dental practice management Archives

Collecting Payment Out of Network

How do you collect payment when you are out of network, and the company prohibits patients from assigning benefits to the practice?

What are the patient’s payment options? Can the patient use HSA/FSA?

The answer is that the patient can use HSA/FSA to pay the practice in full and then reimburse their HSA/FSA when the insurance reimbursement check is received.

According to the IRS website: “If amounts were distributed during the year from an HSA because of a mistake of fact due to reasonable cause, the account beneficiary may repay the mistaken distribution no later than the due date of the tax return (not counting extensions) following the first year the account beneficiary knew or should have known the distribution was a mistake.”

This rule covers the scenario where a patient charges 100% of the dental treatment fee to their HSA/FSA because the exact insurance reimbursement amount is unknown at the time of treatment, and the insurance company subsequently sends the patient a check for partial reimbursement. The IRS has a form for this purpose.

It would be easier for the patient to put the full treatment amount on their credit card and subsequently get reimbursed to the extent allowed by the insurance company.

There is another very good option. According to CareCredit®, if the practice is out of network with the patient’s dental insurance carrier, the patient can charge the full amount of the fee to CareCredit®. When the patient receives partial reimbursement from the insurance company, the patient has the option of putting those funds toward early repayment of the CareCredit® balance.

The patient is not obligated to use those funds to accelerate CareCredit®repayment, of course. The patient only needs to pay off their CareCredit® balance within the prescribed interest free period to avoid interest charges.

By being aware of these payment options, practices can be best prepared when dealing with out-of-network insurance questions.

No More Deer in the Headlights: Speaking Confidently About Fees Chairside

Most dental team training programs have a glaring omission: clinical team members are often not trained to answer patients’ questions regarding fees. Administrative team members at the front deal with these questions every day, and many are quite adept at explaining value for the dollar with regard to proposed treatment. However, when patients turn to an assistant or a hygienist chairside and express concern about dental fees, the clinical staff are often unprepared.

It is common for back-office team members to be uncomfortable with these types of questions. They may respond by saying, “You have to speak to someone up front about that,” which is a true statement except that it is often conveyed in a halting tone that betrays a lack of confidence. The effect that financial questions have on assistants and hygienists is similar to Superman being exposed to kryptonite. Over the years, the super-human caped crusader was unstoppable—until he was exposed to material from Krypton, his home planet. Back-office team members should not lose their superpowers when a patient asks why a procedure seems so expensive.

Here are three very good answers when patients ask about fees chairside. My comments are in italics.

Our fees reflect the quality of care provided uniquely to you. Dr. Smile uses only the best materials and technology. This statement brims with confidence and reinforces value for the dollar.
It’s a great investment in your health. You deserve it. Patients need to hear again from their trusted assistant or hygienist that the proposed treatment is in their best interest.
Patients tell us all the time that they wish they had decided sooner to have the treatment. Let’s go to the front and you can speak to Julie about different financial options. This transition is seamless and can be used with any of these answers.

Clinical team members are not expected to make financial arrangements or discuss fees in depth with patients. However, their verbal responses to patients’ questions about fees and body language are very important. The deer-in-the-headlights look is an expression of anxiety. When all dental team members are properly trained to handle the money question and respond succinctly with rock-solid confidence, patients feel more comfortable moving forward with recommended treatment. Practices owe it to the team and the patients to provide such training.

Asking the Right Questions to Improve Efficiency

Are you asking the right questions? We all want to know what is going to change in the next ten years. One of most prescient business leaders in the world, Jeff Bezos, founder of amazon.com, says that we should ask another question: “What will not change in the next ten years?”

Bezos, quoted in Peter Diamandis’ book, Bold: How to Go Big, Create Wealth, and Impact the World, says that no one has ever told him that Amazon’s delivery is too fast. He concludes that in his business, one factor that will not change is the need to improve delivery speed.

Amazon is continually trying to deliver orders faster. The company pioneered e-books. No more waiting for a book to arrive; simply click and the books downloads to your Kindle or other device in seconds. The company is now testing how to deliver tangible products in hours using drones.

There are three critical factors that will not change in dentistry. Let’s discuss speed and how we can apply the lesson to dentistry. I will address the other factors in subsequent posts as we continue to explore lessons from Amazon.

In dentistry, there is always a need to make the delivery of dental services faster by improving efficiency. It is important to note that I am not advocating spending less time with patients. On the contrary, I am focusing on finding ways to use your time and the patient’s time more efficiently.

Here are the right questions for your team to discuss.

How can our appointment process by streamlined? How can we spend less time on the phone scheduling and confirming?
How can we make better use of automated confirmation systems?
How can communication between front and back be improved so we can schedule more efficiently?
How can we ensure that we have some openings in the schedule at the ready for new patients who want to be seen very soon, even if they do not have any urgent dental needs?
How can we streamline the check out and fee collection process?

I pose these questions to teams when I consult with practices and challenge the teams to find answers. While practices do not arrive at perfect answers, they improve these processes, and that is the goal.

To have a substantive team meeting, work through these questions in depth to improve efficiency. As I always say, you may not have all the answers, but if you have the right questions, you will improve your business.

Next post: The second factor that will not change in dentistry and how you can improve.

www.davidschwab.com

Dental Marketing: The Patient’s Point of View

Have you heard of “the curse of knowledge?” If an astrophysicist tries to help a high school student with his Algebra I homework, the supremely educated adult may not understand why the student just does not get it. Part of the answer is that the astrophysicist knows too much—that which is obvious to the scientist may leave the student oblivious.

Micah Soloman has an interesting article in Forbes on the curse of knowledge. Mr. Soloman writes:

“In healthcare, where the stakes are extremely high, the patient experience and patient satisfaction often suffer from devastating manifestations of the curse of knowledge. It can lead healthcare workers to deal poorly with the distress experienced–because they’ve seen a similar non-life threatening situation (say, a broken ankle) so many times before and it always turned out all right that they discount the pain and fear experienced by someone for whom this is happening now.”

A similar scenario plays out in dental offices every day. A patient is scheduled in an endodontist’s office for root canal therapy. Let’s say that the patient has been told by his brother-in-law that root canals are very painful. The brother-in-law is seldom right but never in doubt, even though he has never personally had this procedure.

Based on modern misconceptions of root canal therapy and comments from his uninformed brother-in-law, the patient is very nervous upon arrival at the office. To allay the patient’s fears, team members in the endodontist’s office may simply say, “Everything is going to be fine.” This message is part of their mantra because every day patients show up afraid and leave saying that they cannot believe the root canal was so easy. This message, though meant to be helpful, may not be Continue reading Dental Marketing: The Patient’s Point of View

Bezos Drives to the Post Office

In a television interview, Amazon founder Jeff Bezos said that in the early days of his company, he collected packages bound for his customers, loaded them into his personal vehicle, and drove them to the post office. You won’t see Jeff waiting in line at the post office to ship packages these days. By Cyber Monday 2013, Amazon was selling items at the rate of over 300 per second! The company had net sales in 2014 of $89 billion and Amazon is on track for $100 billion in sales in 2015.

Jeff Bezos is an inspirational figure. He started a very small business, scoffed at his critics, and created an empire.

There are start-up dental practices that have few patients. There are doctors in these new practices who are wondering if they can generate enough revenue to keep the doors open.

While the challenges are daunting, there is always a market for excellent dentistry. Every day 10,000 people in the United States turn 65, and our youth-obsessed culture creates a continual market for cosmetic services, even as patients need care for periodontal disease, the replacement of missing teeth with dental implants, and basic restorative services.

The next time you wonder if your fledgling dental practice is going to succeed, think of Jeff Bezos carrying packages into the post office. He started with a vision, understood that people wanted to take advantage of easy, online shopping, and built his business even while the skeptics were wringing their hands. Now consider the latest brainstorm from Mr. Bezos: delivering packages to your front door via drone. It is easy to imagine all sorts of practical problems, not the least of which are drones falling out of the sky and causing hazards, but that vision of drone package delivery will probably also become a wide spread reality.

Entrepreneurs with imagination and perseverance often succeed, a lesson that applies to dental practice management.

David Schwab Ph.D.

www.davidschwab.com

New Dentist Should be a Manager

A new dentist joins an established dental practice. Let’s call this individual Doctor Newcomer. The owner of the practice, Dr. Established, has high hopes for the freshly minted dental graduate. Dr. Established thinks that Dr. Newcomer will pick up clinical speed and confidence and one day be ready to take over the practice.

Dr. Newcomer soon learns that one of the hardest aspects of joining a private practice is dental practice management. Not only is Dr. Newcomer inexperienced in dental marketing, but there are added pressures of managing the team.

Dr. Newcomer is relatively young. It is quite natural for the new, young dentist to hang out with the team, swap stories, and talk about the road ahead. The problem is that the new dentist is often drawn into the staff orbit. He or she relates to team members rather than Dr. Established, who is the boss.

Bad habits and patterns soon emerge. Team members bring Dr. Newcomer into their confidence and Dr. Newcomer reciprocates. Before long, even in the most professional dental offices, Dr. Newcomer unwittingly crosses the line and starts to share gossip with the team. Inevitably, someone makes an unflattering comment about Dr. Established, and Dr. Newcomer is in the middle of this cabal.

Dr. Newcomer is not savvy in the ways of office politics. He or she does not yet know that there are no secrets in a dental practice. Dr. Established finds out that Dr. Newcomer is talking about him behind his back. In the eyes of Dr. Established. Dr. Newcomer has become part of the problem rather than part of the solution.

The best way to guard against this scenario is to be aware of it at the outset. Dr. Established needs to make it clear to the entire team that the management structure of the practice has changed. It now consists of Dr. Established and Dr. Newcomer. There needs to be respect throughout the team for everyone’s position, and the role of Dr. Newcomer needs to be clear to everyone on the team from day one.

David Schwab Ph.D.

www.davidschwab.com

Dental Marketing: Stop Losing Dental Patients

While many practices make great efforts to attract new patients thorough dental marketing, there are practices that are losing patients at the first point of contact. I call dental practices all the time and my personal impression is that more practices are experiencing busy times during the day when they cannot answer the phone. Instead of a live person providing a greeting, patients sometimes get a recording.

There are two issues here and two very good solutions. First, being adequately staffed to answer the phones is very important but often either overlooked are rationalized away as not possible. The same practices that attend dental practice management courses and other dental seminars and come away convinced that they should provide “Ritz-Carlton” service often miss the primary reason for the success of Ritz-Carlton: the company is always well staffed with helpful people.

I have checked into discount hotels late at night when the check-in line literally snaked through the small lobby and outside the building. At the Ritz, there are always plenty of well trained staff to expedite the check-in process, answer the phone, and handle guests’ needs.

In a dental practice, if you expect people to pay your fees for extensive treatment, then you need to cover the phones, even during busy times when all lines are ringing and multiple patients are checking in and out.

I know that some people will say that due to staff budget constraints, it is just not possible to provide adequate phone coverage 100% of the time. If this scenario has to happen, then my second recommendation is to have a specific outgoing message that callers will hear when you are busy. Instead the usual, after-hours outgoing message, put a special message on your voicemail system that says something like this: “Thank you for calling Dr. Smile’s office. Our office is open today. If you got this message it just means that we are busy for a moment but we will call you right back. Please leave your name and number and we will return your call in five minutes.”

For the busy potential new patient who is calling during his or her coffee break, this message is reassuring. The patient now knows that you are in the office, you care about the call, and you will call back momentarily. This is great dental marketing!

By following these two dental marketing tips, you will lose fewer patients and capture more new patients at the first point of contact.

David Schwab, Ph.D.