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Real-time Transaction Technology Transforms Libbey Family Dentistry Annie Libbey, DDS, and Kerri Goodrich

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by Annie Libbey, DDS, and Kerri Goodrich

As our name implies, our practice is a family affair. Libbey Family Dentistry in Forest, Virginia, is a husband-and-wife team (Drs. Chris and Annie Libbey) complemented by a part-time associate dentist, three hygienists, two chairside assistants, one sterilization technician and two administrative team members.

We provide comprehensive dental treatment to patients – ranging in age from one to 100. This treatment includes preventive, pediatric, cosmetic, general and periodontal services. On average, we see about 200 patients per week, making sure that each is offered information about their dental care. We often explain the links between oral and systemic health, and frequently work in conjunction with our patients' physicians.

Because we're concerned with our patients' overall health and education, we've actually turned our sterilization center into an instructional tool by positioning it in the center of our practice. That way, we can describe our sterilization process and discuss how it prevents potential infection from the wide variety of microorganisms found in blood and saliva. In addition, our patients can easily see our commitment to infection control.

Limited Infrastructure for Technology
In 2005, after completing an Advanced Education in General Dentistry Residency program, we moved to Lynchburg, Virginia, to transition into the practice of a retiring dentist, Dr. William P. Lea. At age 74, after a distinguished 43- year-long career, our mentor was held in high regard by his clients and the community. Lea graciously turned over his patient list and helped us get to know them, clinically and personally. However, technology was not a high priority in the office we inherited.

Limited by the existing infrastructure – a DOS-based medical records system and no Internet access – our practice was forced to communicate with payers and process insurance claims by snailmail and telephone. As you might expect, reimbursement turnaround time was slow.

It could take four to eight weeks to hear back from an insurance company just for a predetermination. Then there were telephone calls – and usually follow-up calls – to our patients to inform them of their payment picture for a specific treatment. There was no sense of urgency to the process, and by the time we relayed coverage and eligibility information, clients would sometimes decide to forego treatment if they perceived the out-of-pocket expense as too high.

Claims management and payment was just as slow and frustrating. After calling payers to check eligibility and benefits details and submitting paper-based claims, we would sometimes wait up to two months to fully close out a claim and collect payment from the patient and the insurer.

All these paper-based processes carried associated costs of printing and postage, not to mention the expense of staff time spent conducting multiple phone calls with payers and patients, printing statements, and stuffing them into envelopes. In terms of our bottom line, these processes were negatively affecting cash flow and stretching out payment cycles.

But it wasn't just the fiscal cost that bothered us – most importantly it was the cost to patient care. In addition to the overhead involved, these time-consuming, manual tasks limited our ability to focus on improving patient care and building patient relationships.

In Search of a Better Way
Over the years, we steadily updated our dental records system and adopted emerging technologies such as digital radiography, gradually taking the steps we needed to modernize our practice. We realized the next level was to automate benefits, eligibility and claims transactions with payers, but in 2008 we lacked the space and infrastructure to do so. As the practice grew, we made the decision to build and relocate to a facility in Forest, Virginia, which would include six operatories (with room to expand to nine), a sterilization area, three checkout areas up front and much needed storage space.

In January 2009, we moved into the new office, complete with high-speed Internet access, computers at every desk and operatory, digital progress notes and our state-of-the-art sterilization center. Our goal of a paperless practice was now within reach, and the time was right to transform front- and back-office processes with automation and real-time payer communications.

Although half of all dental practices still rely on "tried-and-true" paper-based claims processing, industry statistics show a trend toward automating these processes and implementing real-time communications with payers. Automation and real-time transaction processes take the guesswork and hassle out of insurance and also help dental offices cultivate a loyal, satisfied patient base by:
  • Delivering a seamless and efficient patient experience;
  • Providing patients with their exact financial responsibility while still in the office and eliminating the need for a subsequent patient statement;
  • Assisting patients in understanding their benefits during an appointment so they can easily ask questions and address concerns; and
  • Offering a more complete treatment planning consultation by submitting a predetermination and receiving benefits details in real time.
With these benefits in mind, and knowing the technology would help us accelerate cash flow and minimize claim rejections caused by manual errors, we decided to implement technology which would facilitate automated eligibility, adjudication and reconciliation processes. The issue then became which system to implement. After talking with other dentists, we learned about MDE real-time, Web-based insurance information solutions. Several colleagues were already using the system and were enthusiastic about its ability to access insurance benefits, eligibility verification and predeterminations in a single mouse-click.

Based on these recommendations, and after research of some other vendors conducted by our office manager at the time, we selected Mercury Data Exchange (MDE). By February 2009, it was fully operational in our new office. Because the system is Internet-based, it required no software or hardware purchase or installation.

After just a few short months, we started realizing significant back-office benefits, including a 20 to 30 percent weekly reduction in paper expense and about $200 savings each week in postage costs.

Because electronically submitted claims are far less likely to have errors, our rejection rates also dropped dramatically, and are now more in line with the industry average of two percent. Moreover, those claims, which are rejected can be corrected and sent back to the payer within the same business day for reconciliation, further minimizing payment delays. As opposed to waiting up to two months for payment with paper processing, we are now collecting insurer payment on clean claims in as little as two weeks.

Goodbye, "Sticker Shock"
As difficult as paper processes were on our business, they were literally hurting our patients suffering with unresolved caries, abscesses and other painful conditions as they waited for responses from their insurance companies about treatment coverage.

Real-time predeterminations and pre-estimations, where additional documentation is required, have changed that. With on-the-spot insight into benefits, we now provide accurate numbers for insurance coverage and out-of-pocket costs – while we're face-to-face with our patients. It allows us to truly "inform before we perform" and helps to eliminate the dreaded "sticker shock" about costs. We can also educate patients about their insurance coverage and answer questions about clinical and financial issues. In general, we have found patients are more likely to accept the care we recommend – and pay for it in a timely fashion – when the treatment and financial conversations are held concurrently and backed up by X-rays and other documents.

Another benefit is our ability to schedule appointments to coincide with pay periods, or structure payment plans tailored to patient needs. Sometimes we can help them secure a third-party credit card, which automatically pays us on time and allows them a three-, six- or 12-month payment period. These services along with MDE help us collect payments faster and prevent missed appointments – and subsequent lost revenue – for fear of resulting costs. We can even use the real time predetermination to find out when the next X-ray will be covered based on patient history.

Our patients love knowing on the spot how much insurance will pay and how much their copay will be for a given treatment. We can also help them avoid surprise dental bills that arrive months after treatment. When they know about their out-of-pocket costs in advance and can plan for them, they're approximately 80 percent more likely to pay – sometimes even before treatment begins.

A Practice Transformed
Between the move to our new facility in Forest and the adoption of real-time, Web-based EDI transaction solutions, our practice has been transformed. The new facility has plenty of room for our growing patient population, and with real-time transaction processing technology, we can deliver the responsive, patient-oriented care that keeps our chairs filled.

As an office, we're presenting a more professional, modern image. In the back office, our administrative staff no longer spend hours on the phone with payers or searching through payer Web sites. They're now free to sit down with patients, explain the financial options available for recommended treatment plans and ensure more effective care. As a business, we've streamlined communications with payers and patients, maximized our cash flow, reduced administrative expenses, eliminated time-consuming manual processes and shortened payment cycles.

Perhaps the most important benefit is our ability to provide patients with the care and information they need to maintain their dental health. As dentists, we have more time to spend with patients and focus on their treatment because we're no longer dealing with the hassles and headaches of paper-based insurance eligibility, benefits and payments.
Author Bios
Dr. Annie Libbey is the co-founder of Libbey Family Dentistry and Kerri Goodrich is the practice's insurance coordinator. For more information, e-mail annie@libbeydentistry.com, call 434-316-9090 or visit www.libbeydentistry.com.
Dentaltown Magazine
September 2025
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