10.24.14 Issue #659 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Overwhelmed by Overhead? Look at Payroll
By Sally McKenzie, CEO

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You hate to admit it, but overhead is controlling your practice. It dictates every decision you make, from whether you can buy that new piece of technology you’ve been eyeing to how much salary you can pay yourself each month. To make matters worse, you have no idea how you got here, or how to turn it around. You’re overwhelmed, so you just continue along, hoping you’ll magically find yourself on the right track someday. All this does is make the problem worse, until you’re burnt out and wondering if you’ll ever make enough money to retire.

Unfortunately, this is a common scenario many dental practices face. The good news is, if you’re ready to commit to making real change in your practice, you can take back control. First you have to determine why overhead costs are soaring, and one of the first places to look is payroll. That’s right, if your practice overhead is out of control, payroll is likely one of the main culprits.

Payroll costs should be between 20-22% of your revenues, with an additional 3-5% for payroll taxes and benefits. Did your eyes just bulge out of your head? Are you wondering how that’s even possible? It is, and I can help you get there. If your payroll costs are way above this benchmark, it’s likely because you’re too eager to give staff raises, you have too many employees or your hygiene department is under producing.

Any of those sound familiar? Whether your practice is dealing with one of these issues or all three, it’s time to reign in your payroll costs and reduce overhead. Here’s how: Don’t give raises just because. You have to take the emotion out of giving raises. Team members need to earn raises based on performance, not receive them just because they asked or because it’s been a year since their last pay hike.

I know it’s easy to fall into this trap; you want to keep your team members happy, especially the ones who have been with you for years, so you throw more money at them and hope the extra incentive will lead to improved performance. But if these team members aren’t doing anything to increase production and improve systems now, giving them a raise isn’t going to change that.

Instead of giving in every time an employee asks for more money, establish a compensation policy and use performance measurements to determine pay raises. Explain when raises can be discussed and under what conditions they will be given. Set clear expectations and goals for every team member, so they know exactly what it takes to earn a higher salary.

Don’t be too quick to hire new employees. It’s clear to you that certain tasks aren’t getting done. Instruments aren’t getting sterilized as quickly as they should be, and if collection calls are being made, they certainly haven’t been very effective. Your team is complaining they’re overworked and need more help, so you do what you think is necessary. You hire more staff. Problem is, nothing has changed except your increased payroll costs.

Hiring more staff doesn’t guarantee improved efficiency or production. The only guarantee it gives you is an increase in overhead. While more people might seem like the answer, training and coaching existing staff is a much more cost effective way to make your practice more efficient. Invest in your employees and they’ll not only become better at their jobs, they’ll be reenergized and poised to help you meet practice goals.

Before you hire someone new, look at how much time patients spend at the front desk. Every patient takes about 10 minutes to check in and check out. There are 480 minutes in an eight hour work day, so if your practice sees 15 to 22 patients a day, the front desk is spending 150-220 minutes seeing patients, which is something one front desk person can easily handle. If the practice works a normal 8-hour day and one front office person spends more than 240 minutes with patients, then it’s time to consider hiring a new team member.

Now let’s talk about assistants. If procedures are streamlined, including room set up, seating and dismissing patients and clean up, one assistant can efficiently see 13 patients a day while maintaining two treatment rooms and using two operatories. If you see 14 or more patients a day, not counting hygiene exams, then you can justify hiring a second assistant.

Get your hygiene department on track. If you’re overwhelmed by overhead, chances are your hygiene department is under-producing and a weak or even nonexistent recall system is probably to blame.

Let me explain. Your hygienist’s salary shouldn’t exceed 33% of his or her production, excluding doctor’s fees, and he or she should be well aware of practice expectations: to produce three times his or her wage. If that’s not happening at your practice, it’s time to look at the hygiene schedule.

Your schedule may appear overbooked, but what about all those openings that pop up over the course of the day? That’s lost production, and more importantly lost revenue. If patients aren’t in the chair, hygienists can’t possibly meet production goals, no matter how good they are at their job. If you want to up production rates and reduce overhead, hire a Patient Coordinator who’s tasked with keeping a steady flow of patients coming in and out each day, thus keeping your hygienist on track to meet daily production goals.

Skyrocketing payroll costs shouldn’t be keeping you from practice success and profitability. Focus on getting these costs under control, and you’ll reduce overhead, increase production and improve efficiencies in your practice.

Next week, 3 ways to boost employee performance and reduce overhead.

For more information on this topic and more, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
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Belle DuCharme, CDPMA
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Appeal Letters for Denied Dental Insurance Claims
Part One: Preparing the Appeal

By Belle DuCharme, CDPMA

Can you feel the blood pressure rising as you read the latest denial for a claim you have submitted for payment? It may be the first appeal or it may be the fifth, but still the same results: DENIAL.

You have checked the eligibility and benefits, and all are verified. There is money left in the calendar year maximum to cover this particular procedure. There aren’t any wait periods for this procedure on the policy or applicable frequency limitations. You have double-checked the code to see if it is a current CDT, ADA code and it was the correct code for the procedure. Your narrative was concise and you sent in the required x-rays and documentation, so now what? This is the typical process when sending a claim for payment, and usually it works. Many offices will close the claim and send the statement to the patient for payment at this point. If you choose to fight, here are things to consider.

1. Follow the appeal protocol of the insurance company that denied the claim.  Each company has its rules for appeals. You can obtain this from their website or there is usually information on the denial EOB on the bottom of the page or on the second page of it.

2. Construct a formal letter on your letterhead. No hand written notes on the EOB or original claim.

3. Don’t skip the details on the letter. Your full address, phone and email contact information; the patient’s full name, address, phone number, date of birth, member ID, claim # and/or check # and also a reference number for the claim if you have one.

4. Stick to the clinical facts that support the procedure. Use the doctor or other provider’s clinical notes. If they aren’t complete, ask for clarity and have the providers update the notes in the clinical chart. Don’t say what might have or will happen in the future if the procedure wasn’t performed. Insurance companies don’t pay for your professional intuition.

5. Give more detail to the narrative than previously submitted, such as: “#2 URM decay under existing restoration, lack of remaining tooth structure, full crown necessary.”  Label it ADDITIONAL INFORMATION: “#2 URM recurrent decay under failing MODL composite; placed 5 years ago, less than 50% of supragingival tooth structure present, cusp fracture, full crown necessary.”

6. Look at the x-rays that you sent. Are they of good diagnostic quality and do they clearly show the whole tooth? If you sent one periapical, now send the bitewing or the full mouth x-ray if there are missing teeth in the arch. If the x-ray does not give enough visible evidence to the necessity, then include a labeled intra-oral photo with arrows pointing to the evidence. Insurance companies do not have detailed reasons for turning down a claim; often they choose “missing information that supports claim” or “pending action.” Unless you can speak directly to a representative or a supervisor, you have to read between the lines as to what they want.  When you perform a crown or bridge on a patient who is under periodontal care or has periodontal disease, submit the periodontal charting to show there is enough supporting bone. Write this in narrative also. If you are doing a crown on a tooth that has had endodontic therapy, send the final report letter from the endodontist stating the prognosis status (“favorable”).

7. Don’t use the verbiage to describe the condition that was used in the denial. If “normal attrition and wear” was used in the denial as the reason for non-coverage, then use other words to describe the condition such as “craze line cracks, fracture lines, dentin exposure, cold sensitivity or pain to loading.”  If an occlusal guard is covered for bruxism then use the word bruxism, do not use the term “TMJ pain relief.”The wrong word can trigger a denial.

8. Let the patient know you are appealing the denial of his/her claim, and it might make a difference if they call the insurance to ask why the denial. Often the patient is told something different than the office and this can be used in your appeal. For instance, a patient phoned the insurance company after the claim had been denied twice. He was told by the representative, “it should have been paid.”This information was used in the next appeal.

In Part Two of this article, I will provide you with samples of real time appeal letters that got the claims paid.

For Professional Business Training for Front Office and Office Managers, call McKenzie Management today and arrange a time that meets your needs.

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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Nancy Caudill
Senior Consultant
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Is Your Business Team Sitting in the Appropriate Seats for their Personality?
By Nancy Caudill, Senior Consultant

Have you taken the time to observe your business team’s individual personalities? Are they outgoing and struggling to stay on task, or quiet and steady? Do they tend to “command” an audience? Is there someone who never speaks up at the monthly meetings, or perhaps someone who’s a “chatterbox”? There’s no “right or wrong” personality type, however, there are personalities better suited for specific job descriptions, and having employees in the “wrong seat” can affect their ability to be productive and happy.

Seats = Power?
Let’s assume you have three business team members and they have specific seats they sit in throughout the day. Do these seats have a “pecking order” in terms of seniority or power? They shouldn’t, but it’s interesting to observe their reaction when an employee is moved from one seat to another. It’s like relocating the Empire State Building! The main point is to be concerned with what tasks are associated with the seats in the office space.

Seats = Job Descriptions
Let’s first assume there are specific job descriptions for the three employees in the business area: Schedule Coordinator, Financial Coordinator and Patient/Hygiene Coordinator. If you have an Office Manager, usually she/he is responsible for one of these job descriptions as well, unless you have a very large practice with many employees, requiring an Office Manager whose primary responsibility is to “manage” the office and all the tasks that come along with that job description.

So if the three employees do have specific job descriptions, their job descriptions determine where they sit. It is that simple. Below is an example of how you can determine where your business team should be sitting.

Schedule Coordinator
This coordinator is primarily responsible for the doctor schedule and making appointments, as well as the management of information from patients, such as demographic information, as well as the task of greeting everyone with a smile and a name, opposed to a “…and you are?” This person, for example, could not sit in a seat that is not near the reception room door in order to greet patients and to be able to make their next appointment upon leaving.

Financial Coordinator
She/he checks-out the patient, which may include presenting treatment as well as collecting monies that are due and reviewing their expected portion for the next appointment. When not processing patients, this job description may oversee the accounts receivable, delinquent insurance and billing. This person must be located in the seat that’s easiest to access from the clinical area and hopefully has some privacy.

Patient/Hygiene Coordinator
This coordinator is responsible for maintaining the integrity of the hygiene recall intervals, the recall system itself, the 5 steps of recall follow-up for the past 12 months, as well as confirming that the hygienists are scheduled to their daily goal each day. He/she can also take all incoming new patient calls and oversee marketing for the practice.

Personality = Job Description = Seat
All business team members should have their personalities evaluated to confirm they are in the right seat. This will also correspond with the right job description. For instance, Julie is very friendly, never meets a stranger, and enjoys the art of communication. Her attributes may be wasted as a Financial Coordinator whose focus is on collecting money. Joe is really good with numbers, doesn’t like to be interrupted and is the “steady Eddie” – he would pull his hair out sitting at the check-in seat. This personality type is typically quieter than other team members, very task-driven, and prefers a controlled environment with no interruptions. Susie, the friendly and customer-service oriented Schedule Coordinator, enjoys the challenge of a multitude of tasks at the same time. She would not be happy being away from seeing patients or interacting with them.

Review your business team job descriptions to see if they are helping or hindering your practice potential. Consider taking the online Employee Assessment Test offered by McKenzie Management to see if you have the right people in the right seat.

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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