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Tiff and Kristy explain how viewing claims as stories can improve how practices can streamline that process. They touch on doctor-led language to use from start to finish, how artificial intelligence can improve the process, safety protocols to implement, and more. Episode resources: Sign up for Dental A-Team's Virtual Summit 2025! Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:01.881) Hello Dental A Team listeners. I am so excited to be here with you today. I have the one and only this Kristy back on the podcast today. She has done at least one other podcast with me so far. Kristy is a consultant here on our team. If you have not gotten the chance to meet her yet, please hop on over to our social or hangouts. We've got our Doctor Collab that we do every single month and our doctor and team kind of round table get together that she's at every single week. So if you're a current client, you know where to find her. I hope that you've had the chance to meet her. If you are a listener and not yet a client and you haven't met Kristy yet, Kristy, welcome. We are just so excited to have you here. And I know I probably don't say this enough, but I'm just so happy to have you on the team and Dental A Team is so happy and so proud. to welcome you into our team and our family. You've been here now for, it feels like forever, like you started with us seven, eight years ago, but you've been here now for, gosh, I'll go on your fourth month and I'm so excited. You've got so many amazing things under your belt and your wealth of knowledge is massive. So, Kristy, how are you today? Thank you for being here, but how are you doing? You're pumped? Kristy (00:57.848) Thank Kristy (01:15.502) Yes, Mary Pump. It's a subject that is near and dear and and help benefit doctors and teams. So I'm excited to be here. Thank you. The Dental A Team (01:25.134) Good, you're welcome, you're welcome. And I do kind of try to make sure that when I do pick the topics that we're going to talk about and who's going to talk about them with me, I do kind of choose based on your passion because I know all of us can do most of the things. Like all of us have been around a block of time or two, but I know we all each have our individual passions set aside of things that really, really drive us or areas where You've seen incredible massive results and Kristy, this one today, I actually think you've seen massive results on a client already that you've been working one-on-one with when it comes to this subject matter. So I think it's really cool. Thank you for being here with us. Doctors who are joining us today and team members alike, I'm really excited for this one. Our main goal at Dental A Team is to produce results for you. We want you to have a thriving. Wonderful practice and business that supports a lifestyle that you want to live. So our goal is always to increase profitability, increase joy and happiness, and make sure that your business is supporting that life and it's working for you, not you always looking for your business. So our subject matter today, I want you guys, doctors, and then team members who are listening to it that maybe your doctor sent it to you or hasn't listened to it yet. Make sure that you guys actually truly do listen to this one. The title. is going to be, it's going to say something, I don't know yet around optimizing claim results. And I don't want it to just get shuffled over to your team because docs were actually speaking to you guys today. Team members can pick up the bits and pieces as well, because I think you are going to be able to do that in tandem. But docs, these are areas actually where you can help hold some accountability lines and where you can help provide a ton of value and information back into optimizing your claims for the best results. The reason that we talk about this, reason it's so important is because, gosh, a lot of your money's actually tied up in claims processing. Even if you're a fee-for-service practice, if you're sending claims on behalf of the client, on behalf of the patients, by any means, you're getting a lot of money wrapped up and tied into the claims. And then you've got a whole human, a whole body, who's wrapped up in not only sending those claims and like doing their best to get as much money as they can in as possible, but they're also spending a lot of time on the phone with insurance companies. The Dental A Team (03:48.763) with the claims departments trying to get that money into the practice. So if we can streamline a lot of those places and spaces and just get that money returned as soon as that claim's received, I think it just helps to reduce a lot of the overload, reduce a lot of the work and overhead in a lot of spaces. So today is all about how you guys, doctors, and your back office support team can help optimize those claims. so that your billing department can just shoot them off easy peasy style. And then also kind of like some futuristic talk on some things that we see coming down the pipeline. So Kristy, I mentioned that you've already got a couple of practices really, actually, I've seen quite a few of your practices already, working on streamlining their claims processes. A lot of doctors who are learning how to do the claims themselves just so that they can help their team and support their team. And I think it's brilliant actually because those doctors now see it from a different angle. So it's kind of like, yeah, they do need that thing. Like that thing that I'm like, it's fine, dental assistant that we didn't get it, it's okay. Now their brains are like, no, actually we do need it in order to get paid. So I think it's brilliant that you have a lot of them doing that. But with that said, Kristy, what are some key spaces that you really had your current doctors now or doctors you've worked with in the past and doctors you will work with in the future? Where do you have them really focusing a lot of energy on? to ensure that those claims processes are optimized and can just be sent out really easily. Kristy (05:17.644) Yeah, honestly, Tiff, I believe it's in the tools, you know. A lot of it is our x-rays, intra-oral pictures, and even clinical notes, if you will. And we can dive deeper into each of those, but definitely utilizing the tools and making the most of each of them. Really, that claim has to tell a story, right? And it tells a story of what happened from start to finish with the patient. The Dental A Team (05:48.273) Yeah, I love that. And I love that you mentioned those pieces. And I think specifically, like, we'll dive into the x-rays because I think that one's pretty common. We've been doing that for a long time, but then I to take a lot more time on a couple of the other pieces that are in tandem there. But on the x-rays, I've been a dental assistant, right? And I've been like, it's OK. It's fine. Or like, dang it, doctor. Like, do I really have to retake that x-ray? Because like, I've taken 16 already on this patient. So what is it that they're looking for? Kristy (05:50.446) you The Dental A Team (06:17.318) on the x-ray that you can help key in. So when a doctor walks in and sees that x-ray, if it doesn't have these parameters or if it's, you know, cut over here, like what should they have set in place where even the dental assistant or hygienist knows, actually that's a retake, like I need to retake that. What are those spaces that most of the time, if a claim's lucky enough to get to the doctor auditor, what are they looking for specifically that you know of on those x-rays? Kristy (06:43.596) Yeah, obviously depending on what procedure we're doing, again, the x-ray has to tell a story, right? So if for some reason we're doing a crown and you cut off the clinical portion of the crown, that x-ray probably isn't gonna work. So a lot of people think, we need a PPA for a crown and they're getting the apex of the tooth when really we need to see that clinical portion of the crown. But again, it's a two dimensional The Dental A Team (07:10.782) Yeah. Kristy (07:13.52) right? So if that x-ray isn't showing the fracture or the break, we have to use our other tools or pull them into it. But specifically for the x-rays, thinking is this capturing what I'm seeing visually in the mouth as well, right? The Dental A Team (07:29.501) Yeah, yeah, that's brilliant. I love that you said that's got to have the crown if you're doing the crown, you got to the crown of the tooth, you got to have the top there. So because I know sometimes they do get cut, right, we'll get the apex really well. And then we're like, okay, but I've got two x-rays, if you smash them together, I've got both of the pieces. It's like maybe sometimes, or a bite wing. But also, I think, and I've done this a time like with your premolars, right, if you don't have it just right, then you're, you're not getting just the individual tooth right now, I've got overlap. So then it's kind of hard to, especially I know for me when I was a dental assistant, I would overlap a lot, right? In the beginning, especially, but I'd be like, come on. And the doctor's like, okay, but it's an open margin on the current crown. And I can't see that. I can visually in the mouth, but on the x-ray, I can't see the ledge because there's an overlap. So making sure too, I think for going backwards a little even, maybe even at diagnosis, that makes me think like, when you diagnose it, making sure you're putting the reason for the diagnosis in your notes so that when you go back to it, that patient now comes back in for that treatment. Even the dental assistant, if that's today you're taking the x-ray, right, can look at why are we doing this? I would love for the dental assistant and the support team to know why we're doing things, no matter what. So why are we doing this? Because even at that point, she or he can look at that x-ray and be like, okay, does that make sense in conjunction? Does this x-ray make sense and work in conjunction with the reason that I read for that? So making sure maybe even from a doctor's standpoint that we're always vocalizing it and then it's getting in those clinical notes at diagnosis. And then we're teaching and training our team to utilize those pieces just as much as they do. What's your thought on that? And then I think that kind of slides into then also intraoral photos. Always, if you can do an x-ray and an intraoral photo, I think the insurance companies are like, great, you just made my job easy. Now I've got everything and it's quick to pass it in as a paid claim. What are your thoughts on those pieces? Kristy (09:30.22) Yeah, I think there's two things there, Tip. You pretty much mentioned an app diagnosis, and that's a huge proponent of this because many times we're not doing that treatment same day. And from a time standpoint, right, we don't want doctor to have to come back in and re-diagnose it because we've put the picture up there and he can't even see why we're doing it, right? So again, that x-ray needs to show a story. And if it doesn't, then to piggyback on what you said, let's make The Dental A Team (09:52.093) Thank you. Kristy (10:00.154) sure we're using our intraoral pictures to take a picture if it's not showing the abfraction or you know the broken tooth or just the reason why we're doing it because again from a claim standpoint we're at we're sending that in and asking them to pay on something for treatment that we've done and if they can't see it because they don't have the pleasure of having a patient sit in front of them right so making sure we're utilizing that but The Dental A Team (10:24.004) Yeah. Yeah. Kristy (10:30.134) like I said from a time standpoint making sure that clinical note says why are we doing this and be specific you know not just that there's a crack in the tooth but maybe it's a distal buckle fracture running across the floor of the tooth or you know be very specific so they don't have to go back and re-diagnose at time of treatment as well. The Dental A Team (10:42.992) Yeah. Yeah. The Dental A Team (10:53.535) I agree. think you encompassed all of those pieces there. The x-ray that needs to show the pieces, the intra-oral photos, but then also the clinical notes, the pre-clinical notes for sure, right? The clinical notes at the exam date, but then also you kind of mentioned like, where is it? So even if it's on the, even if it is in the exam notes, it needs to come back again and follow through to the clinical notes on the day the treatment was done. Because now what I'm thinking, if I'm doing these pieces, right? I'm thinking, okay, what's the person like, behind me, the next person that has to have a touch point on this patient's case, what are they going to need in order to do their jobs the best? And my billing coordinator was always like, I just need more information. I need better descriptors or better adjectives even, making sure, like you said, we're really encompassing where that fracture is, maybe how big it is. I know there's a lot of buildups out there that are done because keywords, 75 % or more of the tooth structure has been lost. you've lost three out of four cusps, you've lost like how much of that tooth is missing, how much of the tooth was replaced. Those pieces actually do, I think, tend to make a difference and those pieces come from your clinical side. So your doctor's vocalizing those pieces and oftentimes docs, you are vocalizing those pieces, but it's not always getting translated into the notes. So making sure you're training your team on how important that is because now your billing coordinator can go in and just copy and paste that clinical note. they're not a clinician. They shouldn't be writing their own stories, right? They shouldn't be trying to depict their own story from piecing all these things together. They should be able to go to your clinical notes, copy what it says, and paste it for the doctor who's going to be looking at it on claim state. My opinion or my concern, right, would be if there's not enough easy data to read, to see, to just say an easy yes, I think it's an easy no. And so I think We have to assume, right, that insurance companies are, we know everyone's out, every business is there to make a profit. Insurance companies are not different than that. So for them to say yes, absolutely, to every single claim, like, that's just not, it's never going to happen in the world we live in today. So to assume that they want to say no, you've got to convince them to say yes. I think that kind of a mindset, Kristy, keeps you in the space The Dental A Team (13:20.065) on the clinical side of how do I convince someone who's not sitting here in my chair with my eyes seeing this patient right now, how do I convince them out of no to say, yes, this patient needed that? How do you, how do you feel about that kind of mindset? And have you seen that with doctors? Like how does a doctor, from your standpoint, you do fantastic at mindset and, leadership and training. How would you help a doctor kind of sit in that kind of a mindset? is it's very easy to be like, I hate insurance companies,…
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