“Navigating Audits And The Challenges Posed By Insurance Companies.” with Jamie Marboe-Nichols

In this episode of the Ultimate Dental Podcast, Dr. David Moffet speaks with Jamie Marboe-Nichols about her extensive career in dental hygiene and consulting. They discuss the importance of creating a robust hygiene department, navigating audits, and the challenges posed by insurance companies.Jamie shares her journey from being a dental hygienist to a consultant, emphasising the need for knowledge and preparation in the face of focused reviews. The conversation also touches on the impact of genetics on oral health and the significance of periodontal care in patient treatment.In this conversation, Jamie Marboe-Nichols discusses the critical importance of accurate documentation in dental practices, particularly in relation to insurance approvals. She emphasises the need for alignment between clinical notes, periodontal charts, and radiographic evidence to avoid denials from insurance companies.The discussion also covers the implementation of SOAP notes for effective patient documentation, the necessity of regular chart audits, and the role of AI in enhancing diagnostic accuracy.Additionally, the conversation touches on the oral-systemic health connection, highlighting the importance of thorough examinations and the mechanical disruption of bacteria in the mouth.What you will learn:[01:20] Introduction and Background[04:14] Journey into Dental Hygiene[07:20] Transitioning to Consulting and Coaching[10:25] Navigating Hygiene Audits[13:15] Understanding Periodontal Care[16:20] The Impact of Genetics on Oral Health[19:31] Insurance Challenges in Dentistry[22:20] Focused Reviews vs. Audits[25:24] Preparing for a Focused Review[28:18] Connecting the Dots in Documentation[32:21] Understanding SOAP Notes for Effective Documentation[36:45] The Importance of Chart Audits[39:24] Navigating Insurance Reviews and Approvals[43:30] The Role of AI in Dental Diagnostics[50:29] The Oral-Systemic Health ConnectionTakeaways Creating a bulletproof hygiene department is essential for success. A strong foundation in dental hygiene can lead to a fulfilling career. Insurance audits are becoming more common and require preparation. Knowledge is the best defence against audits and insurance challenges. Periodontal care is crucial for maintaining patient health. Genetics can play a significant role in oral health outcomes. Focused reviews differ from audits in their scope and focus. Building relationships with patients is key to successful dental practice. Consulting can provide valuable insights for dental practices. Continuous education and adaptation are necessary in the dental field. Documentation must connect clinical notes, charts, and images. SOAP notes provide a structured approach to patient documentation. Regular chart audits can prevent issues with insurance approvals. AI can serve as a valuable second opinion in diagnostics. The mouth is integral to overall health, not separate from it. Accurate imaging is crucial for insurance claims and patient care. Doctors must verify and sign off on all patient notes. Patient education is key to understanding treatment needs. Effective communication within the dental team enhances patient outcomes. Implementing new practices requires accountability and support.Sound Bites I've been a dental hygienist for a long time. We thought we had this, but we were humbled. We weren't connecting the dots well enough. You have to have all three match up. The doctor needs to back that up. AI is a good independent backup. You’ve got to stay in that lane.