‍

‍

This week, the Dental Amigos welcome Harold Gornbein, Co-Founder partner of Apex Reimbursement Specialists who has over 30 years of experience within the dental insurance industry. Harold has worked in sales and account management for Ameritas, Dental Benefit Providers, PacifiCare Health Systems, and United Concordia, as well as his own employee benefits agency. His wealth of industry knowledge, experience, and relationships provide Apex clients crucial strategic guidance on credentialing management, UCR Fee analysis, dental billing, and fee schedule analysis and optimization. Apex’s services help to position dental practices at the head of the negotiating table for higher paying fee schedules potentially producing thousand’s more in revenue without additional chair time.

‍

In this episode, Harold discusses PPO fee negotiation, insurance verification, collection rates, the importance of transitioning practice ownership with proper credentialing and the value of outsourcing to reimbursement specialists. He emphasizes the significance of annually updating UCR fee schedules to maximize revenue at your practice. Harold also discusses the significance of insurance compliance when transitioning practice ownership and the benefits of outsourcing billing to professionals like Apex, which can save practices significant costs and improve efficiency. 

‍

To get in touch with Harold and his team, visit apexreimburement.com or email him directly at harold@apexreimbursement.com.

‍

Listeners who want to reach Paul can do so at Paul@DentalNachos.com and those who want to reach Rob can do so at Rob@RMontgomery-law.com.

‍

FULL EPISODE TRANSCRIPT

‍

Bumper  

Welcome to the Dental Amigos podcast with Dr. Paul Goodman and attorney Rob Montgomery, taking you behind the scenes of the dental business world. All the things you didn't learn in dental school, but wish you had. Rob is not a dentist, and Paul is not a lawyer, but since Rob is a lawyer, we need to tell you that this podcast is for informational purposes only and shouldn't be considered legal advice. Listening to this podcast does not and will not create an attorney-client relationship. As is always the case, you should formally consult with legal counsel before proceeding with any legal matter. Learn more about the dental amigos at www.thedentalamigos.com. And now, here are the Dental Amigos.

Rob Montgomery  

Hello and welcome to another episode of the Dental Amigos podcast, the only podcast, as far as we know, hosted by a lawyer and a dentist. I'm Rob Montgomery, and I'm joined, as always, by the head Nacho himself, Dr. Paul Goodman.

Paul Goodman  

Excited to be here talking Rob.

Rob Montgomery  

It's always fun to talk with you, Paul, and we've got a great guest joining us today, Mr. Harold Gornbein, with Apex Reimbursement Specialists, and Harold is going to talk about some best practices, some hidden tips about the insurance credentialing world, and he's been a good asset for a lot of our clients, so I'm excited for him to share his knowledge with our listeners. Apex Reimbursement Specialists is a dental insurance carrier, portfolio revenue cycle management firm focused on fee schedule analysis and optimization, credentialing management, UCR fee analysis, dental billing insurance verification and coding analysis for due diligence, acquisition, compliance and revenue opportunity for DSOs, group practices, and solo practices around the country. Harold Gornbein has over 30 years of experience in the dental industry, specifically in the dental insurance industry, considered an industry insider by many. He's worked in the sales and account management for Emeritus Dental Benefit Providers, Pacific Care Health Systems and United Concordia, as well as his own employee benefits agency. His wealth of industry knowledge, experience and relationships is a tremendous asset to Apex clients. Like I said, many of our clients have had the good fortune of working with Harold and his team at Apex. And now, without further ado, here's Harold Gornbein, welcome amigo, and thanks for being on the show.

Harold Gornbein  

Hey Rob and Paul. I definitely appreciate the opportunity to maybe become an amigo of some sort. You know, I love this opportunity. Love the your audience, dentists are a group that we really appreciate working with, and like you mentioned, 30 years in the industry, so I'm kind of dating myself a little bit, but definitely here to serve dentists across the country and especially your audience. Definitely appreciate being here and any information that I can impart upon them, and I hope that helps their business become more successful. That's that's my mission.

Rob Montgomery  

Well, we are confident you will do that. That's why you're here. You've got me by one year of experience in the dental world. I can also say, you know, you are an official amigo after you've been on the show. So you've attained amigo status.

Paul Goodman  

Credentialed. That's your credential. Now, it was easier than credentialing with a PPO. We're not that easy.

Harold Gornbein  

I need to put some amazing guac pictures, nacho pictures, everything in my office. So now when I do like, Zoom calls stuff to all see all the nachos. I'm credentialed. I'm good. And it didn't take four months to get it done.

Paul Goodman  

I was gonna ask, we always start off with this fun question, what's your favorite nacho topping? And if we were in your town, where would you take us for nachos?

Harold Gornbein  

Listen, if you were in my town, if you're in Baltimore, I would take you to Serengeti, which is a great steakhouse actually, downstairs from our office, and they kind of throw everything at it. But when I think, what do I enjoy most about them? You know, toppings on nachos is like great carne asada steak with amazing sour cream and guacamole on top. It's hard to narrow it down to one topping, but man, it's got to be a great carne asada. I used to live in California, so I used to go to Tijuana all the time in Mexico. Went over the border. It had to be carne asada. So if a place has a good one, like Serengeti does, then we are in good shape. So that's my experience.

Rob Montgomery  

Good stuff. All right, so we're going to do things a little differently today with Harold from our normal sort of free flowing format.  Listeners, don't worry, this is not going to be a structured discussion by any stretch, but we've got some questions that people have kind of floated to us, that they wanted us to ask Harold, and I think that there are great questions for our audience to hear the answers to. So we're going to roll through some of these questions about the credentialing process, insurance and practices, and chat with Harold about those.

Paul Goodman  

No one teaches us in dental school that these will be the line of questionings you hear the most, sometimes outside of your office too. You could be at a party, and people ask you about PPO insurance. So these arethings my community is asking daily, Rob and Harold because it affects their life so much.

Rob Montgomery  

This is business, right?

Harold Gornbein  

There's a hot topic. You know, at the end of the day they've got to pay their bills, their salaries are going up, you know, different wages and cost of business going up. And the main complaining every day, which you know both of you do, is, are the insurance carriers are not paying me enough?

Rob Montgomery  

Yep. And what's the breakdown? Do you know Harold and Paul, like, what percentage of practices are exclusively fee for service versus PPO?

Paul Goodman  

I'd say roughly 15% out of network, but Harold might have better thoughts.

Harold Gornbein  

I would say you're probably right, Paul, probably in that 15 to 20% range are fee for service. I think that there's a big push in the industry. More and more practices would like to do that, and they're trying to figure out strategies to do so, and I think that's why over the course of at least the time that Apex got started, back in 2012 between 2012 and now, I think now is a great time to negotiate, because a lot of practices are looking to go out of network. And I think the insurance carriers are feeling the heat a little bit.

Paul Goodman  

Before Rob starts with his first question, I'd just like to clarify, our practices, I think we can talk about this with you and Rob as much as you like, I'd call ourselves an out of network practice, a little different than fee for service, in my mind, an out of network practice. And I think that that's like key, because insurance is a big part of my life as an out of network practice, it's just different than when I was participating with PPO. So just for our listeners, just because you're out of network doesn't mean you don't hear these questions, and doesn't mean that dental insurance is not a big part of your life. As an out of network practice, we're not reducing our fees for dental insurance, but there was a time that we were in network, and by that time, I mean most of my career. So this is a very relevant discussion.

Harold Gornbein  

I think it's an important point, because even if somebody is out of network, and people consider themselves fee for service that most likely, I bet they're still seeing about half their patients, or have some level of insurance, and they're either filing the claims on their behalf on some level. So important insurance plays a big, big, important role. So I agree with you 100%.

Rob Montgomery  

All right, well, let's dig in. I feel like Ed McMahon on the show, question number one, are PPO fees negotiable, and why should the carriers negotiate?

Harold Gornbein  

It's a good question. When we first got started, from my experience, being on the insurance carrier side, and having built the networks and negotiated a lot of deals with dentists over the years, negotiations are definitely possible. We all, from the inside, understood that, but I think over the years, and especially if you go back a number of years ago, a lot of dentists didn't realize that. So when we first opened the doors at Apex Reimbursement Specialists, I used to call on doctors all the time, and I would call and tell them what we did. They're like, really? We can negotiate? You didn't know that? I said, Yes, yes, you definitely can. And then practices would say, and dentist would say, Well, why should I? They were just a number. You know, there's 100 and some odd 1000 dentists across the country Met Life, for example, has 100,000 providers participating. You know, why should they care about me? And I think as the years go by, that's even more important. You know, as I mentioned a little bit earlier, there's a lot of membership plans being created, and a lot of dentists looking to term their relationships insurance companies. But because of that, now the insurance companies are taking a little more notice. They need their networks put together. It's much less costly for them to retain a provider, then to try to go out and recruit a new provider. And that's the position we take with  carrier networks. Listen, let's get our client illustrate why they should get higher fees and open the doors to negotiate higher fees, versus them trying to recruit new dentist. And for years now, the carriers have been flexible in that regard. Not all of them do. Delta still is probably the most tough one to deal with, but the carriers do negotiate. They want to keep their networks intact, and I think today they're under a lot of pressure due to all these membership plans so they definitely, they definitely do, and that's been our experience. Not everywhere, but the vast majority do.

Paul Goodman  

Really important. I'm going to ask next so if the dentist is out there listening saying I participate with a lot of insurance plans, are my UCR fees important? And tell us what UCR is.

Harold Gornbein  

It's amazing, and both of you probably recognize this, especially when providers are participating with a lot of networks. They're like, I'm getting paid. I have my contracted rate. I have the carrier fee schedule that I've contracted to receive as payment, why is the UCR so important? And so I always ask, in our experience, what we see is the average practice out there, about 70% of the revenue comes in the doors, probably insurance related. So that's carrier contracts. That still leaves about 30% of their revenue in cash. So if you're not paying attention to your UCR fee schedule, that means it's possible that you're under charging even for your cash-paying patients, and you're leaving money on the table. So if you're not looking at it once a year, in an analytical way, based on our experience, you're leaving probably a good 10% to 15% of the revenue on the cash side, on the table, you're losing out on that. So if you're a million dollar practice, and you're doing $300,000 a year in cash and in fee for service, and you haven't adjusted your fees for a while, you're leaving probably a good $30 to $40,000 just uncollected and on the table. So that's that you're missing on that. That's number one on the on the UCR side of it, you're missing on the cash. Two, which is, in this case, very important. The other $700,000 is insurance related. If you're not adjusting and keeping your UCR current to market rate. You're not putting any upward pressure on the insurance companies when you go to negotiate, because they're saying, Hey, we look at the claims that Dr. Smith is submitting and their fee, let's say, is a is $100 for a pro fee. If something everybody like to get $100 for probably, let's say for a pro fee, keeping the numbers easy, and their contracted rate is $130 they're like, Wow, our spread is only $30 we need to be that. We need that 30% to make a margin. That's the insurance company's thinking. We tell our clients, listen, what you need to do is price that pro fee instead of 100 because you haven't adjusted in a while. Let's look at your UCR and the UCR fee, let's say, might be 120 we need to, we need to adjust that speed 120 and now we're putting some upper pressure on that carrier where the carrier was charging 130 we're now, instead of saying we're spending a claim for 100% a claim for 120 now that spreads a little bit closer. So if we want to keep that 30% spread now we really want to renegotiate, or, excuse me, get that carrier fee closer to 140 150 there's an opportunity, which I think is often missed, because you're right, and I think the question alludes to a lot of pay a lot of providers do not, do not Increase it or adjust, or you see our fee regularly, but if they do, they could put some upper pressure on the insurance company, making their negotiation efforts much, much easier. That's on the contracted side, and then the cash side, they are producing 30, 40, grand, if they're a million dollar practice. So very significant, and I think it's often overlooked, UCRs, a lot of clients will say, I said it and forget it. Or they look at their UCR fees and I'll ask them, Well, how did you analyze it? Well, we looked at the fees and we just started penciling the extra two, 3% and that's where we're at. Well, how do you know that's the right fee for your market? So very important to analyze it correctly. Be vigilant on an annual basis. Do not set it and forget it. You need to put upper pressure on the insurance companies, and that'll help you negotiate by adjusting that you see our fee schedule.

Paul Goodman  

To interject for a second. Pay attention to stuff that really impacts your life. I'll share with you. And this is not probably surprising to non-dentists, but dentists will consistently look for better cement for their crowns, right? I need better cement, but they forget or fail to realize the cement they're using is actually really good. And if everyone had to go back to using crown cement from 10 years ago, the impact on patients would be negligible, because it was pretty awesome back then. But then they don't pay attention, Harold and Rob, to these things which have huge impacts on what you're doing. So maybe our listeners can get from this is, if you're looking for new cement, even though your cement currently is pretty awesome, kind of turn your attention to some of these other things. I think it's just comfortable to them. I use cement every day. I bond teeth day, every day, bonding agent. We're on the I don't know what generation we're on, but, and that's all to be said. Patients want our technology to get better. But as a dentist, this is your morale, this is your money, this is your things you can do. So what you said there, Harold was really, really valuable.

Rob Montgomery  

Our mututal friend David Goodman was on the show recently, and he was talking about this too, and we had this conversation Harold that, you know, it's not, I think people are, and dentists are reluctant to raise their fees because they're worried that, oh, well, people are going to think it's too expensive. But it's not like you drive by the dentist office like you're driving by a gas station, right? Wow. Gas is 357 a gallon there, you know, like, this is how much a perfect cost. Like, as long as you're not a pig about it. You know, you can do it. You know, in a way, that's that makes sense for your business. And it's not like you're going to scare patients away. I mean nobody. I mean nobody remember. They don't remember your office. And say, How much is it for a cleaning what's

Paul Goodman  

interesting? What Harold says here is they do the first time for to be curious, but then once you're a patient, if they were on a game show of, how much did my last cleaning cost, they would lose every time, right? They or how much did the last crown cost? Because we, we're much more sensitive to it than the patient. And it's just a good point that, you know, the thing and what, also, what, everything we're paying for is dentist rises. So this is one of the challenges, and control, what you can control. And I think it's a really good point. Harold.

Harold Gornbein  

We would tell we, you know, we speak to dentists every single day, and I think you're Rob your point that you mentioned is that they're afraid, right? They're worried, potentially, that patients are going to walk down the street. And we do this every day our experience, and we try to give a lot of confidence to the dentist listen based on our experience, and we do this every day. That's not happening. You know, if you have a patient who's gonna walk down the street for $3 difference that maybe they're not a great patient for you. Because when we talk about UCR and making some adjustments, we're not telling we're not there. We're not illustrating something that shows, hey, this is once 100 and now it's 200. We're talking about something that was once 100 and now it's 110 108 and it may not sound like a lot of money, and I don't think we're gonna lose in based on the data, doesn't show that we're gonna lose patients over but doctor, you do that code 1000 times a year, 5000 times a year, 5000 times. $5.25 grand helps pay for that newest cement. Helps pay for helps you contribute towards the CBCT and pay for everything that not just provides you and all the work that Rob is doing for you. So that's it's a common concern, but we dispel it by data and specifics, and really, given the confidence that no we need to move forward with this. And keep in mind the cash side is affecting maybe 20, 30% of their patient base, and not the other 70% we're looking to put pressure on the larger group, which is not less of the patient, but the insurance companies,

Rob Montgomery  

Okay, yeah, good stuff. Question number three, I bought a practice and we were submitting claims under the previous owner's credentials. Is that, okay? Ironically, I'm not asking this question, Paul, yeah, go ahead.

Harold Gornbein  

This is, this is, like, one of the hottest topics that we see every single day. And Rob, you see transitions all the time. And Paul sees with all the nachos out there, and all his listeners got hrough this on a regular basis, and I will tell you that in a pure comp, there's, there's, there's a custom in the marketplace, there's a custom in the marketplace. You know, you're a new dentist and you buy a new practice, and you buy this practice, and until the credentialing happens under your own tax ID, right, which could take three months, four months, just depending on the payer. You're saying to yourself, what do you do? What does the average dentist do? Because they don't want to disrupt cash flow, and so they have an arrangement, potentially, with the with the selling dentist, and they said, Oh, just submit claims that are my name. No problem for the next three, four months until they're until the credentialing is done, and no harm, no foul. And I will say that's the custom in the marketplace. The reality is, if you were ever audited, and Delta is known for this, especially in the Medicaid world, it's really rampant. Audits happen all the time. And they go to review a chart do a chart review or a billing review, and they said, Oh, well, Dr Smith is the treating dentist who did the work. And if it happens to not be Dr Smith but Dr Jones, who did the work, you weren't the one that Dr Jones wasn't the one that was credentialed, it's very possible that the insurance company may ask for that money back, or, worst case, actually not even credentialing you in the future. So it's not a it's definitely out of compliance to do it that way. We advise our clients to do it in the most compliant possible way. And I'm sure, you know, we can have discussion here a little bit on a transition service agreement that Rob. Could create that helps create that bridge from the seller to the buyer, and really maintain the seller's tin in place the right way, like there's a right way and a wrong way. Wrong way would be just start jump in there, start providing treatment, not under your credential, but under the seller or some other dentist credential, even if you're not even, even if it's not a buyer, seller, relationship you have. You're an associate in a practice, right? And you work for Dr Smith and Dr Jones, the associate, and Dr Jones did all the work, and the front desk team still submit the claim under Dr Smith, and went through and like as if Dr Smith did it, but he didn't do the treatment. Dr Jones did the treatment, and if you're ever audited, that's a time for an insurance company will claw back that money, take back that money, and cause some legal headaches and financial headaches. There's always these articles that we see in various industry magazines and newspapers that a dentist might have caught this fraud or that fraud. Sometimes it has to do with credentialing properly. Not to say it doesn't happen in a wide swath of custom in the marketplace. We just try to give the best, most compliant guidance to the dentist, whether you're an associate, whether you're a seller, whether you're a buyer, in the right possible way, because we don't want anybody going to jail. We don't want anybody having to pay claims back. We want to do it the right way. But it is something that happens all the time.

Paul Goodman  

I have a quick question, Harold, while you're handing out some free advice here, if this is more so this is for an in network provider. If someone like my office is bill insurance is out of network, can, can maybe, I apologize, is this very too simplistic? If you buy a practice and you bill an insurance out of network, they just pay you, right? There? Is there any credentialing process for that? Or you just start submitting claims and getting paid? I obviously, I know the patient's not getting their adjustment, which could cause a problem, but could they still get insurance reimbursement with the new seller, the new owner as an out of network.

Harold Gornbein  

Yeah that happens a lot as well. It's a great, great question. So what do you do? You walk in there and there's an out of network pay. You're out of network, but you see a patient with an insurance network, and so you're an out of network provider. Most insurance plans have an out of network benefit. So what's the cleanest and probably best way to submit that claim? You don't have to have a, let's say, a full credentialing process. Obviously, because you're not, you're not in network at this at this point, but the carriers for the clean the claim to go as smooth as possible. You'll want to submit your W-9 with that first claim it because, in essence, they actually just register you as a dentist, see it doing treatment in that practice. So it's not a credential. It's just notifying that you exist and you're not catching the carrier by surprise at all. So even though you're out of network, and it's not an out of network reimbursement, best practice would be to submit your W-9 with that first claim, and then they registry, and then you're good to go going forward.

Rob Montgomery  

And we do see it a lot. I think it's especially egregious when people try to bill under a seller's credentials when the seller is not even involved in the practice anymore. I just don't know how you could possibly defend that situation if an audit came, came in knocking and, you know, for us, we, you know, best practices with all that is to try to become credentialed prior to the sale.

Harold Gornbein  

Yeah. We try our best. You know, there's always a concern if I, if I get into the process too soon, do I notice the sellers staff get notified? There's a lot of, you know, you got to minimize it the best your ability. Insurance companies, you know, they're not, I wouldn't, I wouldn't say not perfect is not the right word. But sometimes you do things that don't make any sense, that we do our bet, we do our best to minimize that risk. But I think to your point too, is, is we always ask a potential or a buyer buy any practice? Can the stuff? Can the seller just stay on, put a transition service agreement for, you know, three, four or five months, something like that, let them see the patients, and until that during that period of time, no harm, no foul, you you get the revenue from the tin that you actually are, in essence, kind of renting for that period of time. You know, Rob, you're the attorney, you're the locks, where you do this every single day, but it's something that good best practices to do.

Rob Montgomery  

Yeah, absolutely. Paul. You wanna do question number four.

Paul Goodman  

I don't wanna brag, but I might go to Shake Shack later, and after my daughter's play, I told her we could go there. And I don't think Shake Shack has a collection problem, because every time I go there, I just pay, right? I'm not like, Can I use my burger and milkshake PPO and pay later? So I feel their collections are probably 100% but us in the dental world, we're not Shake Shack. Also, if I think I have a collection problem, I don't think our collection rate is where it should be. What could be affecting it?

Harold Gornbein  

That's a really, really good point. And this happens every single day. I think you're right. Shake Shack does a great job. You know why? Because when you go, you go that register, they say, Hey, give me your credit card. I'm paying the whole rate. We're done after that, no money, no burger. And I will tell you in I know both. You probably see this too. There's a lot of practices across the country that will see the patient, they'll bill the insurance company, and then whatever the insurance company pays on their end bill, like send an invoice to the patient, they don't even collect a point at point of treatment, which is really off the charts. So some good practice. Let's go with the assumption that you're an in network provider. You're getting contracted rates, all that good stuff, and you're in network. The patient's in network will go with what we see a lot of in the collection rate. What could affect it? Couple things. One very important aspect of the process is doing insurance verification. You know, when you're seeing that patient, you need to verify. What are the benefits that that patient has? What happens a lot is people don't do the thorough investigation of what the insurance verification, what the insurance benefit is, so they just go with whatever fee schedule or benefit they might have had in their practice management system for that patient the last time they were in maybe a year ago. What if their benefits have changed and they haven't verified What's the new benefits now, they may bill a patient off the old fee schedule, or even the old benefit plan that they had previously, and then we get in there and we look at, okay, what did you charge this patient? We charge them $100 but your fee schedule that you should be working off of pays on 110 so you should, we need to click that extra $10 it may not sound like a lot, but when you doing 1000s of claims, it adds up. So a lot of mistakes are at the insurance verification level, and are they charging the what's important in that verification is, you know what the benefits are gonna be paid by the insurance company, and you know what the patient is liable for. If you don't know what the patient is liable for, how do you know what to collect at the front desk? You know, Shake Shack, the pricing is right on the screen, right? They know exactly what it is. There's no mistakes. They know exactly what it is. In the dental practice, typically, you don't have all these few schedules on the screen in front of them. You as the as the front desk person and insurance coordinator, need to know what the benefit is. And so if you don't collect right from the patient, you're going to have this balance. You're going to have this negative collection rate that's on and now in your practice management system, and after that patient leaves. And let's say you were supposed to collect 15, and you only collect 10 how many practices out there are feel bad to call that patient for the extra five bucks? They don't. They just let, they just let the balance accrue. The key is the collect from the get go. So one, insurance ratification is important. Number two, did you actually update the fee schedule in your practice management system for that patient, that we see that happen so so often that there's such an accounts receivables problem, there's a billing problem is that they haven't updated the fees within their system for all since the last time this patient either has a benefit or, let's say, In our case, we, or the or the practice negotiated a brand new fee schedule for Aetna, for example, and now you see an Aetna patient. If the practice didn't take that new and improved fee schedule that was just negotiated for them and actually key it in to their practice management system. Guess what? They're still charging up the old fee schedule through crate or creates a deficiency in what they're able to collect. So we see insurance revocation. We see the fee schedule not being inputted correctly. We see the front desk staff not calculating the liability of the patient, so I don't even know what to collect. They might even guess that creates a deficiency and they let the patient walk out the door, and they don't collect after that. So these are all couple really good tips to do, right your insurance revocation correctly, update the fee schedule correctly, know the benefits you can collect from the patient at point of service. Don't let them go out the door without paying for that service. But it happens, happens all the time. Those are some, some things that we typically see,

Rob Montgomery  

Yeah because otherwise, you're just setting yourself up for a bad situation, like, Yeah, are you going to chase your patient for $5 right? No, you know, but you shouldn't. You shouldn't have to, right? There's, there's a different way to do it.

Harold Gornbein  

Right? It just adds up. The other part that's really critical, if you think about this, and it's the hard one of the hardest parts of the collection, dental billing and collection world is you submit a claim. The front staff you submit a claim. If that claim isn't paid, like they within 30 days, 15 to 30 days, there might be a problem. The claim might have been denied for whatever reason. And if your front. Yeah, your front staff, front desk staff is not following up with the insurance company, doing their denial management getting the insurance company what they need to get that claim paid. It's just showing unpaid within their practice management system. It has a negative effect on their collection. Rate happens all it's a very hard part of the job. If you have somebody your front desk that's multitasking, they're like answering the phone. They're treating the patient. They're calling insurance companies, which they all hate to do. They're calling insurance companies. Sometimes something gets left behind. If they're so busy doing all these different tasks, maybe they don't. They say, I'll get to the insurance company tomorrow. I'll get to the insurance company tomorrow. Sometimes they forget. They don't go back to battle that claim to get it paid, leaving it it's like the path of least resistance. Sometimes people get lazy and they don't go to collect.

Paul Goodman  

Also, I've been down this road before. Sometimes in there some big Seinfeld fan, and one time he returned a jacket at a spite and they said he couldn't return the jacket out of spite. So how about this one? You're trying to pay someone to collect money, and the amount you're paying them is more than the money you're collecting. Do you still try to collect it, right? You pay someone an hour of time, who makes $35 an hour to collect 20 and then multiply that my 100. So your advice there is, uh, is spot on.

Harold Gornbein  

Happens all day. This is the life blood of the practice. Practices, if it's not collecting and collecting everything it's entitled to. You know, we can't, we can't pay our bills. We can't pay, you know, a lot of time staff gets paid, but the dentist doesn't get paid, right? There are the debt the dentists on the distribution of some level, and they'll, they almost want to pay their practice there the staff more than themselves. But if we get them paid everything they're entitled to, you know, they can get paid everything they deserve, and have earned so very a couple, a couple important tips there. Yeah, real important.

Rob Montgomery  

That's good, good stuff. All right. So we'll move on to the final question, question number five, and it's an easy one, I think, for you Harold but throw this softball up for you, why should I outsource to a company like Apex versus negotiating, doing billing myself?

Harold Gornbein  

Yeah, I know, excellent question. And we get asked this every day. I get calls from Dennis every day, why should I hire you versus doing it myself? And so for us, I will tell you, a big thing in this industry is really were professionals. We do it every single day, and not just that. We do every day. We know who to contact with, who to contact. We know what data they want to see, and that the average dentist needs to understand. That we see 1000s and 1000s of fee schedules across the country every single year. So when we're presenting a case and trying to create leverage on behalf of that dental practice. We're illustrating exactly benchmarking where you the practice are deficient and not getting paid what you're entitled to. So I would ask the dentist, I would ask the practice, if you do it yourself, you don't have access to any of that information, how do you know that you're going to be able to get the best you can? Yeah, you might get, you might get a couple points. You might get a couple because you called them. But how do you know you're getting everything you're entitled to, what the market really will bear so much like, you know, you know, if I had to have a teeth pull, you know, a tooth pulled, I'm not doing myself. I'm going to the experts. I know I need to make that happen. So I think for us, we do it every single day. It's a profession, and it's something that needs to have a lot of attention to. And I tell dentist to they make a lot more money in the chair versus what I do. They're making their their their bread and butter is in the chair, not sitting on the phone with an insurance company. So that's really on the negotiation. Negotiation side doesn't mean they can't do it. But if they want to send the phones as long as, as long as we do, they want to compile data and do all the homework and spend their evenings doing it, potentially, because they should be in the chair doing dentistry. I'd like to, I'd like to hire them. Hire them if they could do a better job than us. I say that on tongue in cheek, to a certain level, but when we get to, when we get to billing, as I mentioned earlier, you know, well, the average practice out there does not have a large administrative team. The average practice that's doing $700,000 a year, so they have a couple people the front desk paying attention to the staff, paying attention to the to the patients that are walking the door, the phone is ringing, the claims are piling up. All these things are multitasking, and a lot of demands of just running the business. They don't have the time to focus on each and every claim in a very detailed manner to make sure that you're getting paid everything you can, because things get lost. And I would tell you, I would tell a dentist staff calls in sick, right? Our mindset might call in sick, but doesn't mean but we're always making sure the work gets done for the practice, so we never miss a day at work. We're always there. And I will tell you, cost wise, from a labor perspective, you're looking at strictly P and L. I. Believe that for for a client to hire us, about half of what, what they can, what they'll actually pay to do it themselves. I always, it's funny, I always ask a practice. I'll say, Well, what do you pay? What do you pay today for insurance verification? Let's say, if the front desk is doing it, what do you pay for insurance verification today? They're like, I don't know. I pay my staff at the front desk, does it? And I don't, I will tell you. I'll tell you what it cost you. You're paying your front desk staff, probably with with taxes and just feet, just salary, probably $30 an hour, right? I know when they call the insurance company, they're on with the insurance company for about 2030, minutes. Well, we all can do the math that's costing you about $15 every time your staff picks for the phone. When we do it, it's about six or $7 to go that phone. What cost less? So not only to the cost less, but you're getting done professionally and consistently in a timely, effective manner, so that your your front desk staff can pay attention to the patients. Our job is admin, your job is clinical, and in doing so, you're gonna run a very efficient and profitable practice. So it'll be a little bit of a the why use an outside company versus do it themselves? I just think that when you're when you're when you're a jack of all trades on some level, you're a master of none. And I think that that plays out at the front desk every day.

Rob Montgomery  

Age old. Yeah, well, and I think too, as far as you know, where do you find out what is normal, you know, and spoil alert, going on blogs and Facebook groups, asking a few people, is this normal? Does not constitute industry knowledge. Okay? It's not a substitute for experience. Just because you and we hear that sometimes like, well, I talked to a few people, and I think this is right. Like, no, well, that's, let me tell you about a few sample of a few 1000. That's not right, you know. And you're right. There's people you talk to have, they have the wrong perspective. So, awesome stuff. I think this is really helpful for for our listeners Harold and really appreciate you taking the time to be on the show today, if our listeners want to get in touch with you or learn more about Apex reimbursement specialists. How can they do it?

Harold Gornbein  

Well, they can go to our website, Apexreimbursement.com they can call me directly. My direct office line is 410-834-3088, that's 410-834-3088. My email is Harold@apexreimbursement.com and I return calls as quickly as possible, definitely, within 24 hours. I will give you all the time you need. If somebody needs me to come visit them, more than happy to do that. If dentists out there have study clubs or any groups they just want education, I'm happy to speak where everybody might need really, there's a lot to learn in this industry. It changes fast, and dentists are great clinicians. That's their expertise, and we love what we do. We feel in our world, we are the experts in our space, and we're here to we're here to help make businesses as successful and financially effective, and help dentist create some wealth for themselves.

Rob Montgomery  

Good stuff. And as always, those that information, the contact info that Harold just mentioned, will be up in the show notes. Well, thank you, amigo. You are officially an amigo, and we appreciate you taking the time and imparting all your knowledge and wisdom and experience on our listeners.

Harold Gornbein  

Thanks so much. I appreciate all the time. I appreciate being an official Nacho now, and Rob and Paul, you've been so kind and generous with your time, and I appreciate being here.

Paul Goodman  

Thanks, Harold.

Rob Montgomery  

Thanks, Harold. Good stuff there from Harold. An interesting topic for most of our listeners, right? A very impactful and relevant one.

Paul Goodman  

I mean, it everyday thing you get asked this, you think about this. I mean, it's as simple as pay attention to how you get paid. And just because we never taught this in dental school, there's a lot of myths out there, and it can be demoralizing. But, you know, I did it myself during a period of time before we were out of network. Some of you introduced me, Rob, and it was great. I mean, you basically, except for removing calories from my favorite nachos, Rob, I can't think of anything better than getting paid more for the exact same work you're doing anyway.

Rob Montgomery  

Yeah, there you go. And what I kind of take away from this too, it's like, it's little bits add up, yeah, stuff. And it's just like, a little here, a little there, and you multiply that by 1000 you multiply that by 10 years, by 20 years, all of a sudden, those little numbers turn into big numbers, and that's the difference between maybe being able to retire soon making more money, or not being able to do other things in your practice and practice the way you want to, and so paying attention to the details, right? Paul, 100% All right. Well, thanks everybody for listening. Paul, always a pleasure. Thank you. Bye.

Bumper  

Thanks for listening to another great podcast with the dental amigos, and don't forget to tune in next time to have the dental business demystified. If you're looking for more information about today's podcast, you can find it on the dental amigos.com if you're looking for Paul, you can find Paul at Dr Paul goodman.com and if you're looking for Rob, you can find him at yourdental lawyer.com. This podcast has been sponsored by Orange Line Media Group, helping dentists and other professionals create content people love. Find out how we can help you take your business to the next level at WWW dot Orange Line, mg.com, till next time.

‍