The Group Dentistry Now Show: The Voice Of The DSO Industry – Episode 99

Dr. James Anderson joins the Group Dentistry Now Show to discuss eAssist Dental Solutions.  eAssist made the Inc. 5000 list in both 2021 (3-Year Growth 174%) and 2022 (3-year growth 209%.)  Hot topics included in this audio-only podcast:

  • Dr. Anderson’s entrepreneurial journey
  • Dr. Anderson’s experience running his own dental group
  • Why he started eAssist Dental Solutions
  • The benefits of outsourcing your billing department
  • The current employment climate & outsourcing
  • The value of a knowledgeable dental billing specialist
  • And much more…..

To discover more about eAssist Dental Solutions visit – www.dentalbilling.com

Here is a great read on dental billing recently published on Group Dentistry Now – 7 Deadly Sins of Dental Insurance Claim Denials

If you like our podcast, please give us a ⭐⭐⭐⭐⭐ review on iTunes http://apple.co/2Nejsfa and a Thumbs Up on YouTube.

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry. The Group Dentistry Now Show: The Voice of the DSO Industry has listeners across North & South America, Australia, Europe, and Asia. If you like our show, tell a friend or a colleague.

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Full Transcript:

Bill Neumann:

Hey, I’d like to welcome everybody back to the Group Dentistry Now Show. I’m Bill Neumann. As always, thanks everybody for listening in or watching us on YouTube. Again, without a great audience, we wouldn’t get these great guests here.

Bill Neumann:

This is really interesting, because we always do a little bit of prep work before we start to record, learned a couple things about Dr. James Anderson, who is our next guest here on the Group Dentistry Now Show. He is the co-founder and CEO of eAssist. Dr. Anderson, thanks for joining us today.

Dr. James Anderson:

Thank you, Bill, for having me on.

Bill Neumann:

So, really, really cool thing, a bunch of cool things I learned about him, one in particular is that he actually has had nine dental practices in his career. He has sold six of those and currently is running three different locations as a group practice in Utah, right? These are all in Utah?

Dr. James Anderson:

That’s right. Two are called Lakeview Dental and the other is Treehouse Dental in Highland.

Bill Neumann:

I’d love to talk to you a little bit about that before we get into eAssist, if that’s okay?

Dr. James Anderson:

Yeah, sure. I’d love to share my story.

Bill Neumann:

Okay. Well, that’s great.

Dr. James Anderson:

I made some mistakes along the way. I hope others don’t repeat them.

Bill Neumann:

Well, that will be great. There’d be some great tips, I’m sure, as well. Just a little bit on his personal background. Again, multisite owner, right? Three locations, has nine successful dental practices, sold six of them. He also is the CEO of eAssist Dental Solutions, which we’re going to find out more about in a second.

Bill Neumann:

Some really interesting things here. He’s got a great background, so I’m not going to run through it all. If I miss anything super important, Dr. Anderson, you can say, “Hey, Bill, you missed this,” okay?

Dr. James Anderson:

Sure.

Bill Neumann:

But, entrepreneur of the year in 2020 by Business View Magazine and also, a magazine that really fueled my fire early on was Entrepreneur Magazine. You were listed among the top entrepreneurs in the country by Entrepreneur Magazine. I used to love reading that. Just a great publication. It would always just get me excited about trying different things.

Dr. James Anderson:

Right.

Bill Neumann:

Congratulations there. Let eAssist to six straight years of being on the Inc. 5,000 list.

Dr. James Anderson:

Yeah. We just won it again, so seven years now.

Bill Neumann:

Seven years. Oh, wow. Congratulations.

Dr. James Anderson:

Thank you.

Bill Neumann:

Unfortunately, I guess this ended, but chairman of the Dental MBA Advisory Board of Roseman Dental School. We were just talking about this as well before we started to record, where there just isn’t really a lot of great business education out there for dentists, whether they have one location or whether they’re trying to scale up. I think that there’s more and more out there, but it’s a shame that that program just really ended relatively recently.

Dr. James Anderson:

Recently. They just switched it to a leadership program or a leadership certificate, from what I understand, and that’s an important skill. Every dentist has to be a leader, but it was unique. It was, I think, one of its kind where a dentist could come out with a dual degree like lawyers do. Sometimes there’s lawyer MBA, JD MBA degrees. This was a DMD MBA degree, but for the various reasons, it’s no longer being offered anymore.

Bill Neumann:

Yeah. Yeah. That is a shame. Talk a little bit-

Dr. James Anderson:

[inaudible 00:04:02] people need to turn to podcasts like yours, Bill, and other resources to learn the stuff. From what I understand, you’re doing great work here.

Bill Neumann:

Yeah. We’re close to… Not quite, but we’re almost a hundred podcasts and I believe we have a little under 1200 articles on the website that are free. So, if you’re willing to dig through the archives or just use the search function, which is pretty easy if you’re looking for something, but I think the MBA program probably is a little bit more structured.

Bill Neumann:

Dr. Anderson, I’d love to talk a little bit about, before we talk about eAssist, let’s talk about these practices. I mean, nine practices. That’s not typical for a dentist. What’s why behind some of that?

Dr. James Anderson:

Oh, that’s a great question. My wife would want to know that answer too. I think I missed a few baseball games along. I still remember having my Franklin day planner while my son was batting, planning out my weeks and looking at stuff and wondering, “Why am I doing this?”

Dr. James Anderson:

I just set a goal that I’d start one new dental practice a year. This was 2002. No one was doing it. I graduated 2002 from Oregon Health and Sciences University. I loved it there. I loved my classmates there. I learned a lot. A great school. I built my first practice the year later, 2003, and then 2004. In 2005, skipped a year, and every now and again. At the end, we ended up with nine before eAssist was born and went in a different path. The motivation was I just wanted to do something great.

Dr. James Anderson:

What I learned was that I found that I found more satisfaction… This was surprising to me. After my first year of being open, I found more satisfaction signing the paycheck of the people that were working for me than I did fixing a tooth. I enjoyed fixing a tooth. I still do. I’m a dentist, I still practice every other Friday, twice a month, but there’s something about paying someone for a job well done that just is very satisfying for me. Knowing that I’m helping them put food on their table and pay their mortgage and live their life, and paying them as much as I can and them serving our customers and our patients the best way they can. It’s just a virtuous circle. I realized that I started counting my success not how much money we were making, but how many employees I had. It’s a crazy paradigm.

Dr. James Anderson:

I remember talking to one of my associates who was making more money than I was in one of my practices. He only had five employees. I think I have 12. He was like, “Why do you have so many?” “Well, I found a place for everybody, and we found a way to continue to expand with all the people we had.” In the end, I’m grateful for the decisions we made there.

Dr. James Anderson:

That’s probably the ultimate reason, Bill, is that there’s something about entrepreneurship and job creation. There’s creativity there, there’s satisfaction. The dentists listening to this understand this principle. Having five to 20 practices for the target market here, there’s something about taking the risk of going and creating something that doesn’t exist and asking people to come follow you. Come along with me and let’s do something great together, and I’ll pay you money to do it. It’s exciting to be there.

Dr. James Anderson:

I loved MASH when I was a kid. I always wanted to be Hawkeye Pierce. I watched it every night after the news. He was a captain in the military and he was a doctor. I didn’t become a real doctor, my kids remind me about that, but I became a dentist. And so, I wanted to be that guy to help people.

Dr. James Anderson:

I don’t think anyone’s ever asked me that question before, Bill, but that’s probably the answer, to offer as many job as I could.

Bill Neumann:

Well, that’s great. Yeah, you don’t hear that a lot. You mentioned something else too, building something that wasn’t there before. Every practice was de novo, right? You didn’t buy any existing practices. These were all built new from the ground up?

Dr. James Anderson:

That’s right. They were all scratch practices. That term de novo wasn’t in use back in 2003. It was just a startup scratch practice and we just found good locations. They were usually in front of grocery stores. Now, everybody does that, but it wasn’t really done back then, here in Utah especially.

Dr. James Anderson:

I was inspired by a mentor in Oregon, Dr. Danny C., who came from China and started a gentle dental up there and other places. He hired me right out at dental school. It was just a wonderful mentorship and I really appreciate him. We took that and created something and made sure that they were all new and fresh and clean.

Dr. James Anderson:

There was something about… I didn’t want to inherit other people’s systems and culture. I just wanted to create my own. That’s part of the fun of it, was to build something from scratch, and I wouldn’t do it any other way.

Dr. James Anderson:

The only practice I struggled was one where we took over an office that had already been previously a dental office and I found six months later after we were there that the dentist five years ago had done something wrong to the patient illegally and was arrested, and there was a bad reputation in the community around that dental office location. It was vacant for all those years, and I went in not knowing that. So, that office struggled. That was a mistake. It reminded me, this is why I like to build my stuff from scratch. You never know what the history is.

Bill Neumann:

That’s a good point. Yeah. Yeah. So, you got to nine locations and then you started eAssist when you had nine locations.

Dr. James Anderson:

Well, we started selling some of them before we built eAssist. I can’t remember the exact timeline, but I would sell them off usually to dentists one at a time. It was before VC money and PE guys discovered dentistry. And so, I was with the same motivation, help a younger dentist, do a turnkey solution, get it up and going, do something they couldn’t do themselves and then give them the key.

Dr. James Anderson:

eAssist was born because my main practice while I was doing this, I had a rockstar office manager. For those of you who don’t know eAssist, we were nation’s largest outsource dental billing platform. We help dentists find office managers that can do dental billing remotely for them and are very efficient and are very good and completely aligned, paid based off of results and with accurate reporting every day and very, very helpful.

Dr. James Anderson:

We have customers in every state and eAssistors in every state that service customers everywhere. It’s a wonderful thing. We get about a hundred new eAssistors that apply every week to come and work for what we do. Our system is designed to find the very best and allow those best people to serve you.

Dr. James Anderson:

So, eAssist was born because my front office manager, who was a rockstar, her name was Jen Harvey, she was with me for 5 years and then her husband was transferred in the military. Of course, whenever you get those, “Hey, can I talk to you doc,” at the end of the day, you get [inaudible 00:11:18]. You’re like, “What? I’m doing these procedures.” I know there’s something. Either they want a raise, or they’re leaving or something. She told me she needed to leave and move to Washington, so I knew I was in trouble.

Dr. James Anderson:

I had her help me find her replacement, but the numbers kept going in the wrong direction. The insurance wasn’t being collected properly by her replacement and we were growing too rapidly. Our over 90 grew quickly. Up to $250,000 was outstanding at one point, and I hired and fired six different office managers. It made me feel so bad. One of my buddies even said, “You fired someone right before Christmas.” I don’t remember doing that, but I knew we were in trouble. The numbers were going in the wrong direction.

Dr. James Anderson:

When I’d ask them, “How much time are you spending on the receivables?” They’d pull out the AR report and there was handwritten notes on the first few pages but the report was getting thicker and thicker and thicker and thicker. I realized at that point that we were in trouble here and I needed more people, not less. I needed someone to help me.

Dr. James Anderson:

I went to Google and did a search for dental billing; “Will someone please help me with my dental billing?” No one was there. It was just, we will bill your patients for you like a collection agency.

Dr. James Anderson:

When we first started eAssist, the name of the company was Insurance Claims and Collections. It was a terrible name. We bought a booth at the Utah Dental Convention. I found a Han Solo, frozen in carbonite, replica from Empire Strikes Back. That was the prop to convince Dennis to stop by and ask what’s going on.

Dr. James Anderson:

I had a lot of people getting pictures with Han Solo and I would say, “Hey, do you feel like your insurance company is locking up your payments like Han Solo over here? Do you want a picture?” No one knew what we were doing. They were like, “What are you doing again? Why do you ever need that?” A lot of people, gainsayers and naysayers, said, “No, this is never going to work.”

Dr. James Anderson:

We just realized we had a problem. We solved our own problem and then we started selling it to other people, but we built a system that allowed us to centralize all of it.

Dr. James Anderson:

We bought dentalbilling.com and it solved our problem. Our over 90 dropped from 250,000 all the way down to 60 to 70,000 within six months. We really solved… We had to write off about 30k of uncollectable due to timely filing, but it was important to have daily reports, it was important to have a system that aligned paying people based off of results, all these important concepts that they don’t teach you in dental school and that you often resist to do as a young business owner.

Dr. James Anderson:

Even an established business owner, you sometimes don’t believe in the law of abundance, that if you share more and align people’s interests so that the more they do and the more they produce, the more they make. That’s critical to succeeding. When you can build a system like that… Like we mentioned earlier, Bill, while we were talking earlier, if you sometimes struggle with your staff, like why won’t they do this, and you have the staff meeting and every week you’re talking about the same thing, then you think you have it resolved and then three months later you’re talking about the exact same thing that you were talking about three months ago, this should sound very familiar to every dentist who’s also practicing owning a group practice, what you discover is it’s not the people, it’s your systems.

Dr. James Anderson:

You’ve got to build a different system. If it means you have to build some custom software, then build some custom software, but figure out that system that allow the people to be self-managed rather than you having to manage them, including their aligned pay.

Dr. James Anderson:

One of my favorite books is Patrick Lencioni’s The Five Dysfunctions of a Team. So powerful. Bill, have you had anyone on this show talking about that before? Those ideas?

Bill Neumann:

No.

Dr. James Anderson:

Let me just take a minute and then I can go back to the practices and ask me some more questions about that. Through all my travels now and all the stuff we’ve done, we have about 1700… Well, just a number of people that are helping with eAssist all over the place and a number of customers everywhere. We’ve discovered this one principle, that teamwork makes it work. It sounds so trite and trivial, but how do you really build a great team from a local front office team and a back office team, but also corporate team to help your teams grow?

Dr. James Anderson:

There’s five principles Patrick Lencioni says you got to figure out. Number one is trust. They got to trust each other. It doesn’t just mean that they trust their integrity, that they’re honest people, it’s also their competency too.

Dr. James Anderson:

There’s two components of trust, your character and your competency. If you trust each other on both those levels, then the team can overcome the second dysfunction, which is the inability to have a healthy conflict over ideas. This is very, very rampant in dental offices. They really struggle debating ideas, and people take it personally when people disagree with each other. You’re in a staff meeting and you have a conversation about something and all of a sudden people are… Whenever you hear these phrases, “I don’t want to step on your toes,” or “I’m too afraid to tell you this,” or “I don’t want to disagree with you,” you know you have dysfunction.

Dr. James Anderson:

Number two, you don’t have a healthy conflict over ideas. It never can become personal. It shouldn’t let it become personal, but it feels personal. It’s critical that your teams overcome that.

Dr. James Anderson:

Then, number three, Jeff Bezos said this in an Inc. 500 article talking about why Amazon was so successful. He said there was one reason why he overcame dysfunction number three. Now, he didn’t credit Patrick Lencioni, but he used the phrase that Patrick Lencioni coined, and that is, “After the decision maker has reached a decision,” whoever the decision maker is, and there’s been a healthy debate over ideas, everyone’s been able to express their opinion, once that decision is reached, then a healthy team will disagree and commit if they disagree with a decision. They’ll commit to it. That’s fundamental, and it’s what built Amazon. It’s what built a successful team, and every dental office has to have that philosophy.

Dr. James Anderson:

The next dysfunction is inability to have accountability where people don’t have KPIs and don’t want KPIs. Sometimes it’s you as a dentist, you don’t really think that they’re that important or you don’t necessarily know the right ones to pick, and it’s critical.

Dr. James Anderson:

Andy Grove did a lot of work on this on his book Measure What Matters Most. Or, he was just quoted in Measure What Matters Most about how he built Intel and how critical KPIs were, important ones that would drive success.

Dr. James Anderson:

And so, you’ve got to figure out accountability, including allowing your team members to hold each other accountable. It’s not just you as the “boss” holding people accountable. If you build a system where the team mates hold each other accountable, whatever that looks like for you, it’s going to be different in every scenario, in every culture, in every problem it is your team is trying to solve. But if you can build a system where the teammates will allow each other to hold each other accountable and not wait for the boss to hold each other accountable, you’ve got something great. You’ve overcome dysfunction number four.

Dr. James Anderson:

Finally, dysfunction number five is lack of attention to results. At the end of the day, what is the team trying to accomplish? You have to measure that number.

Dr. James Anderson:

All of those philosophies are what built eAssist. Understanding how important a teamwork is, is critical to our success and it’s what built our dental practices. Making sure that our teammates… Finding the right people, of course, but then building trust and then understanding how critical accountability in some aligned systems are make all the difference.

Dr. James Anderson:

I know I’ve said a lot, Bill. Anything you want to ask me about from what I just mentioned there?

Bill Neumann:

What was the name of that book? It’s Patrick Lencioni. I’ve seen him speak before too at a dental meeting. I can’t remember which one, but yeah, he was pretty impactful.

Dr. James Anderson:

The Five Dysfunctions of a Team.

Bill Neumann:

Five Dysfunctions of a Team. We’ll try and find that link and put it in the show notes because it sounds like it helped you build your business.

Dr. James Anderson:

Well, we discovered it later. It helped us go from good to great, I think is best way to define that.

Bill Neumann:

Okay. Yeah, yeah. It’s fascinating that I have seen him speak before too. That’s great guidance there.

Bill Neumann:

So, you’re running, again, you had your multisite, your dental group and then you start eAssist. You built that really… Did it come to you after you struggled after your great office manager left and things started to go in the wrong direction as far as you couldn’t find somebody that could really help handle the billing like she could?

Dr. James Anderson:

That’s right. We realized… I remember Adam Smith taught about division of labor and the wealth of nations. His theory is that if you hire one person to make a pin from beginning to end, that one person may be able to make three pins a day. But if you hire three people to make a pin and one person does the shaft, another person does the top, another person welds it and packages it, you can produce a hundred pins a day. So, yes, you’re taking a risk by hiring more people, but by doing that your output’s so much more if you get the systems right.

Dr. James Anderson:

That’s what eAssist was. We took a risk and we built it. After we couldn’t find the right office managers, we decided to figure it out. No one was doing it. We wanted to hire somebody else because it’s hard to do the heavy lifting here.

Dr. James Anderson:

We figured out a system that allows… After I built it for ourselves, I had a classmate who then said, “Hey, can you help me? I have an office up in Idaho and it’s struggling. Can you help me?” We did. Then I have an associate who said, “I have a problem with my collections. Can you help me?” He was based in Utah, at Riverton. I said, “Sure.” We repackaged the system so that it would cost less money for people to hire us than it was for them to hire somebody else. By utilizing economies of scale, if we can make a phone call to Delta Dental or whomever and talk about a handful of claims rather than just one claim, then we’re much more efficient. That kind of efficiency can be passed on to our customers.

Dr. James Anderson:

You needed a daily report too. Every day, I wanted to make sure I saw exactly what they were doing, what efforts they were making but reward them for results at the end of the day. How much money do we collect? How many claims do we appeal? We can talk about some worse claims stories here later, but we realized very quickly how challenging it can be to get claims paid sometimes and you need full-time attention.

Dr. James Anderson:

So, eAssist was born out of a desire to solve my own problem. It wasn’t supposed to be a company that we would use to help other others with. I was just trying to solve my own problem. Then I realized I’m having so much more fun hiring more people. eAssist allows us to build a system to bring in a lot of people. Like I said at the very beginning of the show, my motivation is to hire as many people as I can. And so, eAssist is a mechanism for that. For every customer we bring in, we need a new eAssistor for the most part.

Dr. James Anderson:

It very, very quickly allows me to build a community of like-minded individuals that are solving problems to a scale that I’ve never been able to do before. That’s probably why it’s so satisfying for me. Our goal is to deliver peace of mind to dentists and be the backbone of the practice. If your office manager quits ro your office manager doesn’t show up for work, or for whatever reason, I’ve seen that before, or says they need to move, you can take your time hiring her replacement or his replacement rather than the next person that comes through because your insurance will always be collected. The backbone of the practice will always be functioning at a high level. And so, that’s how eAssist delivers peace of mind to dentists.

Dr. James Anderson:

I get a number of emails from doctors who say, “Thank you so much. I can sleep well at night knowing that all this is working. I can focus on dentistry rather than making sure that money is coming in.” We’re like a second set of eyes where we never handle any of the money, but we keep honest people honest because we see all the adjustments, we see all the revenue coming in. We know what’s going on and together as a team, we help the office manager succeed.

Dr. James Anderson:

We’re really the office manager’s assistant. And so eAssist was born, to your point, Bill, out of a problem that I had for myself and then classmates and friends of mine said, “Can you help me?” One thing led to another, and here we are. Last year, Henry Schein invested in us. I think it was last year. He invested in us, so we become a part of what they do.

Bill Neumann:

So, Dr. Anderson, as far as this need that you had in the practice and now all of a sudden it’s a.. Well, it’s a big business, right? I mean, you had an investment from Henry Schein, seven yeas straight on the Inc. 5000 list.

Bill Neumann:

So, go back to the system or the process that you have that makes you so successful. Can you give us a little bit of an idea? I’ve got a couple of locations, I have an office manager that is doing other things, can’t focus on the billing, or maybe they left. When somebody reaches out to eAssist, what does that process look like and how do they work with eAssist?

Dr. James Anderson:

Okay. That’s a great question. Let me answer that by first saying that we serve all types of customers, new startups and large DSOs. Usually you got to go check your over 90.

Dr. James Anderson:

The question I like to ask doctors is do you know what your over 90 insurance outstanding balance is? You need to know that number. That’s as important as your collections and production KPI that I’m sure you know.

Dr. James Anderson:

When I was a full-time practicing dentist, I would check that scoreboard every day on my Dentrix. I’d click to see in the office information tab where I was and how many patients I saw and what I’ve collected for the month. It’s like a game for me. I wanted the high score. So, you got to add one more component. You got to know what your over 90 is. It should be near zero. That’s the term we coined, near zero. Not at zero, but near zero. It’s near zero depending on your growth. As you grow more, sometimes it’s not zero but near zero.

Dr. James Anderson:

For most of our customers that call, it’s at 30,000, at 50,000, at 100,000. We had one customer that had 4 million in the over 90. Now, a lot of that had already been collected by the practice but was just never posted properly by the staff. So, you have that issue too. Every customer that comes in, usually that’s the problem. Not only has the money, some of it hasn’t been collected, some of it has, but it hasn’t properly [inaudible 00:26:36].

Bill Neumann:

They don’t know. Yeah.

Dr. James Anderson:

At that point, you can’t really bill customer. You can’t bill patients. You send them this bill. They’ve already paid, but you say they haven’t and it hasn’t been posted, you have an accounting nightmare. Some of the onboarding is cleaning up the accounting. Anything older than two years, we often recommend that we write it off and just close those accounts down, assume they are not collectable or have been collected already.

Dr. James Anderson:

The customer, if it’s a new customer coming in that… Let’s say it’s a new startup, for instance. You have three practices, you’re going to start a fourth one. You have to hire someone really, really good. Usually very, very strong to run your practice if you’re not going to outsource or centralize your billing of any kind right from the start.

Dr. James Anderson:

And so, what we do is allow you to hire someone who may not be as skilled in this area, would be less expensive to hire, but is so friendly and so happy and so kind to patients and answers the phone in the first ring and is so good and can present treatment plans and collect the copay. But the goal is to allow your staff to do that heavy lifting so that we can be on the phone with the insurance company demanding payment.

Dr. James Anderson:

Those are two different personalities. When we try to mix them together into one, those people are out there but they’re very difficult to find. Like my office manager, they’re rock stars and they’re very expensive. When they leave you, you’re in trouble. You can’t replace them. So, we recommend you build a system where your office manager has an assistant and that assistant is an eAssistor who is there to do all the heavy lifting for them, to be their assistant. That’s why the name of the company is called eAssist, to help the office manager. You have an assistant, the hygienist has an assistant, it’s time your office manager does.

Dr. James Anderson:

If the economics work right where if you pay us $1,000 for the month, we should be collecting $2,000 of income that we weren’t collecting before or three or four. If we do, then the system’s working. You’re making more money even after you pay our fee than you were before.

Dr. James Anderson:

For larger group practices, often practices will reach out to us when they are doing 80,000 to 100,000 in collections and it’s just too much work for one person and they need to add a second person. Instead of adding a second person that’s full-time that requires benefits, that requires healthcare, that requires you to do dentistry on their teeth and on their kids’ teeth and pay FICA and SUI and FUI; instead, you pay us. Our system works so you don’t have to worry about all that. It’s more affordable, it’s more efficient. Because of that, it makes sense. It’s why people keep coming. Answered your question, Bill?

Bill Neumann:

Yeah, it sure does. You mentioned it, you really work with different sizes and shapes of customers, right? You’ve got somebody that has one location, somebody that maybe has the friendly office manager but doesn’t have the skill set to collect, right? That’s a nice compliment that you have. You work with people, doctor owners that may have five, six, seven locations like yourself when you had that before you scale back to three, and now CEO of eAssist. Also, you had mentioned, again, before we started the record, we won’t mention any names. You have some pretty substantial groups too. You mentioned somebody over 200 locations, and that’s a little bit more of a customized approach.

Dr. James Anderson:

That’s right. In situations like that, what we discover, larger DSOs and even some midsize DSOs already have some of these systems figured out and they’ve already had a centralized billing of some kind. But they reach a point where they realize it’s less expensive for me to use eAssist than it is for me to keep staffing this machine that we’re building. Not only less headache, but that’s not why you would do it, just because it’s hard, but it’s less expensive.

Dr. James Anderson:

When the economics work like that and we can fit into the system and customize a solution based on whatever your needs are to fit into this spot or that spot, even if it’s just you want us to focus on the over 90 initially. Okay, that’s what we’ll do. We’ll build this custom solution just for you and put the package together and get it going and win your trust over time and then hopefully become an integral part of your team as you begin to scale.

Bill Neumann:

This is a great conversation. I love it. Let’s make it even a little bit more fun. Let’s go into the worst claim stories.

Dr. James Anderson:

These are fun. I’ve got a couple that I can share. When I read this one, this was four years ago, five years ago, I couldn’t believe what I heard. This is a reason why your front office manager sometimes will be on hold with the insurance company. And then, when a patient needs a treatment plan, has to hang up. After being on hold for 30 minutes and not talking with anybody, they got to start all over again the next time there’s a break, but they’re presenting the treatment plan and then whatever. Sometimes they appeal and it doesn’t work.

Dr. James Anderson:

This is a true story. We had a claim that wouldn’t be paid. It was a simple crown. The insurance company said that they had not received an x-ray, a radiograph. We sent the x-ray digitally. We used an NEA attach number two and they said they couldn’t read it, they couldn’t find it, they couldn’t see it. When we appealed the claim, we then meld the x-ray to them, a copy of the x-ray. They still said they never received it. We faxed it to them, they said they never received it.

Dr. James Anderson:

As you appeal, you go back and appeal, you do something and then you appeal 14 days later and then come back and say we don’t have that record of it. What our eAssister did was put the fax on auto dial and for two hours straight, the same x-ray was being sent to the same fax number, to the same person who’s kept saying that I have not received your x-ray. Finally, after two hours, she called up Tanya and said, “Shut off the fax. We got the x-ray.” That’s a true story. That’s an example of what goes on.

Dr. James Anderson:

We’re very friendly towards insurance companies. They have a difficult task to do and the people there are wonderful people. Some people that work at eAssist actually used to work at insurance companies. That’s part of the beauty of our model.

Bill Neumann:

That’s great.

Dr. James Anderson:

Here’s another true claim story too. We had another example where an eAssistor, that’s what they call themselves, those that work in various offices for you, the crown was denied. Appealed it twice, it was denied. Requested a peer review, it was denied.

Dr. James Anderson:

It’s critical you have an intraoral camera not just for the patients so you can show patients and hopefully it increase your treatment plan acceptance, but you do it for the insurance companies. If there’s one nugget you take away that you didn’t know, you got to have an intraoral camera in every single operatory and take a picture of every tooth you’re about to do a crown on. Anything that’s going to be considered major, you need to have an intraoral camera photograph of that so that the insurance companies can see it. It’s so much easier to get claims paid when you do.

Dr. James Anderson:

I’m not sure in this example, if we had that or not, but after peer review, this claim was denied by the dentist who was working for the insurance company. But our eAssister knew that this claim was legit. The doctor was adamant that it was legit, so she appealed it to the State Insurance Board. This was like the fourth appeal. Once the State Insurance Board got it, within two weeks the claim was paid.

Dr. James Anderson:

That’s another example of the claim that would have been-

Bill Neumann:

The extreme [inaudible 00:34:18].

Dr. James Anderson:

Yeah, sometimes. The easy stuff like some fillings and some prophies, that’s different. But when you start doing more high-dollar issues and treatment and whatever, you sometimes see this and you have to be creative. And if your systems are aligned so people are paid more based off the results they get.

Dr. James Anderson:

This isn’t fee splitting, which is a term used in the medical billing, because we’re not setting the treatment complete. You’re deciding which code to use. We’re then taking your code and then making sure the notes are complete, making sure all the information is necessary for the insurance plan we’re about to send it off to, and then we submit the claims.

Dr. James Anderson:

There’s three things we do, we’ll submit the claims for you, make sure they’re clean, submit them. Number two, we’ll follow up on the claims until they’re paid. Then number three, we post the claims. By doing that heavy lifting, doing three things, sending the claims, following up on claims and posting the claims, your staff now can focus on verifying that claims, verifying the insurers. Not just a simple verification, but a full breakdown of what those benefits are so you can present a proper treatment plan. That’s critical to any treatment planning success. We can talk about that, Bill, in a minute if you’d like.

Dr. James Anderson:

The next part is patient portion. You’ve got to send bills, you’ve got to send statements. We do that for many of our customers, but if your staff is worried about what are they going to do once this is handed over to eAssist, have them bill customers and call up customers and ask them to pay and make sure that’s going on in your practice. It has to be a part of your collection systems. We do that if your staff doesn’t want to.

Dr. James Anderson:

Then we have an accounting feature where… It’s so critical that… Here’s something that you may not be aware of. So many claims now are being paid, especially after COVID, through EFT. They’re no longer sending checks like they used to. In order for you to validate whether or not those EFTs have cleared the bank, you just can’t trust when you log into the portal and it says yes it’s been paid to you. You can’t trust that.

Dr. James Anderson:

I have seen claims that have been paid to associate dentists who used to work in my practice, but now have their own and that money was paid to their bank account even though on the claim form it was me. It’s because in the computer systems somehow it recognized that this doctor used to work for me and now works over there, and so they sent it over there. When you log into the portal it would say that the claim has been paid, but it really hadn’t. It had been paid to somebody else.

Dr. James Anderson:

So, you’ve got to go in and verify into the bank account that that claim has been paid, which means your office manager needs access to your bank account, unfortunately. That means they can see everything you got, or you use a solution like eAssist where we do it for you and we send a nice email to your staff if you’re not doing our full service. We’ll just do that part and we’ll send a nice email, it’s all automated with our software, that tells you that these claims have been verified, they are in your bank account. You can close out those claims and post them to the customers or to the patients.

Dr. James Anderson:

Those are some of our services. We also do a full schedule service where we keep your schedule full, making phone calls to patients. It’s been a wonderful thing and a very important part of many dental practices, workflow and ability to scale.

Bill Neumann:

I think with the issues that we had, we still continue to have, so they started with COVID. Maybe they started before COVID, but certainly exacerbated by COVID, the great resignation, right? You just don’t have staff, so in some cases you just can’t… Not that your office manager isn’t qualified to do this or the personality isn’t the right fit, you just might not be able to find somebody, right? I mean, you just may not have somebody. So, have you seen eAssist really become instrumental in helping out these practices that are just without office managers?

Dr. James Anderson:

Yeah, even before COVID. My own experience was, Bill, that the really good office managers, when I needed an office manager, we’re already working for someone else full time unless there are new move-ins to your community. Especially if you’re in a smaller town, 50,000 people, 100,000 people. The ones that are really highly skilled that can do all of these things are already working for the other guy down the street and she’s really god.

Bill Neumann:

Yeah.

Dr. James Anderson:

So, you’ve got to be able to find, you’ve got to be able to teach people how to do this skill or how to run your dental practice by doing the division of labor, like I discussed earlier. You bring in someone who’s really… Even like a bank teller.

Dr. James Anderson:

We had one of our rock stars in our Syracuse practice. Her name is Kristen. She had zero dental experience. Zero. But she sold furniture and she was so good. She understood what customers were. She came in with our office manager who was living there. Her name is Sandy and she is the co-founder of eAssist. For six months, she just shadowed and learned all she could and then she took over. Knowing that eAssist was there to do all the billing, she could make sure that the staff was running well and the patients were happy and we were selling dentistry, which is right.

Dr. James Anderson:

It’s the same thing as selling furniture for the most part. There wasn’t a technical skill she needed to learn except a few phrases and things that [inaudible 00:39:48] and others so that people can understand what a crown is and what the ADA codes are, but not the complicated billing and how to process a claim and what not to downgrade and what adjustments you should not accept.

Dr. James Anderson:

That’s critical too. Often, as young dentists or as managers of dental offices, we don’t realize insurance companies often will hope that you accept on first pass a downgrade of certain ADA claims. It appears legitimate, they come back in and say, “Okay, you’ve sent this in. It needs to be downgraded. Here you go, accept this fee,” and the rookies will accept it and then the insurance company is off the hook for hundreds of dollars instead of appealing it until you can figure out, “No, no, no, you shouldn’t downgrade it. Look, and this is why, and here’s the documentation. Please go.”

Dr. James Anderson:

You’ll find many times if you know how to do that right, you’ll make yourself thousands of extra dollars, and that’s what eAssist really does a good job in doing, ensuring that we don’t downgrade claims that shouldn’t be downgraded. That’s one of our many skills, or the people that operate your practices, part of the platform many skills.

Dr. James Anderson:

My point is that by having an eAssistor here and having someone like that, with one phone call and in 14 days you can be up and going with this person. You can find people that used to work at Chic-fil-A that are really kind and nice. Bring them in and start your building of your staff.

Dr. James Anderson:

It’s easier to find people that don’t have a dental skill than it is those that have it. And so, we’re here to help you. There are people that don’t need eAssist. There are people that have rock stars that are humming along and it’s great and the practices aren’t growing and everything’s fine until that person leaves.

Dr. James Anderson:

And so, we’re an asset for my fellow doctors, for my peers to help them continue their dreams of building dental practices and serving people. When there’s a need, we can help you fill it.

Bill Neumann:

Well, that’s great. A lot of our audience are also scaling up, so they may be in a situation where practice one or practice two, they’ve got that great office manager and they don’t need eAssist, but the third or fourth or fifth practice, they can’t find anybody, right? Or, to your point, you hire the nice person that doesn’t have the dental skillset, that knows how to deal with people, and then you can bring eAssist in to handle the billing.

Dr. James Anderson:

Yeah. Rob Linder is our new COO. He was the CEO of a DSO that he founded. They had 20 practices and they were buying some of the practices that were using eAssist. At first, Rob tells the story he wanted to cancel eAssist. They had their own internal team. He felt like they could do it better, but his CFO analyzed it. This was before Rob started working for us. His CFO came to him and said, “No, no, no, no, no. Our offices that are using eAssist are collecting more money than the offices that aren’t.” Their system is doing a better job. Even though we’re spending money over here, it’s less expensive for us to keep them

Bill Neumann:

Right.

Dr. James Anderson:

And so, they did. When Rob came to us and told that story, we were heart warmed. We were like, okay, sometimes people don’t realize it. They see an expense on their line item, they don’t realize, like I said earlier, if you’re paying us a thousand, we’re collecting $2,000 extra for you that you weren’t collecting before and keep you over 90 near zero, keep your collection ratio high, near 100%, between 95 and 100% up there and [inaudible 00:43:20].

Dr. James Anderson:

Often, there are issues that have to be resolved. One of the big concerns, I think you mentioned this, Bill, when we were doing our pre-show work through, is that one of the things that gets neglected often is the insurance breakdown has to be done before a patient comes into the practice. Not just so you know if the patient has the insurance and that they have benefits left over, but you also need to know the details and the nuances of fluoride. The age limit, for instance, of when they’ll pay for an adult prophy or adult fluoride. You need to know how often they’ll replace a crown. Is it every three years? Every five years? Every eight years? It’s different. If you don’t get that right, if you think for that insurance plan it’s every three years or every five but for that plan it may be eight, if you don’t make a phone call to the insurance company, you can’t get that information anywhere.

Dr. James Anderson:

If that’s the case and your office manager presents a treatment plan and you’re replacing a crown and that crown is five years, six years old and it has to be eight before they accept a new crown, and you tell the patient that the insurance company will pay for half and then you use the line that we all have learned to use that helps protect us, but it doesn’t do a very good job against a one-star Google review that you may owe more. This is just an estimate, the best estimate we can give you. And so, if you owe more, then we’ll send you a bill.

Dr. James Anderson:

That makes patients mad. If you don’t get it right, it makes them mad. So, if you skip that step, you tell them that the insurance is going to cover half and then you find out, no they won’t, that crown isn’t old enough to be replaced or that buildup is not accepted for that insurance plan or the fluoride is not the wrong age.

Dr. James Anderson:

There’s about a hundred codes we’ve identified that have nuances like that that you’ve got to call and get a breakdown for so that you’re ready to give a treatment plan. At the moment they’re done with the treatment planning in the op. You already have it there, you can process it, you can give them a proper treatment plan. If you can figure out that workflow and build that into your systems, magic happens. People are so happy. They’ll pay for the treatment, they just want to know what it is. If you get it wrong, they’re upset with you. It’s a real problem. And so, one of our services is Patient Breakdown IV Solutions. Those that work in the platform will do that for you, do those breakdowns and make those phone calls.

Dr. James Anderson:

One of the important things that set us apart from some of our competitors, in the beginning, we were the only people to ever do this. No one was doing it. They were doing in medical, but we were pioneers here. All of our people here that work for eAssist in the platform, helping our customers like this, are in America. They’re not overseas. It’s an important part. You’re dealing with office managers who have been office managers and who are really good at what they do, that pass a series of important examinations.

Dr. James Anderson:

We’re like Upwork, Upwork for dental billing where we test people skillsets, we make sure we match the right people with the software you have, and you have freedom to choose who you want to be working for you or with you. But it’s been a wonderful system that has helped a lot of dentists have peace of mind.

Bill Neumann:

Well, this is great information. Before we go, are we leaving anything out? I know it’s pretty easy, so if anybody wants to find out anything more about eAssist, it’s pretty simple. You mentioned it earlier on, you go to dentalbilling.com. That should be easy to remember, dentalbilling.com. We’ll put it in the show notes, but that’s an easy one to find out more.

Bill Neumann:

Dr. Anderson, I’ll give you a couple final words before we sign off here. Great, great info. Appreciate just the insight on how you not only built your practices, which is awesome, but then the fact that you are an entrepreneur and you built eAssist, and it was built out of the need that you personally had. You’ve created just an incredible business, so kudos to you. It’s cool to hear these stories.

Dr. James Anderson:

Well, I appreciate that. It’s the team that did it and all of us together trying to solve problems and make it better for dentists.

Dr. James Anderson:

I bring this up every now and again, but I had a classmate who committed suicide. You hear these horror stories and it was just horrific. We miss him. We miss him a lot. Our goal is to do all we can to deliver peace of mind so that this stigma that dentists have that it’s a stressful profession melts away. This is a happy profession. We’re serving people, helping people. It’s a wonderful career. We provide a tool to help you have peace of mind as you scale your practices, so let us help you. We’ll help you succeed

Bill Neumann:

Well, thanks Dr. James Anderson. Real pleasure. For anybody, again, all the information including Dr. Anderson’s tips on… The one book in particular to read, we’ll have that in the show notes. We’ll do an Amazon link or something so you can just order it if you really want to get it.

Bill Neumann:

Appreciate everybody listening in, watching. Remember, dentalbilling.com. Dr. James Anderson, thank you, from eAssist, CEO and co-founder. Again, just thanks for being a part of the show, whether you’re the audience members or whether you’re participants. We’re getting up to a hundred podcasts now. Every time I do this show, I’d learn so much, and hopefully you do as an audience.

Bill Neumann:

Thanks, everybody. Until next time, this is Bill Neumann for the Group Dentistry Now Show. Appreciate it.

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