Episode #392: Compliance, Documentation, and CRUSH: Building Practice Freedom with DeVon Banks

Naren Arulrajah: This is the Less Insurance Dependence podcast show with my good friend Gary Takacs and myself, Naren Arulrajah,

Gary Takacs: We appreciate your listenership, your time, and most of all, we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal, professional and financial satisfaction.

Lester De Alwis: Welcome to the Less Insurance Dependence podcast. I’m your host, Lester De Alwis. This podcast is dedicated to helping dental professionals build stronger, more profitable practices with less reliance on insurance. Today I’m thrilled to welcome Devon Banks, CEO and founder of D-TECH Billing and Claims. Devon has been a force in dental billing compliance and a revenue cycle management since 1998. That’s nearly three decades, helping then hundreds of dental practices across the country, clean up their coding, protect their revenue, and run smooth operations. She’s a former certified trainer at Henry Shane Dentrix, an industry recognized speaker on compliance and her firm Bo to, both a remarkable 98% client retention rate with some practices staying with her team for 17 years and counting. What sets Damon apart is her core philosophy. That is coding isn’t about reimbursement, it’s about compliance. And in a year where CMS is rolling out the Crush Initiative with AI driven and fraud detection, that perspective is more critical than ever. So today’s episode is titled as Compliance Documentation and Crush Building Practice Freedom. So we will explore why Bulletproof Documentation is the hidden foundation of insurance dependence and what the Crush initiative means for the average dental practice, and how a compliance and how clean compliant gives, owners the financial clarity that need to confidently reduce PPO dependence. So if you ever felt trapped by insurance because you weren’t sure of your real numbers, this conversation is for you. So, Devon, welcome to the show and we are so glad to have you here.

DeVon Banks: Thank you for having me. I’m really excited to be here and dig into these topics today. This is very timely, wasn’t intentional, but I’m glad we’re here on this day. Ties right into amazing things we’ve been seeing recently, so thank you for having me. Exactly.

Lester De Alwis: So Devon, you’ve been in the dental billing and compliance since 1998. That’s nearly three decades and hundreds of practices served and a 98% retention rate at D-TECH. So take us back. What did dental billing look like when you started and what’s the single biggest shift you watched dentists struggle with as the insurance landscape has gotten more complex?

DeVon Banks: Man, if I could take you back to 1998, I don’t know. I mean, back then we didn’t have Google, right? the internet wasn’t recently born. Mm-hmm . systems back then were truly just paper driven. there were no mm-hmm . analytics. There were no type of like software that was analyzing things that we were doing in the dental industry. It was really just truly a paper driven system. Appointment books were paper ledger cards were paper insurance claims were paper x-rays were not digital back then. we were, I was coming along right when a lot of those things were starting to break through mm-hmm . So I’ve really seen this shift over the last 27 years from completely paper to more dependent on computers and computer software automations, ai, all the things, mm-hmm . So back then we just had very minimal scrutiny of our claims.

DeVon Banks: we sent things in, everything was driven by people, right? So we had people that were looking at our claims. They were not very scrutinous of our claims back then. Honestly, it was just, you submit the claim. If they had coverage for it, they paid it. They weren’t really looking at our documentation. We rarely sent in narratives. We rarely sent in clinical notes. it was just at that time, maybe x-rays and per charting that we had to submit for dealing and root planning. And it just has really gotten more intense over the years. So we’ve had to kind of adopt and a adjust to what we’re seeing in the market now, which is that everything is being scrutinized. There are software systems that the insurance companies are using to, kind of aggregate data and look at comparisons between clients and their competitors in their zip code or in their region.

DeVon Banks: they’re looking for, anomalies and things that just don’t add up with what their peers are doing locally. they’re looking for just improper coding. And so it’s just really shifted quite a bit and they don’t need people to do it anymore. They’re using automation, they’re using AI and they’re using software to handle a lot of these tasks. Dentistry, unfortunately, is just behind the curve on a lot of these things. So we have clinicians who are doing the things the same way that they used to do years ago, and they’re not really educating themselves on kind of what the status quo is now and how they need to fall in line to that so they can remain under the radar. so there’s real time scrubbing of claims now. There’s, AI driven, flags that are popping up and unbeknownst to the client, they’re looking at you more scrutinously a after the fact.

DeVon Banks: We have post-payment review audits that are happening now. We are starting to see retractions of money that were paid one to two years prior, even more as they go back and kind of audit their payments. So, these are the trends that we’re seeing, and it’s going to get more so not less over the next few years. So, there’s more codes, right? The codes are changing constantly. Mm. Years ago, you know, the a DA was published codes every so many years now we’re seeing, tens of codes being added and changed and deleted every single year. And it’s a lot to keep up with. So there needs to be some type of a mechanism in place for our offices to really keep educated on these things and make sure that they’re being compliant in all the things they do within the practice.

Lester De Alwis: Yeah. Yeah. I think, with this evolution you just mentioned, it doesn’t look like the issues got any easier. It just got more complex. It

DeVon Banks: Got more complex, and it will continue to do so. So the quicker that everyone gets on board and tries to stay in the loop by, coming to these types of podcasts, webinars, going to continuing education in person, that needs to be on the uptick, not on the decline. We need to do more to educate ourselves.

Lester De Alwis: Amazing. So you said something powerful. Now most dentists think coding is about reimbursement. It’s not about compliance. What are like, what are dentists getting wrong day by day in their coding and documentation, and why are those gaps quietly putting practices at financial and even legal risk? Yeah,

DeVon Banks: That’s a very good question. So it’s interesting, I get a lot of questions on what code I should use . when people, reach out, sometimes it’s clients, and they initially start with, this patient has Medicaid. What code should I use for mm-hmm. This patient has Delta, what code should I use for procedure, blah. And I always have to tell them, I know I’m an insurance, specialist and an insurance expert, but the code you’re using has zero to do with what insurance they have. So you have to, they have to learn to take that out of the equation. Mm-hmm . Coding is in place to document, right? It’s in place so that there’s consistency and documentation. We should not be coding to get paid. I know that seems kind of counterintuitive, but coding is not there for people to get paid.

DeVon Banks: It’s there to document. The insurance companies have piggybacked on a system that’s there truly just to document cases. If your patient has no insurance, if it’s your mom, the doctor’s mom’s coming in and you’re just gonna do her work for free, you still have to use the accurate code. Those charts can be requested at any point, whether it be by the insurance company, a family member can sue you. This happens a lot, right? Where family members will sue their own family member provider, you could be called before the board, right. To have to justify your actions. So your record keeping needs to be completely above board and compliant no matter what insurance they have or if they have insurance at all. And I think that’s the big mindset shift that needs to happen, is that we’re here, in dentistry, trying to be consistent with the way we’re documenting things so that the next practice knows exactly what happens once they convert records over, or even within your own practice. we want your own team members, your other associates, hygienists, even admin at the front, clinical assistant. It should be just, it’s the language we use in dentistry is the coding, and it needs to be used properly so that everyone in the practice, everyone outside of the practice knows what’s happening for that particular patient to keep the patient safe as well. Okay.

Lester De Alwis: Yeah, I think that is a complete shift in how owners should, actually need to think about this. like you said, you know, it’s not about compliance. it’s, it’s about compliance. It’s not about reimbursement. So, it’s a complete shift, which I think a lot of owners think it the other way around.

DeVon Banks: Yeah.

DeVon Banks: And I typically tell my clients, if you do everything you need to do on your end to properly document your case and code properly, I will have everything I need to get your claim paid. Right? So they, I want them to reverse the mindset, don’t, don’t document so that I have what I need. I want you to document properly. That’s first and foremost, because that keeps your license safe, right? Yeah. If you’re not doing that, then you can’t even be a dentist potentially if they, if they ding you or, put you into some type of, program where you have to go to training and all types of, costly classes to get back on track with documentation. So do what you have to do to keep your license safe, and then I’ll have what I need to get your claim paid just by default. It’ll just be icing on the gate. Yeah.

Lester De Alwis: In simple, there is no shortcut.

DeVon Banks: Yeah. Yeah. No shortcut

Lester De Alwis: . So now CMS is rolling, is now rolling out that crash initiative, which is comprehensive regulations to uncover suspicious healthcare. So using AI and realtime data analytics to flag suspicious billing patterns. And the a DA has already raised concerns. Yeah. Why is this the wake up call and dentists can’t ignore, and how does getting compliance right actually become a foundational or reducing insurance dependent rather than just a defense defensive shield?

DeVon Banks: Well, there’s a couple of components to this that I wanted to mention specifically since this kind of recently rolled out. Mm-hmm . Number one, although CMS is kind of triggering this call to the states that they’re going to be mandated to audit all of their Medicaid providers,

DeVon Banks: The way that the PPO providers behave is typically gonna be a reflection on the way CMS is behaving for Medicaid. So it might be something that, comes to play at some point that the PPOs will start to audit all of their providers as well. The way it currently stands, offices, supposedly, there’s random audits that occur both on the Medicaid, Medicare and PPO side of things. I do believe some of it is, gonna be predicated by whistleblowers, people who call in and give anonymous tips. That could be somebody within the practice that could be a patient that also will trigger an audit. of course, them detecting abnormalities in the algorithm of your coding and things of that nature can trigger an audit. But this is very different. This is a mandate from the federal government down to the states that they are going to be required, which means every single Medicaid practice is going to be audited.

DeVon Banks: How long is that gonna take? We’re not really sure how quickly the states are gonna get on board and put in a mechanism by which to, stand this whole program up. I’m not sure, but it’s coming. I’ve been saying this for a while. I never even knew about PR until recently when it was dropped, but I’ve been saying this for a while because the trend is that we are seeing more audits. Even before crush was initiated, we were seeing more audits on the PPO and the Medicaid side. So I think that, I’ve been saying it for a while, it’s coming, this is here, this is no longer me just making up things or guessing, or based it on only what I’m seeing in my practices. This is something that we, it’s now here, right? So it’s the time to take this serious.

DeVon Banks: they’re looking for red flagging suspicious billing activity. They’re going to be looking for coding abnormalities. They’re gonna be looking for consent to making sure we have signed off consent from the patients to make sure that if there’s non-covered services that was properly authorized by the patient, they’re gonna be looking for unusual billing combinations. High volume billers are gonna be especially targeted. oh, Medicare is going to probably come into this at some point. I think they’re rolling this out on the Medicaid side first, and then they’re gonna switch into Medicare. So we just really need to get prepared and almost start looking at this as you’re an auditor, if you’re in your own practice, you need to start auditing yourself, like, pay attention to the way things are being done in your own practice, or engage with someone like myself to come in and take a look at things for you from an outsider’s perspective to see like mm-hmm .

DeVon Banks: Are you doing everything properly and are you at risk for being, deemed, gonna be audited? But now are you at risk for penalty during an audit? And kind of what can you do to remedy as much as you can before they get to you? It does go a long way, from what I’ve heard. Okay. It goes a long way if there’s been some self remediation, right? If you’re getting ahead of it and being proactive and, Hey, look what we’ve done over the past year. we’ve done all of these things, we’ve implemented all of these measures to get better at this. We did our own audit. We figured out where we were kind of sufficient in certain areas, and we’ve taken these steps to get things better. I believe that goes a long way, in terms of showing, the organization, with CMS, that, you’re trying , you’re not just a willfully ignorant in this, in this scenario. So, I really think we have to take it serious. It’s coming. I hate to beat the bare of bat news, and I’m not gonna say I told you so, but, I kind of did. I’ve been saying this for probably over the past few years, and I think, once Doge did its thing and they found that there was a significant amount of fraud, waste, and abuse in our industry, they’re now coming for us. I’ve been saying it for a while, it’s unfortunate, but here we are.

Lester De Alwis: Yeah, it is. It’s, it’s such an important point. I think Crush really is the wake up call here. Yeah. It’s forcing practices to get their houses in order on the compliance side. Yeah. But once that foundation is solid, it opens the door, to something bigger. And that is if, it gives dentists the confidence to start thinking about reducing insurance dependence instead of just reacting to it. and that’s where having the pa the right patient flow becomes just as important as compliance. So a quick shout out to our sponsor, which is Ekwa Marketing. They help, practices build a steady stream of the right patients. so moving away from heavy PP Reliance feels like a smart step, not a risky one. So they’re offering a complimentary marketing strategy meeting. If you want to see what that could look like for your practice, or you wanna do an audit for your online visibility, you can check them out at lessinsurancedependence.com/msm.

Lester De Alwis: So let’s get back to the conversation now. When a dentist tells you that they want to drop a PPO, or shift towards a fee for service practice or fee for service, fee for service practice, how do compliance and documentation either accelerate or block that move? And the deeper question I think we hear most of the time is that, I want to push back. I think a lot of owners stay trapped on insurance because their documentation is so messy, they don’t actually know there are true numbers. So they, so they are dropping any payer fields like, terrifying. So is that the real story underneath insur insurance dependence? Or how do you, what do you think about?

DeVon Banks: I think that’s the narrative that a lot of dentists wanna believe, but that’s just simply not true. unless you go completely fee for service whereby you are collecting in full at the time of service, not submitting mm-hmm. To insurance at all. Otherwise, you don’t eliminate the compliance issue. Right. If you’re submitting to insurance, even as an out-of-network provider, you are still subject to audit. Yeah. Not to mention, you’re still subject to review by your board of your state. So there really isn’t a world that exists where dentists are allowed to just heart blanche, do whatever they want, and not have any regard for any types of rules or any types of systems that are in place. There are still rules that license is still in jeopardy. If they’re doing anything outside of the scope of what they should be doing and the way they should be doing it, I don’t know that I think there’s any way like, to get around that the compliance issue, there’s going to be some level of compliance in of, in any dental, office.

DeVon Banks: there’s not a way to get around that. The thing that getting out of network does help with is, oh, am I adjusting correctly? Things of that nature, am I, accepting the right fee schedule based on my contract? So that’s more of a contractual thing. So getting out of network frees you of the contract restraints. It doesn’t free you of compliance restraints. So if you’re gonna be out of network and still submitting to insurances, there’s still rules. There’s still insurance laws that regulate that. So I don’t really know that they’ve thought that through. Now listen, I’m all for getting out of network and, if it’s feasible for your practice, well, a well thought out plan should always preface that, of course. And lots of, analytics that go into that and really making good decisions and really mm-hmm .

DeVon Banks: assessing whether your practice is ready for that. And then of course, preparing for that transition. I’m all for that. I love helping practices do that. But if that, if they think that process is going to get them away from compliance, it’s just simply not true. And I just feel like later is when you’re gonna feel the burn when you think you’re like flying high and you’re, above the fray, and now all of a sudden you still get audited. so yeah, they could still retract monies from you. There’s still all types of ways that they can kind of force their hands. So, I just, and again, getting out of network is a wonderful thing if you’re able to, so this is not to diminish that or to, talk anyone out of it. I don’t think I could if I wanted to, but just be clear on what that really impacts and just have a good sense of reality around what the implications of that is. And does it really help you with compliance? Not really, honestly. Not really. Exactly. Yeah. Doesn’t really change much there.

Lester De Alwis: Yeah. So let’s bring this all the way home with something practical. If a dentist is listening right now and thinking, my documentation and coding are probably a mess and I want to fix this, what’s the very first move they should make this week? One concrete step that can take before they are hiring a billing partner before they invest in software or before anything else.

DeVon Banks: I think there’s a couple of things they could do. I would say, one of them would be just to pull a list of the top, maybe 10 procedures, 10 to 20 procedures you’ve performed over the past year, and look at what they are a, and then start to take some sample accounts on your own. The same thing an insurance company would do. Look at some of these sample accounts. Check to see if you have, you know, the proper sign off from the patient, accepting the treatment, accepting the fees. do you have your clinical documentation? Is it right? Is it there, is it complete? is it comprehensive? One thing I don’t think dentists do enough is look at your x-rays. Look at the quality of your X-rays. Are they of diagnostic quality? Are there cone cuts? Is the resolution poor? Are you really showing, is there elongation of the x-rays?

DeVon Banks: Because technically, unless you have diagnostic level X-rays, you’re not supposed to even charge for them. We’ve had that happen where insurance companies, we sent an FMX to an insurance company to document scaling and root lining treatment. Mm-hmm . And they came back and retracted the FMX funds because now that they’re looking at the FMX, they decided that they weren’t diagnostic in quality and they weren’t. Right. So, these are all the little things that you open yourself up to when you’re, when you’re being audited, they start, they look at everything you’re doing, not just, one or two items. They’re really looking at the totality of the way you’re managing that patient. So I would say pull your top 20 codes, take a look at the way you’re documenting them, making sure you’re documentation matches that code, which means you’re gonna need to make sure you have an a DA companion code, a DA code companion book to make sure that you really have a sense of like what each code means, and if you’re matching that properly with the documentation.

DeVon Banks: Mm-hmm . I would say making sure you’re, of course, checking your aging and your denials to see if there are any patterns there, because it might be that you’re impacting your aging by coding improperly. hmm. I would say, honestly, one of the big things I recommend is don’t try to fix everything at once. Right? Let’s look at the, let’s look at everything and see where the gaps are, and then let’s put together a really comprehensive process. Okay, what are we doing month one? What’s really important? What are we really bad at here? And, sometimes we kind of, have knee-jerk reactions as finding issues within a practice or any business, and we want everything done tomorrow, but Rome wasn’t built in a day. So you don’t wanna overwhelm the team. You don’t wanna overwhelm yourself if you’re the owner, let’s, let’s just methodically go through, implement something new audit, see, are you doing better at that?

DeVon Banks: Once we get in the habit, move to the next thing, right? And maybe even two things at once, but trying to implement everything tomorrow is just not gonna work. You’re gonna have revolt from the team, dentist owner shuts down, eventually it becomes too much to manage, and then nothing happens. So I would say, just start looking at your own systems yourself, right? There’s no, there’s no better. You have access to your own system. You don’t, even before you bring an outside person, look at what you’re doing and if you realize that there’s some issues there and you feel overwhelmed and unable to, kind of get yourself back on track, then absolutely. Elic, elicit the help of someone seasoned and really, talented that can help you along this process. Because implementation is hard, change is hard. working, getting change done through other people is hard. And, you wanna make sure you’re staying the course and, hopefully protecting yourself from any long-term damage as it pertains to an audit.

Lester De Alwis: Amazing. Now, of course, this podcast is about taking action. And if anyone listening to this episode wants to get in touch with you all, just have a conversation about this whole topic, get an understanding about where things are moving and what they can do for their practice, how can they reach out to you?

DeVon Banks: I can be reached at, devon@dtechbc.com. That’s D-T-E-C-H bbc.com. First name is Devon. you can also reach me 2 4 0 4 6 1 9 5 9 0. Pretty easy to find. I’d love to sit down and talk with you. No, complimentary of course. just to kind of point you in the right direction. I’d love to do that. I’m here to help.

Lester De Alwis: Amazing. And if so, if you want more information, there are, there is more, links in on the show notes of this episode, so you can quickly go and grab them and, reach out to Devon as well. So Devon, thank you so much for spending your time with us today. Thanks

DeVon Banks: For having me. This has been great. I appreciate you inviting me over.

Lester De Alwis: So the biggest takeaway from our conversation is that compliance and the documentation are just an are aren’t just defensive check boxes. They’re the foundation of confidence, clarity, and ultimate freedom. So when a practice knows its numbers, codes correctly, and documents them bullet, the documents are bulletproof and the doto insurance dependence opens. So if you’re ready to take action, start by scheduling a complimentary marketing strategy meeting with Ekwa Marketing lessinsurancedependence.com/msm. And if you’re looking for mentorship and you need some help with coaching, you can also book a complimentary coaching strategy meeting with Gary Takacs thrivingdentist.com/csm. Now remember the practice that when, that the practices that win in this next chapter of dentistry won’t be the ones leaning hardest on insurance, they’ll be the ones with the cleaner systems, the strongest documentation and the courage to build on their own terms. So compliance is on the flow. Freedom is what you build on top of it. So thank you for listening to the lesson Insurers Defenders podcast. I’m Alvis and I look, and I look forward to seeing you on the next episode.