Accountability At The Front Desk
Case Study: Dr. R. Peters’s Front Office Team—Business Training
Jane, Mildred, Delores and Siva attended the Front Office Business Training at McKenzie Management. Dr. Peters had indicated that he wanted to see more definitive job duties and accountability from his team. Jane and Siva were hired to help at the front desk and would also be helping in the clinical area as dental assistants. Two days a week there were three dental hygienists appointed full days resulting in approximately thirty-four to forty patients (including Dr. Peters’s patients) checking in and out in the eight-hour work day. However, on the other three days a week there were about twenty-two patients checking in and out at the desk. Mildred and Delores had been with Dr. Peters for about six years and were happy with their jobs; “We aren’t certain why we are here and we don’t know what to expect from this training course but we are open to learning new skills or new ideas,” they said. Jane and Siva did not have any experience at the front desk but were being trained by Mildred and Delores when they had time.
Upon questioning the team about office systems and reviewing the reports they brought in, it was apparent that there were several broken systems affecting the success of the business area of this practice. Dr. Peters is a fine dentist and has a loyal patient following but is distressed that his payroll overhead is becoming increasing difficult to pay. “We are obviously busy but every time there is a complaint about the stress from being too busy, I hire another person. However, the efficiency does not improve. What is to be done?”
The first discussion was job descriptions and who was doing what in the practice. Mildred and Delores were both doing scheduling, processing insurance, financial arrangements, answering the phone, entering data, sending out recall cards and other patient correspondence. The Accounts Receivable report indicated a 26% in the “90 Day Plus” overdue category. This should be 10–12% to be healthy. When asked who was in charge of the collection system, the response was, “We call people when we have time.” When asked when the last time anyone was called, no one knew. The same question was asked about the recall system. “We send out cards and that is it,” was the response from Delores and Mildred.
The assignment was for each employee to write their job descriptions, including every task that they performed in the day. The purpose was to see what tasks were being duplicated and what was left off, and to assign areas that each person would be accountable for. Breaking the tasks into definitive areas resulted in Mildred being designated as the Scheduling Coordinator and Delores as the Financial/Insurance Coordinator. McKenzie Management’s time and motion studies at the front desk reveal that one full-time Business Coordinator working efficiently can process 20–22 patients per day without feeling stressed. Because there were 34 plus patients 2 days a week it was necessary to have 2 full-time business area employees. The days when there were only 24 patients, there would be time for collection calls, calling unscheduled treatment and recall, insurance follow-up and other outgoing calls. Mildred would be first to answer the phones and greet all patients upon arrival and check them in. Even though she was not the only person scheduling she was responsible for the final result and making sure the schedule met practice goal. She was also responsible for tracking new patient numbers, and patient retention and the recall system.
Delores was second to answer the phones and responsible for patient check-out, collecting over-the-counter monies, the accuracy of insurance data, eligibility and claim process and follow-up. She also presented treatment plans and secured financial arrangements prior to scheduling patients’ follow-up visits. Both Delores and Mildred were enthused about their new titles and responsibilities. “I now have direction and goals and don’t feel like I am flying by the seat of my pants at work,” Delores happily chimed.
It was determined that Jane and Siva were not needed at the front desk, but there was need for a part-time dental assistant two days a week to help with the patient volume, particularly in the hygiene area.
On the days where there were three hygienists it was decided that the hygienists would appoint patients that did not need restorative care or need to pay at dismissal. By having the hygienist appoint some of the patients, it helped to prevent a back-up at the front desk when people were leaving and arriving at the same time. This change created more time for Delores to discuss treatment plans with patients and securing patient acceptance.
Siva agreed to work part-time as a dental assistant and Jane was given an opportunity to secure a position elsewhere with an excellent recommendation. Dr. Peters wanted an assistant with him at all times so it worked out well with two full-time assistants and one part-time. Dr. Peters was very pleased when the staff overhead came down and his team became more efficient and happy with their work.
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