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Dr. Joel Gould of Modern American Dentistry Alleviates Potential Stranglehold on Practice Finances by Specialized Billing Employee

Case Study
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Dr. Joel Gould of Modern American Dentistry Alleviates Potential Stranglehold on Practice Finances by Specialized Billing Employee

Nearly 30 years ago when Dr. Joel Gould started his business as a single-dentist practice offering general and cosmetic dentistry in Vancouver, Canada, patients were fewer, the pace was slower, and the insurance environment was far less complex.

Fast forward a decade to when he moved to Manhattan Beach, California. As his business steadily grew – with more patients, more staff, more operatories, more products and services, an associate doctor and a second office – his confidence in the billing and collections function steadily shrank.

The highly specialized insurance billing position was difficult for other team members to back up; the workload had become excessive; and whenever the person took vacation or sick time, claims piled up and collections were suspended. That’s when Dr. Gould came to the realization that “The idea that one specialized person in your practice could actually have a stranglehold on the finances – on all the money that’s supposed to be coming in – is terrifying!”

Five years ago, he added even more space in order to expand his brand into the under-served field of sleep solutions and sleep apnea treatment. The timing was right to outsource his billing and collections to a professional company so he could devote more time and attention to building his new service offering. He also wanted greater peace of mind that comes with decentralization of the financial function of his growing business.

Partnering with eAssist Dental Solutions has given Dr. Gould the confidence he needed, knowing all of his insurance billing is being handled timely and accurately, and is resulting in maximum collections. He likens it to having automated one of the most critical pieces of practice ownership, reporting, “I have a much higher degree of confidence that I’m getting paid properly, and that my practice is going to stay on track when I know eAssist is working with me.”

The Early Years

Dr. Gould had always handled his billing in-house, explaining, “It was possible when we were a slower, smaller, single-dentist practice. Plus, I had team members who had been with me for years. But as things started to grow and change, the billing started to get complicated.”

It was possible when we were a slower, smaller, single-dentist practice. Plus, I had team members who had been with me for years. But as things started to grow and change, the billing started to get complicated.

— Dr. Joel Gould

As is the case in most dental practices, his is very insurance-driven. Dr. Gould admitted that with a second doctor on board, claims were starting to add up, and it had become difficult for his staff to stay on top of all the submissions, much less all the necessary follow-up and complicated appeals.

Each member of the team had their primary job or set of responsibilities, along with some secondary duties. Dr. Gould said he had replaced people over the years, but each time, with just one person in charge of all the billing, the job inevitably evolved into a highly specialized position with no one qualified to provide effective backup.

It was all-too-apparent to him that “when that person needs time off, is out sick for a few days, or is just having an off-day, claim submissions begin to pile up. If you don’t have a second team member available and capable of immediately picking up the billing, it’s a real problem.”

MEET DR. JOEL GOULD

Joel Gould

Modern American Dentistry

  • Native of Winnipeg,
    Manitoba, Canada
  • Doctorate in Dental Surgery from University of Western Ontario 1991
  • Collaborated with Canadian government to provide on-site dental care and treatment to elementary school children in underserviced Ontario areas;
    established dental clinic in rural Ontario community
  • Volunteers at Children's Dental Center, Inglewood CA
  • Collaborated with dental lab Dimitry's Dental Studios, as part of his Smile Makeover processes; developed several other cosmetic dental products; and completed training in the art, science, and application of facial fillers. His patients now have options for a one-stop solution for dentofacial esthetic and anti-aging treatments for the ultimate Perfect Smile Makeover.
  • Author of "The Perfect Smile"
  • Writes regular column "The Smile Doctor" for Pageantry Magazine — leading publication in pageant field distributed in 52 countries
  • His informative and entertaining segments on modernizing dentistry have been seen on network TV, i.e., FOX, NBC, ABC, CBS
  • Hosts radio podcast "Get Your Smile On" available on iTunes and SoundCloud

The Turning Point

Dr. Gould knew he needed to do something differently. Coincidentally, the staff member responsible for the billing and collections function had given notice that she would be leaving. In addition, he had recently expanded into the sleep apnea / sleep solutions arena, so timing was ideal to consider the help of a professional company to take billing out of the office.

He explained, “In early 2015, there weren’t many companies doing what eAssist does. I was impressed with the various dental insurance billing backgrounds of the founders. They had put together all of the greatest assets and all the things they had learned over the years, and tried to simplify the billing function.”

Instead of replacing the resigning employee with another employee, Dr. Gould brought eAssist on board as “the replacement that’s there every day; they’re not going to take a vacation, have a slow day, or call in sick. They have the qualified backup as part of their team.”

Even so, Dr. Gould admits he was nervous at first about bringing on an outside billing company. But it didn’t take long for him and his team to become confident that “these people actually understood the billing process, and could have the right conversations with the insurance companies.”

From Dr. Gould’s vantagepoint, the insurance companies have gotten progressively harder to work with, using non-dental people to review claims and make coverage decisions. He lamented, “Their job is to NOT pay us; they’ll take any excuse possible to deny a claim.”

He values “having that extra layer of insulation against the aggravation and frustration of dealing with insurance companies. It’s nice to have a professional corporation that knows dentistry, is totally focused on a regular basis, and will get down into the nitty-gritty of billing.”

When presenting treatment plans, we find patients to be more compliant when they understand what’s covered and what’s not. The insurance collections are professionally done by skilled eAssisters, and we spend far less time on the back end managing patient collections.

— Dr. Joel Gould

Financial Peace of Mind

Dr. Gould reports “eAssist does a great job keeping my over-60-day accounts receivable very low, and almost nothing in the over-90-day category.” He appreciates that oftentimes they catch and fix mistakes. And, that they fight for everything the practice is rightfully owed, saying, “In the past, if a claim was denied I would have to get involved. Now I only get involved if it has gone all the way down the chain of command and now there’s something different that I need to contribute. I know that eAssist goes to bat for us quite a bit to appeal denied claims and get them covered.”

It is also important to Dr. Gould that by using eAssist, he has been able to decentralize the financial function of his increasingly complex business. He confesses, “I’m always worried about fraud and theft. I’ve seen so many dental practices be stolen from. Knowing that the billing function has been taken off-site, and that it’s being handled and scrutinized by others makes a big difference. The likelihood is much less that somebody will try to steal or squeeze some money out somehow, because we have a totally separate set of eyes working on this.”

Benefits to Team and Patients

Dr. Gould described these key benefits:

  • With eAssisters handling the billing and collections function, the in-office team is freed up to focus on the time-consuming but essential Insurance Verification process.
  • eAssist keeps the office informed about billable vs. nonbillable procedures, up-to-date on changes, and aware of any trends they may be seeing with denied procedures. As a result, the in-office team not only has the time, but the best information to accurately determine the patient’s portion of fees.
  • Dr. Gould appreciates the cross-learning that goes on continuously within the eAssist company that keeps them in a unique position to notice emerging trends, such as insurance companies beginning to deny claims that were previously accepted. The doctor is able to let the patient know when presenting a treatment plan that insurance companies have been denying an aspect of the treatment as a non-covered benefit. The patient won’t be happy, but they will be much less upset if warned in advance.
    Moreover, the doctor and his team build long-lasting credibility with patients by knowing and understanding their coverage, and explaining it honestly in connection with treatment recommendations. As Dr. Gould put it, “Every patient believes their insurance should pay for everything, but that has become more and more complex, and it’s just not the case. Patients get very upset if we get that wrong. So, we make sure we get it right.”
  • He went on to explain how this allows them to spend their time on the front end explaining the procedures and costs to the patient: “When presenting treatment plans, we find patients to be more compliant when they understand what’s covered and what’s not. The insurance collections are professionally done by skilled eAssisters, and we spend far less time on the back end managing patient collections.”
  • Additionally, patients benefit because disputed claims get handled more quickly, and typically with much better results when appealed by experienced eAssisters.

Words of Advice

Dr. Gould offered these points of advice to colleagues who may be struggling with similar billing challenges:

  • “If you have a smaller practice, you can probably get away with handling your billing internally. But if you’re at the point where you have a busy practice, and one person is doing all the billing, it may not be a bad idea to evaluate outsourcing your billing and collections function. You don’t worry about it until that person calls in sick or takes time off; then it becomes pretty terrifying to know that one person is literally the link to all the money coming into your practice.” He went on to say, “One individual can have a bad day or take time off, but a group of people will have protocols that ensure submissions aren’t missed or delayed.”
  • Even if you’re lucky enough to have an employee with all the right skills and knowledge, he advises. “They can’t compare to a company whose main job is actually billing insurance companies. It’s a different level of competency.”

When asked if he would specifically recommend eAssist Dental Solutions, Dr. Gould said, “I like having the confidence of knowing eAssist is always looking at my claims and the billing is always getting done. They know what they’re doing, and they really do go to bat for me.”

He closed by adding, “I couldn’t be happier with the company.”

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