Mar 05 2025 30 mins 1
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.
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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, I'm not doing this. It's so easy to get to that space of like, I'm over it, I'm not doing this anymore, but how do we keep them in that space of no, I'm actually here to convince them that it's a yes.
Kristy (14:01.408)
Yeah, I think part of it is just really taking the time to see it from their standpoint, right? And making sure, I mean, just in anything we want to know that
The Dental A Team (14:08.58)
Thank
Kristy (14:16.14)
we're doing the right thing, right? So as long as we're coming in it with that mindset that there is without a shadow of a doubt, again, even a doctor going from the diagnostic phase to having the treatment, right? How many times have we seen a doctor come back in and go, now, why did we treat a plant of crown on this too? Right? So if we have that doubt, because we don't have that narrative, why would the insurance company not have that same doubt, right? So just flipping
The Dental A Team (14:31.15)
Yeah.
The Dental A Team (14:45.218)
Yeah. Yeah.
Kristy (14:46.164)
that script to go, I know our doctors are doing good care and doing what's right for the patient, we just need that data to support what we're doing. So easily coming from that perspective, it usually flips the doctors, you know, to thinking. Yeah, thinking the other way. So.
The Dental A Team (15:03.502)
mindset. Yeah, that's beautiful. That's beautiful. And I think that helps too then to think, okay, well, what x-rays, you know, what x-rays do I need? And what intra-orals? If I couldn't see this patient's mouth today, what pictures would I potentially need in order to confirm or deny that yes, I do in fact need to do this treatment? So if I, I might think if I'm a, if I'm a doctor clinician, I might think, okay, if I go back two weeks ago,
look through the diagnosis that I did, could I say yes or no, like support these diagnoses based on the data that I have at hand. And that I think kind of helps flip that script too. And realistically, think regardless, it's probably just good common practice to have a lot of that stuff on hand anyway, because it's not just the dental insurance. There's other board cases and things like that that
You really do. Having the stuff behind you is just a safety protocol. And while it might take a couple extra seconds, like chair time and while the patient's in there, I think it saves potentially a really long, rigorous amount of time later on both aspects. Fighting for a claim to get paid and then prepping for something unthinkable. You guys, we always have to think of worst-case scenario. How do I get prepped for that? Because if we're not prepped for it it happens, well, shoot.
I've seen it happen, right? And I'm like, girl, I don't know, my hands are tied. But I think that kind of mindset you're describing really would go hand in hand and just be a safety protocol for a practice. So making sure we've got all of those. And I know, gosh, a long time ago, because I was in practice taking x-rays at this time, which was feels like a whole lifetime ago at this point, but they really started requiring even in our PAs and intraorals for anterior fillings, which at that point,
I was like, throw the claims in the air, I'm over this. That's ridiculous. But when we started taking, we started implementing them in the practice, taking those PAs once a year, we found decay that we didn't find before. We were like, well, shoot, this is why things like that happen. So x-rays like apex and crown of the tooth for sure, but also making sure like even if it's just fillings, you've got the data to back it up. Intraorals, I think always.
Kristy (16:59.918)
You
The Dental A Team (17:24.102)
I just love interaurals for everything, and I think a lot of people take the extra aural photos now too, which are insanely helpful, especially for the like, bruxism and the wear, things like that. But then you mentioned also the clinical notes, making sure those clinical notes are really dialed in and they say what you need it to say in a clinical way. Your clinical notes don't have to be readable by layman's term, right? They need to be, they need to work for doctor's terms. They need to work for your terms. So making sure those pieces are there.
Before we just stick to those three, before we got started today, you actually even mentioned like AI. And I think AI is just like this crazy thing that's just, I mean, the amount of like emails that my boyfriend has written with his AI tool that have gotten him way past like the point of, you know, like he thought this was never going to be resolved. And then he's got email held, like it's been insane. So I'm so excited. And I know the world is excited for all this AI stuff to come in.
Kristy (18:04.718)
Thank
The Dental A Team (18:24.369)
But I'm excited to see how it really truly benefits the patient. And so Kristy, just ideas out there, like how do you think these AI pieces, Pearl and all of these companies and even just writing narratives, but how do you feel like that's gonna play a role in optimizing the claims and really helping practices get that, get them cleaned up faster?
Kristy (18:44.076)
Yeah, I'm going to take one step back and then go forward on AI, but because you did such a good job on the intraoral pictures too, I want to also make a comment here about that too. It's not just in the doctor's realm, but also in the hygiene realm too. Like when hygiene is doing perio measurements, right? And they're diagnosing for perio, snap an intraoral picture of that bleeding. That picture will go
The Dental A Team (19:01.232)
Mm-hmm. That's it.
The Dental A Team (19:12.589)
Yeah.
Kristy (19:14.01)
long way when you're doing your perio services. But with that being said, that also ties to the AI because what I'm seeing with AI is the offices that have it, they are not getting the rejected claims because the AI is so consistent in measuring the amount of tooth structure, right? The amount of decay, the bone levels. And so it just, it doesn't lie.
The Dental A Team (19:28.637)
Yeah.
Kristy (19:42.702)
It is consistent and there's no bias within the AI. So truly, I have yet to find a claim that has been sent to insurance that has x-rays, intraoral pictures, and or AI technology attached to validate the treatment they've done. I have not heard of anybody have a claim denied. Yeah.
The Dental A Team (19:59.238)
Yeah.
The Dental A Team (20:05.57)
That's amazing. I think one thing that I heard too, I don't know if it's implemented yet, but I can't imagine that it won't be, is the insurance companies actually having their own on their side that you send in your x-rays, you send in those those pieces and they shoot it through their own AI spaces. And so then it's like confirming your AI and your diagnosis or your no AI if you didn't send it, but it kind of feels like even
not having that tool within your practice is like, that's again that like safety protocol, like what are all the safety measurements I can put into place to make sure that I'm covered? It almost feels like one of those systems or tools might be just a good safety net for that. Have you seen, I mean, I know we don't work with the insurance companies, but have you heard of that yet or in your speakings? No? Yeah.
Kristy (20:53.546)
Yeah, sorry, I have heard that. In fact, one of the things that we've talked about from an insurance perspective is insurance companies know more about doctors than doctors know about them. I bet if you asked an insurance company how many crowns a doctor did, they could answer that question so much faster than even the doctor. And so, yeah, we would be fooling ourselves to think insurance companies are not using AI on us as well.
The Dental A Team (21:11.081)
That's fair.
The Dental A Team (21:22.131)
Totally, totally fair point. Because even just pulling like how many claims it takes us, we're like, I don't know, where do I find that information? And we're like, hobbling back and forth trying to find it. That's a really good point. They just click a button and they know it. I love that. So from a clinician standpoint, from our doctor's standpoint, I think they have a ton of control over the tools they're using to diagnose and then passing those tools. I think that's how I would.
want a doctor to think about it, right? Like, what tools did I utilize to diagnose this because someone else has to diagnose it without the patient in front of them and confirm my diagnosis, which is annoying. I agree with you guys. I'm 100 % behind you on that, but it's the way it is. safety protocols put into place, safety nets are clinical x-rays, clinically readable x-rays, intra-orals, notes. And something we didn't really hit on...
But I think you mentioned earlier, Kristy, that I think is really important with the notes is the note templates. So making sure, right, that the doc can have, even your support team should be able to fill in a lot of the clinical note for you because they're there to dictate what you're saying. And so they can dictate that and then utilize that template. And the doctor then goes back later to confirm, just like the other guys are confirming for you, that those notes are correct. Now, Kristy,
Do you do it the same way? I'm assuming, right, because we all have been in this world together for a long time in the dental world, but do you do the same thing and train your dentist to train their team members to do that as well? Fill in the templates, the support team supporting them, filling in those templates.
Kristy (22:59.618)
Yeah, I know there are a lot of doctors that like to do their notes because they want to make sure the details are there. But having those templates and the doctors can create those templates, right, for each procedure. We still want them to be custom notes, right? But the basis for what we do, like usually there's only a few types of anesthetic we use or how many different composite materials do we use? You know what I mean? We can have those basics in there and then the doctor can
The Dental A Team (23:26.748)
Okay.
Kristy (23:29.592)
go back and verify anything that the assistant has updated and if there's anything to add they can do it and sign off on those notes but absolutely having those templates can can help time wise and I will also say you know with the notes and billing insurances back in the day we used all these cam narratives and guys if you're doing that we need to get out of that habit truly it has to be a custom note and you're
seeing it more and more where they want it cropped, you know, they want it taken from the actual narrative in the clinical note. So it's very important that we do have those details in there.
The Dental A Team (24:00.651)
Yeah.
The Dental A Team (24:11.78)
I love that and I totally agree and I think that also then if our team is supporting us in that and getting them done, I have a lot of doctors that are like, I'm so far behind on notes, I've got two weeks worth and I'm like, oh my gosh, to me, I'm like, that's two weeks worth of claims that probably have not seen the light of day except for your profis that have gone out.
That also helps clean that up where if our support team is doing them, our doctors are going back through adding their snippets that they need to, but confirming it, signing it off. now tomorrow my billing rep can get in first thing in the morning and send all of today's claims off. So I think it helps. We're talking about optimizing, like we want to optimize in every level. want all those safety nets together of how did I diagnose this? How do I confirm it? But then also we want it all prepped and ready to go. So our team can take it and just get it out there. The longer it sits there.
the worse it gets. There's timely filing for sure, which is a year, but you guys have to think, I have a year, that's awesome. But if I wait three months because I didn't get my notes done and then my girls have to fight to get it paid, like it's just not worth it and you're overhead. So great points, Kristy. So optimizing claims, if we're to it up, you guys, literally, I think Kristy, the best thing we can like summarize all this is how did I diagnose it?
And what are those safety nets? And how am I going to allow someone who's not sitting here to diagnose it and confirm it? So x-rays clinically, readable x-rays, intraoral photos. I love that you said the perio as well. I know the calculus, the nasty like, you know, behind the teeth pictures, those are always fantastic as well. And then notes, I think the templates is a brilliant idea. And adding that AI piece in there, I think is like the biggest safety net of all because it's all there.
One thing I do want to mention, and I know this because I've got a lot of doctors who are like, oh, I didn't even look for the x-ray until after the fact. And it happens. It's whatever, right? We've got, you diagnose it, you do it, whatever. If you get in the habit of, your x-ray is not up on the screen, you don't touch a tooth, you'll never run into that again. We used to run into it in my practice constantly. And my billing rep was like, I don't know what to do because we're not going to get these claims paid. And so we made a rule if the x-ray was not up.
The Dental A Team (26:28.428)
you didn't touch the tooth. one space there, but make sure your x-rays are readable. They're up. You're looking at them. Your notes are super, super duper clear. Your intro aural follow it. And you guys, think AI is probably worth looking into if you're not using it already. If you have it you're not using it, go freaking get trained and use it. Kristy, any last tidbits or thoughts on any of that that you want to wrap up for them?
Kristy (26:48.782)
Absolutely.
Kristy (26:55.104)
Yeah, I all of that I agree with you 100 % and I also think just so you know, we mentioned it used to be a year filing for claims. There's some of them that are getting down to 90 days, we may even see some less. So guys forming these habits today are going to reap rewards. And I will also say, many times, it's the office right waiting for that insurance money. You also touched on fee for service. That's very important.
The Dental A Team (27:07.138)
Yeah.
The Dental A Team (27:16.845)
Yeah.
The Dental A Team (27:23.65)
Yeah.
Kristy (27:25.008)
If we're asking patients to pay fee for service, we want them to get their money right away as well, right? That helps them stuck to your office. So all of it comes full circle to help each other.
The Dental A Team (27:31.896)
Thank you.
The Dental A Team (27:37.71)
Those were amazing points. Thank you, Kristi. I knew there was, I could tell there was something in there. You're like, nope, I got a little extra. I love it. I love podcasting with you. Thank you so much for being here with us today. You really do have this brain that just like you hear something and then it expands and you're like, okay, but and, and I love the way the way you present it. So thank you so much for being here with us today. Doctors, I hope if you are driving, you're going to re-listen to this. If you weren't driving, you were feverishly taking notes. Team, if your doctor hasn't heard this one yet,
send it over to him or her. It's a big one for them to be able to really support you guys and vice versa. This is all encompassing you guys. If we want to optimize the claims process, we want to optimize getting these things done, we all have to work together from start to finish. So ensure these things are put into place, fill the habits, do the things now that might take a little extra time upfront so that you're saving time and energy and work later. We want you to be insanely profitable. We want you to love your life. These are really easy ways that you can start doing that.
right away. So Kristi, thank you so much everyone. Thank you for being here. Drop us a five star review. We love to hear from you guys, especially when it comes to topics like this. How helpful was the information we want to hear from you? If you need help, if you want notes, templates, if you want ideas, if you're a current client, reach out to your consultant. We are all here to love on you. If you're not yet a client or you're just a listener for now, [email protected] and you can hop over to our website.
and we've got our practice assessments up there. thanks again, Kristy, everyone. We'll catch you next time.
