Podcast appearances and mentions of roy shelburne

What if one missing note in your chart could cost you your license—or even your freedom? That's not a scare tactic—it's exactly what happened to today's guest, Dr. Roy Shelburne. A respected dentist turned federal inmate, Roy learned the hard way that poor documentation and billing practices can destroy even the most well-intentioned practice. Now, he's using his story to help others protect what they've built—and to ensure no one else has to go through what he did. If you're running a dental practice and think documentation is just a formality, think again. This episode is a must-listen. I'm joined by Dr. Roy Shelburne—a dentist, speaker, and compliance expert with a story that'll stop you in your tracks. After being sentenced to federal prison for documentation-related issues, Roy has made it his mission to help other dentists avoid the same fate. In this conversation, Roy opens up about what happened, what he wishes he had known, and the simple (but often overlooked) systems that can protect your practice, your license, and your peace of mind. We also talk about why clear documentation isn't just about legal protection—it's the key to smoother insurance reimbursements, fewer patient disputes, and stronger clinical care. Here are some of the interesting things we talked about in this episode: If it's not in your chart, it didn't happen—legally or clinically. Why blind disregard can be interpreted as intent to defraud. The real reason so many dentists struggle with insurance claims. How to build a 7-step compliance program that protects your entire team. Why moving to ICD-10 may be on the horizon (and how to get ahead of it). How better records actually lead to better patient care. This episode is packed with wisdom every dental professional should hear. Don't wait until it's too late—learn from someone who's lived it. — Key Takeaways 00:42 Introduction and Event Announcement 03:04 Roy Shelburne's Journey: From Prison to Advocacy 10:24 The Importance of Clinical Record Keeping 16:57 Documentation: Key to Efficient Reimbursement 26:02 Implementing a Compliance Program 32:15 Final Thoughts and Lightning Round — Connect with Dr Roy

Have you ever felt overwhelmed by the labyrinth of billing and coding in your dental practice? Prepare to navigate this complex terrain with confidence as we dissect the art of billing department optimization. Our conversation steers you through the process of decluttering your practice management software, much like tidying a hoarder's abode. We confront the common fear of conflict head-on, revealing its true nature as a growth catalyst, essential for the evolution of your billing operations. With Dr. Roy Shelburne's harrowing story as a backdrop, we underscore the dire consequences of inadequate billing knowledge and the non-negotiable need for compliance in every patient transaction.Dr. Shelburne's narrative serves as a stark wake-up call about the risks of neglecting proper billing practices—a lesson he learned the hard way. We unpack the six-part framework that transforms billing departments from chaotic to controlled, discussing everything from software setup and insurance complexities to the formulation of Key Performance Indicators (KPIs). Our discussion highlights the pivotal role office managers play as coaches, guiding their teams through the transformation with dedicated coaching and unwavering accountability to breathe new life into your practice's financial health.And if you've ever questioned the potency of your dental practice management software in crafting precise treatment plans, this episode is a treasure trove of insights. We dissect the software's often-underused capabilities, emphasizing meticulous training and the exacting entry of insurance benefits. By concentrating on these strategies, you'll learn how to leverage technology to its fullest, ensuring your treatment plans are not only accurate but also reflective of the cutting-edge advancements these platforms continuously integrate. Join us for a journey that promises to fine-tune your billing efficiency and catapult your practice's revenue to unprecedented heights. Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:dentalbillingcoach@gmail.comJoin us for Dental Billing - Disrupted in Atlanta, GA on April 20th, 2024. For more information click the link below. https://www.eventbrite.com/e/dental-billing-disrupted-tickets-807335551367?aff=oddtdtcreator

How would you like to get inside the mind of the legendary Howard Farran, founder of Dentaltown and author of Uncomplicate Business? We've got an enlightening chat with Howard on this episode, revealing the inspiration and journey behind creating Dentaltown, an empowering online community and mobile app for dental professionals. Howard unpacks the power of Dentaltown's resources including interactive message boards that serve as a hub for advice, support, and professional growth within the dental industry. We don't stop there, we also delve into the critical aspect of creating a healthy work environment in the dental industry. We speak candidly about the destructive impact of toxic team members, the vital need for mentors, and the role of management in cultivating a positive work culture. Addressing and eliminating toxic behavior stands out as a major topic, with a fresh perspective on why it's better to strive for 'B players' who bring harmony, rather than 'A players' who may be toxic. Finally, we circle back to our guest, Dr. Howard Farran, CEO and founder of Dental Town. His insightful take on the significance of networking and peer-to-peer learning in the field of dentistry is a must-listen. We encourage you, our listeners, to join Dental Town, contribute to the practice management message boards, and share your wisdom with your peers. And don't forget to download the Dental Town app for instant access to these invaluable discussions and resources at the end of this episode. Find your tribe, elevate your practice, and enhance your professional journey with us in this episode. Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:dentalbillingcoach@gmail.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event in Chantilly, VA on Sunday 1/7/24 with Dr. Roy Shelburne: thedentalbillingcoach.com

Ever wondered how a seamless transition from a clinical role to office management is made? This episode is your golden ticket, packed with advice from my personal journey managing multiple dental practices. Anchoring this episode is a deep dive into the importance of understanding management principles within the dental industry. We'll share the challenges and triumphs from my adventure in the realm of dental office management and provide you with practical insights. If you are new to the office management scene, this episode will be your guidepost. Transitioning to the structure of a dental practice, we examine the pivotal role of the billing department. An efficient billing department is a linchpin to a practice's financial success, and we discuss how an office manager can ensure this by identifying and filling performance gaps. The focus then shifts to an often overlooked aspect – the psychology of patient experience. Why do some patients willingly spend more at certain practices? The key lies in creating an exceptional patient experience, and we recommend eye-opening reads like "Unreasonable Hospitality" and "The Nordstrom Way" to further illuminate this aspect.Lastly, we delve into the meaty topics of accountability, psychological safety, management styles, team dynamics, and their impact on a dental office. We shed light on the importance of fostering a psychologically safe environment and how doctors can support their managers' decisions. This episode will empower you to navigate through the stages of team dynamics and shape both team performance and patient experience. Whether you're an established manager seeking fresh insights or a new office manager finding your footing, this episode offers invaluable resources and strategies for enhancing patient experience and boosting your bottom line. Tune in for a journey packed with insights, inspiration, and practical tips for creating a successful and fulfilling dental practice. Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:dentalbillingcoach@gmail.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event in Chantilly, VA on Sunday 1/7/24 with Dr. Roy Shelburne: thedentalbillingcoach.com

Are you leaving money on the table due to incorrect dental billing? Ever wondered how diagnosis codes can make a difference in your practice? As your host, Erica Aguilar, I bring to you a comprehensive guide on the significance of these codes and how to pick the right one from the CDT book. We delve into the importance of documenting a diagnosis during the exam for payment qualification and how to ensure your clinical documentation is not just current but compliant. Ever had a patient confused about the difference between a prophy and a gingivitis cleaning? Not only will we explain the necessity of code D4346 for gingivitis cleaning, but we'll also highlight how a lack of correct documentation can lead to revenue loss for your practice. We take a closer look at how insurance companies are responding to preventive measures like gingivitis cleaning. We also introduce the PREVISOR program for dental risk assessments, discussing uses of D0602 and D0603 codes for the CARRIES risk assessment, and how to enhance benefits through Delta Dental with the PREVISOR program. Get ready to step into a new era of dental billing and codes! Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:dentalbillingcoach@gmail.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event in Chantilly, VA on Sunday 1/7/24 with Dr. Roy Shelburne: thedentalbillingcoach.com

I've had the opportunity to sit down and have a deep and enlightening conversation with Jennifer Lyman, a devoted dental hygienist with a heart for recognizing signs of sleep apnea in children. It was fascinating to hear about her journey and how her experiences have shaped her practice and fueled her passion for educating others about sleep apnea, a potentially fatal condition that we should all be aware of. We also got to talk about the beneficial effects of myofunctional therapy in dealing with sleep apnea and other oral health issues. Jennifer shed light on the signs and symptoms we should look out for in both children and adults, along with the connections between sleep apnea and conditions like ADHD. She emphasized the criticality of referral to sleep centers and the potential hazards of ignoring what may seem as trivial as snoring. Towards the end, we tackled the complexities surrounding medical billing in dental sleep medicine and explored the essentials needed to successfully implement oral appliance therapy or myofunctional therapy. Jennifer underlined the importance of a dedicated team and the value of continual coaching and training. We also discussed how to navigate insurance coverage and ensure a smooth billing process for patients. For those eager to learn more, Jennifer shared her contact information. After listening to this enriching conversation, I'm sure you'll appreciate the crucial role oral health plays in our overall well-being. Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:billingcoach@dentalbillingcollege.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event with Dr. Roy Shelburne: thedentalbillingcoach.comWould you like to schedule a FREE 30-minute consultation? Spots are limited to 4 per month. Email your request to:admin@dentalbillingcollege.com

Do you ever wonder about the intricacies of insurance claims and the importance of having proper documentation in dental practices? We bet our guest today, Dr. Roy Shelburne, can shine a light on that. A seasoned dentist, practice owner, and survivor of a healthcare fraud conviction, Dr. Shelburne's story is striking, a true eye-opener for other dental professionals, as he shares his experiences and the lessons he learned.Dr. Shelburne passionately dives into the world of healthcare fraud, defensive documentation, and the consequences of insufficient documentation. He emphasizes that everyone in the dental team should take responsibility, reflecting that there's no such thing as an innocent mistake in healthcare documentation. Together, we explore the complicated relationship between dental practices and insurance companies, discussing how insurance benefits can influence the care provided by dentists. To prevent falling into pitfalls, we underline the importance of understanding these benefits, accurate documentation, and the use of templates and drop-down boxes to support claims.Wrapping up this riveting conversation, we delve into the critical role of proper documentation in a dental practice for more than just ensuring payment. We also discuss how to utilize templates and flexible records to accurately reflect a patient's condition, and diagnosis, and how to navigate insurance company guidelines. This episode is brimming with valuable lessons from Dr. Shelburne, who now uses his experience to guide others in the industry. Don't miss it!Got questions for Dr. Shelburne? Connect with him @ www.royshelburne.com Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:billingcoach@dentalbillingcollege.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event with Dr. Roy Shelburne: thedentalbillingcoach.comWould you like to schedule a FREE 30-minute consultation? Spots are limited to 4 per month. Email your request to:admin@dentalbillingcollege.com

Do you ever find scrubs irresistible? Kiera did, and her love for scrubs steered her into a fascinating journey through the dental industry. Today, she takes us through her evolution from a dental assistant in Utah, all the way to owning her own practice and establishing the Dental A Team. This company is Kiera's brainchild, dedicated to aiding dental offices with practice management. Kiera's journey is an inspiring one, and it isn't just about her story. She's also here to educate us on the critical role of billing in dental practice management. She gives us a comprehensive rundown on understanding the revenue cycle, ensuring clean claims, and the significance of everyone on the team comprehending their role in the process. But hold on, we're not done yet. Kirra shares golden tips on maximizing revenue and minimizing loss in the tricky world of dental practice. Finally, we wander into the realm of patient experience. Kiera draws on lessons from giants like Nordstrom, Disney, and Starbucks, putting the spotlight on the amazing impact of small changes on the overall patient experience. Get ready to absorb strategies on infusing the patient experience into practice - the role of the front office, the importance of intentionality, and much more. From billing to patient experience, this episode is a treasure trove of insights, tips, and strategies for anyone in the dental industry. Tune in, listen up, and let Kiera guide you through the intricacies of dentistry!Connect with Kiera: thedentalateam.com Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:billingcoach@dentalbillingcollege.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event with Dr. Roy Shelburne: thedentalbillingcoach.comWould you like to schedule a FREE 30-minute consultation? Spots are limited to 4 per month. Email your request to:admin@dentalbillingcollege.com

Ever wondered why so many dental claims get denied and overlooked? This episode takes you behind the scenes of dental billing and claim appeals with Morgan, popularly known as Front Office Friend, who brings an impressive 11 years of experience in the dental field to the table. Morgan's lifelong love for dentistry drives this insightful discussion as we dive into the state of the dental industry, including a startling study that reveals only 33% of all denied claims are ever appealed.Running a dental practice isn't all about the teeth, as Morgan showcases in our enlightening chat. Her valuable advice on managing insurance aging reports and establishing robust systems within dental practices is sure to make your operation run smoother. Highlighting the importance of financial policy discussions with patients prior to treatment, Morgan emphasizes how this simple yet significant step can prevent misunderstandings and streamline the process.The conversation doesn't stop there, as we delve into her inspirational journey of authoring The Front Office Handbook. Inspired by her personal need for lists and checklists, Morgan provides insights into the importance of staying updated with the latest trends and technology in the field. Finally, we examine Morgan's vibrant presence on social media where she continues to enrich the dental community with her insights. Tune in to gain a wealth of knowledge from this seasoned professional in the dental field.Connect with Morgan: frontofficefriend.com Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:billingcoach@dentalbillingcollege.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event with Dr. Roy Shelburne: thedentalbillingcoach.comWould you like to schedule a FREE 30-minute consultation? Spots are limited to 4 per month. Email your request to:admin@dentalbillingcollege.com

Get ready to demystify the labyrinth of dental billing changes coming in 2024! You'll gain invaluable insights into the American Dental Association's new service category, Sleep, and how this addition increases the dental categories to a total of 13. We'll break down how these extra codes can lead to more precise interactions with providers and patients, and why this doesn't automatically mean insurance payouts will increase. Then, we'll pivot to understanding the intricacies of the 2024 claim form, shedding light on the new boxes and their role in speeding up the claim process. You'll understand why it's crucial to get your practice management software updated with the 2024 claim form. We'll delve into new additions such as Box 3A and 11A, which require payer IDs, and Box 39A, which demands the last date of scaling and root planning. We'll also unravel the complex concept of locum tenens, and the introduction of the new Box 53A to identify temporary providers. So, tune in and arm yourself with the knowledge to navigate these changes smoothly! Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:billingcoach@dentalbillingcollege.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event with Dr. Roy Shelburne: thedentalbillingcoach.comWould you like to schedule a FREE 30-minute consultation? Spots are limited to 4 per month. Email your request to:admin@dentalbillingcollege.com

Are you ready to navigate the world of dentistry with no background whatsoever? Imagine learning everything from dental administration ABCs to a PhD level understanding in just six months. Welcome to the Front Office Lab, our unique dental front office training program where we equip you with a wealth of resources, assignments, and in-depth trainings. In this journey, you'll not just master the administrative ropes, but also uncover the significance of marketing and advertising in a dental practice. The second part of our discourse illuminates the wide career horizons that the Front Office Lab program opens up. From being a dental practice office manager to a treatment coordinator, the opportunities are numerous. We delve into the qualifications each role demands and introduce you to the concept of 'perfect day scheduling'. Furthermore, we share the importance of dreaming big and creating a five-year plan. We wrap up by honoring the dental heroes and mentors who have enriched my career, and sharing the inspiring journey of turning a no-patient practice into a successful venture. We emphasize the role of family support during a career transition and give you a walkthrough of our student center orientation and Front Office Lab program syllabus. Embark on this exciting journey with us. Connect with Ericka on LinkedIn:www.linkedin.com/in/dentalbillingcoach Email Ericka:billingcoach@dentalbillingcollege.comJoin us in the lab: thedentalbillingcoach.com/frontofficelab Get your ticket to our next live event with Dr. Roy Shelburne: thedentalbillingcoach.comWould you like to schedule a FREE 30-minute consultation? Spots are limited to 4 per month. Email your request to:admin@dentalbillingcollege.com

“A bend in the road is only the end of the road if you fail to turn.” ~Dr. Roy Shelburne Dentistry is at a turn in the road. We are moving faster and crazier than before. The reality is things have changed more in the past 5-10 years than they did in the previous 20-30. Dr. Roy Shelburne joins us today to share his insights on opportunities in dental billing and how you can embrace and navigate what's coming.

‍In this episode, Dr. Roy Shelburne, breaks down medical and dental insurance billing, and the shifts he has seen in the dental world. He expects to see more movement towards medical billing in the future and recommends training on it! Dr. Shelburne goes over different billing code manuals, how to implement them, and how to make sure you are following the right information. While internet searches and groups are a helpful resource, he endorses finding a qualified consultant in billing as an important step. With rules and codes constantly changing, this might be one of the overlooked areas worth updating in your practice!‍Drop in on Michael and Roy's conversation here to get the latest recommendations and predictions for medical and dental billing!‍You can reach out to Roy Shelburne here:Email: royshelburne@gmail.com‍Mentions and Links:Medical Dental Cross Coding with Confidence 2023Dr. Roy Shelburne Bootcamp and CE EventsICD - International Classification of DiseasesADMC - The Academy of Dental Management ConsultantsADA - American Dental AssociationADA Coding ManualADA Coding Manual Companion‍‍‍If you want your questions answered on Monday Morning Marketing, ask me on these platforms:My Newsletter: https://thedentalmarketer.lpages.co/newsletter/The Dental Marketer Society Facebook Group: https://www.facebook.com/groups/2031814726927041‍Our Sponsors & Their Exclusive Deals:CARESTACK | Cloud-Based Dental SoftwareSCHEDULE A FREE DEMO TODAY!Click the link below and get 1 MONTH FOR FREE + 10% OFF your Annual Subscription + 50% OFF Your Set-up Fee!Check out CARESTACK now: https://lp.carestack.org/thedentalmarketer‍‍‍Dandy | The Fully Digital, US-based Dental Lab‍For a completely FREE 3Shape Trios 3 scanner & $250 in lab credit click here: meetdandy.com/tdm !‍Thank you for supporting the podcast by checking out our sponsors!‍

What Are You Willing to Do?Episode #496 with Rachel Wall, RDH, BSYou want a successful, profitable practice. So, what are you willing to do to achieve that? There are a few key things you should be willing to invest in, and Kirk Behrendt brings back Rachel Wall, CEO and founder of Inspired Hygiene, to help you identify what's worth doing to help your patients and your practice. To hear her advice for elevating your systems and your practice, listen to Episode 496 of The Best Practices Show!Episode Resources:Rachel's website: https://www.inspiredhygiene.com Rachel's Facebook: https://www.facebook.com/InspiredHygieneRachel's social media: @inspiredhygieneSubscribe to the Best Practices Show PodcastJoin the To The Top Study ClubSee our Live Events Schedule hereGet the Best Practices Magazine for Free!Write a Review on iTunesLinks Mentioned in This Episode:Overjet: https://www.overjet.aiPearl: https://www.hellopearl.comDenti.AI: https://www.denti.aiDr. Roy Shelburne: http://royshelburne.comInspired Hygiene's Standard of Care worksheet: https://www.inspiredhygiene.com/standardofcareMain Takeaways:Be willing to commit to a high standard of care.Be willing to look into medical reimbursements.Be willing to get out of your comfort zone.Be willing to consider assisted hygiene.Be willing to train and to delegate.Be willing to use AI diagnostics.Quotes:“There's not one way to run a dental practice, and there's not one way to elevate and improve a hygiene department either. And you're going to hear a lot of great things from all of Kirk's guests. If you get one little pearl and put it all together, it's going to make an amazing difference.” (4:55—5:10)“You want to have as few denied claims as possible. We're playing in that lane. We want to have as much success for our patients in our practice as possible, from a clinical and a financial standpoint. So, what are some of the things that we can arm ourselves with to be able to make sure that our diagnosis is ironclad, and our documentation is ironclad, and that our systems within the practice are supporting the hygienists to be able to have the time that they need to do a diagnosis? Because that's always the knee-jerk reaction with this. We're in this age right now of like, ‘Okay, something's got to give.' Hygiene wages are going up. Reimbursements are going down. And the first thing everybody thinks about is time, ‘Well, we've just got to see more patients in the day.'” (10:37—11:31)“Consider something like assisted...

Keeping well-organized clinical records it's one of the most challenging parts of running a dental practice - one single mistake could put your practice in serious legal trouble. So, what can practice owners do to protect their business? Roy Shelburne is a dental professional, consultant, and speaker with more than 36 years of experience in dentistry. As a practice owner, Roy learned the importance of proper record-keeping the hard way. His unfortunate experiences with the law inspired him to become a speaker and help practice owners improve their record-keeping practices. Today, Roy joins me to share his unique story, the lessons he learned from his experiences, and a few valuable tips for practice owners on how to avoid potential legal risks. Tune in to find out more! We discuss the importance of documentation, billing, and coding and why your whole team must be careful, concise, and diligent regarding clinical records.   Key Takeaways  These clinical record-keeping mistakes could doom your practice (00:00) Roy's story and lessons from his unfortunate experience with the law (01:30) Potential legal risks practice owners should know about (10:41) The importance of documentation (18:44) How a single team member's mistake could put your practice at risk (23:54) How can dental practices reduce record-keeping errors? (28:05) Lightning round questions (30:43)   Additional Resources Learn proven dental marketing strategies and online reputation management techniques at: https://www.drlentau.com Learn more about Roy:http://royshelburne.com/ This podcast is sponsored by Cloud Dentistry, the largest dental talent marketplace. Find out more at: http://www.clouddentistry.com/Len

In response to the recent popular episode with Dr. Roy Shelburne, I decided to reach out directly to my local state Medicaid office to talk to somebody about how criminal medicaid cases are handled. Although I wasn't able to convince any members of the department to join me on the podcast directly, I was able to take and share notes from the conversation. There was a lot of listener feedback with confusion about how a dentist could end up in prison over simple billing and coding errors. I was able to shed a lot of light on that in my conversation with the Medicaid auditor. I also give my thoughts on a recent Medicaid fraud/kickback scheme involving the indictment of two individuals at a Texas pediatric dental office involving 6 million dollars worth of fraudulent and criminal dental billing to Medicaid (allegedly).

Dr. Roy Shelburne joins us on this episode to tell his incredible story about being arrested for Medicaid fraud. After years of running a busy and successful practice in Virginia, Dr. Shelburne received a phone call that the FBI had raided his office. All of his personal assets were seized, and he was tried and found guilty of medicaid fraud. He served 19 months in prison, and now spends his time consulting dentists on how to prevent this from happening to them. This was an eye-opening conversation. As pediatric dentists, many of us see medicaid. You may think that if there were an error or mistake with an office's Medicaid billing, penalties and fines could occur and simply be paid as long as the mistake was innocent. Dr. Shelburne's story demonstrates that this isn't always true. For anybody looking for more information on Dr. Shelburne, his website is: http://royshelburne.com/ Link to registration for Dr. Shelburne's Dental Billing Bootcamp: https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fform.123formbuilder.com%2F6180041%2Fform&data=05%7C01%7C%7Ce22febb87d32459cfd8708da54595fb1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637915040111326747%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=CBiK8%2FzfZ8Dp0LZGJpdrBQ3Nlsi2URYTti%2BOh60O%2BVI%3D&reserved=0

Trends in Insurance Reimbursement Episode #432 with Dr. Roy Shelburne Everything you know about dental insurance today — well, it may be different tomorrow! So, to help you stay ahead of the trends and changes and protect your practice, Kirk Behrendt brings back Dr. Roy Shelburne to share his expert advice. There are ways you can maximize your reimbursement, and it starts with one thing: read and understand your contracts! If you want to collect every cent you're entitled to, listen to Episode 432 of The Best Practices Show! Main Takeaways: Dental insurance rules are constantly changing. Always read and understand your contracts. Double and triple-check your documentation. Audits are done for a reason, not at random.   Be prepared when communicating with insurance. Quotes: “What you know about dental insurance today, the rules are going to change tomorrow. The codes are going to change tomorrow. So, we have to continually keep our focus on understanding and doing it correctly.” (4:36—4:52) “[Insurance companies] like claims that are clean. They don't like to have to send it back and ask for other information. It's harder for them and it's more expensive for them. So, that's the reason why they're concerned about having it done the right way.” (8:29—8:42) “So many dentists look at the contract and only review the fee schedule and think, ‘Okay, I can live with this fee schedule.' But, in fact, there are all kinds of other limitations or restrictions on that plan that have a broader effect on the reimbursement scheme. So, they aren't aware. It's like, ‘Well, this says it's going to pay at this amount.' However, there's also a different section in that contract that says, ‘Oh, and by the way, under this situation, we can't pay. Under this situation, we can't pay.' So, it's understanding, first off, the restrictions and limitations not only in the fee schedule, but also the way the contract is set up.” (9:18—9:59) “The contract, primarily, is seldom read. Or if it's read, it's misunderstood. And secondarily, the contract that you've signed with the insurance company gives them the right to change that contract with 30 days' notice. So, not only have dentists not read the contract when they signed on originally, those letters that the insurance companies send to their network dentists periodically could have some very significant modifications to that contract where they're letting you know it's changing, and the person who gets that letter, or the doctor who gets that letter, looks at it and goes, ‘This is junk mail,' dumps it in the trash can, when the contract has been changed and it's been disclosed in that letter that you haven't read.” (10:14—10:56) “The concern is, we're talking about inflation and how it is now increasing at a not foreseen rate. Maybe, what was it, in the ‘80s, it was similar to this? But now, do the costs for dentists go down? Absolutely not, as far as you have to pay teams more money. We have to be competitive in the employment market today. And as far as the supplies, they've gone out the roof. And what has been the trend with reimbursement? Has it increased? No. Absolutely, it's going down. How do you make that work? How do you work harder and make less? And how many additional patients do you have to see, and what's your capacity?” (13:39—14:33) “As far as the EOB, I think it's meant to be obtuse, to be able to not follow. The more confused you are, the less likely you are to go ahead and counter, to appeal that denial.” (18:34—18:46) “Ignorance is no excuse. And honestly, the bottom line, you're going to bleed a whole lot of money on the table if you don't pay attention.” (20:30—20:36) “In my experience, although they say it's a random audit, I don't think that's a thing. It's an audit that is caused, triggered, by being unusual in your submissions. And the insurance companies view that very, very specifically, very succinctly. So, any kind of deviation. And as far as the...

In this episode of The Art of Dental Finance and Management podcast, Art meets with Dr. Roy Shelburne, a medical records keeping and business systems consultant who helps protect dentists from committing healthcare fraud. Dr. Shelburne has developed a compliance program for dentists to help them keep accurate records in their practice.In March 2008, Dr. Shelburne was found guilty of healthcare fraud, racketeering and money laundering and spent 19 months in a Federal Prison Camp. He illustrates how important it is for dentists to keep good records with accurate coding and submitting claims properly. If your records, billing and coding systems are faulty, claiming ignorance is no defense. Reach out to Art if you have any questions regarding dental finance and management for your dental practice. More information about the Eide Bailly dental team can be found at www.eidebailly.com/dentist.Being more strategic in all aspects of your dental practice will lead to increased profitability. https://www.eidebailly.com/industries/health-care/dentists#chatForm

Dr. Roy Shelburne spent 19 months in federal prison for health care fraud.  Dr. Shelburne shares the lessons that he learned in the hardest way imaginable to help other practitioners avoid the same fate.  Dr. Shelburne's website is www.royshelburne.com.We thank CareCredit for financially supporting Dr. Shelburne's appearance.

We continue our tour and meet Ted of CareCredit, April H, RDH, founder of Swipper Designs, Dr. Roy Shelburne (dentist, speaker, writer and coach), Jill of Schooley Mitchell, Mango Software, Gary of Tooth Showers, and the illustrious Nurse Jill! To connect with our interviewees- carecredit.com swipperdesigns.com royshelburne.com schooleymitchell.com mangolive.com toothshower.com Stay in the loop and go ahead and follow us here: https://www.facebook.com/DentalAlementsPodcast https://www.instagram.com/dentalalementspodcast/ https://www.youtube.com/channel/UCBw0a93RbY8uC6PZKUKO3Sw https://www.linkedin.com/company/dental-alements-podcast   Thank you for your continued support.  Cheers!     April & Cindy     

When did dental insurance start? How are CDT codes added and changed? Dr. Roy Shelburne breaks it all down and gives his prediction for the future of dental billing.

When did dental insurance start? How are CDT codes added and changed? Dr. Roy Shelburne breaks it all down and gives his prediction for the future of dental billing.

John Stamper speaks to Dr. Roy Shelburne, of the Academy of Dental Management Consultants, about best practices and his experience in the dental industry.

Dr Roy Shelburne is a nationally known speaker and writer who focuses on maximizing legitimate reimbursement, increasing revenue, reducing risk, and lowering stress for dental practices…and, most importantly…keeping other healthcare professionals out of prison. Having practiced for almost 43 years, Dr Shelburne has a wealth of knowledge. Listen in as he and Penny discuss tele-dentistry, reimbursements, HIPAA, and how COVID19 has and will continue to impact the way you do the business of dentistry. Dr Shelburne can be found practicing at The Appalachian Dental Group in Jonesville, VA. You can find out more about him at royshelburne.com. *Doxy.me discount code is DEVDENT April 24, 2020 Update from the ADA on PPE Coding Less than 48 hours after the recording of this podcast, that ADA released their guidance on billing for PPE.  The current recommended code for filing is D1999.  This doesn't mean it is reimbursable, yet this is the recommended code for filing.  See the ADA's statement here https://www.ada.org/en/publications/ada-news/2020-archive/april/ada-advocates-that-third-party-payers-should-modify-fee-schedules

Reese welcomes special guest Roy Shelburne on this episode of Dentist Money™. A popular conference presenter, Roy takes time from a busy schedule to tell his fascinating story. From spending 36 years building a successful practice to federal prison, it's a personal journey that will both frighten and inspire you. But most importantly, as dentistry compliance issues continue to increase, it will change the way you document your work.

It's amazing how less than $3,000 a year could change a life. On this episode, Dr. Roy Shelburne shares the true story of how his world was turned upside down with a single phone call, all because of insurance. Dr. Shelburne now spends his life inspiring dentists and their teams to put systems and processes into place to ensure that they employ the most current best practices when it comes to patient billing.  Also, on this episode, listen to a real life phone call of a patient calling into an office to request an appointment. In this call we explore the ways in which you can handle questions about insurances that are not accepted.  For full show notes and more information, please visit www.TheDentalPodcast.com.

When we say minor, he billed 3 million dollars and was found guilty of overbilling $17,000. To us, that's a minor coding mistake that can be easily corrected and refunded to the right entities involved. However, he spent 3 years in prison, lost his dental license, then another 5 years of probation for a mistake we all make with coding. Dr Shelburne shares his experience in how his life was completely ruined by something we all overlook in dental offices. His message is a powerful one in that we all need to take a second look at how we do things in business. From documentation to higher coding standards, Dr. Shelburne sheds light on the true reality and liability of relaxed business standards, especially when it comes to dealing with patients who have insurance or other 3rd party payor support. To contact Dr. Shelburne you can email him at roy_shelburne@yahoo.com. His website is www.royshelburne.com. To contact our hosts please email help@veritasdentalresources.com.

Very interesting story that applies to all of us as dentists in regards to record keeping, coding and billing. Some of the topics may just put you on the other side of the law and get you in trouble. Dr. Shelburne shares his personal story of practice ownership, federal agents, court, prison, and the life he has made himself afterwards. He took the fall for us and now he is teaching us how not to fall. A wonderful interview that might just freak you out a bit.