Hello, and welcome to season two of Dentistry Support the Podcast with your host, the kindhearted and infectious Sarah Beth Herman. We're back for a new season and ready to pack a punch. In every episode, we'll be sharing you quick, impactful insights into the challenges our dental community and leaders in all industries face.

Expect a little bit of flair, a few laughs, and you might even recognize a friend or two. Because of you, we are the number one podcast in dentistry and number one in management and business, and we couldn't be more excited.  Practical wisdom and leadership with a servant's heart, all delivered in just enough time for your commute or morning team huddle.

We're glad you're here. So let's get into it. Please welcome your host, Sarah Beth.  Hey everyone. 

Welcome back to the show. I am Sarah Beth Herman. If you are in the dental industry, I have a few questions for you. Have you ever had a claim denied because of incorrect insurance information?  Or maybe a patient was blindsided by a bill they didn't expect because you thought treatment was covered, but it turns out it wasn't. 

Have you ever billed out x rays just to realize they were denied due to frequency limitations?  And this is one of my favorite examples.  Have you ever had a front office person tell you the claim is 12 months old and we need to close it out? Because insurance states you can't bill it after 12 months.

Okay, this last one, we won't be addressing that in this episode, but check next episode and you're going to hear more on that.  Just stick with me for a moment. If you've experienced any of those other situations, you're going to want to keep listening to this episode. And you probably know how frustrating and costly insurance mistakes can be.

I often see them happening in dental offices just like yours. As a result of the task of insurance eligibility going all wrong or getting outsourced without the proper safeguards in place.  In the world of dentistry today, accurate insurance verification is the backbone of your revenue cycle and patient experience.

Basically, every dental office is one bad verification away from a bad review. When your office makes the choice to outsource dental insurance verifications, it can go one of two ways. Really great. Or, it might cost you more than just money. It could cost you your patient's trust, your business, and even your reputation.

Now let me be clear, this isn't an episode telling you that you need to use my company Dentistry Support to handle your eligibility verifications. But what I want to do is give you the tools to make the right decisions, no matter who you choose. Even if that means you keep everything in house.  Execution is everything, and accountability really does matter. 

So let me prepare you for either how to build the best practices that last in your office, to do your own verifications, or learn what to ask and what to expect when you choose to outsource eligibility. Insurance eligibility verifications isn't just a checkbox on your to do list. It's not just a task that you come in, take care of, and tell the manager it's all done. 

In my opinion, it's the foundation of successful dental billing and patient experience. And it's also the future of your dental practice. As dramatic as that sounds, it literally impacts everything.  If you are new in dental, I'll briefly tell you this. For Insurance verification is detailed. It's tedious in some ways, and no matter what technology comes your way, it will be dependent on human touch. 

I have a whole episode on AI and dentistry, and there are many great uses for it, but I'll tell you that I've tried almost every software out there, and I've been pitched so many times and sold on so many softwares. And when I put them to the test, they just don't deliver. I won't cover all of those details in this episode, but I encourage you to go back and check out that show when you finish this one.

Insurance verification is all about confirming a patient's insurance coverage before any dental visit and making sure that both your practice and the patient are fully informed about what is covered, what is not, and what costs they might be responsible for. Let me clarify this though. Insurance verification is not, can my patient get this treatment done?

Nor is it a diagnosis tool. It is simply letting you know their coverage of insurance based on their specific dental insurance plan.  One thing I find fascinating about the dental industry is that it's like no other industry I've ever worked with or heard of before. For the simple fact that there is always at least one team member who is advocating for the patient from the standpoint that dental is too expensive.

Or that their insurance only covers blank, and they don't need to do blank. They're almost trying to defend the patient if they don't have great coverage. I've seen it go as far as side conversations, undermining the dentist or office manager in treatment, because of the cost.  I wish buying cars was like this, or buying groceries was like this.

You either agree with me or you're irritated I brought this up.  Either way, you can't disagree. Dental has it hard because there have been shady dentists who've ruined it for the honest ones. And the cards are stacked against the industry in a lot of ways.  I'll cover more on this topic in a few episodes from now. 

Let's get back to the topic of this episode.  Why is eligibility verification important? besides the patient portion part.  Mistakes in eligibility verifications are one of the top reasons for claim denials in dental practices. When your team misses something, It can lead to not just delayed payments, but also extra work and a lot of frustration.

And that might sound scripted, but I'm telling you it's true.  Here at Dentistry Support, we make every effort with some incredible safeguards, and sometimes mistakes are inevitable. We do our best, but one error and the patient feels the hit.  Patients hate surprises, especially on their dental bills. The average patient comes in concerned about the bill before they even know the diagnosis of treatment.

Money isn't the only barrier to treatment in a dental office, but money is a big one.  Verifying coverage up front builds trust, and it makes sure that they know what to expect, which is so important to the future of the relationship with your patient and their referrals.  When eligibility verifications are done right, your practice runs smoother.

Just imagine your perfect day for a second. What would that look like?  Would it involve not a single word about dental insurance for the entire day?  Would your patients feel comfortable starting treatment right now? Would they schedule that follow up appointment?  All of that is dependent on clear communication from the beginning. 

You are effectively reducing all of the burdens on your team. Streamlining operations. And now you can actually focus on providing excellent patient care.  I want to share a story with you that might hit close to home.  We work with a dental practice out of Louisiana who previously had outsourced their insurance eligibility verification to a third party provider. 

Everything seemed fine on the surface, Costs were down. The team was less overwhelmed. Eligibility was being verified daily. About eight weeks in with this previous verification company, the office manager had a meeting with their billing department because their patient balances had increased overall by 35 percent and their insurance denials were up 15 percent. 

The pressure was intense in the office because this was a high performing practice. Their average monthly production was 650, 000 to 750, 000. So if we're talking numbers, and not percentages, At our initial meeting before they joined Dentistry Support, they shared that that 35 percent increase was the sum of just over 91, 000, and a total of over 300, 000.

That 15 percent number was the sum of 38, 000. I asked the office if they had done, if they had recently completed an audit on what was happening with their claims, and they shared that nearly 60 percent of their claim denials were due to  incorrect or incomplete insurance verification.  Patients were getting billed for procedures they thought were covered, and the office was trusting the verifications were completed.

The majority of the claim denials and non covered services were not collectible by insurance, and the office was now going to have to collect from the patient. Ultimately, the practice was losing out on hundreds of thousands of dollars in revenue.  When the practice reached out to us, we dug deep to understand what was going wrong and how we could prevent this same issue with their patient dynamics.

It turned out that the outsource team wasn't catching frequency limitations, and they weren't providing proof of eligibility to the office.  Here at Dentistry Support, we don't just do a basic check of eligibility, we go above and beyond.  Verifying every detail and making sure that both the practice and the patient are well informed. 

Whenever I'm asked about how we do eligibility verifications, I always laugh just a little bit  because I say that we're eligibility verification on steroids.  I get people that ask me all the time, well then what goes wrong? Why would anyone ever leave your support?  If an office chooses to leave dentistry support, it's not because of our support, because that is next level.

It is typically the insecurities of the dental office staff. We don't just check a box. We verify a full breakdown of benefits with every patient, every time. And we customize that breakdown of benefits per office. And we don't charge any extra for that either.  We also verify on whatever schedule works for each individual office.

We have same day verifications done in under 60 minutes, for no additional fee. But back to this practice. We immediately onboarded them and leveled this practice up where they needed to be, no, no, no, where they should have been all along. This is your reminder. Your reminder that accuracy isn't just about numbers. 

It's about your reputation and the relationships you build with your patients.  And communication, it is everything.  Outsourcing eligibilities can be a great way to manage your workload. Your finances, your budgets, your P& L.  But it does come with its own set of challenges. Especially when it comes to something as important as insurance eligibility verification. 

Because I believe it starts right there.  One of the biggest risks with outsourcing is the accuracy of information.  Insurance plans are complex, and they are constantly changing.  If your outsource team isn't deeply integrated with your practice, they're going to miss critical updates or fail to obtain complete information.

These mistakes aren't just inconvenient, they will lead to denied claims. upset patients, and a lot of extra work.  And when I say integrated, I don't mean that they need some sort of special software. I mean they need to know how to use your software.  And that happens through a hands on view during your onboarding process.

Make sure you show, don't tell. It's easy to say what you want, but it's more time consuming to show what you want. Take the long route and document it. We screen record and build our internal Bible for our offices on exactly what they want us to do so that we aren't having to retrain or ask questions later on how they want something done. 

Another challenge that I see is the potential for communication gaps.  When your eligibility verification is outsourced, there's often a disconnect between your in house staff and your third party team.  This can cause delays in getting verifications completed and misinterpretations of coverage details, or incomplete data entry into your practice management system.

And let's be honest, Communication breakdowns can turn a well oiled machine into a chaotic mess. I've seen it head our way with a bad experience from other third party verifiers and offices in desperation for help. HIPAA compliance is non negotiable in dental practices, but when you outsource, there is a risk the third party provider might not adhere to these regulations as strictly as necessary. 

This can expose your dental practice to legal risks and penalties. Not to mention the damage it could do to your reputation.  I have a story I'll get into in just a moment that you don't want to miss. Keep listening, it's an interesting one.  As your practice grows, so do the demands of eligibility verification.

Unfortunately, not all third party providers can keep up. This can lead to bottlenecks. Increased turnaround times and errors during peak periods. And the last thing you want is for your growth to be hindered by lack of scalability. Okay, here's the story.  An example that might hit close to home again. We work with a dental practice that outsourced their eligibility verification and didn't realize they were walking into a compliance nightmare. 

The previous third party provider they used wasn't fully HIPAA compliant. And and sensitive patient information was being mishandled. What do I mean by that?  They were emailing breakdowns, patient protected information, and details about the patient's appointments in a non encrypted email format.  They were also discussing patient matters over the phone for eligibility needs. 

Their team was not monitored or recorded while working off site.  And to make matters worse, there were constant communication breakdowns. Information wasn't getting relayed to the practice in time, which led to billing errors and patients who were rescheduling appointments because they didn't know what was covered. 

When we stepped in, we not only made sure they were in full compliance, but we also made sure that we streamlined communication processes to make sure that nothing fell through the cracks. We immediately implemented our HIPAA compliant chat system. Eliminating emails, which are never secure. Hacks happen all the time. 

We gave them immediate access to our 24 hour help desk for any same day needs. And we made sure their team was protected and knew how to work with us immediately to give them instant access to our team.  I have always believed third party support should be an extension of your office and not feel like we're working somewhere else. 

My goal is to always bridge the gap of communication with your dental practice and our team.  You should expect this from any third party company. If they don't have it, make them get it or choose another company. Expect the best for your team and for your patients.  So how are we different?  At Dentistry Support, we get it.

We know that managing insurance eligibility verification isn't just about checking boxes.  It's about protecting your revenue, your reputation, and your relationships with your patients.  We are passionate about dentistry and the industry, and advocating for your practice growing, the industry becoming better, and getting to the bottom of insurance with you. 

We don't cut corners. Our verification process is thorough and detailed, covering everything from planned maximums to waiting periods.  We make sure that every detail is accounted for so that you don't have to worry about claim denials or unexpected patient balances. If you have insurance verifications  in house and it's not like this, revamp it now.

Make it better. Decide how you want your eligibility to be done and put it into action. The more time you waste researching how it should be done right, is more money you're leaving on the table and more patient experiences that are going all wrong.  Insurance details can change on a dime and we stay on top of these changes.

Our real time updates and detailed daily recap reporting make sure that your practice always has the most current and accurate information. You should never have to ask, what have you done for me lately? Or what have you guys been working on? Or when will this get done?  Working with our team reduces the chances of communication breakdowns  and lets you know when a patient needs to be informed ahead of time. 

Whether you're a small dental practice or a group practice, we have the flexibility to scale our services to meet your needs. As your practice grows, we grow with you, ensuring that your verification process remains smooth and efficient. If you have this in house, set your team up to be scalable. Know what your goals are, know what your next plan is. 

Our team at Dentistry Support consists of experienced professionals who specialize in dental insurance verifications. We stay up to date with industry trends and regulations, ensuring that your practice remains compliant and that your verifications are conducted according to the highest standards. And now for our TGM, our that's good moment of the episode. 

If there's one key takeaway from today's conversation, it's this, accuracy and accountability and insurance eligibility verification are non negotiable. Whether you're managing a dental practice or running any other type of business, you The details matter. It's not enough to have the right processes in place.

You need to execute them flawlessly and be prepared for the challenges that come with outsourcing. Peter Drucker, a legendary management consultant, once said, What gets measured, gets managed. This couldn't be more true when it comes to your eligibility process. You need to keep a close eye on it, measure its effectiveness, and make sure it's being managed with the utmost care. 

Also, know that it's okay to revamp things. Nothing stays the same. When you notice changes happening, when you notice a break in the system, you'll need to modify approaches as your business changes. At Dentistry Support, we are passionate about making things better for dental practices. We care deeply about getting it right.

But we're also humble enough to recognize when we don't.  When mistakes happen, we learn from them, we grow, and we move forward stronger. We are dedicated to providing the best support possible, and we are always striving to improve. So when you're ready to make sure that every insurance verification is handled the right way and that every patient interaction is positive and informed, let's talk.

Even if you choose to keep all of this in house. I'm still happy to chat through what it needs to look like for you to have the best practices in place so that they can stand the test of time.  Let's make sure the next time you verify insurance, it's done with care and precision for your patients. 

Thanks so much for joining me today. And as always, I'll catch you on the next episode. 

Thank you so much for tuning in to this episode of Dentistry Support the Podcast. If you want to get in on the conversation or have something to share, join us on our Facebook group, The Dental Collaborative. Looking to connect or to be a guest?

Head over to dentistrysupport. com. Or if you'd like to learn more about your host, Sarah Beth, or maybe you're thinking of starting your own podcast or looking for mentorship opportunities, well, just visit sarahbethherman. com. If you've got just a sec, remember to rate, subscribe, and leave a review for the podcast.

That helps us keep growing. Thanks for supporting the show, and we hope you'll join us again in the next episode of Dentistry Support the Podcast.