Insurance Processing

We have been in a few office recently that were not using some of the tools we commonly recommend to assist in processing of insurance claims- to refresh your memory here they are again:

1. Insurance Solutions Newsletter – find it at:

2. “Coding with Confidence” by Dr. Charles Blair – also found on the above website. We recommend using the most updated version due to insurance codes changing.

3. Marianne Harper’s Book “Cross Walking – A guide through the crosswalk of Dental to Medical Coding” found on her website: The Art of Practice Management

4. The website for the National Association of Dental Plans and specifically the free subscription to FastLook which provides current attachment information by procedure code. Sign up under the FastLook tab at

5. For those we have seen since the ADA Meeting know we are recommending you look at “Practice Booster” which includes our first two recommendations. It is more important than ever to be sure you are using the right codes. Take a free test drive of Practice Booster and see what it can do for your administrative team.

6. Always use the latest version of the ADA CDT code book for claim submission

Insurance processing is becoming more complex. From a risk management standpoint you must do all you can to ensure you are using the right codes for the procedures you are doing – it is your license that is on the line. Be sure your team is properly equipped to do the job you think they are doing.

ADA and Pop Cap Games – a Halloween alternative to sugary snacks

Many of you know I am a fan of the family-friendly Plants vs. Zombies app and game and play it regularly on my iPad. I was happy to learn the ADA and Pop Cap Games (developer of Plants vs. Zombies) have created a partnership and a program called Stop Zombie Mouth. To celebrate Halloween with your patients, or as a giveaway at your practice or home, member dentists can order Zombie trading cards featuring the the characters in the game Plants vs. Zombies.  Instead of sugary treats, patients can get cool trading cards with download codes, and a great healthcare message.  These trading cards can be ordered from the ADA catalog of products for free plus a nominal shipping charge.  Game coupons can also be downloaded for free at the website Check out the website, it has tips, fun facts, freebies to download like coloring pages, an Halloween party invite and several others.  What a fun way to differentiate your practice this Halloween!!

Great Quote from Delivering Happiness by Tony Hsieh of Zappos

If you have not ordered shoes from Zappos you are missing an experience – it is a great lesson in trusting the customer as well as providing top notch service. Here is the quote from the book Delivering Happiness by Tony Hsieh. It is in our resource store and a interesting book to read on how Zappos came about.

“There’s a lot of buzz these days about “social media” and “integration marketing”. As unsexy and low-tech as may sound, our belief is that the telephone is one of the best branding devices out there. You have the customer’s undivided attention for 5 to 10 minutes, and if you get the interaction right, what we’ve found is the customer remembers the experience for a very long time and tells his or her friends about it.”

When is the last time you talked about your patient intake calls as a group? Are your patients and potential patients excited and happy about their interactions with the practice over the phone?

Insights from our Academy of Dental Management Consultants Annual Meeting

We have just returned from a fabulous educational meeting and networking session in Las Vegas,  with the prestigious Academy of Dental Management Consultants. Day one was our members only meeting and we learned the latest from a compliance panel on OSHA, HIPAA, Risk Management and HR. Presentations from members on a variety of topics.  1. Improve scheduling with the use of Onset, a patented delivery system for immediate anesthesia by Onpharma. 2. Using dental retail products to create profit centers in your practice. 3. Improve insurance reimbursement through Practice Booster. 4. Technology updates, which apps can simplify your life. 5. Training techniques to improve learning. 6. Social media and it’s importance in marketing our businesses. Day two was an inspirational keynote presentation by Bill Rancic, from season one of Donald Trump’s, The Apprentice. He spoke  on entrepreneurship and the importance of being the conductor of the orchestra, you do not need to know how to do everything yourself. Surround yourself with excellent people who are decisive, creative and never make excuses.  Then, trust them to do a good job! The world has changed, and we must change with it!

There were great receptions for lots of networking and tours of LVI and Zappo’s headquarters.  A very busy and educational few days! We even got a picture with Elvis!

The nicest/best things a dentist has ever said to a dental assistant

These are some of the responses to the question “What is the nicest/best thing a dentist has ever said to a dental assistant?” that Kevin Henry asked and published in the Dental Assistinig Digest.  Take the time to say something nice to your assistant and watch them shine!

Thank you.

You are irreplaceable. Great job!

At my last yearly review my boss said, “I can’t think of anything you could do to improve your performance, you’re awesome.” That was really
wonderful to hear.

“I really appreciate what you do.”

That I am an asset to the team!

You are wonderful, and you are the best. You are one of the
smartest people

I’ve met, and you will succeed at whatever you pursue.

That my work is detailed, focused, and patients feel comfortable
in my care.

“You’re the best.”

You have good oral hygiene.

After I complete my work each day the doctor says THANK YOU.

I could not have made it through this day without you. Thank you.

That I am one of the best assistants they have ever had.

You are the best assistant I’ve ever had.

I can’t get through the day without you being here because I don’t know where

anything is.

The doctor told me, “Perfect!” during a procedure.

You have made my job easier, thank you for all your hard work.

You’re the best!

That I was the best assistant he had ever worked with in 10 years and asked if I

had ever considered dental school.

I could not do my job without you.

He said I am a very loyal employee.

After all these years (28) of working together at chairside I can’t imagine what

my life and practice would have been like without you.


Thank you, I appreciated your help today. Keep up the excellent work.

That I was an excellent assistant!

I’ll explain this to you.

I can’t do this without you.

He really likes my work.

I was the best dental assistant he ever worked with!

You’re the best employee I’ve ever had. You’re the most diligent dental assistant I’ve ever had.

That he was thankful that he could trust me over some other employees and thanked me for being problem free.

Nice X-rays.

“That is just beautiful,” and “Thank you.”

You are doing such a great job and I value you.

You know more than some dentists who are graduating from dental school.

Thank you.

You are my most honest and hard-working employee.

My present dentist said, “I’m so sorry you’re going through such an awful experience. (My dad was dying) Don’t worry about your paycheck,
I’ll pay you for whatever time you need. Take as long as you need.” (He did
just that and he came to the funeral.)

You have finished.

You are an asset to our practice.

“You’re an exceptional dental assistant, above the rest,” “Your good qualities far surpass any negative ones that you may have and you are
excellent with the patients.”

“I can’t manage to work without you.”

The only positive comment I ever got from a dentist was when I was
in school. A dentist exclaimed, “Who took these X-rays?” I told her that I
did. She said they were perfect X-rays, the best she’d ever seen.

“She is the brains of this outfit.”

That I was being wasted at the front desk, and I should be assisting.
(This dentist rarely gave compliments, and this was actually a huge




Raising your Fees

Many Doctors have hesitated to raise their fees. Whether it was fear that lower priced competitors would take their potential patients or that they “could not raise fees in this economy”, fees have remained the same since 2009 for many practices. Other practices feel they should “maintain the status quo” because they will only take a bigger write off from an insurance plan.  Some doctors have gone so far as to  “negotiate” a lower fee with some patients, thinking that if they could get this patient and the case, it would fill the book. Somewhere in this belief is the idea that more patients will offset lower fees, and will lead to higher profitability.

We look at profitability numbers each month with our clients. Our busiest practices are not the most profitable, and the practices that do the most large fee cases are not as profitable either. Why is that? In a word, overhead. The more patients you see, the higher your overhead. The more large cases you do, the greater the likelihood of not pricing the case right for the amount of time it takes and more likelihood there is of providing one or more of those crowns in a multiple unit case, for only the lab fee.

Overhead has not stopped increasing because of the economy.  You and your team would like raises, the lab wants to be paid, supplies are costing more – you cannot not raise your fees.  We recommend raising fees on an annual basis.  Many teams struggle with raising fees because of the anticipated reaction from patients. We hope you are subscribed to Words Matter for some suggestions on how to handle this challenging topic.

Raising your fees is one of the best steps you can take to improve profitability.  The chart below shows the relationship between a specified percentage fee increase and the effect this increase will have on profitability.

% Fee Increase


































When is your next fee increase?


Dental Fees are on the Web for your Patients

There are websites designed to help consumers estimate what dental services will cost them. One for you and your team to check out is:
On their website they state: “Fair Health is a not-for-profit organization whose mission is to help consumers understand the out-of-network reimbursement system and estimate out-of-network medical and dental costs. Our free website has an easy-to-use cost estimator tool to help with your health care expense planning. We also offer clear and unbiased educational articles and videos about the medical and dental reimbursement system.”

Fair Health was formed in 2009 as a result of a fraud investigation by then NY State’s Attorney General Andrew Cuomo. The ADA granted access to the CDT codes in February of 2011. They will have medical information available in August of 2011.

We have always recommended that you submit your full fee to the insurance company on a dental claim form. It now becomes even more important to not submit contractually discounted fees.  Not only because this will skew the maximum allowable fees determined by carriers based on data submitted by practices but it will skew the costs posted on websites like Fair Health. This will cause consumers to question the fees you are charging when they have a “non-biased” resource about what your fees “should” be.

Have a team meeting and make sure everyone knows about this website and how your fees compare to what is posted on the Fair Health website. Talk about how to deal with patient’s concerns and what to say. As always if you need help, don’t hesitate to get in touch with us.

Benefit Language


You are struggling to get your patient to want the treatment that they need.  The patient puts off or makes excuses about beginning treatment.

Desired Result:

The patient to go ahead with your treatment recommendations. To willingly schedule and make a financial commitment to proceed with treatment.

How To:

So that your patients want the treatment that they need, train yourself to use benefit language. Benefit language is a learned skill. It requires the ability to create benefit/feature statements that link the patient wants to their needs. Benefit/feature statements let another person know the advantage(s) of taking action. It helps people be open to concepts or ideas they may be otherwise closed to.

The formula for a benefit / feature statement is:

They are used:

  • To motivate others to see value in a request or guideline
  • To help someone be open to listening to information
  • To personalize advantages the patient will receive

It is critical that the benefit be stated first, prior to the procedure or the logical features of your recommendation. This feels awkward initially, as we are accustomed to stating our request and then justifying it with facts. Try using the “WIIFM” (What’s In It For Me) technique. Visually tattoo WIIFM on your patient’s forehead as you present treatment. Using benefit/feature statements and answering the What’s In It For Me question for your patients, allows them to understand why this treatment solves their problem.

  1. Listen for the patient “want” (benefit). Common benefits are to save money, save time, improve their appearance, and to avoid pain.
  2. Match it with the recommended dental procedure.
  3. Now, state the logic or features that support your choice of dental procedure. Answer the question “Why / How does this treatment achieve the benefit the patient wants?”
    Example: So that we can help you maintain the youthful appearance that is important to you, I would recommend whitening your smile.  Whitening would be perfect for you since it will give you the brighter, younger looking smile you want
  4. Many people also find that stories of other patients or your own personal experiences help increase understanding and give the patient time to process the information you are providing. In this case it might be something like; “We had a patient, Mary, who told us that after she had whitened her teeth she was out to lunch with her sister who commented she looked much more vibrant. Her sister was certain she had tried some kind of procedure at her dermatologist and could not believe it was whitening that made such an immediate difference!”

The Patient is Denied Credit by Your Financial Partner


You offered your financial option of working with an outside partner such as Care Credit, to provide long term interest free payments on their dental treatment and the patient’s application was denied.

Desired Result:

The financial administrator feels confident discussing the denial process.  She/he is able to offer assistance and an explanation without causing embarrassment to the patient.

How To:

Although we all wish that every patient qualified for patient financing, the reality is that some applications are not approved. When that occurs, patients typically want to understand why — and that may make team members unsure of how to respond. Here are some points of information you can use to confidently talk with patients in a positive, helpful manner.

  1. Patients will receive a letter within 10 days from the issuing bank, regarding the reasons for the decision and the source of information used.
  1. The credit decision is based on a number of factors, and applicable law limits what the financing company can share with your practice. If your patient wants to speak with a representative, refer them to the Cardholder Support Center and provide them with the toll free number.
  1. Sometimes an application is not approved simply due to a “typo” or missing information on the application.
  • Review the application with the patient to check for any data entry errors, such as misspellings.
  • Make sure the patient has included a complete street address, not a post office box (P.O.) number.
  • Check that the patient has included all sources of income.
  1. You can also suggest that the patient re-apply with a co-applicant or have a family member apply on their behalf. In many cases, this may result in an approval.

How to Say It

Here is a sample script to use as a guideline when talking to a patient about an application that was not approved:

“Unfortunately, our financing partner was not able to extend you credit at this time. You will receive a letter from the issuing bank within 7 – 10 business days, indicating the specific reason for the decision. Applying with a credit-worthy co-applicant is a good way to increase your chances of approval.”

Preventing and Handling Late Patients


The patient arrives more than 10 minutes late for a scheduled appointment.

Desired Result:

The patient receives the care that they need and the practice does not inconvenience another patient by running behind.

How to:

Before we can address the late patient issue, we must first make sure that we as a practice are not training our patient to arrive late because of regularly running behind and not seating patients within 10 minutes of the scheduled appointment time. If we do not respect our patient’s time, it is difficult for us to address the late patient arrival effectively.

As a team, analyze your procedure times and identify causes of running behind. You must make staying within the scheduled time frame a priority. If you are 10 minutes behind or more acknowledge the delay, and give the patient an approximate wait time. The more cordial and caring you are in addressing this with the patient, the more likely the patient will be considerate with you.

“Mrs. Jones, I am aware that your appointment today was for 11:00 am. Unfortunately, Dr. Robert’s assistant just informed me that he will need some extra time with his patient. We should be seating you in about 10 minutes. Can I offer you something to drink while you wait?  Thank you so much for your patience!”

As a good will gesture, follow up with the patient by sending a handwritten note thanking them for graciously waiting to be seen. If you feel it is appropriate include a gift card to a local coffee shop as a token of your appreciation.

When a patient is late:

  • Notify the clinical team to determine if the patient can still be seen for their regular appointment.
  • Try to at least see the patient for a quick check, even if they need to be re-appointed for the original procedure.

“Tina, we were worried about you, I’m glad you’re here.  I hope everything is o.k.” Empathize with the patient’s reason for being late.  “I’m sorry traffic was so terrible, I know it can really get bad at this time of day.  Let me check in back to see if they have the quality time that they need for this procedure.”  If the answer is no… “Tina, in order to devote enough time to what we had originally scheduled for today, we will need to schedule another appointment.”

  • Once you see a pattern developing with a late patient, say something like the following:

“Tina, we need your help.  We would like to discuss how you could help us stay on schedule with your treatment, as well as your patient appointments. Can you tell me what might be preventing you from being on time?  Maybe you and I can come up with some solutions that could work.”

  • When a patient is late and they are too young to be responsible for getting themselves to the office, it is important to communicate directly with the responsible party. Many children are embarrassed and have no control over the situation.