9.17.10 Issue #445 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Keep the Schedule Full this Fall
by Sally McKenzie CEO
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I don’t know about you, but I am really not interested in Christmas trees right now. So it’s a little frustrating to see some department stores already cluttering their windows and aisles with holiday trappings. And for dentists, the Holidays are likely the last thing you want to be reminded of, as family feasts and office parties typically translate into holes in the schedule and production nightmares. While it may be too early for most of us to think about trees, tinsel, or turkeys, it’s not too early for practices to ensure production doesn’t hit a sour note once the carolers start singing. 

One of the easiest and most effective means of ensuring that your production remains strong throughout the fall months is to alert patients with insurance that they have unused benefits. Last week, I provided you with a letter that you can customize and send to your patients with unused dental insurance benefits. In a challenging economy, I can assure you that patients want to make the most of the benefits they have coming to them - and they are no more willing to throw money away than you are these days.

Yes, your patients are still very focused on spending needs rather than spending wants. And that puts you in an excellent position to remind these patients, who may have put off needed dental care, that in just a couple of months they will lose any unused insurance benefits for 2010. Whether that amount is $200, $400 or a mere $50, it’s theirs to use… or lose, which makes this the perfect time to promote your bread-and-butter dentistry.

In addition to sending patients a letter notifying them of unused insurance benefits, contact them via email, phone, and text message. Your email should be sent a few days after the letter is sent. The purpose is to alert them that you have sent an important letter to them regarding monies that are available to them for dental care. Here’s an example:

Our computer estimates that you still have unused dental insurance benefits available to you. Unfortunately, you will lose those benefits if you do not use them by the end of the year. We want to help you secure the insurance coverage available to you on every dental procedure you schedule, and this is an excellent time to take care of any hygiene visits or dental treatments that you might have been putting off. Just reply to this email or give us a call today at 555-1234, and together let's make sure you get the treatment you need and the most out of your dental insurance benefits.

In addition to alerting patients of unused dental insurance, this is a good time to inform your patients about treatment financing plans like those offered through CareCredit. I readily advocate the use of financing companies because you want to do everything within reason to make it easy for the patient to accept treatment and easy for the practice to receive payment.

Moreover, educating your patients about available insurance funds as well as interest-free financing options can be an essential means of helping the patient get past the financial barrier to receive the treatment they need. Remember, the last thing a patient wants to do is throw away their insurance coverage. For many, all they need is a reminder that funds are available to them. And patients will be sincerely appreciative that you took the time to inform them.

Now that you’ve sent your letter and your email, don’t overlook text messaging. This is proving to be tremendously effective in reaching patients. Moreover, there are many technology programs available that allow you to send a text message to your patients quickly and easily. Keep your text simple and straightforward. For example: 

You have $200 in unused dental insurance benefits that will be lost at year’s end. Get the care you need and use your insurance money. Schedule your professional dental cleaning today. Reply to this text or call Dr. Greg’s office at 555-1234.

Patients want quality dental care they can afford. Give them multiple reasons to secure that care from you.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com. Interested in having Sally speak to your dental society or study club? Click here.

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Nancy Caudill
Senior Consultant
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How Does YOUR Practice Compare?
By Nancy Caudill, Senior Consultant McKenzie Management

Dr. Brian Holley – Case Study #311

How many times do you ask yourself the question - “I wonder how I am doing compared to my dental school classmates?” Your recollection of some of your buddies in school was that your dental skills were better than theirs. Therefore, you must be doing better.

“So… how am I doing compared to everyone else?” In order to answer this question, let’s make sure that we are comparing “apples to apples.”

Dr. Holley’s Practice Statistics

  • His A/R (from the Aging Report) not including credit balances is $156,500
  • The practice is producing $125,000/month
  • He employs 3 full-time hygienists, each working 4 days/week
  • He personally works 200 days a year

The A/R
There are two important facts about a practice’s A/R that determine whether or not it is healthy. First, the A/R total should NOT include any credit balances, as the credit balances will reduce the actual amount that is owed by patients. If you struggle with this concept, think of it this way:

Joe owes you $10 and Betty owes you $20 for a total A/R of $30
You owe Bob $5
What is the total amount owed YOU? $30 - not $25

If the Aging Report was generated and included credit balances, the A/R would be $25 and not $30.

The second piece of the puzzle that you need to know about Dr. Holley’s A/R is his monthly NET production. Industry standards would indicate a healthy A/R to be 1x or less the monthly net production. Therefore, if Dr. Holley’s net production is $160,000, then his A/R is okay. If his net production is $75,000 a month, it is $81,500 - too high!

The Production
There are two definitions of “production” - gross and net. One is before all the various production adjustments are posted and the other is after all the production adjustments are deducted. What are considered “production adjustments?” PPO adjustments, senior courtesies, employee discounts, bad debt write-offs, cash courtesies, etc. Any adjustments that reduce the amount that the patient pays are considered “production adjustments.”

Some practices that participate with the various PPO programs will post “their” fees to the patients’ ledgers and post the PPO discount/adjustment AFTER the claim is paid and the EOB (Explanation of Benefits) is reviewed to determine how much to adjust. Other practices will post the PPO fees for all their services in the practice management software, assign the Fee Schedule to the Account and post the PPO fee (which is already adjusted) to the patient’s ledger.

By understanding these two concepts, when you hear that your dental buddy is producing $125,000 a month - is this Gross or Net Production? The average production adjustments in practices that participate in 3 or more PPO plans are 30-35% of their gross production. It could also be as high as 48% if a few of the PPO plans have low contractual fees.

The average practice that does not participate with any PPO plans will adjust around 5% of their gross production for courtesies. What do you do? Do you even know?

Number of Hygiene Days
Wow… Dr. Holley is working with three hygienists every day that he works. He must be doing really good! The better question is: are they producing at least 3x their daily salary? How “busy” are they? Are there enough openings per day per hygienist that, in reality, the practice is really only supporting two full-time hygienists? The practice may actually be spending one full-time hygiene salary in additional overhead because the practice cannot support three full-time hygienists.

After generating Dr. Holley’s recall report for the next 12 months and factoring in the number of new patients, SRPs, and past due patients, it was determined that he actually only needed 10 days of hygiene per week instead of 12. As a result of being over-staffed, none of his hygienists were producing to their optimum because there were too many unscheduled time units.

Number of Doctor Days
The same scenario is true for the doctor. Just because the “door is open” does not mean that there are enough active patients to keep the treatment rooms efficient. I have had more than one dentist tell me that his/her accountant indicated they needed to work more days to increase their revenue. It is not that simple! A dental practice is not a retail store that generates sales by being open MORE days. The key is to be open at times that encourage patients to schedule appointments.

By reviewing the number of “unscheduled time units,” the same theory is applied to a doctor’s schedule. If Dr. Holley can produce as much revenue in 192 days as he can in 200 days, his overhead will be reduced by 8 days and he will be more productive per day. And a dentist that is not being productive during the day is a dentist that is at the front desk “bugging” his/her Schedule Coordinator by asking questions like “Have you called Jack Jones?” or “Did you call Sue Roberts?” Of course we called them!  We knew you were going to ask!

As you and Dr. Holley read about how well other offices are doing, causing you to feel “inadequate” about yours, get your facts first and make sure that you are comparing apples to apples and not apples to oranges!

If you would like more information on how McKenzie's Consulting Coaching Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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Belle DuCharme CDPMA
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Set a Standard for Treatment Planning and
Insurance Narratives

By Belle DuCharme, CDPMA

Who does insurance narratives in your practice? Most often, the business coordinator or the insurance coordinator are responsible for extrapolating the information and condensing it to meet each insurance company’s claim submittal requirements. Often when filing the claim, the information has not been provided and questions have to be asked of the doctor or dental assistant who are busy with other patients. When the clinical team is formulating the treatment plan, their main focus is on what the patient needs to get to a healthy state for periodontal and restorative concerns, and to also address some cosmetic recommendations. Not a lot of importance is placed on the existing restoration because it is being replaced with something better. Throw in possible bite therapy and orthodontics, and the treatment plan takes on a life of its own.

Their focus should not be on what the insurance will approve to pay, but rather on what the patient needs and or wants from their dental treatment. No matter what your stand is on insurance, you will need to comply with their requirement of complete information to get the benefit dollars allotted for the patient. Even if you choose not to participate in the world of the PPO, your patient wants reimbursement.  It would be great if all patients would have optimum dentistry, but the truth is that many people put a higher value on the care that is covered by their policy versus that which is not. To get paid, proving that the existing condition is no longer or was never satisfactory lies on the evidence you can provide on an insurance claim.

Take for example the following illustration. A business coordinator was trying to clean up some unpaid claims. On this particular claim, which was now almost six months old, a crown was denied because it was placed on a third molar. A periapical x-ray was submitted, along with a narrative explaining that the crown was an initial placement and the existing restoration was a large MODL amalgam with a fractured mesial cusp undermined by decay. Since most third molars are out of occlusion, there was a claim denial. However, in this patient’s case all of her third molars were present and in occlusion. In other words, failing to restore this tooth would have jeopardized the integrity of her arch. The claim was resubmitted - with 4 bitewings and a periapical of the tooth in question, and one of the opposing teeth with a supporting narrative, and the claim was subsequently paid. 

If your focus is trying to treat what you have found with $1,000 or $1,500 per calendar year, then you are dooming the patient to patchwork dentistry that has a never ending story of trying to solve one crisis after another. Putting together a total treatment plan does not happen on the patient’s first visit unless you can read the future. You will not be able to determine the outcome of your cosmetic recommendations unless the periodontal, orthodontic, endodontic, surgical and bite issues have a favorable outcome. This could take a commitment of a few months to a few years in your practice. Phase the treatment based on your estimation of patient compliance and treatment success one step at a time. Explain to the patient that a clearer picture of their treatment will evolve as each phase is completed satisfactorily. The condition developed over time and now needs to be addressed over time also.

To assist the business staff in this treatment process, use a form that contains the following information not only for proper insurance documentation but for proper record taking. Having more than enough information is better than not enough.  Put this information in the chart notes area in the computer or simply scan into documents.

Diagnostic evidence for tooth #________________
Available PA______FMX___Panorex __ BWX ____Intra-oral photo_________Dated_______
Existing restoration description___________________Estimated age of existing_________Initial placement_______________
Caries evident Active___Incipient____Recurrent decay_____
Fracture__ Chip___Cusp undermined and or weakened____Horizontal or vertical cracks not visible on x-ray____Open margin or defective margin___Overhang or food trap with gingival irritation____Third molar in occlusion________
Porcelain fracture_______Thermal sensitive____Pressure sensitive___Percussion sensitive____Cracked tooth syndrome_____Previous endodontic treatment__________Date____
Pulpal exposure____Failing endodontic therapy____Endodontic referral_______
Missing tooth since______ Implant present____ Date placed____­­­Bruxism evident______
Bruxism contributing to bone recession_________
Occlusion with opposing____Bone recession____

Narratives should be short, while still containing the information that the insurance company asks for to determine payment of a claim. For more help with insurance and all the other issues that affect your day, call McKenzie Management today and sign up for one of our training courses designed to address the real world of the dental practice.

If you would like more information on McKenzie Management’sTraining Programs  to improve the performance of your team, email training@mckenziemgmt.com

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