Ep. #432: Trends in Insurance Reimbursement, 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.

Snippets:
0:00 Introduction.
2:52 Dr. Shelburne’s background.
7:37 Why insurance companies like clean claims.
10:30 Read your contracts.
11:49 Where trends in reimbursements are at today.
15:41 How to play the game of shared agreements.
18:31 Learn to read the EOBs.
21:23 What to know about insurance company audits.
27:05 Things to know about reimbursement.
31:35 You can negotiate fees.
34:35 Reimbursements dictate the treatment.
37:40 Missed opportunities with reimbursements.
40:41 What dentists get wrong about reimbursements.
44:30 Slowing participation with less desirable insurance.
47:15 Last thoughts on insurance reimbursement.
50:46 More about Dr. Shelburne and how to get in touch.

Reach Out to Dr. Shelburne:
Dr. Shelburne’s website: http://royshelburne.com/
Dr. Shelburne’s Facebook: https://www.facebook.com/royshelburne
Dr. Shelburne’s social media: @2thdoc55

Dr. Roy Shelburne Bio:
Dr. Roy S. Shelburne, DDS, is a 1981 Honor Graduate from Virginia Commonwealth University’s School of Dentistry. After graduation, Dr. Shelburne opened his practice in his grandfather’s old hardware store. He has served as president of the Southwest Virginia Dental Society and has volunteered at Virginia’s various MOM projects across the state. He has also served as a short-term missionary to Honduras with Baptist Medical Missions International.
Some dentists may fear litigation, but few worry about going to prison. On October 24, 2003, the FBI broke down the back door of Dr. Shelburne’s office and confiscated all of his business and dental records. Over the course of the next three years, every aspect of his life was subjected to the closest scrutiny. He was indicted in October of 2006. In March of 2008, he was found guilty of healthcare fraud, racketeering, and money laundering, and spent 19 months incarcerated at the Federal Prison Camp in Manchester, Kentucky, before his release in 2010.
During the investigation and trial, it became apparent that his records, billing, and coding systems were faulty, and that ignorance is no excuse. While incarcerated, Dr. Shelburne had ample time to reflect on his life and found that true release comes when we draw from our strength, character, vision, wisdom, and experience. A speaker, consultant, and writer, he now specializes in records keeping and business systems that protect and defend other doctors from facing the same troubles.

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