Most dental offices think they have insurance under control, but often there are thousands of dollars slipping through the cracks. Listen as Jill describes specific systems and training to maximize reimbursement and minimize accounts receivable.
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HSP #64 with Jill Coon audio
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Links and References from the Show:
JillCoonInc.com
Contact Jill at jill@jillcoon.com or 561.319.4743
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Jill Coon's Bio:
Jill Coon is a Registered Dental Hygienist and Business Consultant who has been in the dental field for 30 years. Jill is a dental virtual office manager who assists the dental practices across the country with their daily operations to allow practices to focus on patient care and customer service. Jill began her career in dentistry at the age of 16 as an oral surgery assistant. While studying for her degree in Science at Palm Beach Community College, she trained to become a dental assistant. Three years later, she became a full-time hygienist and has been practicing for 26 years. She has managed dental offices nationwide since 1997.
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Howard Farran: It is a huge honor for me to interviewing my buddy, Jill Coon. I have known you since day one in 1987. I think you have been in the field for 30 years even thought you like you could be my daughter. You are a really interesting…rare breed in the fact that, I only know a couple of hygienists or office managers who eventually one day said, hell I’m going to start my own dental office or partner with the dental offices. Another friend of mine in Arizona here in Phoenix, Michael Bonanno. He decided after being an office manager for years to start his own practice and be an equity shareholder. I know that you have done everything. You started out as dental assistant, I think you got a job when you were 16 years old in oral surgery. You started out in blood and guts that is why it saddens me that you moved to the paperwork side of things instead of oral surgery. I mean what is more fun than pulling four wisdom teeth out? So hey, congratulations on all you have done. You have been helping dentists on Dentaltown and Facebook for years. So what’s got you excited today in dentistry?
Jill Coon: Just everything. I like the changes. I like to see what is up and coming, what’s new. I like to educate everybody and keep everybody informed and in the loop of the changes that are going on.
Howard Farran: And there’s a lot of changes going on especially where you are… it seems like you are focusing a lot on dental insurance reimbursement and that is a…we’ve seen a lot of changes with that in our life. Remember back in ‘87 where the big deal was capitation and everybody thought capitation was going to take over dentistry and there was public trading companies like Orthodontic Centres of America was on the New York stock exchange and the orthodontists thought chained orthodontic clinics were going to take over everything and then they…and then Orthodontic Centres of America spectacularly imploded and there was a dozen DSMO’s on NASDAQ and everybody said corporate industry is going to take over and then they all imploded and were gone for 10 years. So it sounds like we’re in round two. Now everybody thinks corporate dentistry is back, they think Obamacare…tell the dentists what advice would you give them on dental insurance? Don’t you spend a lot of time on that, is that not a big focus of yours these days?
Jill Coon: Yeah, so basically what I do is, I train offices on how to verify dental insurance to be able to accurately quote their patients. I don’t necessarily say that you have to be a network to be able to do this, but you want to be able to understand what the insurance benefits are for your information only. To be able to educate your patients on what their companies are and collect accordingly, so you’re not brown filling anybody.
Howard Farran: Jill, back in the day there was a company called Trojan, kind of a strange name that did that for you. Maybe that is why they called it Trojan to protect you. But are they still in the game? Are they still out there?
Jill Coon: You know I have noticed that they are still out there. I don’t know how thorough they are with the verification. I do know that the more you want them to be, the pricier they are with the verification. Most of the…
Howard Farran: Now in my office we literally call. We have a human being call on each one. Kellony calls every single patient’s insurance and gets a voice deal. Do you think that’s….and we fill out a sheet…so you think that’s overkill? Do you do a lot of this via website or do you like to talk to a human or what are your thoughts on that?
Jill Coon: At least once a year you get on the phone and you call and you find out if the benefits are the same. You do the complete breakdown and complete meaning like maybe in your office, if you do porcelain crowns instead of let’s say the porcelain to metal, you want to know certain instances of what is covered and what is not covered, waiting periods, if it’s downgraded an those kind of things. So I check everything from soup to nuts, from the beginning to the end so that once a year you might as well get on the phone and do it and then after that, when the patient comes in each time I just log on mine just make sure that they’re still active, that the group number didn’t change or that the benefits didn’t change. If I see a change to the benefits I will call again.
Howard Farran: Do you have that sheet in front of you? How many questions do you actually ask? Do have your sheet in front of you or…?
Jill Coon: Well I know my sheet by heart, but I sent it to you.
Howard Farran: Oh I’m sorry. It might be in front of me. Can you go through that? I mean I think there is a ton of dental offices that have never even done this or thought about it, or…
Jill Coon: Oh yeah, absolutely and then at the end of the podcast I’ll happily email it to you so that you have it and you share it with everybody. Basically what I do is I ask for preventative services. I want to know what’s covered. If the frequency of the exams are covered. Like the problem focus exam does it go against the frequency of the initial exam or the periodic exam? Can you do a treatment the same day with the problem focus exam? The reason I ask these questions is because, if it goes against the frequency and you’ve got he patient in the chair, then you need to know to collect that money. And sometimes even the problem focus exams can fall under basic services where you have a cover now. You know if it’s covered you might have copy and a deductible to meet, so that’s why you want to be really detailed with everything that you ask. Cleaning for example. Regular prophylaxis cleaning. They can be about two times a year, two times in a twelve month period or one every six months, those are three different things. Oka? If someone said two in 12 months, you can have somebody come in in January and you can have somebody come in in April, but if they come back in before their twelve month period it’s not going to covered a third time. If it is covered one in every six months and they came in January and April, you know the April one is not covered. Do you see what I mean? If it is one every six months to date and you did the April cleaning again, and it wasn’t covered because it’s shy of the six months. If you did it six months plus one day it might be covered. See what I mean? That’s why you ask all these questions. So I started with the preventative on my sheet. I always ask if you’re in or out of network. If they pay based on use your own customary, the insurance company, and the latest thing that we’ve noticed over the past two years, I’ve noticed that there’s a lot of shared networks with the dental insurance. For instance, if you’re with start with are you in or out of network? If they pay based on [unclear] customary, the insurance company and the latest thing that we have noticed over the past two years, I have noticed that there are a lot of shared networks with the dental insurance, for instance if you’re with Sigma PPL, let’s say your out of network for Sigma.
Howard Farran: Okay Jill, I have got to stop you. There’s on iTunes, you know we’ve had tens of thousands of downloads and a lot of non-US people don’t know what some of these terms are, so try to, when you use a fancy term that they wouldn’t know if they don’t work in the United States, could you explain that as you go? Like what is in network and out of network?
Jill Coon: Okay in network means that you are a participating provider for the insurance company, which means that you are under contract with the insurance company to accept whatever fee schedule they give you. Out of network, you do your usual. Does that makes sense?
Howard Farran: Yes.
Jill Coon: Does that help Howard? Okay, and basically if you’re out of network and your usual and customary fees are above average, let’s say that you charge a $116 for a cleaning and in your area the usual and customary for that specific plan may be a $100, then you would technically balance your patient for $16 to get your full fee of the $116. When you’re verifying with the insurance, if you are not a participating provider you ask them, you say okay, this is my normal and customary fee, are we within usual and customary? Some insurance companies will say no, some will offer to give you that rate that is usual and customary so you don’t have to guess, others will make you ask three or four questions to get that number, like is $115 in that usual and customary? Is $150 in usual and customary? Is $100 usual and customary? So you kind of play that game to ask questions to get your answers.
Howard Farran: Crazy.
Jill Coon: It is, but it works. When I had my dental practice and I was doing the billing. If I had to send out five statements a month on a million dollar a year practice, that was a lot. The rest of my money was waiting on insurance pending and again, following up on five claims a month for the outstanding claim, that was a lot, if I had to do that. When I sold my business we only had $30 000 dollars in the accounts receivable and that’s because we were waiting for insurance under 30 days.
Howard Farran: And what would you say the average dental office is? One month’s production is in their account receivables? Would you say the average is, your 30 day average production or collection is about what your account receivables are?
Jill Coon: Well if you’re doing $100 000 a month and I’m just trying to think in my head what it would be…if you’re doing $100 000 a month, using the insurance companies pay schedule, if you’re a participating provider it would be easier for me to find this. If you’re doing the insurance schedule, you’re doing $100 000 a month, roughly 35% percent is going to be outstanding.
Howard Farran: So you’re saying only ten days? Ten days office production should be your account receivables?
Jill Coon: Pretty much.
Howard Farran: That’s amazing.
Jill Coon: Yeah if you are collecting and doing it correctly yeah.
Howard Farran: So did you want to continue on that insurance breakdown that call or did you cover that all.
Jill Coon: No, you want me to carry on. I’m ready.
Howard Farran: Yeah.
Jill Coon: Okay. We did the preventative part which is the exam, okay. Then the X-ray, now let’s get into the X-ray. There are some offices that when you go in to get your teeth cleaned, you want to find out if people have history of let’s say a full set of X-rays or bite wings or periapicals. If they have history, you need to know if the insurance company is going to cover it and how it’s covered. If they’re not going to cover it then you go ahead and you collect for it. If it falls under the deductibles you need to be aware of that and if it falls under basic services, you need to be aware of that. So that way you can figure it out correctly and collect accordingly. I have seen plans cover bit wings that are 100%, but I’ve seen periapicals fall under the deductibles at80% coverage. So this is why we ask every itemized detail, especially under the preventative because we all assume X-rays are under preventative. We all like to assume that problem focus exam is under preventative and that’s not always the case. Ironically so, there are some plans too when I’m verifying insurances that preventative doesn’t even fall under their maximum, their calendar year maximum. Sometimes it can have $1500 maximum, $2000 calendar year maximum or plan year maximum if you will, and some could also have even higher or lower, it depends. I’ve seen as high as $15 000 a year. It just depends on the plan. But you want to find out everything because you need to know if there’s history, you need to know if it’s covered, if it’s not. So that part’s done. Then we get into the basic services. The basic services would usually be filling and root canals and extraction, maybe simple extraction most of the time. There are some plans that will cover the filling, let’s start with the filling first. The reason I ask about the filling is that if your office does amalgam restoration, then you know that you can basically figure out your percentages right away. Most practices I deal with, they do composite restoration so there is no more amalgam so I need to know okay, do they downgrade these fillings on the back teeth, meaning do they, does the insurance company allow for the benefit of a silver filling and then do the percentage off of that. Then you charge the patients the difference up to the white filling. So that’s why you want to know all of this because there are sometimes that they’re only downgraded on the molars only, or sometimes it’s downgraded on molars and premolars. And again these fillings also have a history. So you want to know, did they have a filling twelve months ago, two years ago? Does their plan pay once every 12 months or once every 24 months? Most of the time I see it covered once every 12 months for children under 12 years old and then the adults they allow it once every 24 months. Have you run into that with your office?
Howard Farran: Yes, yes absolutely.
Jill Coon: Okay, well that’s why I do that and then I ask them and I can accurately quote. Now back onto the root canals, same thing. Endo also has frequencies. If somebody has had a root canal done and they need to have a re-treat, it may not be covered because they have had it already. So we want to know if the tooth is going to be covered. Have they had history, what are the time frames and then when you’re submitting these claims, that’s another whole animal, but when you’re submitting these claims you want to put as much documentation into the remarks box on the claim. If I had a patient come in for a root canal and they had a root canal let’s say three years ago, and I want to find out what their history was in if they were insured by the plan and this particular plan said there’s one every 24 months so it’s okay, you can go ahead and do the re-treat if you need to, but what if it was done a year ago and you need to re-treat it? Then you need to know what the patient’s out of pocket is. You need to know that you’re able to quote the patient accurately. Core build up, I’ve seen actually core build up covered under basic, and I’ve seen them actually covered under major. The post and core is always covered under major but basically, the big thing that was buzzing around with Sigma, they always say that Sigma doesn’t cover the core build up because if you do the build up the same day as the crown, they don’t cover it. But Sigma pays on seat day. I’m going to use this company as an example. So you want to know, do you pay on prep or do you pay on seat day? Core, usually you do them on the prep day right? Because you’re doing them, you’re prepping the tooth, you’re going to take the impression and then you tell the insurance company the seat date and then they’ll pay the claim. It’s not an issue. But that’s why you ask how that’s covered as well. Then we get into major services. The major services would be your crowns and bridge, sometimes extraction, especially the surgical extractions…can I backtrack one second? Back to perio. Okay perio also can fall under basic or major, but with perio you need to find out what it is that you’re doing? Are you doing bone grafts? Are you doing extractions and bone grafts? Are you doing (unclear), are you doing (unclear)? Anything like that. Again, there’s frequency but that, is it covered? Is it met? How do we quote our patients? What I do, I custom tailor my form that I will send you Howard again, I custom tailor my form for every practice that I’m working with, so let’s say that you only do, you don’t necessarily do (unclear) surgery, but you have a provider coming in that does it and it’s a specialist. Guess what? That specialist can be billed as out of network under that plan? He doesn’t necessarily have to be in network if he’s a true specialist. So it depends on the insurance company too and how they allow their providers and you want to know this because if I’m turning around and this guy is working for you, and we’re doing treatment for a patient and he’s out of network, I want to make sure that I know if that check is going to come to me or is that check going to go to the patient, because he’s out of network. And how much is the patient going to pay? And how much is the insurance going to pay? The next thing is, if you’re planning (unclear), they have frequency. Can you do the scaling and root planing in the same day, or full quadrant? Can you do the cleaning the same day, because some patients might need only one quadrant or one to three teeth in one quadrant done, and the rest of the mouth needs a prophylactic and in order to understand your insurance benefit, I’ve seen offices where they’re current for the 43/42 which is the actual cleaning of one to three teeth, the code for that, and then the code for the cleaning and they’ll submit to both but then the insurance company will end up kicking it back and only paying for the cleaning. They’ll pay the lesser benefit. They won’t allow for the other ones so you want to know, can you submit a cleaning the same day? If not, does it have to be a week apart? Does it have to be a day apart? Also the scaling and root planing, you want to know do you need to do, can you do all four quadrants the same day to get it covered, or does the patient have to have a break in between? And what’s the frequency of that? Some allow only one per quad every 24 months. Some allow once a year. So that will also help you in quoting. That’s what I think so far is basic. I have to go back, but now major. Major services. Am I talking too much?
Howard Farran: No, not at all. I’m loving it.
Jill Coon: Okay. Under major services, we are dealing with crowns and the build ups like I said, and then even some surgical extractions could be there and we want to find out whether implants can be there, are they covered, is the implant covered? Is the crown covered? Are they downgraded? Are the implant crowns downgraded? The best yet that I’ve seen now is, if you do sometimes two implants in an arch, it will be downgraded to a denture, a partial denture. Do they downgrade those implants restorative? They may not cover the implant placement, but they can cover the final restoration but the insurance companies have the right to tell you well, the patient is missing two teeth in this arch, it’s going to be downgraded to a partial denture, but do you know that? Do you ask these questions? We assume that because they’re missing two teeth, we think they’re going to be covered because we’ve extracted those teeth. It’s not the case. So that’s why we always ask. Okay, if you’re downgrading, how many teeth in an arch have to be missing in order for it to be downgraded? That’s basically the just of that.
Howard Farran: So how, yeah…how long should this take and I mean, first of all, when somebody from your front office calls an insurance company, how long does this usually take?
Jill Coon: On average it’s about 15 minutes per person, if you’re physically calling. If you’ve already got the breakdown it should not take that long, but if you’re first doing it for the first time, and I’m also including the whole time from the insurance company by the time you get the prep on the phone. It is on average about 15 minutes per patient, but the ironic thing…
Howard Farran: And how does a dentist train the front desk to be able to do this 15 minute phone call?
Jill Coon: How does the dentist train? They hire people to train or what I’ve done with my clients, I do virtual training with them. So I’ll run through and I’ll have them fill out the form, what they need to report on the form and then we’ll do a mock one, and then I’ll make them actually call a couple of patients and give them…
Howard Farran: So this is one of your services where you long distance train a dentist’s receptionist? First of all, what is the politically correct way to call a dental office front desk? Some of them don’t like the term receptionist, some of them don’t like front desk. What do you call them?
Jill Coon: Dental front desk. Dental team. It’s not a manager, but it’s a receptionist. The person at the reception.
Howard Farran: Okay. I get a lot of negative viewer mail on whenever I call a front desk a receptionist. I don’t want to…I understand…what’s that?
Jill Coon: How about insurance coordinator?
Howard Farran: Yeah but, if you say insurance coordinator then treatment plan presenter, then office manager, I’m still looking for generic word to cover administrative. Would you call them maybe dental office administrators? So you have a service where that if a dentist says hey, my front desk administrator does not, we currently don’t do this. We fill out…and I want to get this person trained. So they can call you?
Jill Coon: Yes.
Howard Farran: And what would they call and what’s your website?
Jill Coon: Okay they can call me at 561 319 4743 and my website is www.jillcooninc.com.
Howard Farran: And then the phone number one more time, that’s your personal cell?
Jill Coon: Yup, that’s my personal cell, I use that for everything.
Howard Farran: Okay and that was 561 319 4743?
Jill Coon: Yeah.
Howard Farran: How long does it take you to train someone to do that?
Jill Coon: About and hour, about an hour to do it accurately and then what I do is once I have trained somebody I actually offer them support so I will do training with them. Do a mock session with them and then I will have them verify someone’s insurance and send me their sheet and I can automatically see what is missing or what they need to work on and then send it back to them so I offer support with that afterwards too which would be at least three calls afterwards for support if they need it.
Howard Farran: Yeah. So I don’t know if that would hurt your business model, but we would love to have an online CE course set up on Dentaltown if you ever want to get together with Howard Goldstein and create a course on that. It might, some might view the course and it might be more business overall. I mean you never know.
Jill Coon: Well guess what, you’re going to be the first to know and then this is going to be out there for everybody. I am actually creating a program and a curriculum course to actually teach people how to do insurance and teach people how to actually do this, like I do, virtually. So I am actually developing a program so I’m happy to actually put it out there and you can put it out there for continuing education credit and we can put it on Dentaltown.
Howard Farran: Oh you just made my day.
Jill Coon: It’s going to be video theory, where they do have to get certified and if they’ll get certification at the end so that they know what they’re doing. Because I’ve been into offices so many times where I’ve seen people say that they understand insurance and they know what they’re doing and I’ve been like really? You know what you’re doing, then why is this this way
Howard Farran: Well you know I always say in dentistry you only manage three things; people, time and money. You only have three functions, you make something, sell something, watch the number and I can tell you that dentists, they just always dream about doing root canals and placing implants and doing bone graphs and CEREC and CAD CAM. I mean they just, we didn’t go to dental school because we had a passion to learn insurance and accountancy and payroll and all the necessary stuff. So it’s hard for most dentists to get interested in it. Jill, you’ve have been a dental consultant for 30 years. You are a hygienist, you have been…you have consulted in practices around the nation. When you walk into your typical Joe average dental office, what errors are you seeing from the business side from the administrative side the front office side because doctor is… she’s too interested in bone grafting techniques and not the front desk. What errors do you see the most?
Jill Coon: I am going to say this politically correct.
Howard Farran: Don’t be, not on a Howard Speaks podcast. The last thing anybody would call me is politically correct. In fact I am politically incorrect but I am dentally correct. What do you normally see? Take off your gloves and tell the truth.
Jill Coon: I see a lot of people that have not been trained properly. I see a lot of people trying to cut corners and do things the quick way, shortcuts, not being very detail orientated. I see a lot of people just…if they don’t understand what… let’s say you get an explanation of benefits back from the insurance company and you don’t understand what they’re asking, they kind of shove it on the side and you’re not getting paid for that. I see a lot of claims outstanding over 30 days old. The efficiency part is not there. It is not necessarily the front desk, the team member’s fault. It’s just that they have not been trained, or they have been poorly trained and carried it from office to office.
Howard Farran: And you know another thing I’ve always seen, it seems like when a staff person is dropping the ball, they actually spend more time courting the dentist relationship. You know they will come into work with donuts, they’re always flattering him and it always seem like his favorite or her favorite employee is always, almost the most useless. And then the person who’s up there just busting their butt and the dentist comes up and wants to say something or a joke or do this, come on, get out of my way, I’ve got things to do. Get out of here, and then that dentist doesn’t like that person and that is the one just crushing it on every level. So I always…you also see it in staff turnover. When you see a dental office in like, the average staff is only there like two years, going back 20 years but one person has been there 20 years and who is that, oh it’s doctor’s favorite and as soon as that doctor walks out of the room, it’s Dr Jekyll and Dr Hyde and it’s just bat shit crazy. So okay, I want you right now to talk to a dentist who just got out of an implant course and he is all excited about implants and she just learned how to bone graft and she is listening to us thinking man, I don’t pay any attention really to that stuff, what should that dentist be thinking about? Go through a checklist of dentists focused on too much dentistry that could roll up her sleeves and go look at the front desk at make sure they’re dotting I’s and crossing T’s. What would they be looking for?
Jill Coon: Honestly I think dentists need to start worrying about their accounts receivable to see what their collections are. If there’s any outstanding claims they need to go through to find out, to see, are they collecting what they’re producing. They need to, actually I believe doctors and dentists should be trained on how to verify insurance so they understand what the staff is going through. Because honestly, if you’ve got a staff member coming to you, telling you Dr Farran, its taken me 15 minutes to verify the insurance. I can’t wait for the patient to come in that day to verify it because we’re so far behind because we’ve got 10 chairs going. I think in order for you as a dentist to understand what we, the front desk people do, or office administrator people if you will, do, then we need to put you in that box with us. You’ve got to learn to do our stuff. Unfortunately we can’t be in your box because we’re not licensed to drill teeth, but you’re the business person. You were not taught to be a business person in dental school. I know you’re a business person, but most dentists they want to think that they’re business people and business savvy, but they really don’t understand the insurance. They don’t understand the business side of it and it is truly numbers, but you have to understand the numbers.
Howard Farran: You know that natural curiosity built one of America’s billionaires. Sandy Weill, the founder of Citigroup and Citibank. You know what happened to this kid? You know why he became a billionaire? He was just a Brooklyn boy, got a job at a bank and he just had this one question. He says, you know when my momma writes a check at the grocery store and she goes to the grocery store, where does it go and how does it get the money from my mom’s bank account to the grocery store? And he was working at a bank. Nobody could answer the question. They all said oh it goes to some clearing house, it does something, nobody could explain to him. So here is a little Brooklyn boy who rolls up his sleeves and he is working at a bank and he just keeps chasing down the exact process and the deeper he dug down into it, the more he realized it was just completely crazy, it was completely unorganized and then computers were coming along, so he got into the actual…so think of a dental office, where you think of dentistry as root canals, fillings and crowns, he got into your section, the administrative part and he started adding computers and streamlining it and it was so efficient he started doing the business for other banks and Citibank got so huge because they completely automated and made everything on the backend so functional. There’s a man who rode all the way to the top just by dotting every I and crossing every T and trying to find the nitty gritty details of how does a check clear. I mean that was an amazing book. Sandy Weill, you’ve got to read that book and what percent of dentists do you know can go up there at the front desk and monitor today what’s going on up there.
Jill Coon: None.
Howard Farran: Yeah none and that is why many of my consulting friends, I know a dozen, or probably 30, 40 dental office consultants over the last 30 years, and they said they walk into offices and 50% of them have embezzlement going on today because the doctor is clueless. You can even have your bank, I’ve got the Chase app on my phone…you can see your deposit on your iPhone every night when you walked out to see if there is any cash deposit or what the deposit was. So how do you try and get a dentist interested in this?
Jill Coon: Any dentists who wants to grow their business and who wants a few changes. I mean really what I do to is to get dentists to see what I do. My clients that come to me, they come to me because they know their front desk needs help, meaning they’ll call me because they’re running behind and they need somebody to verify insurance so they might need me to work on outstanding claims and credit balance support and you know, other things, anything that they need. I’ll go in and I’ll start doing the searches and the reason that I started doing the virtual stuff that I do, the virtual office manager that I do, is because I like to make a difference in the practices around me. So what I do is, I go in and I can clean that up or I can go through it and see what’s going on, and I can make an immediate difference if it’s in the practice collection just on that, without changing a thing on your side. I don’t have to go to your office and say okay well this team member needs to do this and you guys need to do, you’re hanging the chart, the crossover with the charts and tell the dentist how to talk to the patient or talk to the staff. I don’t do any of that kind of consulting, I do the immediate stuff on the number so that they can see, okay wow. She’s able to clean that up and she’s able to keep me collecting and now she’s verifying my insurance and I’m noticing a difference in my collection because my team has what they need to do what they’re doing. So now I’ve made the difference, so of course if they see it then they’re going to understand it. Does that make sense?
Howard Farran: Absolutely.
Jill Coon: That’s what I like to focus on, is making the difference. I mean I also do medical billing, we’re not going to talk about that today. That’s another whole animal.
Howard Farran: Medical billing for dentistry?
Jill Coon: Yes, because like for instance I have had a couple of patients that have had implants done and they’ve had to have the implants done (unclear) and I’ve gotten implants covered on patients that have diabetes or even pregnant patients that need (unclear) some of that stuff can go under medical. Even cancer patients, some of their treatment can go under medical. So it just depends, but like I said that’s a whole other animal. There is a lot involved with medical billing, a lot of offices have started it and feel like it doesn’t work and they walk away. But you really have to be a registered provider to bill medical. It doesn’t mean you have to be in network, but you have to sign up to be a provider so that the medical insurance would recognize you as a provider.
Howard Farran: I want to just say one thing you also said about going back onto composite restorations. A lot of times they are downgraded to the amalgam fee and that’s a pet peeve of mine because dentists don’t want to hear this, everybody wants to hear that the tooth color, whiter, brighter, sexier filling is the best filling and the bottom line is, the old, ugly metal silver fillings that are half mercury lasts twice as long as these composites every dentist I say it to, says oh maybe your composites, but not my composites. When you look at the average amalgam in the United States, it’s probably about 14 years. When you look at the average composite I’d say it’s probably about 7 years, but the reason they downgrade it to the amalgam fee is because these dentists never do amalgam so the last time they submitted their amalgam fees, it was probably 1985 and it was really low, and they keep raising their composite fees so the insurance…I talked to the insurance company, I said why do you downgrade to the amalgam fee? They go well amalgam usually, the submitted fee for that is half the price of a composite. If every dentist in America would start doing amalgams again because they last twice as long, especially when the patient is an old, bald ugly guy like me who just wants it to last forever. I’m not trying to win any beauty contests by having white resin fillings on my molars, but if they would start doing them and submit the fees for them like they would on a composite, the downgrading to amalgam fee would disappear. But it does concern me that dentists don’t do amalgams when they’re clearly indicated in certain patients. Especially like Alzheimer’s, dementia, the person doesn’t even know the name of their children, they have no home care. There’s certified nurse assistant making $11 an hour who is in charge of 20 people in a wing, and I mean you are a hygienist. If you followed me, and I have done it to a dozen nursing homes. If you followed me as hygienist Jill for 30 years and watched how long a certified nurse assistant for $11 brushes grandmas teeth with Alzheimer’s, I mean it is 30 seconds and the toot brush never hit a pre molar, a molar or the lingual of, it’s just swish, swish, swish and spit in a Dixie cup and I’m just standing there…it’s kind of like when you go to the physician. As a dentist, don’t tell him you’re a physician because their oral exams, they take a Popsicle stick and they say open your mouth and they say ah, and you say ah, and then they throw the stick away and I’m just thinking what the hell was he looking for? A gerbil to pop out of my mouth? A dove to fly out? A scorpion? I mean you couldn’t have done any form of exam. I mean there’d have to be a tumor the size of a ping pong ball hanging on my uvula for them to even see a thing. So it’s crazy. So tell me more about your virtual assistant thing. So how do dentists find you? How long do they work with you? I mean do they call you…are you kind of an emergency disaster…you know your house floods and a disaster guy comes out here and Shop-Vac’s all the water out? Do they do just find out they’re over 90 on their account receivables and call you and say Jill, I’m over 90, can you get me to over 10 or 15 days and then you take it from there for a week or two? Walk us through your average client.
Jill Coon: My average client is somebody, let’s say that they’ve had a change of staff and they don’t have the personnel right now to be able to submit claims or do things and they may need help or they’re overwhelmed, because I’m more of an adjunct to the front desk as well. I’ll go in, but they find me that way. They find me because they need extra help. For instance, I filled in for somebody that was on maternity, so my services could either be contract, they’re all contract but whether they’re project based or whether they’re permanent or whether I’m going on a month to month, meaning some of the things I can do, so you understand. When a doctor calls me, and sometimes it’s the front desk person that calls me, or an office administrator that will call me and say hey, listen I need help because I can’t really get all this done. Can you do this for me for a little while until I get caught up? And it works fine, then we get on the phone with the doctor, the doctor ends up telling me you know I really like this concept, can you stay on board with me for a long term and I’ve got clients, still to this day that have been with me for three years since I actually started the virtual side of it. I’ve got clients that have been with me for six months, I’ve had clients that actually come and go. I have clients that I actually log in once a month, just to run the reports and just to see what they’re doing.
Howard Farran: So you log into their management information system? How do you do that, what kind of program do you use?
Jill Coon: It can be accessed anywhere, it could be GoToMyPC, it could be LogMeIn, it could be any of those programs that you want to log in. Like anywhere.
Howard Farran: And what practice management software systems do you work with the most and which ones do you like? I mean there’s Dentrix, EagleSoft, SoftDent, PracticeWorks, Open Dental. Do you work with all of those?
Jill Coon: And MacPractice too, yes all of them.
Howard Farran: If a dental student was listening- these podcasts are huge in dental schools and they were coming out from the administrative side, do you have any favorites on the management information systems?
Jill Coon: Right now I’m honestly going to say I love Dentrix. I really love Dentrix by itself. Dentrix and Open Dental are my two favorites, because they are comprehensive, they are very easy to work with, they’re similar to each other and truthfully, Dentrix is the most user friendly. If you realized any time, honestly, when was the last time you hired a new person to fill in...
Howard Farran: You know why Dentrix is the most user friendly?
Jill Coon: No.
Howard Farran: I’m, since I’m 52 and started in 1987 I started on SoftDent, so of course I’m still on SoftDent and it has a different owner about every 15-20 minutes. I think Carestream owns it now. I don’t even know. When they tell me it’s under new ownership, I just think oh, it’ll be someone else in a couple of years. But I’ve seen with it, that was the old DOS system and Dentrix started up in Provo, Utah by Gordon Christensen. They saw that when Windows came out, when Microsoft Windows came out, that was very different than DOS driven and Dentrix is the only one who said you know what? I think this DOS and Microsoft, this was when Microsoft wasn’t a sure bet, and they said I think this is a game changer so Dentrix was a virgin company that started on Windows. I think it was Windows 3.0, whereas my, and the other systems are DOS systems and they’re programmed to kind of look like Windows, but they don’t have the functionality that you’re used to. So everything you’re used to on Windows is in Dentrix. So you’re right, it is massively more user friendly and some of those older Legacy systems should just start from scratch and rewrite the thing.
Jill Coon: You know what I started on? Dental Mac. Do you remember Dental Mac?
Howard Farran: Yes I do. What were those two guys names? They were Bernie, we used to call them Bert and Ernie. Those two guys. They looked like Bert and Ernie. And now that disappeared and now DentalMac is making a comeback. I think they’re out of Nebraska.
Jill Coon: Mac Practice. Yeah they still have some glitches but Mac Pratice is okay. It depends on what you’re going to do some of your claims with.
Howard Farran: I think Mac Practice is onto something because when people are business people, it’s easy to look at a mark and say oh, half the market is boys and half is girls, and it looks like we should focus on makeup mascara to the girls and not the boys. Race is another low hanging fruit that they say, they say oh Howard’s Irish and that guy over there is Mexican and there might be different demographics there, but where people miss the most is age demographics. I mean senior citizens think very differently than baby boomers versus generation Xers and Dentaltown just passed the app on the phone, just passed 30 000 downloads, 85% of them went to an iPhone and when people log onto Dentaltown, if they’re coming from a dental school it’s all Mac’s. So demographically, the old guys like me who are on a DOS and what’s mine…SoftDent, the only future I have is probably a coronary heart attack any day now. I’ll be opening the refrigerator reaching for a Chunk O Cheese and a beer and then I’ll be replaced by a dental graduate with an iPhone and a Mac, so I would keep an eye out on that Mac. It’s Mac Practice, right?
Jill Coon: Yeah, but I know don’t know, there are some still glitches with it. Mac Practice takes longer to go around things, but it takes time. There is a learning curve with it.
Howard Farran: Are they out in Nebraska?
Jill Coon: You know I don’t know. I know the phone number to call them and stuff. To win with them, I like it but what I don’t like is when you do the attachments, it doesn’t tell you the true number where like, even SoftDent which I love SoftDent.
Howard Farran: Really?
Jill Coon: Yeah. I used to have SoftDent when I had my practice, I loved it.
Howard Farran: Really? What about now? I’m still on it so let’s make this podcast just about me. Shall I keep it or shall I switch?
Jill Coon: If it’s not broke, don’t fix it. There is really no reason to fix it right now. If you’re still sending a claim fine, it’s fine. Unless you want to go cloud based eventually like everybody else is going to be doing.
Howard Farran: You know, I think there is a big monkey wrench in the cloud base Jill, and that’s the uploading a CBCT file. I mean…we’ve gone from these little digital X-rays to the CBCT’s and everybody’s telling me that to upload a single CBCT to the cloud is two hours.
Jill Coon: Is it really?
Howard Farran: Yeah. So a lot of people are saying if you do go to the cloud, you’re not going to be moving your CBCT. Yeah there’s a gazillion bytes of data on a CBCT. It’s forever and a day.
Jill Coon: Okay.
Howard Farran: So, but I would have to say on Dentaltown, if I was starting from new it seems like, this could be my perception, maybe you’re different, you’ve been on Dentaltown forever, thank you so much for your 500+ posts. It seems like the most raving fans are always Open Dental.
Jill Coon: Yeah.
Howard Farran: Would you agree with that?
Jill Coon: Yes, but Open Dental, from what I understand, isn’t it also software based, meaning it can be your hard drive and then it could also be cloud based? Can’t it be both with Open Dental?
Howard Farran: I think so.
Jill Coon: Yeah so it just depends, but Open Dental is just as simple as Dentrix. I think people just like a change. They want something different, that’s why they’re raving. It’s just as user friendly as Dentrix to me, the layout and the use of it is very simple. It’s the same. It’s pretty much the same.
Howard Farran: Open Dental reminds me of anybody who’s on cross fit and does cross fit. You know you can’t meet a patient for more than…if they do cross fit they have to tell you within three minutes of shaking your hand that they do cross fit every day. I’m like okay, they just have the most raving fans. So give us some more Jill, I’ve had you for 45 minutes so I am three fourths done and I’ve only got 15 more minutes. Try to coach this dentist again, the average dentist, you and I both know him, they can’t do anything upfront, they’re completely…all they want to do is make something. We put a course on up on Dentaltown on root canals and it’ll get 10 000 views. You put one up on how to efficiently run your front office, you get two views and that was probably because someone accidentally clicked the wrong button. Talk this dentist through what they should be paying attention at the front desk, because you’re a hygienist who’s owned a dental office, sold dental offices all over. What should this dentist, the next time they want to spend all day Saturday at a root canal convention, they should spend next day Saturday going to their front office and doing what? What should they be looking at?
Jill Coon: They should actually start writing some notes, some reports. They can run audit trail reports, they can run outstanding claim reports, they can run collections report, they can run on schedule treatment plan reports, they can run patients that are overdue for hygiene appointment. There are a bunch of reports that actually equate to numbers. You know the dentist that actually picks…
Howard Farran: Now the audit trail, you should never run the audit trail report because then it’s a 50% chance you’re going to have to fire your front office for embezzling money. Go through the audit and when you go through these reports Jill, when you owned your own dental offices, were you running these? What were you running daily versus weekly, versus monthly, versus quarterly, versus once a year?
Jill Coon: Okay. Every day I would run the un-submitted claims report to make sure I didn’t miss out on any claims that went out. Once a week I would run the outstanding claims report, daily I would also run my close report meaning to see what the day sheet is and the summary for the report, you know whatever happened for that day, just check to make sure my deposit match what I am depositing. The credit card match to make sure everything matches. Then I would actually run another trail report at the end of the day just to make sure nobody deleted anything, but when I set up everybody in my office to do things, I have certain restrictions. They weren’t allowed to delete anything. So it depends on how your office is setup.
Howard Farran: You know doc, a few dentists out there listening, you notice if you just go to Target or Coles or Walmart and they have to delete, you know they did something wrong, they entered it wrong and they have to delete it, what do they do? They have to say excuse me, I need a supervisor and then they come and they stick in the key and they delete the obvious because that is what we called in MBA school, internal control over peculation and how you get to embezzlement is the same way you get to bankruptcy. You have one person in charge of everything and you know…like in my office. My cancelled checks are mailed to my home. The person that is going to get the mail and enter the insurance checks isn’t the one making the deposit at the bank. You have to break up tasks so that if at the very least, if you are going to have embezzlement it’s going to have to take two or three or more people and another heads up on the dentist embezzlement…they’re shocked to hear this. A good chunk of the time it’s your wife who’s planning a divorce. I have seen that. No I’m serious, I’ve seen that 100 times. Where they’re completely checked out but the reason they’re staying in this dysfunctional marriage is because they’re moving 3000, 4000, 5000, 6000 bucks a month into a savings account and I’ve known several that moved it to their favorite non-US vacation spot like Sydney, Australia or Cabo in the Caribbean and I know one dentist, by the time he figured out what was going on, I mean his wife had been doing it for eight years at the tune of like 6000 bucks a month. So bottom line is, you want to do that audit trail and go over the audit trail. How do you do the audit trail?
Jill Coon: It depends on the software that we’re doing it, but I would actually run it and see what everybody’s done with the transaction. I would see what they’ve done with prescription because I’ve actually had somebody try to…I actually had a team member, when I first hired this one employee, she funded a prescription for herself under the doctor’s name and I got a phone call from the pharmacist asking me to authorize the prescription, this was Vicodin at the time, you only needed to have it printed out and send it in with the patient. Well let me tell you something, I authorized the prescription but I went into the office and I ended up firing the person on the spot because no. You don’t call in prescription so that being said, you’ve got to pay attention to what’s going on. If something...
Howard Farran: You know what one of my friends just lost his prescription license for doing? So dumb. His assistant…he was ordering the birth control pills and he was doing it to save her money.
Jill Coon: What?
Howard Farran: Yeah he was doing it to save her money. It’s like oh my God. Well I mean Schein sells pharmaceuticals for everything, they’re huge in vet, pharmacy, dentistry. You can order pretty much any type of prescription and he got busted for that. So the audit trail…so you run the audit trail daily at the end of the day and also that’s…that’s also when I’ve been in dental offices, you as the money maker…if I’m in a dentist’s office and you run that audit trail and the team looks at that, you always find at least one missed, didn’t even enter an FMX or PA’s and bite wings, I mean have you ever run an audit trail where someone looked at it and said hey, they forgot to enter the bite wings of the FMX or this or that…so it’s always a money maker, wouldn’t you say?
Jill Coon: Oh yeah, I mean always and the thing is, it’s the same thing like, in some offices that I work, they have yea. I mean always, and the thing is the same thing… some offices that I work with they have (unclear) and they scan their (unclear) then, so they’ll write their notes on the bottom slip meaning what they’ve done, the procedure that they’ve done, not the actual treatment note.
Howard Farran: Well tell me this, if you walked into 100 offices and looked at what was done on the schedule versus what was entered to be billed, what percent of the time would every dental procedure done be entered to be billed for?
Jill Coon: I am going to go that, okay I’m going to use the client’s office that I was in today. At least twice a week I’m finding something that is not billed or more, but at least twice a week.
Howard Farran: Yeah I don’t think I have ever seen it. I mean of course maybe all my friends are not as attention to detail in the front office, but I have never seen it. I used to go in there and say buddy, let’s run this and then look and you go through it and you always find 200, 300 bucks and it’s like how do you not run a daily report if it’s always going to be 200 or 300 bucks? I mean that just paid, I mean 200 to 300 bucks, that’s huge money. So then the un-submitted claims. So what are you saying, they’ve entered the claim and they’ve sent the claims out over the internet and something didn’t go through or what are you saying there?
Jill Coon: Accidentally forgot to submit the claim. Procedure is not attached to insurance. In SoftDent that’s called an un-submitted claim. In Dentrix it’s called procedure not attached to insurance. So basically if you run your reports every day, you find out what you didn’t submit, because now insurance companies have timely filing. They didn’t have them a couple of years ago. Now we’re down to like 30 days. If you don’t submit your claim within 30 days for some policies, you’re out of the money. So good luck trying to balance bill that patient. So I suggest that you run it every day, so that way you don’t lose that.
Howard Farran: And what about, give docs some numbers. If she has a hygienist that sees eight patients, you’re a hygienist, do you recommend pre-appointing the next patient? Would that be unscheduled treatment if your patient came in and wasn’t scheduled for a six month clean, does that fall under unscheduled treatment in your mind?
Jill Coon: Yes is does, because, this is a separate recall report, but yes it still does. It does fall under unscheduled treatment because what happens is, some people believe in pre booking, some people don’t. It depends on the patient, it depends on if you know that they’re going to definitely show up. If those that cancel all the time, you don’t want to do that but you also want to have blocks of time for new patients so depending on how your office is flowing, you want to make sure you have enough time to allow for every patient to be in that schedule. But, the bottom line is, you definitely want to…I’m sorry…you definitely want to be able to get them in the schedule and you definitely want to run a recall report to be able to get them scheduled again. So to me, yes it does fall under the unscheduled reports.
Howard Farran: And I want to say one thing, if your dental office is listening. I know that a lot of people do podcasts for staff meetings and all that , but you know what, treat other people like you want to be treated and in America there is a 150 000 dentists, 120 000 general dentists and 30 000 specialists and one million staff and those people, whenever they have a medical emergency they always go to the emergency room and they just walk in without an appointment, and in my office, we tell the staff if someone walks in or calls in pain then we’re going to see them and we’re going to work back from that and we decide in the morning huddle who is going to go through lunch with Howard, because I’ll give up lunch. I mean I’m 30 pounds overweight, I see fat as just future meals already eaten. So I’ve got at least a week’s supply of meals already in my abdomen and usually the assistants who have children, who have to leave at five, they’ll say okay I’ll go through lunch because I don’t want to go after five, and then my two assistants without children, the smarter ones with higher IQ’s and much more money, they’ll stay late because they don’t have to do that, but so yeah, we do not turn down people in pain. They don’t do it in hospitals and real doctors don’t turn down emergencies and also, it still saddens me to know of one patient that we lost, that we never saw. They died of Ludwig's angina. She was only six years old. I’ll never forget her name, her name was Chastity. I mean it’s just amazing how an infection, some of these superbugs can just go crazy and it went from an abscessed baby tooth to the middle of the night she suffocated because her whole neck swelled up. I mean just crazy. But emergencies have to be seen and that’s what they call an office culture. The fish rots from the head down and it’s got to be the doctor that sits there and says if you have a policy, same day new patients, if a new patient wants to be seen that day, that can be tough but same day emergencies no. They call front desk, they say I’m swollen, I’m in pain, I hurt, I can’t sleep, I can’t eat, I can’t drink we just say come on down and we work back from that problem. You know that’s why we have an extra operatory for an emergency room and that’s why the staff has the right attitude, that’s like- and sometimes they’ll just call, it’ll be a reasonable patient like you, and those call you up and say you’re scheduled in two hours to be seen for something routine like a filling. Jill, I’m so sorry but we’ve got this lady and she’s swollen, she can’t sleep, she’s crying, she’s upset. Is there any way Jill you could reschedule your simple restorative filling or crown or whatever and there are always- everybody likes to help someone. So we never have problems, just a simple phone call and we do that too when they’re running late. But this is about you, not me, I’m talking too much as usual. So Jill, I’ve got four more minutes with you. Give them low hanging fruit on these reports. You’ve talked about unscheduled, claims that didn’t go out, you talked about the day sheet. Actually I think the problem with the day sheet is going to be most people, especially younger dentists don’t even know what a day sheet is. Define what a day sheet is, first of all.
Jill Coon: The day sheet is the procedures that have been done for the day and totals the amount of production and collection for the day. So you want to do a balance and check what the day sheet is, and your year to date, is also gives you that to see what is going on. Where you’re at with your numbers and you can find out what’s billed to insurance, what’s not and it usually lists it on there.
Howard Farran: Okay so tell us again, right now in these final minutes, what do you run at the end of very single day?
Jill Coon: I run a day sheet, un-submitted insurance, I submit all my claims and then I want to see the report that goes out to the insurance. Like did my claim get accepted or rejected? I want to go ahead and if they’re rejected I want to fix it so that I can send that out and get them going. Because I don’t want to find out in month from now that they never received my claim so that one. What else do I run every day? The audit trail like we talked about. I am just trying to think. Now you have put me on the spot, thank you. What else…the insurance report...the insurance report I run once a month over 30 days, some people do it weekly. I think that’s overkill. I think it depends on the volume of the practice. If you have 22 chairs then you need to do that, then by all means do it, but if you’re anywhere up to six operatories, you can do it once a month. What else…the credit card terminals, you want to batch them and make sure they are done, closed up for the day.
Howard Farran: That is a…my embezzlement friends are saying that the credit card terminal now is a new hot embezzlement thing. What are they doing there? I forgot the specifics, have you heard?
Jill Coon: Yeah they are opening up a new bank account with your name. For instance do you stamps? Does your office have your stamp signature where they can sign your insurance forms and stuff like that?
Howard Farran: Yes.
Jill Coon: Say bye-bye. Throw them in the trash. You need to signing them yourself because I can, you know I’ve been here for 10 years. You trust me, you like me, you know that I’m going to do a good job. I can take that and this is courtesy of (unclear), but they can take that if they’re thinking like a criminal, they can take that and say I work for Dr. Farran, here’s his driver’s license, could you give it to me? I’m going to go and open up this bank account somewhere else and then I can call the credit card processing company and route it into a different bank account and take your money without you knowing.
Howard Farran: But they’re doing it with the credit card too. They take a patient’s…I forget the details.
Jill Coon: Yeah that’s different. They will take the patient’s credit card numbers and use it somewhere else. Is that what you are thinking of?
Howard Farran: Well some dental office staff are taking the patient’s credit card number and buying stuff online for themselves, but some are…I think they pay the credit card and then when the patient leaves, they…I forgot. It was on Dentaltown. They debit it back or they debit it back to a different account or something like that.
Jill Coon: Yeah they have to open a separate bank account to be able to do it to get it to go to the other account.
Howard Farran: Well I can’t believe our hour is over and I just want to say that I’m big fan of your posts in Dentaltown and a big fan of your posts on Facebook. I love the videos you post of your daughter dancing, your daughter is just…how old is she?
Jill Coon: She’s 10.
Howard Farran: She is 10 years old?
Jill Coon: She’s 10 years old. She’s singing tonight in a competition again.
Howard Farran: I remember, I think when she was six was the first time I saw her on YouTube singing the national anthem or something, what was it, was it the national anthem, how may years ago was that?
Jill Coon: Well she’s been singing since she was five really and I think two years ago she did the born to fly video. That was her first professional video and then she started doing the national anthem and then recently she has been doing it a lot. She did another video last year. She someday hopes to be on The Voice, so we’ll see.
Howard Farran: What’s funny is when people say there is no such thing as a good or bad singer, you know it’s just you and you sing and there’s no right or wrong, it’s just singing. I’ve had four boys and when every one of them, before they were one, I’d be rocking and I’d be singing, they’d reach out with their hand and put their hand over my mouth like no! Daddy no! And I thought man, when a one year old kid wants you to quit singing, you are a horrible singer. But hey Jill, I just wanted to thank you seriously. You’ve been in this for 30 years, you’re crushing it and you’ve helped so many people on Dentaltown and Facebook. I’m your biggest fan and thank you so much for all that you do for dentistry, for all that you do for Dentaltown and thank you so much for spending an hour with me today.
Jill Coon: Well thank you for having me Howard, I appreciate it.
Howard Farran: And one last time, if they want to get in contact with you www.jillcooninc.com.
Jill Coon: Correct.
Howard Farran: Okay. Alright, thank you very much Jill, have a rocking hot weekend. Bye-bye.