Welcome to episode three of dentistry support the podcast. I am your host, Sarah Beth Herman. And today's episode is all about how I learned what dental billing was. How I learned what it should look like and how my journey in leadership led me to teach one dental group to collect nearly $4 million in just under six months.
And yeah, it really is possible and it really did happen. We're going to chat today about dentistry support my company's and counter with an eight group dental practice. That was literally up in arms. With over $11 million in and collected dental insurance claims. The challenges that this group faced, including a botched conversion from one dental software to another. And I guess the best way I could say it is ineffective leadership within their billing team.
We're going to chat today on the importance of choosing leaders wisely. Especially when it comes to dental billing, like the money that makes your business a thriving one and the consequences of resistance to essential tasks that come along with that dental billing.
Today, I'm talking about dentistry supports commitment to ethical billing practices. And how we choose to charge clients, not because I'm selling to you, but I hope that it inspires you to look at the way you charge your patients. And what really sets you apart.
We're going to talk about my rationale behind transparent, flat rate pricing models. And my resistance to gauging profit based solely on my own clients profitability.
And then a quick story about my first year and a dental office. Through each episode here at dentistry support the podcast.
You're going to hear me recount stories. Real true stories that happened on the job or in my experience. And along the way, I'll be changing some of those specific details about each story to remove any identifiable information that could reveal the exact business that I have worked with. And that's simply out of respect for their privacy.
However, the details about my part in them are always true. And they will definitely be on the cringy side at certain times, but I hope that you'll stick with me. And our intro episode of dentistry support their podcast. I shared my journey into the world of dentistry, which began when I was just 17 years old. So I'm going to take you back to those early days where the office I stepped into seemed like it was frozen in time. Resisting the embrace of modern technology and modern dentistry.
So for a moment, I want you to picture this quaint dental practice, where computers were yet to make their mark. Instead, everything operated on the simple charm of Tweed and wood chairs in a waiting room. Orange countertops. Paper pencils. Good old fashioned paper charts. Even. The x-rays were dark room developed still. Now if you've never set foot in a dental office, pre 2010. This might seem like ancient history.
So let me just share a tiny bit more. I was brought into assist with filing dental insurance claims. Thanks to my coworker, Laura. She worked with me at a restaurant while I was in college and trade school. I remember this office was ancient. It was a brown brick building. The doors creaked when you opened them and they were all made of plywood. Well, I don't know. Maybe it was just wood from the seventies that looked like plywood.
I have no idea. Very old, very archaic.
I know walking in, I was really eager to lend my hand and I was pretty excited about this brand new big girl job that I had. It's funny how certain moments from seemingly insignificant times in our life stick with us so vividly. Like, I feel like I remember the smell of the carpet there. Anyways, as I entered the dental billing room, it was in the far back corner of this small dental office. The site when you opened the door, it was wonder, remember, There were dental charts and piles upon piles, not just on desks, but the floor, the chairs, the countertops, the cabinets were literally open and you could see piles of charts in there. There were stacks of dental, insurance, claims, and paperwork that needed to be attended to. When I think back on what it all looked like. It's almost like it comes to my mind and a cartoon type vision of just stacks everywhere and not really knowing where to begin.
I'll tell you this. At the time that I learned dental billing, dental claims were not sent electronically. At least they weren't at this dental office.
The process at this dental office was so intense. We would grab a blank claim form, fill it out. Complete the form based on whatever the paper ledger from the patient's chart said. Fold it. Place it in an envelope. Go make a copy of the x-ray. If it was needed. In the dark room then. Put that inside of the envelope where the claim was that put a stamp on it and mail it out. Every single claim.
If you saw 20 patients a day, which this office probably saw three or four times that amount. And your backlog and behind because no one else was doing dental billing. I just imagine the workload. It was unbelievable at best. And you had to make copies of every x-ray. Because the insurance company refuses and then back to you and they just destroyed them.
The workload was insane when I think about my friend, Laura, she was buried. The paperwork was insane. The amount of steps that we took to complete each dental insurance claim. Was so monumental, especially when you multiply that by the number of claims that still needed to be done. She was desperately trying to stay afloat. I began to take on small tasks under her guidance, learning the ropes of preparing and sending these claims every day. We would wrap up our shifts at the restaurant and then dive into the mountains of paperwork together.
Just trying to make sure that our office manager would see we were working and we could collect this extra paycheck. It blows my mind thinking of how I knew absolutely nothing about dental billing and this company trusted me to do this process for them. The only thing I feel like I really learned was how to notate teeth numbers on the claim form. Input dental codes, descriptions, narratives, and the cost that I was supposed to write down as far as what they charged. I don't think that I really even grasped what was happening once I sent that claim in. Looking back.
It's a wonder how that office managed to even stay afloat. Like half of the patient charts were just sitting in the billing room. How did they know to go in there and look for them? Keeping track of payments who did that? I literally could not tell you how they kept track of what claims were outstanding.
What claims were denied, which ones were paid. Or even if there was an aging process. It kind of makes me nauseous to think about the disorganization in this business. Can I know there's a lot of those businesses that still exist today.
My friend, Laura and I continued to do the billing for this dental office for the next year or so. As my journey in dentistry continued into my second year. I discovered that this office had multiple locations and one day they approached me with a request that I go over to their second site, assisting with phone calls and scheduling appointments and basic administrative duties. Little did I know I was in for quite an adventure.
I walked into the second location and again, I met with a scene straight out of a time capsule. I mean, did these people ever remodel? I don't know. It was crazy, but. The scheduling book was an actual paper calendar filled with penciled in appointments that could easily be shuffled around when you erased an old appointment and then wrote over a canceled appointment. When I tell you I was not prepared for this first day at the satellite location, I was really not prepared. I made more mistakes in this one day. Then I think I ever did.
And a single day throughout my career in dentistry. First I volunteered myself to take x-rays. It's like the patient back. Completed the x-rays couldn't figure out why they look so weird. All to find out that patient had dentures. I stumbled over terminology like AML GAM.
Instead of amalgam. When I went to schedule a patient for a silver filling. And I walked in on the dentist, filing his teeth down to perfect little squares. And what did I do? I so confidently asked him if it was actually cool to have his teeth look like little chicklets.
What, why did I even say that what is wrong with me? I actually have PTSD when I share these three scenarios, because as embarrassing as they sound, they really were that embarrassing.
And to top it all off, when I tried to leave at the end of the day, the particularly rude office manager, insisted that I stay an extra two hours past closing. Because they had a massive backlog of claims at this location too. And just when I thought it couldn't get any more eventful, my car decided that it wasn't ready to go home when I was finally able to, and it wouldn't start.
So then I had to ask Mr. Chicklet dentist, if he would jumpstart my car. Ah, so why am I telling you all of this? Well, Uh, 17 year old me can start in dentistry knowing nothing completely bombing her first year and a half in dentistry and kind of flying by the seat of her pants and having several rather embarrassing moments and go on to master the art of dental business training.
Thousands of people in dentistry over 25 years. And start this very podcast that you're listening to. And I think if I can do it, you can do just about anything. So if you, things that I learned working in that office, well, There was no training. There were no expectations. There was no follow-up. They just wanted warm bodies, doing whatever they could to keep the office flowing. I worked there for 18 months. And then that time, I don't believe I was ever fully trained on one thing. I was flying by the seat of my pants and there was literally no one holding me accountable to do any single job there. I think back to when I told you about the x-rays that I took on the patient with dentures. I had never taken x-rays before.
I didn't know the first thing about compliance, what I should be doing, what I shouldn't be doing. I mean, there's a million things that went wrong. There, there was a million things. I was just doing wrong in the office. And the reason I even went and took those x-rays was because the patient was waiting for 45 minutes. And no one was coming up to get her.
No one was listening to me to take the patient back. And I just recalled seeing people do x-rays before. And so I was like, they're just going into a room and pressing a button. What's so hard about that. So I just did it. I was like, you know what? I'm just going to take this patient back and help them out.
So I did. This office was in shambles and they just hired bodies to be there. And future episodes here at dentistry support the podcast. I'm going to break down a few ways that you don't have to be anything that resembles my experience at this very first dental office that I worked at. And even if you're someone who doesn't really think you've ever worked at a place that was falling apart like that, You probably have, you just didn't know it. Or maybe you will in the future.
And I want to help you learn how to get past that. About three years ago, dentistry support was contacted by an eight group dental practice who hired us to work their old AR after a conversion gone wrong.
And yep. You guessed it over $11 million in uncollected dental insurance claims that had a. Really bad situation with their billing team.
When I was first introduced to this dental group, they shared with me how they created a remote billing team. They were just in their home office, but there was about 40 people who were part of this team. And their goal was that they were taking billing out of the actual dental offices and everything was going to be off site.
There would be no distractions. There would be more accuracy. They would collect at a higher percentage rates. They were trying to incorporate several different best practices to really create this amazing billing team. Well, in the midst of doing so, they were in the middle of a conversion from one dental software to another.
When that dental conversion happens. Somehow, I don't actually know the logistics of it, they were restricted from having access to the. Previous dental software. All they had was a report. That had every single claim, totaling, $11 million listed on it. And this was a printed document. And so they were unable to utilize the prior system. They had a new system that they were working out of, but none of those balances were listed in there. And they were trying to get their existing. Created billing team. To do this work. They were refusing. The leader was absolutely not okay with it.
She did everything she could to resist having to do this job because it was more time consuming for them to work off of a piece of paper, no system, and have to manually do all of this work. And this company was talking to dentistry support to see if there's any way we could help them. Being that this was such an archaic process.
Their team didn't have experience doing things like this. You know, it's in this moment that I'm listening to them, tell the story and I'm like, wow. Life sure does come full circle. We now work and in an environment in dentistry where. We do everything digitally. Nothing is done via paper anymore. And here I am 25 years after I started in dentistry.
And the only way I began in dentistry. Was on paper. Was working off of paper documents, filing paper, dental insurance claims. And here I have an office with $11 million. And outstanding dental insurance claims. And we're chatting about a possible assignment where I can help them. What happens next? It's kind of crazy actually.
They shared with me how they really loved the leader of their entire dental billing team. They didn't want to risk losing her by asking her to do the work of trying to collect this $11 million, because she was really great at leading the team to collect the money that they were currently producing. So, what they wanted to do was look at outsourcing for the $11 million to keep her happy. This is just all so crazy to me at this point, because they're even telling me how she refuses to send patient statements or guide her team to send patient statements and how they had even hired other frontline team members to do this work and added people to her department. But because she refused so passionately. To do this additional work. That even when they hired new people within the department, She changed their job duties almost immediately so that they didn't have to do it.
We talked for five months. We met. Multiple times a week, multiple times a month. During that five months, most of our meetings were about 90 minutes long rehashing out the same questions, the same concerns, telling me the same story about their current billing team, how their current billing team said.
If we collect the money. Great. If the money comes in cool. But we're not making any sort of effort to go look for this money. When we have all of this other work we're doing now.
This group was often telling me on these meetings, how competitors of mine choose to charge and comparison to how I charge. So the competitors of dentistry support charge, typically three and a half percent of collections. And we choose to charge a flat rate. That flat rate is based on several factors like patient flow. The quantity of claims, a few other things, and then we determine FTE.
So the full-time equivalent or full-time employee that we need. For the job at hand. When I found a dentistry support, my intention was to be a support system for the dental community, rather than capitalizing on the dental communities. Profitability. However, I was also cognizant. Uh, the sales tactics employed by those competitors of dentistry support. They often use phrases.
Like we only charge three and a half percent of collections, so you can trust our dedication and work ethic as we don't get paid, unless you get paid. And while this approach sounds super reassuring. I believe that it ultimately places the success of my business. Or my competitors business at the mercy. Of the dental office and how their profit margins are calculated. My goal has always been to set fair prices. On a calculation that accurately identifies and processes through what the needs of my team will actually be. And I knew changing how I charge meant that I needed to be strong.
In my case that we were a better company, a more affordable option. We were more thorough. We were building a price in an ethical way, and I needed to be able to demonstrate that. Ultimately, yes, they hired us.
They wanted a different contract than we normally offer, and I can see did, and did that. They brought on my team and in just shy of six months, we collected $4 million. We really did. And what happened next was wild. Rapidly their CFO was fired. The next in line to her was also fired. And then it seemed to be a domino effect until a new team entirely was brought on board for their C-suite. They barely connected with us during their fifth and six months with us. And then we got noticed that they were ending our project.
I had hired and promise jobs to 38 people. 38 people I'd have to tell. I'm sorry. We're going to have to let you go. And that broke me. They ended this project and stated the new leadership did not see the benefit to our work being done. They figured that they had already had a billing team and they would be just fine having them do the work. My team, they did excellent. We ended up charging them just under $100,000 to collect nearly $4 million. It was one of our greatest accomplishments with group practices that we worked with. We charged them roughly two and a half percent. If you were to calculate it on a percentage for the work that we did, which is a far cry from three and a half percent that our competitor would have charged. I don't know that I'll ever let go of the feeling I had when they ended our support so rapidly with no reason why no complaint. And feeling like my team knocked it out of the park with their performance.
I mean, it was unbelievable. We killed it. And they fired us. A word of wisdom. Choose your billing team wisely. This demo group did not build their team to support them. There should have never been an employee on a team that is unwilling to do any aspect of billing. That's the first point.
The second, your billing team should be willing to be forthcoming on their progress. The work that they are doing and how successful the business is because of their team and their work. They should be fueled by the completion of a task and collecting aged balances. They should find satisfaction in accomplishing more than was asked of them. Build your team to be that. Build them to orient their tasks, to meet the dreams of your business.
What are your dreams? Start by listing all of the dream scenarios for your business. What would your business look like in a perfect scenario? Would you have no claims aging over 30 days? What a member of your team show you a report daily, not on what you produced, but rather what you collected.
So your benchmarks were on actual money. Not simply build services. Would your leader show you progress on claims every 14 days instead of waiting until they get to a specific date of aging and then race to do the work. What would your billing look like? Would your ledgers be clean with minimal adjustments? Would patient balances be under control. Make a list, dream it all.
Then build your best practices around it. What will it take for you to get there? What does your team need to look like to make this kind of traction?
Here's my take. On how you can lead your practice and create best practices. I'm going to encourage you to implement these right now this very minute, this very week, this very month. Number one, know your numbers. It's just like your personal finances.
If it scares you to look at the numbers. You aren't looking at them enough and if they scare you, you can build a plan to make them better. Two. Know, you're non-negotiables on how billing must be managed. At dentistry support our goal for our dental offices is that they learn to have little to no claims aging over 30 days. That seems impossible for many offices, but it starts with consistency and not only how claims are sent, but that they are always sent daily. And they are researched every 14 days to train the office, to operate from expectancy that if we render services this month, we also get paid this month for those services. There are rules that insurance commissioners set in place for insurance companies to pay in a timely manner.
And oftentimes when you send dental insurance claims through certain portals, they will fully adjudicate a claim within 24 hours. If your dental office accepts EFT or electronic funds transfers, you can actually get your payment direct deposited into your account within 24 hours. With these tools at your fingertips, you can literally control your cashflow and reimbursements. Number three. Plan to review the status of your aging on a weekly basis.
Pull your reports. See where the numbers are declining. Staying the same or improving. Number four design the responsibilities of the team members at your dental office. Who will be filing claims who will be researching? Appealing posting payments and sending final balance dues to patient when it's appropriate.
Number five. Define goals for collection percentages. And when those goals are to be met, Number six. Teach your team to understand how things work. Dental insurance billing can be complex. If a claim is denied. Does that mean? The claim should be immediately closed out. At dentistry support, we seek to appeal claims up to three times for our clients.
We don't just accept the word. No, that's not the final answer.
In future episodes here at dentistry support the podcast. We're going to talk about adjustment types, knowing how to handle narratives.
When the rendering provider didn't do a clinical note in time. And a few other really important hot topics. But for today, I want to encourage you that it is perfectly okay to build your dream team. Take actionable steps today to transform the billing from a headache into to a well-oiled machine. Empower your business or businesses. To prioritize ethical business practices and choose your leaders wisely. You are perfectly within your rights to begin interviewing people about what your dream billing department looks like.
Maybe you've had the same person. In this department for a really long time, and maybe that person has never come to you and said, Hey, this is what your dental billing looks like right now. And Hey, if after this podcast, they come to you and they say, Hey, this is what your dental billing looks like right now.
Be open to hear it. Don't be angry at them for bringing it to you. They never even knew to do it. They didn't even know that something you wanted to know. But if you don't have someone on your team willing to have tough conversations with you about billing the money you are actually bringing into your practice. That makes you a legitimate business that can pay their expenses and stay afloat. A change has to happen. And it's okay to start today. You don't have to feel like a failure because it didn't happen before. But you can start today. And know that it's perfect timing for you to start right now, making better choices. If the choice for your practice is to start talking with new hires or potential new hires on what your dream billing department looks like. Set those expectations early on.
In the intro episode of dentistry support the podcast. I talked about how we're creating generational leadership. And so if you choose to bring someone else new in, or if you are choosing to work and develop an existing team member, I want you to make sure you are clear. The clearer you are. The easier it will be to redirect, to redefine, to meet, to hold accountable, the various aspects of what needs to be done within your business. Do not even consider. Moving forward in this journey of your dental, biller and your dental billing department. Unless you are confident that the person or persons you have in this role fully understand the expectations. And if you don't know exactly where you need to be. Listen to the episode again. There are so many great carrots in here of things that you can take back with you to define what your billing process should look like. Write it all down. Create the perfect department make it so that it works for you and your team and the goals and dreams of your business and the generational leadership that you are promising to participate in. This is your business. If you're listening right now and you don't own this business. It's still your business. We talk about running it, like you own it.
This is your time to shine. Our that's good moment for this episode. It's right here. I want you to recognize that it is perfectly okay to want to boost the financial health and wellness of the business that you lead. It is perfectly okay for you to want to level up your team. This doesn't make you a micromanager or mean bossy or even rude. You are absolutely within your rights as a leader to hold your team accountable. And if people have a problem with it, ask them why. Find out what is holding your team members back? Why are they putting up a resistance at all? Where has the communication been broken down? What insecurities do they have about their role? Do they think that you're asking them to do all of these different things out of the blue, because for some reason you think they're a bad performer. Is their job at risk. Find out where your team is, let them learn to trust you. Don't lead or leave any conversation, feeling that you were wrong because you happen to offend someone. Don't feel like you don't want to hurt someone's feelings because now you're asking them to do work that you hired them to do. This is your business.
This is the business that you have been trusted to lead and run and move forward for generations to come. You need people in your corner. You need people to help you with all of the tasks that you've dreamt up. And to partner with you on your journey of running and owning and leading a business. You hired all of these people or this specific person, because you felt they were strong enough.
And in alignment enough with you. You need them on your team because there's no way you can do all of this alone. You know that together you are better. Whatever the journey is that you have and your leadership. Let's start today, focusing on not feeling bad about holding people accountable or stepping into best practices or following up on training. Or asking for a report. These are all really normal things. These are things that you should be doing and seeking to get that complete alignment with your team. These are the things that will make sure every best practice you create. Lives on for future generations. Teach your team to run your business.
Like they own it. And they will. I'll catch you on the next episode.