3.4.11 Issue #469 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Turn Up the Heat Before You Fire
by Sally McKenzie CEO
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Almost without exception, it is considered to be one of the most dreaded employment experiences. Most dentists would gladly opt for a day filled with screaming children, terrified adults, and gaping holes in the schedule than deal with the unpleasantness associated with this exercise. Few, if any, except perhaps Donald Trump, actually enjoy it.

Indeed, the task of letting an employee go is one of the most difficult and anxiety ridden exercises that a dentist will face during his or her career. It is for that reason that doctors will go to great lengths to avoid confronting an employee on issues that beg to be addressed - attitude, poor performance, instigating conflict, poor patient service, and the list goes on and on and on. Consequently, many dentists are the sideline spectator as low morale and continual employee turnover chisel away at the practice that has been hijacked by the poor performers.

There comes a point when the dentist must regain control of his/her practice and address the problem employee(s). But before that dreaded day arrives, let’s rewind the tape and consider what might have been done differently to avoid the current situation.

First, implement a few common sense human resources strategies and you’ll make significant strides in reducing the number and level of employee headaches you’ll have to face throughout your career. For example: 

  1. Provide clear job descriptions to employees, so they know exactly what is expected of them.
  2. Train new employees but don’t overwhelm them. A new hire will be far more likely to succeed if the training program allows them to assimilate information and tasks at a steady rate, rather than a rapid-fire pace.
  3. Give all employees some form of personnel policy manual. This document spells out the office code of conduct, dress code, policies regarding tardiness, overtime, sick leave, office policies and procedures. All employees deserve to know the rules of the game and what they need to do to remain on the team.
  4. Give ongoing direction and constructive feedback. Too many dentists wait until there’s a serious problem or crisis before they give staff any feedback. The doctor is in a highly frustrated state because s/he has allowed the situation to go on entirely too long. The employee feels blindsided and often will assert they had no idea the doctor wanted things to be “this way” or wanted “that done.”
  5. Be specific. Don’t candy-coat the feedback and don’t beat around the bush. Be constructive not punitive. Tell employees what they’re doing well and what needs to be corrected or adjusted to do even better. 
  6. Know when to cut your losses.

The fact is, there are times when employees - new or long-term - simply must be dismissed. They may fail to follow established office policies, they may be dishonest, argumentative, or difficult to get along with. They may fail to carry out responsibilities, or they may refuse to be a team player. They may gossip about patients, the doctor, other team members or bring down the practice morale with snide comments and cutting remarks. They may be late routinely or divulge confidential information. They may not follow directions or they may be secretive about steps they take in performing their responsibilities so as to make themselves seem irreplaceable. Unfortunately, there are a multitude of reasons why some employees don’t work out.

Whatever the reason, problem employees need to be dealt with directly and clearly using a clearly established system. Unless the employee’s behavior is so egregious that you are forced to take immediate action, the team member should be given the opportunity to improve her/his performance over a 60-90 day period. Explain to the employee verbally and in writing the specific issues that are not satisfactory and document exactly what needs to change in the employee’s performance.

With the employee, develop an agreement that spells out what s/he needs to do to improve performance. It should be in writing, signed by both doctor and employee and placed in the employee’s file. Monitor the staff member’s progress, give regular feedback, and document every step and every conversation in the process.

Ideally, at the end of this 60-90 day progressive discipline plan the employee has had the opportunity to see the errors of her/his ways, make the necessary improvements, and everyone lives and works happily ever after. Unfortunately, the fairytale ending seldom occurs.

Next week, you don’t need Arnold Schwarzenegger to be the terminator.

Want more of me? Click here to visit my blog, The Lighter Side, for more Dental Practice Management info.

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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Frustrated with HIRING the WRONG people? Remove the guesswork. Employee Testing On-Line

Nancy Caudill
Senior Consultant
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Two Little Known Reports that You Must See
By Nancy Caudill, Senior Consultant McKenzie Management

Inquiries are always welcomed from clients and non-clients regarding articles and other information that is viewed on the McKenzie Management website. Recently, a call came in from a former client questioning the large credit balances that were on the practice’s Aging Report.  He was asked to email a copy along with the account statements involved.

 Before sharing the findings with you, let’s discuss two very important reports that you, as a practice owner, should be reviewing monthly:

The Credit Balance Report
Depending on your software, this report can easily be generated to illustrate all the accounts in your practice with “credit” balances. These are accounts that have had payments and adjustments posted against charges that created a negative/credit balance. Many state dental boards require that these “overpayments” by the patient or the insurance company be reimbursed within 30 days.

You should have a protocol in your practice indicating how to manage credit balances in a timely manner. An example would be:

  1. Review the account to determine whether the credit balance is correct or should be transferred to another family member.
  2. If not, print a copy of the account ledger that illustrates how the credit balance was created and place on the doctor’s desk, requesting a reimbursement check be written.
  3. The reimbursement check should be written and returned to the business person for mailing.
  4. A “refund to patient” debit adjustment should be posted, along with another entry stating that the check was mailed, as well as the check number.

Entering a notation on the account ledger that the check was mailed creates a simple “paper trail” should the patient call requesting the status of their refund. The purpose of reviewing your Credit Balance Report monthly is to confirm that credit balances are properly managed and they aren’t being created incorrectly.

The Adjustment Report
Credit adjustments are posted to accounts for a variety of reasons, such as:

  • Insurance PPO
  • Bad Debt write-offs
  • Small Balance
  • Senior Courtesy
  • Family and Friends Courtesy
  • Professional Courtesy
  • Transfer $ - Credit
  • 5% Cash Courtesy
  • Posting Error - Credit

The above are examples of adjustments that affect your gross production numbers. Gross Production – Adjustments = Net Production

There are also debit adjustments, such as

  • Patient and Insurance Refunds
  • Recharge Bad Debt write-offs
  • NSF Recharge
  • Transfer $ - Debit
  • Posting error - Debit

Debit adjustments usually affect collections (refunds and NSF checks) but a recharge of a bad debt write-off affects production, as well as a posting error. When posting a “Transfer $ - Credit” there should always be a “Transfer $ - Debit” to offset it, as this is used to transfer money between patients or accounts.

The business team post adjustments routinely to manage the accuracy of your patients’ accounts.  At the same time, it is your responsibility to review the Adjustment Report each month to monitor their postings. Your production adjustment percent should not vary from month to month unless it is something unusual that you would be familiar with. When you notice that your credit adjustments are higher than usual, consult the Adjustment Report and review questionable adjustments with your business team.

Dr. Jones had over $50,000 in credit balances! He was extremely concerned, knowing that these were supposed to be refunded back to the patients. A few patients had several hundred to more than a thousand dollars in credit balances. Something was not right!

Upon review, it was noted that the patients carrying these large credit balances had “dual” PPO insurance coverage. The primary insurance paid their benefit and the difference between the “allowable” and the practice fee was posted as an adjustment, leaving the patient with a balance. The secondary claim was submitted, at which time they remitted their check for the remaining balance, leaving the patient with a $0 balance. Unfortunately, the business team member was also posting the difference between the practice fee and the “allowable fee” from the secondary remittance, now creating a credit balance. In some cases, more than $1000!

After discussing this with Dr. Jones, I found out that a new business employee was hired and it was “assumed” that she understood how to post PPO adjustments.  Obviously, in this case, she did not! Had Dr. Jones been reviewing his Credit Balance Report and Adjustment Report, as well as tracking his gross and net production, he would have realized within the first month that there was a problem and it could easily have been resolved.

Sometimes we “don’t know what we don’t know” and we “think we know what we know.”  This is true for employees, as well. Supervised training is essential for new employees, even if they indicate that they “know” how to complete certain tasks. It is very possible that the protocol they followed in their previous position is not the same protocol that you follow in yours.

There are occasions when you lose a key business employee unexpectedly and the baton doesn’t get passed to the new hire. Invest in training for the new person on board.  It will save you many dollars and bottles of aspirin in the long run.

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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Are You Getting Reimbursed? Dental Insurance for 2011
Belle DuCharme, CDPMA

“If we aren’t reimbursed, we just write it off. We are busy enough that we don’t need the hassle of getting our patients mad and frankly it takes too much of my staff’s time chasing after unpaid claims.”  Dr. J. Hadenough

Not every practice can boast that it is busy enough to write off insurance money that is due them. The insurance industry will pay eligible claims, but only if we follow the rules in the insurance billing process. Often training is lacking at the front desk, which allows thousands of dollars to go unpaid annually. Claims that are initially rejected by the insurance company, more times than not, are collectable if follow-up is performed immediately. If the follow-up still does not result in payment, then get the patient involved either with a three-way call to the insurance company or by including a letter from the patient addressed to a specific insurance adjuster (ask for the person’s name who will be reviewing the claim).

The reimbursement process is a sequence of interdependent steps that start with the dentist’s service to the patient. The following is the outline of this important process.

Reimbursement Process

  1. With the initial contact on the telephone, collect the complete and accurate information from the patient and verify eligibility and coverage prior to the patient’s arrival in the practice. Name of subscriber and subscriber ID or SS#, DOB, name of employer, group number, name of insurance company and location to bill claims even if you send electronic claims, name of the patient and relationship to subscriber, their DOB.
  2. The exact service performed on the patient.
  3. The documentation of the service. This should be extracted from the clinical notes in the chart.
  4. Translate the service into billable CDT code.
  5. Charge onto patient’s record.
  6. Submission of claim either electronically or by mail or fax.
  7. Claim review by insurance company.
  8. Payment to the provider or the request for additional information for the carrier to be able to make a decision as to whether the claim is payable under contractual guidelines.  Requested information is often x-rays, narratives, periodontal charting or other records.

Lack of information that often holds up claim processing is:

  • Student status for patients age 19-26
  • Secondary insurance that is billed as Primary Coverage or vice-versa
  • Incorrect subscriber ID or using SS# incorrectly as Subscriber ID
  • Insurance company has record of other coverage for claimant
  • Group number missing or incorrect
  • Incorrect payer ID on electronic claims
  • Discontinued or incorrect CDT codes
  • Fee column is blank
  • Proper documentation, x-rays, narratives and perio charting

The dental record is a legal document, and services rendered should be accurately described and legible on paper or precise in the clinical notes area of the software system you are using. The rules for documentation are clear when it comes to billing to an insurance company. If the service is not documented with the elements necessary to justify the CDT codes, then the work should not be billed to the insurance company. The services rendered need to include the diagnosis and any special circumstances that may have occurred, along with the correct date of the service. For instance, if the patient was seen as an emergency on Saturday and you are posting the service the following Monday, make sure that the date of service is Saturday.

Often, it takes an experienced or trained billing coder to catch and correct claims so that they are paid. One claim was rejected because a crown was performed on a 3rd molar. The insurance company did not pay for restorations on 3rd molars, because they are usually extracted or out of alignment. However, when the insurance coordinator resent the claim, she included x-rays showing that the 3rd molar in question was in occlusion and a narrative explaining that the tooth had excellent bone and was a necessary tooth for the patient to chew food. The claim was paid at the contractual rate of 50% of the UCR fee.

Dental insurance benefits are an excellent source of cash flow, with very few problems associated with reimbursement if you provide the information necessary to expedite the claim. Need training to improve your reimbursement rates and increase cash flow in your practice? Sign up for a training course through McKenzie Management and we will give you the tools to succeed.

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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