A/R – Prevention Is Key

The chances that you are reading this and have a 100% collections rate is probably impossible, unless you are a fee-for-service office. Without that luxury, we have two forces that tend to control our accounts receivables – patients and insurance companies. Handling A/R is one of the most avoided tasks in any office, and I can attest to this because I’ve been hired to clean up those dreaded accounts and have seen the damage that can be done when just one month of statements is missed. Below I’ve listed a few techniques you can implement in your office RIGHT NOW to help!

If you were to look closely at the correlation between your numbers and a new hire with no dental experience, you may be surprised to see that your A/R probably went up. My first dental admin job was in a busy office with no training. There is no doubt in my mind that I collected a lot less than I was supposed to and billing errors (and upset patients) were very common until I caught on – aka, trained myself.

If I didn’t know what a “missing tooth” clause was, how was I supposed to explain to the patient that their service probably wouldn’t be covered? Without obtaining the proper information and applying it, the only thing left to do was to bill the patient after their claim was denied. How happy do you think they were to get a bill like that? I quickly realized that I needed to get a certain amount of benefit information from the insurance company in order better prepare my patients. This is the reason consultants will go on and on about obtaining insurance benefits and eligibility prior to your patient’s appointments. We are never going to stop telling you how important it is!

The next key step is putting that information into the practice management software. If your administrative team members don’t know how to enter the benefits so you make manual changes, get them trained – yesterday. Who has time to change every treatment plan or break out the calculator every time you do a treatment plan?

…At the time of service, or even better, before the appointment! This is another very valid reason for getting insurance benefits in advance. It’s probably obvious why, but how do we increase the chance of collecting payments at the time of service?

Here are just a couple pointers:

1. Sound confident and make eye contact. Review the information you need to tell the patient first, then look into their eyes and say “Hi Mrs. Smith! It’s good to see you again. Today your co-payment will be_____. Will you be paying with your Visa card like your last visit?” OR “Hi Mrs. Smith. It’s good to see you again! Your co-payment for today is _____. Would you like to use cash, check or credit?” Note: No need to ask them how they are – they just had dental work done or had a cleaning. They probably don’t want to talk about it.
2. Say nothing! Silence is golden. Continue to make eye contact and smile until they speak. If they are not prepared to pay, this is where you will find out why.
3. Have scripts prepared for the various excuses you will get. “I didn’t know I was going to have to pay today….”, “I forgot my wallet”, “I have insurance….”. You’ve heard them all before, but it’s time to have a written protocol in place for handling them.
4. If they don’t pay, you must make a note (“Okay, I’ll make a note right here in your account that you are going to call before the end of the business day today”) and set a reminder for yourself. Make a note on the schedule, use your software program’s reminder system, send yourself an email, whatever it takes. Please don’t forget to follow up!

Offer a discount if paying at the time of scheduling, not the time of service. Change your policy so that the only way they can get a discount at all is payment at the time the appointment is scheduled – even over the phone. I’d also suggest that for dental work over a certain dollar amount, you require co-payments to be paid at least 3-5 business days prior. This is where you use the incentive of the pre-payment discount.

If a patient trusts your office and is ready to make the commitment to getting the work done, they won’t hesitate and you will know they have the finances to do it. I’ve seen hundreds of last-minute cancellations due to financing or the office waiting until after the appointment when the patient says they forgot their wallet and you never hear from them again.

Having said all this, I understand that most offices out there may not have any type of internal financial policy in place and patients pay when they want or are not expected to pay at the time of service. If you plan to implement these policies, you may have to do it slowly! Try using these phrases:

“We have found that most patients prefer this way because they don’t have to worry about payment when they are numb and just want to get home or get back to work….”

“Many patients are taking advantage of the extra discount that is available by paying at the time of scheduling…”

Reservation fees are more popular for preventing no-shows, but it also protects you financially should your patient “forget their wallet” – again. I’ve had offices require reservation fees for certain types of appointments in their offices, like SRP and Sedation appointments, with remarkable success. Specify this is a non-refundable reservation fee, but use your discretion should a patient call and have a legitimate emergency.

Your A/R is something you should not take lightly and something that often gets ignored until it’s a financial burden to the office. Get ahead of it! Even if you have older A/R that you may never collect, it’s not too late to put in place financial policies that protect your office. Remember, we tell our patients all the time that prevention is key and the longer they wait, the more it will cost. Let’s have that same mentality with our accounts receivables.

Bridget Fay, BBA, FAADOM