Insurance Processing

We have been in a few office recently that were not using some of the tools we commonly recommend to assist in processing of insurance claims- to refresh your memory here they are again:

1. Insurance Solutions Newsletter – find it at:

2. “Coding with Confidence” by Dr. Charles Blair – also found on the above website. We recommend using the most updated version due to insurance codes changing.

3. Marianne Harper’s Book “Cross Walking – A guide through the crosswalk of Dental to Medical Coding” found on her website: The Art of Practice Management

4. The website for the National Association of Dental Plans and specifically the free subscription to FastLook which provides current attachment information by procedure code. Sign up under the FastLook tab at

5. For those we have seen since the ADA Meeting know we are recommending you look at “Practice Booster” which includes our first two recommendations. It is more important than ever to be sure you are using the right codes. Take a free test drive of Practice Booster and see what it can do for your administrative team.

6. Always use the latest version of the ADA CDT code book for claim submission

Insurance processing is becoming more complex. From a risk management standpoint you must do all you can to ensure you are using the right codes for the procedures you are doing – it is your license that is on the line. Be sure your team is properly equipped to do the job you think they are doing.

Great Quote from Delivering Happiness by Tony Hsieh of Zappos

If you have not ordered shoes from Zappos you are missing an experience – it is a great lesson in trusting the customer as well as providing top notch service. Here is the quote from the book Delivering Happiness by Tony Hsieh. It is in our resource store and a interesting book to read on how Zappos came about.

“There’s a lot of buzz these days about “social media” and “integration marketing”. As unsexy and low-tech as may sound, our belief is that the telephone is one of the best branding devices out there. You have the customer’s undivided attention for 5 to 10 minutes, and if you get the interaction right, what we’ve found is the customer remembers the experience for a very long time and tells his or her friends about it.”

When is the last time you talked about your patient intake calls as a group? Are your patients and potential patients excited and happy about their interactions with the practice over the phone?

Raising your Fees

Many Doctors have hesitated to raise their fees. Whether it was fear that lower priced competitors would take their potential patients or that they “could not raise fees in this economy”, fees have remained the same since 2009 for many practices. Other practices feel they should “maintain the status quo” because they will only take a bigger write off from an insurance plan.  Some doctors have gone so far as to  “negotiate” a lower fee with some patients, thinking that if they could get this patient and the case, it would fill the book. Somewhere in this belief is the idea that more patients will offset lower fees, and will lead to higher profitability.

We look at profitability numbers each month with our clients. Our busiest practices are not the most profitable, and the practices that do the most large fee cases are not as profitable either. Why is that? In a word, overhead. The more patients you see, the higher your overhead. The more large cases you do, the greater the likelihood of not pricing the case right for the amount of time it takes and more likelihood there is of providing one or more of those crowns in a multiple unit case, for only the lab fee.

Overhead has not stopped increasing because of the economy.  You and your team would like raises, the lab wants to be paid, supplies are costing more – you cannot not raise your fees.  We recommend raising fees on an annual basis.  Many teams struggle with raising fees because of the anticipated reaction from patients. We hope you are subscribed to Words Matter for some suggestions on how to handle this challenging topic.

Raising your fees is one of the best steps you can take to improve profitability.  The chart below shows the relationship between a specified percentage fee increase and the effect this increase will have on profitability.

% Fee Increase


































When is your next fee increase?


Dental Fees are on the Web for your Patients

There are websites designed to help consumers estimate what dental services will cost them. One for you and your team to check out is:
On their website they state: “Fair Health is a not-for-profit organization whose mission is to help consumers understand the out-of-network reimbursement system and estimate out-of-network medical and dental costs. Our free website has an easy-to-use cost estimator tool to help with your health care expense planning. We also offer clear and unbiased educational articles and videos about the medical and dental reimbursement system.”

Fair Health was formed in 2009 as a result of a fraud investigation by then NY State’s Attorney General Andrew Cuomo. The ADA granted access to the CDT codes in February of 2011. They will have medical information available in August of 2011.

We have always recommended that you submit your full fee to the insurance company on a dental claim form. It now becomes even more important to not submit contractually discounted fees.  Not only because this will skew the maximum allowable fees determined by carriers based on data submitted by practices but it will skew the costs posted on websites like Fair Health. This will cause consumers to question the fees you are charging when they have a “non-biased” resource about what your fees “should” be.

Have a team meeting and make sure everyone knows about this website and how your fees compare to what is posted on the Fair Health website. Talk about how to deal with patient’s concerns and what to say. As always if you need help, don’t hesitate to get in touch with us.

Part 2: What Questions to Ask when Networking. More low cost ways to market your practice

When networking you want others to feel good about themselves, and, to feel good about being in a conversation with us.  We want to ask questions that make others feel good about us as people, even though we have just met and they hardly know us.


Here are our top 10 questions that are not sales oriented in any way.  They are friendly and fun to answer and they will tell you something about the way a person thinks. In one conversation you will not use all these questions.  We recommend knowing them well enough to ask the ones you feel are appropriate for the conversation and the time frame available at your networking function.


Here are the 10 questions:


1.  How did you get your start in your business?

  • People like to share their story

2.  What do you enjoy the most about your profession?

  • The people you want to associate with will love to answer this question

3.  What separates you and your company from your competition?

  • Gives them permission to brag

4.  What advice would you give someone just starting in your business?

  • Mentor question

5.  What one thing would you do with your business if you knew you could not fail?

  • What are your dreams question

6.  What significant changes have you seen take place in your profession through the years?

  • Mature business owner question

7.  What do you see as coming trends in your business?

  • Be a speculator question

8.  Describe the funniest (or strangest) thing you’ve experienced in your business?

  • War Stories question

9.  What have you found to be the most effective ways to promote your business?

  • All small businesses market in some way

10.  What one sentence would you like people to use when describing how you do business?

  • Customer service question


These are questions people will enjoy answering.  You are not being nosy.  Again, don’t plan to ask all 10 questions in one meeting. This is not an interrogation, these questions are meant to establish initial rapport.  When someone answers a question use genuine curiosity, try saying “tell me more”.  Learn as much as you can about your fellow business owners in your community, there may be opportunities to cross promote your business or create a small business breakfast group.  The more people you know, the more people who know you, the larger your practice will become.


What is one networking event you could attend in your community?

Embezzlement: Dentistry’s dirty little secret

Here is an article from that suggests that over 60% of dentists will be victims of fraud.  Read about Dr. Gordon Christensen’s experience.  Make sure that you have embezzlement safeguards in place in your practice! Not sure? Contact us.

Embezzlement: Dentistry’s dirty little secret

By Donna Domino, Associate Editor

April 29, 2011 — Sometimes it’s a spouse, girlfriend, relative, accountant, or business partner.

Unfortunately, more often it’s a trusted, longtime employee who has an insider’s knowledge of your bookkeeping practices and access to your bank account.

Maybe their spouse has been out of work for months and, desperate for money, they begin embezzling from the practice and “cooking the books” to cover their tracks.

But experts say it is often just a matter of greed.

Dental practice embezzlement is not an anomaly; in fact, it’s shockingly pervasive. Some fraud investigators say that 60% of dentists will be victims of fraud during their careers, while others put the figure as high as 90%.

Even Gordon Christensen, DDS, MSD, PhD, and his wife Rella Christensen, RDH, PhD, have been victimized — not once, but twice — by employees who stole from their nonprofit research group, CRA, now called the Clinicians Report.

“It’s often the most trusted employee,” he told

The first theft involved a woman accountant who seemed extraordinarily dedicated to her job: She came in early and left late. She was also intent on being the only one in the office who made financial entries. She was eventually discovered after the office’s door activator recorded her coming into the office at 3 a.m.

“This is usually a person that you think is working hard and is the most trusted employee.”
— Gordon Christensen, DDS, MSD, PhD

“She was rigging the numbers and embezzling an enormous amount,” Dr. Christensen said. CRA took the case to a state job court, where the bookkeeper/accountant somehow twice avoided being held responsible. Finally Rella filed a civil lawsuit against her and won, but the situation took a toll on the Christensens — especially after the accountant’s husband, who worked for an explosives company, threatened them and even tried to run down Rella with his SUV.

“We did win, but I don’t know if it was worth it,” Dr. Christensen recalled. “The endeavor cost many thousands of dollars and lots of time, effort, energy, worry, and grief.”

The second embezzlement involved a young man, a former missionary, who was responsible for depositing funds from German subscriptions for the Christensens’ research group into German banks.

Despite growing subscription levels, revenue was mysteriously going down, which made Rella suspicious. The Christensens eventually discovered that he had embezzled more than $200,000 over several years.

“At first it was deny, deny, deny,” Dr. Christensen said. “He finally admitted it and brought his parents in, who apologized and wanted to repay the money.”

While many embezzlers involve people who’ve had a run of bad luck, these individuals had no extenuating circumstances that motivated them to steal.

“It was simple greed,” Dr. Christensen said. “It’s just appalling that people do this.”

Should you prosecute?

David Harris, who runs dental fraud investigation company Prosperident, investigates up to 100 dental fraud cases per year using four forensic examiners, but he says he could keep 15 inspectors busy. In the U.S., 5,000 to 6,000 dentists per year will be fraud victims, he told

“It’s just so endemic in dentistry,” he said.

Most embezzlers steal about $100,000, but Harris said the biggest theft he’s uncovered totaled $612,000. Insurance only covers so much. Most policies have a fraud coverage maximum of $75,000, he said, adding that some dentists have no insurance to cover thefts.

Office managers, receptionists, and anyone with front desk access are usually the culprits, Harris noted, and the majority of frauds are committed by people who’ve been with the practice more than five years.

Often, normally honest people are driven by desperate circumstances to steal from their employers, he said.

“Something happens that puts their back to the wall,” Harris explained. “A spouse loses their job or dies, or narcotics or gambling problems threaten their basic financial existence.”

Only about 20% of dentists prosecute the embezzlers, he said. In Harris’ experience, several chose not to because the thief was a relative, girlfriend, or a staffer they were having an affair with and they didn’t want their wives to find out. Some dentists don’t prosecute because they are engaged in illegal activities themselves, such as insurance fraud, he added.

In one case, after Harris uncovered a staffer’s theft, she warned Harris that the dentist should think twice before pressing charges because she “had the goods” on him.

“She knew the dentist had been inflating procedures on insurance claims,” he said.

Harris described the dentist’s reaction to the embezzler’s ominous threat. “He sort of turned pale and said, ‘I didn’t think this would be an issue.’ ”

Not surprisingly, the dentist decided not to report the theft.

But sometimes practitioners decline to file charges because they’re embarrassed. A periodontist who lost more than $100,000 to an employee decided to drop the matter. “If this becomes public, all the general practitioners will think I’m an idiot and will stop referring to me,” he explained to Harris.

While checking references is a good idea, it does little to prevent theft because in most cases, the potential embezzler is already on staff, Harris said.

“The thief isn’t going to quit and go someplace else to steal. They’ll just find a weak spot in the system,” he said. “They need money and their ethics become pliable. You trust them and they know what you look at on a monthly basis, so they have all the advantages.”

Like Dr. Christensen, many dentists have been victimized by fraud more than once. One periodontist Harris worked with was the victim of embezzlement three times. “He had a big office with about 15 staffers,” he said. “It’s the law of numbers.”

And even if the thief is successfully prosecuted, few ever serve jail time, Harris said. Generally, it’s a first offense, they usually have no criminal background, and there are mitigating circumstances. Embezzlers will plead hardship, telling judges that they were forced to steal to pay for their son’s kidney transplant, he said, which in one case was true.

Initially, many dentists who’ve suffered thefts are reluctant to file charges against employees who they’ve known for a long time. But insurers require that dentists file a police report if they want to file a fraud claim.

“They feel bad for the employee and say, ‘She was like family. I don’t want her to go to jail,’ ” Harris said. “The majority say they don’t want anything bad to happen to the person. But as the dentist sees what the person has done to him, they get mad.” After the investigation is over, more are inclined to prosecute, he said.

Usually, embezzlers are caught when something unforeseen occurs. One woman’s stealing came to light when she broke her leg skiing and couldn’t come to work after not missing a day in five years. “The dentist brought in a replacement worker who, after a few days, said, ‘Something doesn’t make sense here.’ She had gotten questions from patients who had paid by cash but had received statements that looked like they paid by credit card,” Harris said.

Dentists who’ve been defrauded by longtime employees understandably feel betrayed, Harris said. “They’re mad, hurt, confused,” he said. “They feel they can’t trust anyone afterward.”

“The thing that hits me hardest,” Dr. Christensen noted, “is this is usually a person that you think is working hard and is the most trusted employee.”

What can be shared on email with patients?

The following question was posted to the Academy of Dental Practice Management Consultants which Linda and I belong to. I thought you would all want to know the answer.

How specific can email to patient be reminding them about treatment? Can you mention specific treatment needs or only make a general statement to contact the office? Is this covered under HIPAA?

The answer below is from:  Linda Harvey, MS, LHRM, DFASHRM •

Email is a great source of confusion for everyone.
HIPAA requires that patient info must be kept secure. Regular email transmission which includes responding to email received from patients is not secure.
That being said, there are several options:
1) use a secure portal such as eDossea or subscribe to a service thru Eaglesoft or Dentrix (I believe they both offer such a service).
2) use an email encryption service (there are free ones)
3) implement an office policy that limits what you are allowed to email to patients such as appointment confirmation. I just met the Practice Administrator who said they have a strict policy against emailing patients or responding to patient emails.
4) get the patient’s permission to communicate via unencrypted email. This is an important piece of information one can gather on the Acknowledgement Form new patients sign. BUT, I would still limit the type of information emailed.

Referring back to your question about treatment, I would not mention specific treatment in an email. For example, an email reminder that the pt has unused benefits would be better than saying “are you ready to schedule for those extractions and implants.”

HIPAA is quite serious about enforcing the regulations; plus the random audits are in full force. Have already met one dental Business Associate that was audited. I just got back from Tampa working with a doctor whose staff gave a patient the wrong records on a CD…patient then complained to the Office of Civil Rights. They are now under investigation and have a narrow window to correct and reply to the complaint.

Linda Harvey is a great source of information regarding risk management and being HIPAA compliant.  If anyone needs a speaker for a study club she would be fabulous! Her website is:

Happy Valentine’s Day to all!


Most practices we work with believe in continuous personal and professional growth. They realize they and their team have lots more potential to unlock.  So…ask yourself:

How do you want to grow personally?
Are you a better person today than you were yesterday?
What are you doing to get your team to grow personally?
Are you learning something everyday? What? Is it positive?
What can you do to help your team better understand the practice mission and vision?
How are you planning to grow professionally this year?
How are you challenging and stretching yourself?

These are not easy questions, most require thought and introspection. Really think about it, “Are you a better person today versus yesterday? How?” It is a challenge, it means focusing on personal growth as much as professional growth or the latest clinical courses and procedures. Improving your clinical skills or learning a new procedure to add to your mix of services certainly helps growth and production in the practice. Personal change is by far harder, and it is what will put your practice head and shoulders above the rest. Numbers are important. How you and the team feel about yourselves and what you are contributing to your community, is far more rewarding. We challenge you to spend the time you need to get your team onboard and focus everyone on working on improving themselves. Growth in production will happen naturally as a result.

Tips for 2011

One of the first tips for improving your practice in 2011 is to upgrade your practice management software system AND plan to take time to train your team on all your software can do for you.  Don’t believe that the training you had years ago when you bought the system is enough.  Most practices only utilize a small fraction of their software capabilities.  Make the most of your system and invest time in training.

Do your hygienists have a valid license?

I wanted to share some important information from a colleague about an expired hygiene license.

I just had a client casually check the website of his local state board and found that his full time hygienist’s license had not been renewed for TWO years. She will now have to retake the state board exam! The other part time hygienist’s license had expired in February 2009. In both cases he has hygienist’s working for him with no license! It remains to be seen what type of penalty he will incur because of this. Of course I advised him to lay both of them off immediately until the license issue is resolved. Continue reading “Do your hygienists have a valid license?”