Episode #510: Are You Billing Your Full Fee? with Ariel Juday

You think you're billing your full fee — but you're not! So, to help you get the pay you deserve, Kirk Behrendt brings back Ariel Juday, an amazing ACT coach, to explain why billing your full fee is crucial, how to train your team members to do it, and ways to not be the limiting factor to collecting your full fee. Stop working one out of every three days for free! To start collecting your full fees today, listen to Episode 510 of The Best Practices Show!

Episode Resources:

• Ariel’s email: [email protected] 
• Ariel’s social media: @actdental  
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Links Mentioned in This Episode:

AADOM: https://aadomconference.com

Main Takeaways:

Understand the consequences of not billing your full fee.

Train your team members to always bill your full fee.

Involve your admin team and ask for their input.

Show patients the true cost of your dentistry.

Check your fees annually to be up to date.

Don't assume patients can or can't pay.

Quotes:

“The most important part is you want to show the patients the value of dentistry. If we’re not showing them what it costs, they're not going to know. So, we’re giving discounts, or we’re showing our PPO fee. They're going to think, ‘Oh, this is normal. This is what it is.’ So, we’re not showing them the true value, and they're going to make up their own numbers in their head based off of what they're seeing.” (3:43—4:08) -Ariel

“You can't make decisions off of your practice if you're not seeing the real numbers. So, if we’re billing our PPO fees because we think that it simplifies our processes, we can't make true decisions because we don't really know what the fee is, what is our overhead for that procedure. We really can't make decisions, and we don't know if we’re keeping up with our PPO fees. So, the easiest is to bill our fee and let the PPOs keep up with us.” (4:11—4:44) -Ariel

“Your practice management software is going to try and tell you to put in the PPO fee and bill it. Because that way, when insurance pays, you don't have to do the individual write-offs, and your team doesn't have to focus on anything. So, they make it sound like it’s super easy. A lot of practice managers and team members who don't really know the unintended consequences of not billing your full fee, they also think it’s easier. They think it’s saving them time. But really, the unintended consequences are they could be making mistakes.” (5:11—5:47) -Ariel

“I've seen lots of dentists give back refunds to patients that were never deserved because we’re doing multiple write-offs, because we don't know how to read the EOB and the ledger. So, that's why to keep it simple is actually to bill the full fee. When the insurance check comes in, then we can make the appropriate write-off. We know everything is correct right there. And people say, ‘Oh, that takes me more time.’ In the end, it really doesn't. Because now, you're not auditing accounts later. You're touching it, you're one and done.” (5:47—6:19) -Ariel

“Make sure that our claims are being sent with the full fee. And usually, it’s in your settings. It’s a little checkbox for setting up those claims. You want to make sure your insurance claims are sending your full fee. That's the most important part, because that's so easy you can do that change tomorrow without affecting anything in your software.” (7:43—8:05) -Ariel

“What about the ledger? What are we showing on the ledger? This is one that if you're not showing your full fee on the ledger, I don't recommend doing it right when you get off because it’s going to be a change in the way people are seeing it, the way your patients are seeing it. So, you want to make sure you communicate with the team of the change. But it is a simple change. You go in, and it’s another checkbox showing your full fee on the ledger. Now, this means you have to do a little bit of work, which becomes software-specific of, ‘Okay, but I want to give accurate estimates.’” (8:08—8:42) -Ariel

“That's the important part, is giving patients the accurate treatment estimates. Each software is designed that you can still do that based off of the PPO fee schedule. And this is where the hard work comes in, is you have to still have those PPO schedules put in. But if you've been billing your PPOs, then you definitely have the fee schedules. And you can still do this even when you're out-of-network, is giving them an estimate as well based off of this fee schedule. Your software knows whether to give a discount or not based off of how you input it.” (8:43—9:15) -Ariel

“At least [check your fees] every year. At least check to make sure, ‘Am I up to date?’ And then, throughout the year, spot-check. See some of those big codes, your top 20 codes that you're billing. And we always say if it is a code that a patient is going to see a lot, so their prophys, their bitewings, things that they may be paying out of pocket for or they see more often because they get them done more often, those, we don't want to make a huge increase right away, because then patients are going to think we’ve been deceiving them. But ones that they don't see all the time, the extractions, the crowns, the root canals, those, you can make a bigger increase if you are behind.” (9:34—10:16) -Ariel

“If you are in-network with PPOs and you increase all of your fees, just know you're not going to get a huge check tomorrow. It takes time. But we need to let the insurance companies know as well, ‘Hey, this is how much it costs.’ And if all of us are billing a higher fee for a crown, the hope is, eventually, the insurance company will reimburse a little bit more.” (10:29—10:51) -Ariel

“I know people are like, ‘Oh. Now, you want me to audit.’ But if we’re billing our full fee, we’re looking at every EOB to make sure the payment is correct. And so, you can start catching those things right away.” (12:24—12:35) -Ariel

“You also want to audit your EOBs because insurance companies, they're a business. And they hope that you take what they paid and what they said as fact. And you'll see that they’ll deny some things. Cores are denied a lot because they say, ‘Well, you didn't show proof.’ And all you have to do is send in either the seat date or send in an appeal. But they don't want you to do that so that they don't have to pay. But if you have that process in place that you're reading each EOB and seeing and fighting for what you deserve and what your patient deserves, you can catch those. It does take a little bit of extra work. But insurance is hoping that you're going to roll over and take their fee that they give you.” (13:28—14:15) -Ariel

“The team members aren't the ones setting the fee, so they should not feel bad about it. It’s, ‘This is the fee.’ And for doctors who say, ‘Oh, that's too much,’ no, that's your fee. That's what you should be paid. Value what you do. We don't question the value when we go to the grocery store, ‘Ah, that's too much. I should get a discount.’ No, that is the value. And that's why we want to start showing the patients now. Because as you get out-of-network and now you have to start showing them, at least patients saw, ‘Oh, okay. My crown cost $1,500. But because of my insurance plan, I was getting a discount.’ They already know that, so they don't think, ‘Oh, you've just now tripled the price of your crown.’ So, that's why I want everyone to start showing it now and saying, ‘Hey, this is the value of a crown.’ That way, later on, they say, ‘Yup, I've seen that number before. That's not a shock to me.’” (15:50—16:49) -Ariel

“From my perspective, it’s the team members that project their own feelings that get the results of the hesitancy from the patients. So, we cannot judge any patient on what they can pay. And I always make a joke, we don't know what they have behind their walls or in their couch. Make it fun. Like, we don't know where they're hiding their money. And if they want to pay for it, they will. But I'm not going to assume that they can't pay for it. Assume that everyone can and will pay for it, and they will tell us differently.” (17:38—18:13) -Ariel

“If [patients] say, ‘Oh, I can't afford that,’ okay. Well, now, I go back to my financial agreements and my system within my practice of, okay, what options can I offer? Do we have a payment plan? Or do I say, ‘Okay. What is your paycheck schedule? Are we able to push you out two weeks so that it falls on a paycheck period?’ That's when you start letting the patient decide of when they can pay for it and how they can pay for it. My job is to tell them the value and tell them the investment, and then let them tell me yes or no. And if it’s a no, okay. Now, I'm going to come back with some solutions for you to help you start thinking, ‘How can we make this work?’” (18:15—18:57) -Ariel

“Some team members say, ‘I can't afford that.’ You can if we have the right agreement in place. Same with patients. They may not be able to pay for it today, or they maybe can. We don't know. We have to let them decide that, not us.” (19:00—19:15) -Ariel

“Admin team members are not given excellent training on verbal skills and fees. And when they are, they shine. They can shine. It’s the dentists that becomes the limiting factor on full fees.” (19:49—20:01) -Kirk

“I've had so many dentists say, ‘Oh, Ariel. Let's give them a discount.’ And my first question is, ‘Why?’ And they're like, ‘Well . . .’ And then, it’s, ‘Oh, they can't afford it.’ I'm like, ‘Did they tell you that, or are we assuming that?’ We can't assume, and then I go in and present the value and say, ‘Hey, this is your investment,’ and they tell me, ‘Okay,’ and then I come back, and I'm like, ‘Oh, hey. You owe me that discount you wanted to give because they're willing to pay your full fee.’ It’s in our mind, and the dentist starts thinking like, ‘Oh, maybe this one will be easier.’ But maybe it won't. You can't charge that. The value of a crown is a value of a crown, and you just have to go with it. And once again, you have to value your own work. You're the one doing it. Stop giving out discounts just to hand them out.” (20:06—20:58) -Ariel

“I tell [patients] the value, and they look at me, and I just smile. I'm great with the awkward silence because it’s like, okay, I'm going to let you process. I'm just here smiling, letting you know. I'm not backing down from it. ‘This is what it is. This is what you need.’ And then, they come with a solution, and they say, ‘Oh, okay. How about I pay this? Do you take credit card?’ ‘Absolutely.’ So, it takes time.” (22:10—22:37) -Ariel

“Make it fun for the front, because talking about money is not fun for everyone. And that's where it goes to right people, right seats. You have to have someone who’s okay with talking about money. But I say one KPI that they can track is the over-the-counter collections. And each day, they can say, ‘Hey, guys. Guess what? I collected 100% of what I was supposed to.’ And it makes it fun because it’s an easy accomplishment for them. Or they can celebrate those hard balances. They're like, ‘Augh! I've been chasing Ms. Mary down for months. And today, she paid!’ That's a celebration. And we know it’s not all about the money. But if we’re not collecting the money, it doesn't matter what you're producing.” (22:39—23:20) -Ariel

“You have to take it step by step. You can't go tomorrow and say, ‘Okay, I'm going to bill my full fee. I'm going to drop all my networks, and then I'm going to be a millionaire.’ It doesn't work that way. We have to take it one step at a time and get your team involved, especially the dentists that don't know what's going on at the administrative level. Ask them and get them involved in the process. See how it may affect their day and their processes. And some of it, they may come back and say, ‘Oh, we can't do that.’ Ask them why, and ask them why again, and say, ‘Well, can we try this? Can we try it for three to six months and see what happens?’ Very rarely, will they go back to the old way.” (24:11—24:51) -Ariel

Snippets:

0:00 Introduction.

2:31 Ariel’s background.

3:27 Why it’s important to always bill your full fee.

4:45 Unintended consequences of not billing your full fee.  

7:17 What team members should pay attention to in the software.

9:16 How to systematically update your fees.

11:44 Irregularities in auditing and shared agreements, explained.

15:03 Start showing patients your full fees now.

17:05 Let patients tell you what they can afford to pay.

19:16 Dentists are the limiting factor on full fees.

22:38 Make collections fun for the admin team.

23:23 What to expect by billing your full fee.

25:25 Last thoughts.

Ariel Juday Bio:

Ariel has a master’s in healthcare administration and several years of dental experience in all aspects of the administrative roles within the dental office. Her passion is to work with dental teams to empower team members to realize their full potential in order to better serve patients, improve office systems to ensure a well-functioning team/office, and to help everyone have fun in the process!

Outside of work, she can be found by the beach or the pool reading a good book, enjoying sporting events with her husband, Alex, or exploring the outdoors with her Bluetick Coonhound, Maddux.