website or Amazon and it's all about insurance conversations um due for I gotta work on that for 2023 I gotta do uh Financial conversations and that's going to be fun CDT 2023 the coding companion is huge it's getting bigger and bigger and bigger with all sorts of scenarios um I'm actually I'm loving it I you know this is what I this is see how fun I am I have the book here you can't see it because of the the background but um I will tell you I coding nerds if you've got one in your office and that's the kind of thing that makes him or her excited hold on to that person because they're going to make you a lot of money right they're going to help you with your Revenue every year I do a coding update with all the new CDT codes and so you're welcome to register for that get the replay or attend live and so I just wanted to make sure that she had that and medical billing remember I said medical billing don't call me so I'm hoping that you utilize this and I'm hoping that you all join me in Orlando um February 3rd through 4th two days of insurance two days of nothing but medical and dental insurance and for some of you if you like recoiled in horror I get it that's okay it's not your crowd but if you're like oh really come on come on down we'll we'll see you um so these other people are fantastic and um I hope to see you at some point and I know that we have in April by Elise is planning something pretty fun um tongue ties and tequila in Scottsdale so save the data I think April 21st and 22nd is what Joe told me um save the date for that because how much fun does that sound and I'm been told it's not all tongue ties so there will be other other stuff too so if you feel like listening to more of me and yes I'm going to do q a after this um I do have two podcasts there uh Medicare Advantage so dentists you're going to be like why is she talking about this but my admin team who are listening you all know Medicare Advantage has become a big issue right so there's two podcasts that I did one with Colleen Huff one with Delaine Globe where they talked about Medicare Advantage so you can go back in my nobody told me that and look at that remember how I said um perio you need to get your hygienist calibrated and talking in the same language um it's not released yet it'll be out I think next week but I just interviewed Rachel wall of inspire hygiene we did nothing but talk about how to calibrate your hygiene and Doctor team and then distill that down to the admin so that being said I know Joe's like oh my God she talks so fast I know I do um I want to thank biles I want to thank Joe for um inviting me to always be a part of the Bailey's Family you guys are amazing um the support that they provide you Dennis is amazing you guys have these little clinical pods that get together and you have just it's it's just great I love it so I hope that you connect with me on social media I hope that I see you somewhere if you see my name talking about coding or management I hope that you come to see me and uh with that Joe come on down I'm I'm done I'm going to take q a when you're ready all right all right great content Theresa um lots of good stuff and we had a steady flow of questions while you were chatting away over the last hour um I will start with you know that there were a lot of questions about well where can I find these templates that you're talking about where can I find the handout that you're talking about do you have a website so what do you recommend should we send everyone to your website Teresa and then if if they need something specific from us we can send them to bylase education what do you recommend yeah so so first of all I know that um there is some there are some templates that you do provide for certain procedures but if you're looking for all over the place then I would um I'm gonna put in the chat Duane Tinker is I don't use Dental compliance cop or something like that doing tinker and then also um Andre sherdan the crew process um let me I'm typing it into chat right now they both sell clinical templates and they're fantastic so Andre is a former Eagle cell trainer so if you're Eagle soft that would probably be really good for you but you can always use it for other software Duane Tinker is a former um he actually used to he they call him the compliance cup because he used to do the audience he used to be the auditor of dental offices and he came over to our side um so he's fantastic I think he's compliance cop but anyways I I put that in the chat um so that you can look that up and then if for some reason it gets away from you just email me um happy to send you their way as far as my website I don't have that information on there but there's lots of other