7.3.15 Issue #695 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Production Down? Here’s Why
By Sally McKenzie, CEO

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You and your team members work hard to make your practice a success. You’re always looking for ways to improve your practice, attract new patients and grow revenues, but lately those efforts seem to be in vain. Your production numbers are down, and it’s not only leading to frustration, it’s killing your bottom line.

Weak production is a problem many dentists face, but there are steps you can take to up your production numbers and create the thriving dental practice you’ve always dreamed of owning. Before you can fix the problem, you need to know what’s causing it. I’ve put together a list of common reasons practice production numbers begin to fall, and what you can do to increase production and bring in more revenue.

You don’t have daily production goals. For your practice to be successful, you need to have a vision and develop daily production goals. Determine how much you need to make to live the lifestyle you want, and set your production goals from there.

You aren’t scheduled to meet production goals. Setting production goals won’t do you much good if your team members don’t know what those goals are. Make sure your Scheduling Coordinator is scheduling you, and all producers, to meet production goals, not just to keep you busy. Once you do, your production numbers will increase as will your bottom line. 

Your case presentations are weak. While you might enjoy giving case presentations, spending 5-10 minutes talking with patients about treatment chairside isn’t the best way to get them to say yes. Instead, consider hiring a Treatment Coordinator who takes the time to go over every aspect of treatment with patients, from how much it will cost to how long it will take to the possible consequences of foregoing treatment. Make sure your Treatment Coordinator takes patients to a quiet, comfortable place to discuss treatment. They’ll be more likely to ask questions and bring up their concerns if they’re comfortable, giving your Treatment Coordinator the chance to educate patients and address any perceived barriers.

You never follow up. Most patients won’t say yes to treatment right away. They’ll want to take time to think about their options, or talk over concerns with their spouse. Before patients leave the practice, your Treatment Coordinator should schedule a time to follow up. If that’s not possible, follow up two days after the initial case presentation, armed with information about the patient and any concerns brought up during the first conversation.

If no one follows up and a patient is on the fence about accepting treatment, chances are that patient won’t call your office to schedule. But if the Treatment Coordinator follows up and reinforces the importance of treatment, once hesitant patients will be much more likely to schedule that first appointment.

You have a lot of unscheduled treatment. Most practices only contact patients on the unscheduled treatment report if there’s a hole in the schedule, when they should be contacting them to grow production numbers. Train your Patient Coordinator to track unscheduled treatment, contact patients on the unscheduled treatment report and get those patients scheduled. Your coordinator, armed with a script and winning personality, should reach out to at least five unscheduled patients a day.

Patient retention is down. If you’re losing 50% more patients than you’re bringing in each month, it’s time to figure out why. Is your customer service lacking? Do you not take the time to build a rapport with patients? Do you ignore patient complaints? Make the necessary changes to keep patients loyal to your practice, and production numbers will improve.

Remember, patient retention is vital to your practice’s success, and should be at about 95%. That’s right, 95%. If you’d like to know how your practice is doing at patient retention, click here to take my free assessment.

Patients don’t understand the importance of treatment. Uneducated patients aren’t going to accept treatment. They’ll smile nicely and nod their heads as you tell them your recommendation, with no intention of actually following that recommendation. Educate your patients about their condition and the consequences of not going forward with treatment. Use hand mirrors and intraoral cameras to show them what’s happening in their mouths. Give them brochures and show them videos, then talk about what the educational materials covered. Making this effort will go a long way in getting patients to say yes, and that means they receive the treatment they need while you boost your production numbers.

You pre-appoint. I know most offices still pre-appoint six months out, but it might be time to reconsider that approach. Pre-appointing gives the illusion your schedule is full, which makes it difficult to schedule patients who are ready to start treatment. And if you make patients wait too long, they’ll likely call the practice down the street to see if they can get them in sooner. 

The reality is, many of the patients who schedule six months out will cancel at the last minute, making it difficult for you to meet your daily production goals. Consider developing a new system that leaves room for patients to schedule needed treatment.

There are many factors that lead to falling production, you just need to recognize them so you can get your practice back on track. Once you commit to making the necessary changes, your production numbers will rise and your practice will start to flourish.

Next week, 8 ways to improve production.

For additional 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
Interested in having McKenzie Management Seminars speak to your dental society or study club? Click here.
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Nancy Caudill
Senior Consultant
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Those Pesky Unpaid Insurance Claims!
By Nancy Caudill, Senior Consultant

Doctor, do you know how to run the Outstanding Insurance Claims Report in your practice management software? If you don’t, you should - or at least one of your front office team members should be able to run this report for you quarterly.

There are many very useful reports that can be generated from your PM software, including Production by ADA Code Reports, Accounts Receivables Reports, Adjustments Reports, as well as the Outstanding Insurance Claims Report. You may be asking yourself, “Why do I need to look at this report?” Primarily, because you are the business owner of your practice and you should have an understanding of where all your revenue streams are to know if they are paying off for you. Front Office Training

Two Revenue Streams
You have two revenue streams in your office if you accept the assignment of benefits from insurance companies. This means insurance companies are sending you checks for services provided in your office opposed to sending the checks to your patients. Your first revenue stream (but not necessarily the most important, it just depends) is from insurance companies. The second revenue stream is from your patients. This revenue stream is typically collected from the patient at the time of service either by cash, check, credit card or an outside financial service such as CareCredit.

The Insurance Revenue Stream
Assuming you are accepting assignment of benefits as mentioned above, let’s explore some steps that would be involved in obtaining payment from insurance claims.
First, your patient presents at the front desk and announces that he or she now has dental insurance benefits. The patient is more excited than your business team is, as this means more work for them and a reduced immediate cash flow for the day. It is now their responsibility to enter all the patient’s information into the software correctly, including the subscriber's name, social security number in many cases, and so on. It is tedious but necessary work.

Second, when the time comes for the patient to be dismissed to your Schedule Coordinator, a “guesstimate” must be made regarding the patient’s portion that won’t be covered by the insurance plan. In some cases the insurance plan may cover 100%, but in many cases it does not.

Third, the claim for this patient is electronically submitted to the clearinghouse you are working with. The clearinghouse reviews the claims electronically for any obvious errors such as a missing date of birth. Should an error be detected, the claim is rejected on the report and the error must be corrected so the claim can be resubmitted.

Fourth, you wait for your money! If all goes well and there are no requests for additional information such as a narrative, x-rays or other documentation, you will receive payment for the amount the insurance plan is responsible for within 2-4 weeks. If you are not so lucky, it can be months - despite the requirement that insurance companies must respond within 30 days or pay interest on the unpaid claim unless they have requested information or they are a third party administrator or a non-profit organization.

Fifth is the follow up, and this is where the work comes in. An effective Financial or Insurance Coordinator stays on top of these unpaid claims to improve your revenue stream. This is very tedious and time-consuming, but necessary if you are accepting the assignment of benefits from insurance carriers. The coordinator generates the outstanding claims report for all claims 15 days and over and starts “dialing for dollars”. This call is not really because the payment is expected now, but more to confirm that the claim was received and is being processed. If there is a problem with the claim that the clearinghouse did not catch, you want to know as soon as possible so the claim can be resubmitted. It may take the insurance company several more weeks to “reject” the claim and send you a request for additional or corrected information, or worst case, simply deny the claim.

The goal is that all claims should be paid by the 60-day mark from the time the claim was submitted. If you have claims that are over 60 days, there is a breakdown in your current system. Ask for a copy of the Outstanding Insurance Claims Report and see if your system is working for you!

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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The Future of Medical/Dental Insurance Coding
By Belle DuCharme, CDPMA

Documenting and coding of dental claims has been part of the dental office environment since the 1960s, and until recently hasn’t seen a lot of change. Today’s dental professionals need to prepare for the requirement of diagnostic coding for dental services. Dental diagnostic coding is already used in many university and large private dental practices using Electronic Health Records (EHR) and Electronic Dental Records (EDR).

In the past and at present, the use of the official Current Dental Terminology or CDT codes has been the hallmark of coding dental claims for payment by insurance companies. The CDT codes developed and copyrighted by the American Dental Association (ADA) have been the only acceptable form of coding used on dental claims. The new ADA 2012 dental insurance claim form has a section for medical diagnostic coding of the procedure codes. For billing medical insurance the CMS 1500 claim form is included in many dental software programs. HCPCS or CPT procedure coding system is the most commonly used coding system for reporting medical outpatient services and these codes are developed and updated annually by the AMA, American Medical Association. These codes provide a common billing language for payment of claims. 

When billing a dental service to a medical plan, you must find out from the medical insurance provider whether they will accept services using the current 2015 CDT procedure codes or the CPT procedure codes on claims. Usually in plans that have coverage for both on the same policy, the medical is billed first and if denied is then submitted to the dental plan. Many insurers are prepared for this confusion and have cross-coded to allow for this, however it is up to the dental provider to clarify before sending claims. Medicare and Medicare Advantage claims are in a separate category and not addressed in this article.

The change in the way things have always been done is the crossing over of some dental services into the realm of medical, creating a need for the same coding used in medical, diagnostic coding. Medical coding uses the ICD-9-CM Classification System to translate medical terminology into diagnostic codes. Presently this system is under transition to the ICD-10 codes set to launch in fall of 2015. 

To prepare for the use of medical diagnostic coding, dental offices must prepare to take far more detailed health histories on patients and details on observations of dental conditions. There may be more than one diagnosis for a dental disease or condition.  Getting in the habit of using Subjective, Objective, Assessment and Plan (SOAP) methodology of recording patient data will establish a system to collect the patient information to create proper diagnostic codes for dental/medical claims.

During an initial oral exam, data recorded includes conditions present and any previous dental treatment provided. Dental SOAP notes are written to improve communication by standardizing evaluation entries made in dental charts. Each letter in "SOAP" is a specific heading in the notes:

S – Subjective, the purpose or “chief complaint” of the patient’s visit. This section also includes the description of symptoms as conveyed by the patient: pain and what is triggering it, what causes the discomfort to disappear and the length of time these symptoms have been occurring.

O – Objective, unbiased observations by the dental team. Included under this heading would be things that can actually be seen, heard, measured, felt, smelled and touched.

A – Assessment, the diagnosis of the patient’s condition done by the dentist/clinician. The diagnosis may be clear or there may be several diagnostic possibilities.

P – Plan or proposed treatment is decided upon by the patient and the dentist. The plan may include radiographs, cone beam, biopsies and more tests, referrals to specialists or alternative treatments.

In SOAP notations, the usage of abbreviations is standard. If abbreviations are used they must be standardized to the practice and not obscure in meaning. Notations must be signed. If an error is made, a single line should be drawn through the error, dated and initialed, and the correction written. Corrections in computerized formats will vary according to dental software. Notations without blank lines between the entries will prevent additional information being added without the writer’s knowledge.

Change is here – embrace it! If you need help and training please call McKenzie Management and update your dental business skills today.

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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