Situation:

The patient needs to reappoint for their next hygiene visit.

Desired Result:

Schedule a hygiene appointment, utilize a “reason for return” which is customized to the individual patient and educate the patient about your confirmation process.

How To:

So that the patient senses that your recommendations are customized to their individual needs, it is critical that communication about the preventive care system be consistent with all team members.  Reinforce with the patients the “WHEN, WHY AND WHAT” of the next visit and document on the treatment plan. When would the doctor and hygienist like to see the patient again for preventive care? Why we want to see them and What we are planning to do at that visit.  Recommend the interval for the return visit and verbally use the name of the month rather than say “I will see you in 6 months.”  An example might be:

“Mrs. Smith, so that we can evaluate the fracture lines on the lower right molar and maintain your healthy gum tissue, Dr. would like to examine you in July, sometime after the Fourth! At this visit we will scale and polish your teeth, take x-rays to see between the teeth and monitor the bone around the teeth.”

The patient will associate their visit with an event or seasonal activity, reducing the frequency of broken or canceled appointments. The Why helps to reinforce the importance of the visit. The hygienist schedules the appointment and educates the patient on the preventive care system.  Explain the method the practice uses to contact the patient about this appointment:

“Mrs. Smith, one month prior to this visit you will receive an email from our office confirming this appointment.”

• Show a copy of an email reminder (or a postcard)

“You will also receive an email and text message 2 days prior to the appointment. I look forward to seeing you in July!”

Whenever possible the hygienist should pre-appoint the next visit.  A computer station in the operatory or in an administrative area near the hygiene operatories allows this to happen efficiently.  The appointment book needs to be prepared ahead of time to hold ideal times for certain procedures, such as scaling & root planning and new patient exams / prophy’s.  To provide flexibility, hold one day in the last week of the month to accommodate last minute schedule changes (continuing education course, sick days).

Situation:

The practice experiences patients regularly complaining about the completion of a new health history form.

Desired Result:

A patient who willingly completes the health history form and understands the link between overall health and their dental health.

How To:

The medical history is a critical tool in treating your dental patient.  Using a comprehensive questionnaire which allows you to further explore the patients past medical history is an important part of the new patient experience and the continuing care visits with the hygiene department.

Begin the patient interviewing process by sincerely thanking the patient for the time and effort they took in thoroughly completing the questionnaire. Use this opportunity to help the patient understand the link between oral health and overall health and wellness. Ask the patient,

How do you feel about your overall health?

Document the patient response using quotation marks and prepare second questions to further explore the response. For example:

“Have you noticed any symptoms, aches or pains?” or “When was your last medical physical?”

Many patients complain about completing the medical history forms, because the doctor and dental team do not spend much time with the information.  Let your patients know how important this information is in treating them properly.

Review the medical history and highlight or flag any yes responses so that they are obvious to the other team members. Update the medical history every six months and have the patient date and sign the update. Explain to the patient why some of these questions are important in dental care.

Add the Medical History Form to your team meeting agenda. At a team meeting, go through your health history form and train the team on why you ask the questions on the form. Help your team be prepared to discuss the link between your health history questions and oral health and prevention.  Common areas to discuss are: Tobacco Use, Diabetes, Heart Attack and Stroke, Medications and their Side Effects, Family History of Gum Disease, Heart Murmur and Artificial Joint Prosthesis, Pregnancy and Hormones, Hormone Replacement Therapy, Stress and Immune Deficiency and Nutrition and Diet.

As you become more confident in linking the medical questions to dental conditions, the patient becomes compliant in your record keeping requests and values more comprehensive dental treatment as a way to stay healthy.

Situation:

A desire to improve communication and team relationships.

Desired Result:

Team members respect and acknowledge one another and practice great communication skills.

How To:

At a team meeting have a copy of the quote “The Most Important Words in Communicating with Your Team” for each team member. Hold a discussion on the quote with team members sharing the opportunities they have to use these important words to encourage and help one another. Write this quote on a large flip chart page or poster board and display it in a common area for everyone to be reminded of these words.

The Most Important Words In Communicating With Your Team:

The six most important words in our language are:
“I admit I made a mistake.”

The five most important words are:
“You did a good job.”

The four most important words are:
“What is your opinion?”

The three most important words are:
“Let’s work together.”

The two most important words are:
“Thank you.”

The single most important word is:
“We.”

Situation:

Patient calls and says ” I need to cancel my appointment for tomorrow afternoon.”

Desired Result:

Patient keeps appointment, reducing time needed to refill schedule.

How to:

The five keys to saving an appointment are:

1. Show concern in your tone of voice and avoid being too accommodating.  Most people want to help the patient and try to be understanding, that backfires in this situation.
2. Tell the patient that Dr. is concerned about the “reason for return” to “save” the appointment.
3. Explain your broken appointment policy and waive the fee for the first offense.  Before implementing this make sure your “own house” is in order (don’t run late, abuse patients time or frequently change appointments).
4. If you are unable to “save” the appointment, create some urgency in rescheduling while maintaining control of the appointment book.
5. Document frequent changes and cancellations in the chart in red ink or in the ledger so they are easily seen by all team members.

Lisa the patient calls to say she has to cancel her appointment tomorrow:

“Oh Lisa, I’m sorry to hear that.  Is there a problem?”
—

“I see.  May I put you on hold so I can get your chart / look up your chart?”
—

“Lisa, I see from Laura’s notes that she is going to evaluate your response to the fluoride treatments.  She also noted that late afternoon appointments work best for you.  I’m afraid we don’t have another late afternoon appointment for 9 weeks!  Would you reconsider and keep the appointment for tomorrow?”
—

“Terrific Lisa, I’m glad you can make other arrangements!  I’d hate to see you wait 9 weeks to see Laura.  We’ll all look forward to seeing you tomorrow.”

If the patient maintains they must change their appointment:

“Lisa, at your New Patient visit we spoke about the broken appointment fee of $50 which we assess should an appointment be canceled less than 48 hours before the appointment.  Of course, we will waive that fee this time as it is the first time it has happened. However, next time we would have to charge you.  Let’s find a time that will work for you so that does not happen.”

• Document in the chart or ledger that the broken appointment policy was explained and the charge was waived for the first time.

 

Situation:

Your accounts receivable has gotten too high.  Patients continue to have dental needs but have been slow in paying.

Desired Result:

A patient who agrees to make payments within a time frame that makes sense for the practice and for the patient.  For the patient not to feel judged or ashamed and to understand the practice wants to help.

How To:

We recommend calling the patient first before sending a collection letter series.  Here is how to ask for what is owed using 3 simple steps:

1. 1. Sympathize

Show compassion. “I know how this can happen sometimes”
Purpose: Some patients are angry at you for calling to collect on a bill they have not paid. Remember, most people are really angry at themselves or embarrassed by their financial obligation. Show compassion to help diffuse their anger.

1. 1. Restate their obligation

“Mrs. Smith your account was due on, month/date.”
Purpose: Clarification regarding what was due when and to reinforce it is fair for you to be calling them to collect on the account.  Be sure you pause and let them talk, don’t rush to the next step

1. Ask “how much are you short?”
   • If they can pay some now, negotiate the balance within a reasonable, for your practice, time-frame.
   • If short the whole amount, you are in control of where you take the negotiation next and the payment terms.

“Mrs. Smith, of the $200 that is due now, how much are you short?”

Never ask these 3 fatal questions:

• How much can you pay?
• When can you pay?
• Can you pay something towards your bill?

All of the above statements give the patient control and enable them to give unreasonable answers, such as $20 per month for the next 20 years.

If you are unable to contact the patient by telephone or receive no return phone call from your messages, send a series of letters.  Include a deadline of less than 2 weeks to hear from the patient.  The idea is to collect on the balance or turn it over before 90 days has past.  In our next posting we will share a sample collection letter series for you to adapt for your practice.

Situation:

You don’t want to lie to patients and you do want them to experience the great care you offer in your practice – so how to answer these questions without losing the potential patient?

Desired Result:

A patient appointment and a happy patient at the end of their appointment!

How to:

First and foremost the team must understand and believe the true definition of dental insurance. It’s a partial reimbursement for basic care. Basic preventive and basic restorative…and 95% of all adults need more than basic care. Let your patients know this, they understand and have experienced insurance covering less and less.

Eliminate insurance from your team’s vocabulary. It does not cover 100% of anything, it is a benefit, or like a rebate the patient gets, or a coupon they can use for services. Having a policy does not protect a patient from loss, it contributes to helping them pay for care and they are fortunate to have it.

So with that as the background, let’s also remember that most patients ask questions like this because either they don’t know what else to ask (it’s the only way they know to choose a dentist), or they want to know how to pay for services. Help them with both and get the patient appointed in your practice.

Here are Some Suggestions:

• First: NEVER say “We don’t take that plan”. Instead try saying

“Our Dr. is a provider for all benefit plans, s/he does not participate in any plan that expects the doctor to compromise care for patients or not offer services that would help the patient that are not part of their plan. We work with our patients to get the absolute most out of all policies, and we offer financial arrangements for what your benefits do not cover. Patients love our team, and our Doctor. We pride ourselves on really knowing our patients and taking great care of them. We’ll take good care of you and we will make the most of your benefits. Let’s get you appointed.”

• What if the patient has Medicare or Medicaid and you are not a provider? Here is an idea of what to say, rather than we don’t take that plan

“We do our best to make the most of all benefit plans patients have.  Unfortunately, you have a type of plan that we are unable to work with, it will not pay us for your services nor will it send the benefit check to you. We are happy to work out payment arrangements so you can get the care you need.”

• If the patient is not interested

“In our area, the practice I know of that can receive payment from your plan is XYZ Practice.  We would be happy to see you and work out a payment arrangement if you decide to receive care outside of your plan.”

Situation:

Introduce the benefits of the intra-oral camera to the patient.

Desired Result:

An average of 90% case acceptance on significant treatment. The patient completely understands why the treatment is needed and the benefits of quality comprehensive dental care.

How To:

It is important the entire clinical team is trained in the efficient and effective use of the intra-oral camera. It is an important diagnostic and educational tool to be used at every visit.  We recommend radiographs up on the operatory computer screen or on a view box, and a photo series available during patient evaluations. These tools help the Doctor diagnose needed treatment and the patient understand their needs. Introduce the camera with enthusiasm and prepare the patient for what they will see.

“Mrs. Smith, so that you can see what I see when I look in your mouth, I am going to use this small camera to take pictures of your teeth and gums. They will show up on our monitor here, for you to review with doctor. We can see areas that have improved and areas in your mouth that are perfect. Also we will be able to zoom in and magnify areas of concern so that you can understand our treatment recommendations.

Often times we can see problems early, before they cause you pain, or before something breaks down and requires more extensive and expensive treatment. Our goal is to allow you to clearly see the condition of your oral health and to help you make wise treatment decisions and so you have conservative, affordable care.”

The camera can also be an important part of the emergency appointment. Along with a PA, take a picture of the painful, rough tooth. Leave the picture on the screen in the operatory while waiting for the Doctor to arrive. The Doctor might consider asking the patient “Well, what do you think?”. The patient will often diagnose themselves, and help the Doctor understand what further explanation is needed for the patient to move forward with appropriate treatment.

Situation:

Patients want to schedule appointments when we are not open or during a time that it is not in their best interest to have the procedure done.

Desired Result:

Patients accepting our preferred appointment times

How To:

Have the clinical team prepare the patient in the back for the times the Doctor prefers to do the procedures.

“John, I know Doctor will prefer you to have the first visit for this procedure in the morning. He likes to have things ready for the lab to pick-up the same day and the light is better earlier in the day.  When you return for the second visit we can schedule you later in the day.”

Then, to gain patient acceptance of desirable practice appointment times, offer a choice between two times which meet the practices scheduling objectives. Use the doctor’s preference for the times which you offer.

“John, Doctor would like to see you for the first visit for this procedure on Tuesday at 10 a.m. or Thursday at 11 a.m., which would be best for you?”

Often a practice will ask opening questions which give control to the patient. The practice thinks that they are being helpful, however they often make it more difficult to schedule according to your guidelines because you get an answer that you do not want. The following questions are commonly heard in the dental practice.

“When would you like to come in?”
“When will it be convenient for you to come back?”
“When is the best time for you to come in?”
“Did you want to go ahead and make an appointment?”
“Do you need to make an appointment?”
“What is better for you, morning or afternoon?”
“I imagine Mondays are best for you?”
“Do you need to come in after work (school)?”

Avoid using these opening questions. When we use these questions, we give control to the patient and lose focus on the best time for our patient to receive ideal care. Try offering two appointment times and gain control of your schedule.

Situation:

Patients are past due for their hygiene preventive care visit.

Desired Result:

Schedule a hygiene appointment and invite other family members to make an appointment.

How To:

A strong hygiene department is the life blood of a general dental practice. To keep patients current requires a commitment of time and a great attitude.  Research shows that a minimum of 4-6 hours per week is required to work this system effectively. Using your computer reports, start with the most current past due patients (the last 3 months). Research your available hygiene appointment times and offer two choices. Use the name of the provider to build the value of the appointment.

“Hello Mrs. Jones. This is Jane from Dr. Smith’s dental office. Deb, your dental hygienist (or Dr. Smith) asked me to call you because she recently reviewed your chart and noticed that you were not scheduled for your preventive care hygiene appointment. She was concerned about you and asked me to give you a call to let you know that we have an opportunity to see you this Thursday at 11:00 or next Monday at 1:00. Which of those would work best for you, Mrs. Jones?”

After you successfully make the appointment, ask about other family members who also may be past due or who aren’t seeing a dentist at all. The patient might have a family member who just moved back to town and needs a dentist, or maybe there’s a young child in the family who needs to come in for a first visit. Inviting family members is a great way to get new patients into the practice.

“Great! We look forward to seeing you on Monday at 1:00. While I have you on the phone, is there anyone else in your family we can schedule an appointment for?”

Leaving a message:

With today’s busy lifestyle, it is common to receive voice mail or an answering machine message. Rather than being specific, try leaving a friendly, yet vague message.

“Hi, this message is for Mrs. Jones. This is Jane from Dr. Smith’s dental office and I have a question I would like to discuss with you. Could you please give me a call at (123) 456-7890.”

 

Situation:

Accounts receivable is more than one month of production and too little is collected at the time of service, impacting cash flow and bill payment.  The cost of billing patients is high and takes a great deal of time

Desired Result:

Increase same day of service collections so that 20-40% of the accounts receivable is current collections.  Therefore if you had $100,000 in total accounts receivable, $20,000 to $40,000 is less than 30 days old.

How To:

Prepare for today’s patients by understanding their insurance and calculating their anticipated co-payment.

-“Today’s visit was $357, your portion is $112, will you be taking care of that with cash, check or credit card”

• PAUSE and ALLOW THE PATIENT TO RESPOND
• Notice we did not suggest saying “would you like to pay with cash, check, or credit card.”  Don’t ask a question you might not like the answer to – the patient could potentially say “no I would prefer not to pay today”.
• Be prepared for your practice’s common objections. One we frequently hear is:

–“Just send me a bill, I’ll pay after insurance pays.”

Here are Some Suggestions:

“For our patients who are fortunate to have dental insurance benefits, we submit your insurance claim at the time of service, at no cost to you.  For those that request we receive payment for their portion after insurance has paid, we require a credit or debit card on file.”

“Most insurance companies make payment to us within 30 days.  The balance, not paid by your dental benefits, will be billed to your credit card once we receive insurance payment.  In all cases, as the patient, you will receive an explanation of benefits (E.O.B.) before our practice.  This will inform you of the portion not covered by your dental benefits.  We will mail you a copy of your credit card receipt when we bill your card.”

“If we have not received payment from your insurance company within 45 days we will call you to get involved with us in collecting from your insurance company.  If for some reason we have not received payment from your insurance company 60 days (2 months) after the date of your receipt of services, we will bill your credit card for the full amount.”

“If you would like to handle payment after insurance has paid, let’s complete this paperwork.”

Have the patient complete a form with the necessary information to bill their credit or debit card.  If you would like a sample form, contact us and we will be happy to send you one.