Stop Giving CT's Away and Bill to Medical Insurance!

I rarely see a dentist bill out every single CT, if at all, because they know that dental is not going to cover it. And they're also I think somewhat concerned about the restriction and the limitation of how much benefit the patient has for the year. Welcome to the Phil Klein Dental Podcast. In today's episode, we're exploring a common challenge faced by dental practices, the limitations imposed by dental insurance on billing frequency for CT scans. Many dental professionals find themselves navigating restrictive policies that hinder their ability to provide comprehensive care for their patients. But what if there is a solution lying in plain sight? What if dentists, as medical specialists, could leverage a different avenue to build for these essential scans, not only unlocking a significant financial opportunity, but also enhancing patient care and well-being. So let's get right into it as we discuss the potential benefits of tapping into patients' medical insurance for CT scans. Not only does this approach offer a pathway to financial growth for dental practices, but it also facilitates more regular screenings for oral cancer, ultimately leading to better outcomes for your patients. Our guest today is Kandra Sellers, a registered dental hygienist with over 25 years in the dental industry. She is widely considered one of the most passionate and respected dental coaches. She is an educator in the field of oral systemic health, as well as founder and CEO of Tips Medical Billing. Kandra will be joining us in a moment, but first... it comes to patient dental chairs, why choose between sitting or standing when you can have both? Experience the perfect blend of ergonomics and intelligence with the new Forrest 6400 chair from Dentalese. As the highest rising chair in the industry, the 6400 offers unparalleled treatment flexibility, allowing more dentists to practice without pain. your patients are less likely to interrupt your treatment as they relax in the soothing warmth of adjustable heat and massage, in the comfort of plush ultra-leather cushions and optional neck and knee pillows. And with ARIS Intel, the new standard in smart technology, you'll gain insights into practice efficiency, revenue, and maintenance, all from the only chair that monitors data at no extra charge. For more information, contact your local DSX rep. or visit DentalEase.com. Kandra, thanks for joining us. Thank you so much. Thank you for having me. I'm excited to be here. Yeah, we're very happy to have you. And your other podcast that you did was excellent and got great engagement. So we're happy to have you back. So to begin this one, why do you feel that dentists are, quote unquote, giving CTs away? And do you mean they are not getting adequately reimbursed or just, in many cases, not charging anything for it because the patient doesn't have coverage? I would say both. I really believe in dentistry. We give a lot away because we know that dental is not going to cover it. And so we feel bad and we love our patients. They're like family to us. And so we just don't bill for it at all. And how often do you think that's happening across the board where dentists are doing CBCT? diagnostic imaging, and they're not getting paid for that? Every day, all day. See it all the time. See, I rarely, I can be honest, of the clients that I help, I rarely see a dentist bill out every single CT, if at all, because they know that dental's not going to cover it. And they're also, I think, somewhat concerned about the restriction and the limitation of how much benefit the patient has for the year, $1,000 to $1,500 on average. They don't want to tap into that. Okay. So they don't want to tap into that. And what amount are we talking about that they would be tapping into? What's the fee that would be used for that typical CBCT? You know, I see anywhere, I've seen anywhere as low as $175 all the way up to $600 reimbursed on a CT. It's really going to come down to the patients, the quality of their plan. It's going to come down to the payer as well. So essentially, Kendra, you're saying that practically every CT taken in a dental environment should be considered to be billed to the patient's medical insurance. Is that right? Absolutely. As long as it is medically necessary. I've heard this multiple times, you know, when a dental practice gets a CT and they start utilizing it, they can see so much, which is fantastic. However, that doesn't make it. medically necessary to bill to medical. So a lot of times they'll say, well, I want a CT on every patient because I can see so much. Well, that doesn't mean that it can be billed to medical. It has to be medically necessary. Now, that being said, there's lots of things that we see on that CT that make it medically necessary. Is there bone atrophy? Is there pneumatization of the sinus? Are there impacted teeth? Is there disuse atrophy? I mean, there's so many reasons why we could take a CT and bill it to medical and make it medically necessary. So that's typically not too hard to find a reason. But, you know, again, that doesn't mean that you should take one on every single patient and bill it to medical. Has to be medically necessary. Has to be identified medically necessary using diagnostic codes. So let's use my profession, Kendra, as an example. A patient comes in, they have a history of trauma. They fell and hit their lower anterior teeth. They come into the office. I take some 2D radiographs. I don't see anything that's abnormal. They are sensitive, which is typical to having an incident of trauma. That doesn't seem too out of line, but I do want to rule out any kind of fracture of the mandible, of course. So I take a CBCT, and I also want to look for vertical fractures, which is very challenging to find even on CBCT, but it's worth taking a look. How would I handle that as far as medical insurance billing? Because it certainly seems like it falls under the category of medical necessity. Well, in that situation, I would start with the trauma. There's trauma involved that was a blunt force injury to the face that now you're looking at, you know, is there potential for a fracture? Okay, so in this example, it's clearly a medical necessity. What about the medical insurance company saying, well, you could have just taken a Panorex? So a pan is considered a screening image. It's 2D. If you see anything on that pan that indicates the need for a CT, a 3D image, you can then move to your CT. That being said... This is where we get into the limitations of dental and frequencies and all that we have been brainwashed about frequencies. So in dental, we can take either a pan or an FMX every three to five years. That's where my hygiene brain goes. We can do those every three to five years, which is the craziest thing. And we have to choose between one or the other. And we all know that they are completely different images. But remember, dental is a benefit plan. not based on what the patient needs, right? Right. So we get out of that limitation. So if your CT extracts a pan, you could actually bill out a pan, a CT, and the slices of the CT, the tomographic study, all in the same day on the same patient. And if you needed to, so let's say with a surgical patient or that patient that. potentially needed endo. You could do that the day that you see them for the evaluation. You could do the evaluation and a CT. You could do another CT the day of surgery. And 91 days postoperatively, you should have that patient back on your books for an assessment of the surgical site. And you would bill out another evaluation and CT. So forget about frequencies when it comes to medical, as long as it's medically necessary on the data service. Wow. I mean, this is such a stark contrast to the mindset of a dentist who's relying on these scheduled calendar-based, you know, situations with dental insurance companies. They dictate your practice, the dental insurance companies. Absolutely. Thank you for saying that. Well, no, I mean, it is true. They dictate how much we can charge, when we can charge, how often we can charge, and how little we can charge. Because again, we're basing this on dental fees, not on what medical allowances are. Right. So the question is, how much dentistry is being done by a general dentist? Let's start with a GP. How much dentistry is being done in a GP practice that falls under something that's related to medical? What percentage? Because that would, in my opinion, that's the question I would ask if I was a GP and looking to hire you. I would say, Kendra, you know, what should I be expected to, what proportion of my practice should I be expected to be looking into medical billing for? And I know every practice is different, but typically, what would a GP fall under? Well, it depends on if that GP is doing surgeries and things like that, because so many are now. But again, you can look at your evaluations. We could look at your PANS, your CTs, lateral CEPH. What about TMJ? A lot of even general dentists are, you know, giving out occlusal guards. I can tell you mine was covered at $1,100. And what I typically see a general dentist charging for that is, you know, $300 to $500. Yeah, and those things are 3D printed now. So, you know, that's a very profitable thing to collect on the medical side if you 3D print that for like, you know, $20 or less. Absolutely. So, you know, even on a on a basic general practice, and if you are in network with the dental insurances and writing off 30 to 40 percent, even if you captured even if you captured one third of your evaluations by going to medical, you have nothing to lose. And those are easy peasy claims to be reimbursed with very little follow up. We'll be getting back to Kendra in a second, but first, if you're a dentist who understands the importance of diagnostic accuracy and treatment planning, then you're probably thinking about CBCT for your practice. With the advent of CBCT, the limitations of 2D imaging and the clinical guesswork that goes with it are now things of the past. So the question is, which unit should you buy? Of course, you do your research, ask your colleagues, and talk to different companies. But before you make your final decision, check out the models by Merida. As one of the first companies to market in CBCT, Merida has refined its features for simple, accurate positioning and provides multiple acquisition modes and fields of view. Well known for remarkable image clarity, their technology will help you diagnose apical lesions, root fractures, cysts, TMJ, and so much more. So when you're ready to embrace the transformative power of CBCT, check out the state-of-the-art equipment by Merida. To learn more, visit marita.com slash USA. So you were talking about oral cancer screening. There's a huge surge in throat cancer, you know, HPV related. And that has been going up dramatically. And according to medical experts and reports, the main reason for that is patients are not being screened for it. And the most frequently visited healthcare provider. is the dentist. And all the dentist really needs is a longer throat swab to get back there to do a pharyngeal swab. That should be done on every single patient. They should be taking a swab of the throat just to find out if there's HPV present and how often that HPV is there. They do it over a period of a year or whatever, several different times. How is that covered under medical? So one of my... favorite companies is Oral DNA. And they have a test that actually, it's a swish and spit. And you need to get it way back in the throat. You need to gargle with it, spit it back into the vial, and you send it back to them. And they test for 51 or 52 strains of HPV. So you will have, you know, you'll know if you're even, if the virus is even lying dormant in your body and puts you at risk for any types of cancer. I just went through this with my cousin who actually just had a dissection of his throat because of... lump that he found, you know, probably while shaving or whatever. And, you know, ended up being stage one cancer. He's just finishing up his 33 rounds of radiation and seven rounds of chemo for stage one. And his, his cancer's primary diagnosis was cancer of the parotid gland. So, you know, it is our wheelhouse. And in fact, on Facebook this morning, I just. posted something about what is included in our exams that a colleague of mine, Kathy Forbes, posted. But she posted an article that I believe was in Dental IQ, maybe, that a dentist was sued. I think it was for $11 million for not identifying an oral cancer. And I'm telling you, our number one reason for lawsuit in a dental practice has been periodontal disease, undiagnosed and untreated. I truly, truly believe wholeheartedly the next thing is going to be oral cancer. I've been saying that for years because it is our wheelhouse. It's our responsibility. Right. So the question is, and I know we're getting off the topic a little bit because we're talking about giving away free CTs, but getting back to the medical billing on that, how does one adjust their their behavior on a regular basis in their dental office by testing for oral cancer all the time and throat cancer and getting paid for it. um you know at the at something that's that's a fair price which i think would be necessary to go through the medical side right yeah and i i think we i think a lot of these things this testing gets thrown by the wayside because we're only getting reimbursed on average 35 for a periodic eval even though it is part of the eval it is in the It is in the description of all evaluations that we have to screen for maxillofacial and oral cancer. But it's not getting done because we're on this hamster wheel because we're trying to get that $35 for evaluations, which is nothing. And so, you know, we could actually take, we could actually do these screening exams as well as a PAN every year to screen for maxillofacial and oral cancer. You could do a PAN every year based on that and bill it to medical. What's the reimbursement for that? Well, I will say that is one thing that is not reimbursed well by medical. I think... Based on CMS for Medicare, it's under $20. But if you can save somebody's life, it's well worth it. And then, of course, you've got the salivary testing that can also go to medical and your evaluation can go to medical. So it's not so much the pan. It is definitely a tool. And we don't we're not bound by the dental frequency issue. But if you come up with a package that is, hey, we have oral cancer, maxillofacial cancer screenings, and this is what it includes and give the patient a package that includes the evaluation, that includes the. pan that includes a Valscope or oral ID with an advanced oral cancer screening. And guess what? We also have this swish and spit that you can see if you have If you have HPV, which puts you at a higher risk. Those are all things that we can do to elevate our profession and elevate early diagnosis. We know that once we see the oral lesion, if we see an oral lesion, and even if it's the size of a pin, it could be stage four at that point. We want to prevent. We want to prevent. That's the key, right? Right. So the number one thing is prevention. But on this topic, as far as getting reimbursed from medical, if they put this little package. together that you're talking about, the office will be incentivized to continue to do this, which is better for the patient, of course, but it's also better for the practice because the practice is a business and they have to make money during chair time. They have to pay their bills. So what would that package look like as far as reimbursement if they did what you just described coming from medical? Well, that depends on what the practice is comfortable charging for it. Again, our mindset is to charge. hardly anything when medical will pay them more for it because one, they want people to do it. One, they don't know what they don't know as far as allowed amounts. For me, it really comes down to working with the practice and getting them to understand what is possible. and coming up with a price that they feel comfortable offering to their patients. And everybody's philosophy is different with that. So all this is part of the services, obviously, Kandra, that you offer in your business to dental practices. Is there some sort of preliminary interview that you could do or an assessment with the office before they engage in a business relationship with your company so you can get an idea of whether they even need your services and where they are with all of this? Absolutely. I call it an MBA, which is a medical billing analysis. And basically, they just reach out to me on my website, which is tipsmedicalbilling.com. And on that, if you contact me, it'll ask you a few questions. And one of the questions is, would you like an MBA or a medical billing analysis? And what I do is I get your procedure report for the last... 12 months and I identify the opportunities that you have. You also have an opportunity to tell me a little bit what you're looking for in that MBA. Otherwise, I'm just going to take your procedure report and, you know, kind of dissect it and get a grasp of where all of your opportunities are. And then we jump on a phone call, we jump on a Zoom meeting, and I review that with you. So you can get an idea of what you're doing now and what's possible billing it to medical. So getting back to CTs, and I know a lot of money is left on the table because dentists are, according to you and other people I've spoken to, they're not charging for CTs in many cases, certainly not commensurate to the investment they put into that. So how does a dental practice get the best return from their CT equipment on the medical side of insurance? So it's not about frequency with medical. We lose that limitation of ROI frequency issues with dental. So you can actually take a CT the day that you are diagnosing. and doing the evaluation for treatment. You can take ACT during that surgical phase, or in your case, maybe endodontic phase to make sure, you know, that you have gotten all of the cystic lesion out of the jawbone. You can then take ACT 91 days postoperatively for reassessment of that. surgical site so there are definitely ways now you have three cts and two exams that you have extracted from that encounter let alone any of the surgical piece of it so that's how you maximize your your ct and your roi on it and just billing it out because if you're giving it away you have a hundred thousand dollar machine that's sitting there collecting zero roi Um, I can tell you that even if you bill out $150 for a CT and you do that, you know, I don't know, 15 times a month, um, you've made like 50, $60,000 for the year. Bare bones, right? Yeah. I assume the sales rep that goes into the dental office trying to sell a CBCT to a dentist talks about the medical side of it. You know how I assume, um, that they're well. Who knows, right? Maybe you know. I think some do, some don't. That being said, they don't give a solution to how to do that. I mean, there's a whole train of thought that has to be instilled into the practice regarding medical billing. The fact that we talked about on another previous podcast about being a medical specialist, determining that there is a medical need for the dental procedure. or the procedure that's being done in a dental office. I won't even call it a dental procedure. There's a medical need that has to be determined and defined, properly documented, as you talked about before. And then the office, once they get trained, and it does take you, say, possibly 12 months under your tutelage, depending on which coach they work with, and I know you're one of the best coaches in this area, they eventually will be able to get a tremendous return on their investment and do better for the patient. Right? Because the patient will be getting early detection cancer procedures, which is crucial towards keeping people from getting into the later stages. I mean, to me, we have an opportunity in so many... realms to save patients' lives. We are definitely in our profession as dental professionals, oral physicians, we should be calling ourselves oral physicians because that's what we are. We have an opportunity to save people's lives and prevent. And I feel like we are the only specialty that often prevents and medicine likes to treat the event. versus prevent yeah and we just have so much opportunity with you know maxillofacial and oral cancer screenings with uh sleep apnea screenings those are and and just you know connecting the dots with oral systemic health and an infection especially like with endo that can kill people and you know that that's that's another opportunity how many people don't come to an endodontist or even their general dentist with an abscessed tooth because they don't know how to they're going to pay for it because they don't have dental benefits well guess what if you have if you are taking medical insurance and you can see a patient for that now and bill it through their medical, they're more likely to come to you. Unfortunately, they go to the ER and the ER turns them away and says, go see a dentist. They didn't come to the dentist in the first place. But we now have data that 50% of patients that have an abscessed tooth, 50% of patients that have heart attacks or strokes are due to an oral infection, i.e. periodontal disease or an abscess. Thank you very much, Candra, for the insight. How to... advantage of medical billing, especially with CTs and other procedures related to prevention in the office. Thank you. And we look forward to having you on future programs. Absolutely. Thank you so much for the opportunity. If you're enjoying this podcast, please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.