The Accounts Receivables/Unscheduled Treatment Connection

“Surprise!  You have a $125.00 Balance on your Account!” 

“Ready to Schedule that crown?”

If you place your Accounts Receivables report up against your Unscheduled Treatment report, you will likely see some familiar names.  What do you think the chances Mrs. Smith will schedule that crown, if she currently has a balance in your 120 past due column?  So, let’s talk about the dynamics involved, and how you can prevent placing barriers between yourself and your patients.  Prevention is the cure and prevention is found in effective communication at the very beginning of your relationship with your patients.  Without this prevention, you end up with a large Unscheduled Treatment mountain.   

Financial Policies

Are they clear?  By that question, I mean are they clear to your Team first, and to your patients second? 

It is critical that your Team be on the same page, with confidence and clarity. 

• Confidence- Do you empower your Team to discuss financials and back them up when a patient wants to find a way around them? 
• Clarity- Are your Team Members able to clearly articulate procedures and phasing?  Do they have a clear understanding of your insurance policies?  Do they have a clear understanding of insurance coverage, including limitations? 
• Reliable Data- Is the data you rely on accurate?  If you estimate insurance benefits, what are your doing to increase the accuracy of verifications, with the least amount of work for your Team?  Can your Team depend on the accuracy of the estimates, and if not, what are they doing about it? 
• Clinical Comprehension- Does your Administrative Team understand the Clinical compenent  well enough to express the “value” when queried by a patient?  Are they able to discuss consequences of delay without inserting unnecessary alarm into the equation?  Do they have an understanding of the complex nature, as well as the material and laboratory costs involved with your procedures?  Is your Team able to discuss items denied by insurance with a clear understanding of the procedures involved?
• Money- Does your Team see the connection between Production and Collections and are these numbers discussed on a regular basis?  Are all of your Team Members able to comfortably discuss money and if not, do you role play financial discussions?
• Financial Responsibilities- Is this a form that your patients must sign, or is it a concept that your patients clearly understand? 

Statements

The goal should be to never have a need for a statement.  If your Team is generating dozens of statements at the end of each month, it is time to review your Financial systems. 

• Upon receipt of an Explanation of Benefits, a statement generated immediately, with a short written explanation, increases your chances of a rapid reimbursement by a large percentage.  The patient has typically just received their EOB, and many already know they have a balance.
• If you ran statements on the 2nd of the month, the balance was generated on the 15th, that patient wouldn’t get their first statement for another 2 weeks.  During that time, many patients have discarded their EOB, and forgotten all about a possible balance.  Then they get a statement for $33.00 with no explanation.  You may get a check, and you may not.  You are more likely to have a patient that is less than satisfied.  They are not dissatisfied with your treatment.  They may love your Team!  Now the conversation is all about the money, and it has begun with a negative.
• If you collect in full at time of service, there is less of a chance at miscommunication.  Patients are prepared to pay it all because they know they have to.  If you file insurance claims at all, your patients must be clear that you are providing them with a valuable service at no charge to them.  If you participate with their carrier, you are also applying a significant discount to their treatment.  This courtesy needs to be on the table at all times because if it isn’t, it will actually turn around and hurt you.  You will have provided a service and accepted less than full fee, pending reimbursement from someone else.  If the carrier doesn’t perform in a way that both parties expect, this needs to be understood as an issue between the patient and their carrier.  You have provided a courtesy, and want them to get the benefits they feel they deserve- it is not your responsibility.  Once you take on that responsibility either through ineffective communication, or slow follow-through, it has become your problem.

Participation vs. Non-Participation

Do not begin a relationship with your patients by blurring the lines on this issue at the initial New Patient call.  I’ve heard very honest and honorable consultants and dentists advocate being very vague on this with the premise being “It’s the patient’s responsibility, not yours” or “You’re  being technically correct when you tell them that they can come to the office because they can!”. Both statements are absolutely true.  The only problem is that when your patients receive their surprise statement, they will feel that you have tricked them.

• What to do?  Be confident and clear.  Your Team should comfortably and confidently state that you are not a participating provider (if you’re not) and then explain what that means to the patient.  Your Team should confidently feel that this patient will truly think the experience in your office is worth coming, regardless of your participation status.  Then they can simply explain to your patients that “If you are able to go to the Dentist of your choice, this is how we help you come to us!  We will get as much information from your insurance carrier as we can, in advance of your appointment.  We will estimate what we don’t believe your carrier will pay, and that is all that we will collect from you at your visits. For instance, our fee for 4 cavity detecting x-ray’s is $47.00.  The policy your employer chose for you may pay $43.00.  If so, the $4.00 difference would be your responsibility.   We more than happily file your claims for you (if you do) as well.  Once we receive the payment, if your carrier paid more than we anticipated, we will let you know about any credit, and if your carrier paid less than they indicated, we will send you a statement for that balance.  We have many many patients who choose to see Dr. ________ and we work very hard to make everything go as smoothly as possible for you.  If you ever have any questions at all about the fees for your treatment, we are always here to help you.”  Period.   

• Patients do not know their benefits, by and large.  If we find it complicated, it is reasonable for them to as well.  What they want is to know that someone is on their side, and is trying to help them navigate this complex area.

• Take the time to get an accurate verification if you do estimate insurance coverage.  Watch for hazards like missing tooth clauses and frequency limitations.  Utilize your Practice Management Software or Web-based program to enter UCR as you receive payments, limiting inaccurate estimates for that employer’s plan for future visits for this and other patients.

Emergency Patients

An Emergency patient is a particularily vulnerable relationship.  You have a real opportunity to add a valued patient to the Practice, and you also have an opportunity to send them away.

• If you allow your Emergency Patients to use their insurance coverage for their first visit, Bravo!  If so, you need to make sure that you collect enough from them to cover any possible issues with their carrier.  Emergency patients with a balance after insurance payment are much more difficult to collect from.
• Many offices will collect in cash or credit card at time of service for any patient who has not established a record with the practice, and file with reimbursement to go to the patient- unless they are obligated by contract to accept assignment.  Short of this method of payment, you absolutely need to give yourself some cushion in your estimates, or keep a credit card number on file for any possible balance. 
• Emergency patients can be wonderful additions to your practice, both in production as well as in professional satisfaction.  An unexpected balance places a barrier between you that is unlikely to be overcome- unnecessary and easily preventable.  It also makes it more likely that you will do good work, provide a truly wonderful service, and not get paid for it. 

Your patients will do the equivalent of walking across the street when they see you headed their way.  Your caller I.D. will show them a number that means “Bill Collector” to them, even if the call is to remind them of their recall appointment, or that crown Mrs. Smith needed.  When Mrs. Smith comes up with the $125.00 she didn’t expect to be billed for, having the account go into the 60 day late category…she feels differently about the relationship.  She feels uncomfortable about being “Delinquent” and just doesn’t feel as good about going into your office as she did before.  She may not even know why.  She is not only unlikely to schedule the crown, but she is also likely to cancel her recall “because she has an unexpected meeting.”  The next time you hear from Mrs Smith is when Dr. Brown’s office calls for her records.  You see, she loves you, and really wanted to see you, but….”He’s just too expensive.”  It’s all in the communication. 

Take the time, and make certain that your Team has the time, training, and tools to effectively communicate with your Patients. Do not place barriers between yourself and your Patients, when they can be avoided with focus and commitment.  Many of these patients will ultimately get their treatment done by somebody.  An unexpected balance makes it more likely it will not be you.  During my work, I can usually identify the cracks in your systems fairly quickly-Accounts Receivables issues are typically a direct result of those cracks.  Unscheduled Treatment, in and of itself, is a good test of your systems.  If you have a large amount in that category, now is a good time for an evaluation.

If your Team can see the Accounts Receivables/Unscheduled Treatment Connection, and applies real focus to this issue, I think you’ll love the results you get!