Is Working with Family Hurting your Bottom Line?
Many of the dental practices I’ve worked with over the years are family operated businesses. Maybe the wife serves as the business manager, or the sister handles scheduling patients. While this works great in some practices, in others it’s a recipe for disaster.
Why? Family businesses can be very complex. It’s easy for emotions and family “dynamics” to take over, especially if you don’t have clearly defined roles and detailed practice systems. Often family members think they can do whatever they want with no consequences, and that leads to frustration among other team members and conflict within the practice. Other times, family members take over roles they just don’t have the skill set or temperament for, hurting practice productivity and ultimately your bottom line.
Let me give you an example. “Dr. Steve” asked his wife, we’ll call her Sarah, to serve as his Business Manager. It seemed like a good idea at the time, but sadly this decision has brought him nothing but trouble. From the start, Sarah insisted her sister and family, who live nearby, become patients. The issue? Because they’re family, Sarah’s sister sees no problem with calling and cancelling their appointments at the last minute, causing chaos in the practice and leaving gaping holes in the schedule that the coordinator must struggle to fill.
Even worse, when they do show up for their appointments, Dr. Steve’s brother-in-law always seems to find an excuse not to pay. When Dr. Steve confronted Sarah about this, she reminded him that they’re family and he should be more lenient. So instead of following up to collect payment, Sarah keeps letting it slide.
Unfortunately, Sarah’s problem with collecting payment isn’t exclusive to family members. You may hate to admit it, but Sarah is an easy target. Just about every day there’s a patient who claims he left his wallet at home, or who promises to send a check to cover his bill later that afternoon. Sarah doesn’t like conflict and hates asking people for money, so she just smiles and says OK – and it’s killing the practice.
Bottom line: Just because Sarah is Dr. Steve’s wife and has taken on the role of Business Manager doesn’t mean she’s the right person for the job. Clearly in this case she isn’t. Even when you’re working with family members, you have to make sure they have the skill set and training they need to excel in their roles. If they don’t, it will put a strain on your relationship while also damaging your practice.
Now don’t get me wrong. I’m not saying families can’t successfully work together. It happens all the time, especially in dentistry. Whether it’s a husband/wife, father/son, mother/daughter or brother/sister set up, thriving family-run practices all have one thing in common: they deal with business issues as partners, not as family.
For this to work, you have to keep in mind the practice is a business first and a family operation second. That means what’s in the best interest of the business comes before anything else, which of course can lead to complications when family is involved.
Communication and trust are essential for the family-run practice, as are clearly defined management systems and accountability. Just like with your other team members, you must create detailed job descriptions so family members know exactly what systems they’re accountable for and what tasks they must complete each day. They must understand they won’t get a free pass just because they’re your dad, mom, brother, sister, daughter or son. That means your sister the Financial Coordinator can’t waive fees for neighbors and friends, and your son the Business Manager can’t show up late every day. Just like everyone else on the team, they must be professionally trained and held accountable for their actions.
Another tip? Don’t avoid bringing up problems. All too often family members won’t question one another’s decisions or actions. They don’t address problems and don’t push for change because they’re afraid to start a family argument. Trust me, this will just lead to much bigger issues down the road. Make sure family members, and all your employees for that matter, know how important it is to address conflict and work together to find solutions.
Working with family members can be challenging, but it can also be rewarding. Just remember to put the business first. Develop clearly defined systems and hold family members accountable for their actions. Provide the training they need to succeed and make sure you put them in positions that match their temperament and skill set. This will make for a much more efficient family-run practice, helping you grow production numbers and your bottom line.
Next week, 5 tips for a successful family-run dental practice
For additional information on this topic and more, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email firstname.lastname@example.org
Lack of Front Office Training Can Lead to Insurance Fraud and Abuse
“I was only doing what the doctor asked me to do” explained the office manager of a practice undergoing an insurance company audit. On several occasions, the office manager, who was in charge of billing the dental claims, would approach the dentist for explanation of charges that didn’t fit any of the codes in the current CDT manual. The dentist told her to choose a code that “would get the claim paid” and use the “right words” to document the treatment. The dentist did not write any clinical notes that actually supported the codes the manager chose to bill to the insurance company. The dentist never looked at any outgoing claims.
When the audit was being performed, the patient records chosen to analyze did not correctly support the billing codes and the other records were not complete, such as radiographs or intra oral photos that would have documented what was performed. Without the proper documentation to support the claims, the dentist was told “If it isn’t documented it didn’t happen.”
The dentist maintained that procedures were performed, but the insurance company said they were not a benefit of the policy. Patients called the office reporting that the insurance company said the dentist was not using the “right words” or “right codes” to get the claims adjudicated in their favor. To please the patients, the manager had chosen codes and inflated claims to get the insurance company to pay. She thought it was a game and the insurance companies were “out to get the dentists” by making it impossible to get paid for work that was done for the patient. The office manager in this case was ill-informed and did not know she was committing fraud in the name of the dentist and the practice.
According to the American Dental Association, “Dental insurance fraud is any crime where an individual receives insurance money for filing a false claim, inflating a claim or billing for services not rendered.”
If a service is rendered but then billed as something else to get it paid, that is also insurance fraud. A practice that routinely bills for examinations that will be covered 100% by the insurance company but then does not do the examination is guilty of fraud. Fraud comes in many forms, but is often driven by a lack of training and knowledge of the person who is in charge. Often the charge of fraud is downgraded to abuse because it was not the intention of the manager or dentist to deceive the insurance company to get paid. In situations involving insurance fraud, the dentist and manager can be convicted and possibly fined and sent to prison.
What can you do as a professional dental practice to thwart this seemingly innocent but definitely wrong way of handling insurance billing? Bending the law in the guise of helping the patient is taught by well-meaning clinicians to their staff, and it needs to stop. When the staff member moves on to another office and observes that the behavior is considered unethical, they suddenly realize they have been involved in unsavory business practice. This has a trickle-down effect in the dental community as the word gets out of insurance billing abuse.
Proper training in the rules and regulations involved in filing dental insurance claims is set forth in every dental insurance provider contract that a dentist signs to participate in-network, but very few dentists read the contract. Proper coding information is widely available and the best sources are provided by Tom Limoli with his Documentation, Coding and Claims Manual, or you can use Dr. Charles Blair’s Coding with Confidence Book. You can also get the Current Dental Terminology Book from the ADA.
Each one of these sources is excellent and has something special to offer those who document and file dental insurance claims. Front Office Training and Dental Office Manager Training through McKenzie Management are very explicit in content on insurance filing, and the courses are provided by knowledgeable and senior consultants with years of experience filing “clean claims” to insurance companies.
How to Fix 4 Common Production Killers
If production is down in your practice, you’ve probably already considered making changes. You know you need to get more patients in the chair and reduce the number of broken appointments that are costing you money and leading to chaos in your practice. The problem is, you’re not sure where to start.
Change is never easy, but it’s often necessary – especially if your practice is hurting. It all can be a bit overwhelming, but the team at McKenzie Management is here to help. I’ve put together four common production killers that most dentists deal with over the course of their careers, along with tips on how to overcome them. Follow this advice and you’ll increase practice productivity and revenues in no time.
1. Cancellations and no-shows leaving holes in your schedule. I’ve visited practices that deal with 2 to 3 broken appointments a day. If this is common in your office, I’m guessing you’re not even close to meeting your daily production goals.
The Fix: Start by confirming every patient appointment two days in advance. And that doesn’t mean simply calling and leaving a message. If you don’t actually talk to them, chances are these patients won’t show up.
When the appointment is first made, let patients know a team member will call to remind them of the appointment and a verbal confirmation must be made to hold it. If patients don’t answer when you call, ask them to call back to confirm the appointment. Remind them in the message that without a verbal confirmation, the appointment will be considered canceled.
Now, not every patient wants to confirm their appointments via phone call. In fact, these days most of them don’t. Ask your patients how they’d like to be contacted. If they prefer text or email, send them a text or an email to confirm their appointments. This makes them more likely to respond and gives your Scheduling Coordinator time to fill the open slot if they have to reschedule.
2. Case presentations aren’t effective. After you finish a case presentation, you usually feel pretty good. Patients seem to understand the importance of treatment and tell you they’re ready to schedule. Only they don’t, and you can’t understand why.
The Fix: Chances are you’re simply not spending enough time educating them about the procedure and everything it entails. They know you’re in a hurry so they don’t ask questions or express their concerns. Instead they tell you they understand and they’ll schedule before leaving, even though they have no intention of making that appointment. That’s why you might want to consider hiring a Treatment Coordinator.
This team member presents treatment for all producers in the practice in a relaxing, comfortable environment. He or she should be trained to answer any questions patients have and educate them about the importance of going forward with treatment. Two days after the presentation, the Treatment Coordinator should follow up with patients to address any lingering concerns and get them on the schedule.
3. Patients can’t afford treatment. It’s not always lack of education that keeps patients from accepting treatment. Often they say no simply because they can’t afford it. They understand the consequences of ignoring the problem but they just don’t know how they’re going to pay for it.
The Fix: To help relieve the financial burden, talk to patients about only completing part of the treatment. If a patient needs three crowns, for example, discuss the advantages of placing just one for now and finishing the rest of the work later.
Offering third party financing from a company like CareCredit is another way to make patients more comfortable with the cost. It’s much easier to accept treatment if they know they can pay a little bit at a time rather than having to write a large check to cover it all at once.
4. Patients just don’t have time to schedule the work. Remember, your patients are busy people. They have jobs and families and don’t have much time to spare between 9 a.m. and 5 p.m. So they keep putting off getting the care they need, promising themselves they’ll call your office when their schedule frees up a bit. The problem is, it never does and they forget about making the appointment.
The Fix: Consider offering early morning, late evening and weekend appointments. This will enable busy patients to schedule an appointment without having to take time off work, and that will boost your production numbers and attract more patients to your practice.
You can’t have a profitable practice if you’re not meeting production goals. Take the time to make a few changes and you’ll soon notice more patients scheduling treatment and actually showing up for their appointments. This will make practicing dentistry a lot less stressful, and you’ll reap the benefits of a much healthier bottom line.
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