Finding An $11K Mistake

Episode 068

This week I discuss a recent gap in our practice systems that revealed an $11K mistake. I also do a little self promotion about my new PRF course. Listen in to find out more on episode 68 of the Business of Dentistry.

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Usually I like to think of my office as a smooth and well-oiled machine with no problems, but recently I realized that was just me burying my head in the sand! So today’s episode is about how I came to that realization, how I found the “holes in my game” so to speak, and what we did about it in my practice.

Over the course of the last week we found a big miscommunication problem regarding some insurance claims.

One day between surgical cases, I was walking down the hall when I noticed a group of my team members were standing in the computer room. This is the room where my assistants usually go to enter the electronic patient data, patient health questionnaires, etc. It’s basically an admin room for my clinical staff.

Now I have often seen my staff in that room but they usually drop in to say hi and then move along. But not on this day. On this day I did both of my procedures – simple single tooth extractions under sedation – and they were still in that room after I had finished up.

I could tell by the way they looked at me that they were nervous about something; I got a feeling that something was going on. After I had finished with my last patient I went in to computer room to talk with them, and find out what was going on.

When I asked if someone needed to tell me something two of my admin staff said yes, if I had a few minutes to talk. I told them I did and asked them to follow me to my office. I could tell they were both very nervous, so I told them to relax because it couldn’t be all that bad!

With some trepidation they both began filling me in on what was happening and what they had found. My implant coordinator told me she had been looking for a claim that had been filed; she wanted to follow up on it. As she looked into it she saw the claim had been filed but it had not yet been paid. The work had been done but the claim hadn’t been paid yet.

Next she called Paul, our office manager, and asked if he had done anything with the claim. He said he hadn’t and that it was his understanding Meredith would handle those claims. It was then that she realized there was a miscommunication: she thought he was handling them, and he thought she was!

Next she ran a report and realized there a few implant patient cases that hadn’t been paid. And as she looked at this report she could see there were several pages of unpaid insurance claims. Meredith took it to Becca, my admin team lead, and they looked at it together. They were pretty nervous about what they were looking at because they were afraid to bring it to my attention.

While I’m not proud to admit it, they were afraid to bring it to me because I’d lost my cool in the past. I’m much, much better now because I understand that what’s done is done and getting upset won’t change anything.

We looked into it and figured it was a miscommunication and a failure of systems; everyone thought someone else was doing this job so no one was doing it.

Our next step was to find out the details about this: was this going to cost the practice money? I was under the impression that this was going to cost us money because some of the procedures were over a year old, I thought we had forfeited the claims. But we looked into it and discovered everything had been filed with the insurance companies, but not all the claims had been paid.

They looked into each case over the next few days and realized we owed some patients refunds, we were out about $200 and we had thousands in outstanding claims with several insurance companies. In fact, when they got in touch with those companies they found about $11k owed to us!

Now I tell you this to let you know these things happen on occasion, there are glitches in the system. I’m very proud of my team in how they manage the office and the business. So when this happened we worked through it. And I hope our example gives you an incentive to look at your unpaid insurance claims report  this week and track it appropriately! Let me know what you find, after you listen to episode 68 of the Business of Dentistry.

Tweetable: “Continually look at your systems and your processes.”

Episode Resources

Platelet Rich Fibrin Basics course
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A New Resource and My 1st Uber Experience

Episode 067

This week I have a new resource for you. I call it the Implant Patient Business Packet. I put it together after several listeners asked me to share the forms I talked about in the last episode, and after that I get into my first experience with Uber. Tune in to hear the details on episode 67 of the Business of Dentistry!

More About This Show

As I mentioned today’s show is about listener comments and feedback. I revisit several topics including the implant patient forms, in-house financing and credit card offers that continue to arrive in my office mail.

All of these topics I share with you and revisit because I appreciate your feedback, your questions and even when you challenge me on something. Your input – whether you agree with my thoughts – helps me with my mindset and my practice, and I hope I do the same for you because I want this show to be a win-win for all of us.

And I wrap up with my thoughts on customer service. Recently we were invited to a social outing – my wife and I – for my kids’ school and we went to downtown Nashville. So we opted for Uber because traffic down on a Friday night is awful.

Plus I thought I thought I might have a cocktail and my wife wanted a glass of wine. Instead of worrying about traffic and a designated driver we elected to take Uber, which is something we’ve never done before.

I talked my wife into it as it’s only a 10-minute ride to downtown. We opted for Uber Black, which is a little higher end. I knew if a 20-year old kid showed up in a beat old Camry my wife wouldn’t be impressed so I went for Uber Black.

Our driver arrives, and backs into our driveway because it’s raining. He hops out of the car, is wearing a suit and tie, and is well-groomed. He opens an umbrella, walks over to us and escorts my wife to the car.

He is very professional and pleasant. Because I’ve got an entrepreneurial mindset, I started to ask him questions about being an Uber driver. He tells me the requirements for being an Uber Black driver: car has to be a certain age, certain insurance, etc. It was a very high end service, and we were impressed.

A few hours later we were going home and Jimmy, our first driver, wasn’t going to be available. I knew because I had already asked him on our drive into the city. So I did the general Uber and we got a ride.

The driver arrives and it is pouring rain outside; he calls me when he gets there. He says he’s outside in a black car, but there are like 7 black cars outside! I asked which one he was and eventually found him. But there was no umbrella service this time! The guy doesn’t open any of our doors, we even had to give him directions.

As you can tell our two Uber experiences were very, very different. I’m bringing this up to highlight that customer service matters, and it doesn’t take a whole lot to have better customer service .

The next time you’re impressed with the customer service somewhere pick their brains and ask them about it. Take notes when you have great experiences and tweak them to make them fit your practice. Brainstorm with your team too and come up with ideas that will set you apart from the rest. And then let me know what you did and how it worked out. I thank you in advance for doing so and for being here on episode 67 of the Business of Dentistry!

Tweetable: “There are lots of ways to make ourselves a little better every day.”

Episode Resources

The implant patient business packet
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Patient Communication Struggles

Episode 066

Communicating with our patients is an area where we continually struggle. This week I discuss some of my shortcomings in this area and describe some of the ways we are trying to improve. Listen in for that and more on episode 66 of Business of Dentistry podcast.

More About This Show

Because we’ve focused on the big issues in our office we’ve been able to focus on smaller details, like patient communication. Recently a few things have come up in our office that I wanted to talk about with you and get your feedback.

The first one is my 8 hour rule about sedation: no food or drink 8 hours before your surgery and anesthesia. Yes that’s an old school approach so some people may instruct their patients otherwise, but it’s the rule I use with my patients.

However we routinely have people who don’t follow this. We make sure they are told this rule at their consult and it’s written on their pre-op instructions. They are also reminded of the 8 hour rule when we confirm their appointment. So we make sure they are told about it numerous times before the date of their procedure.

Yet people misinterpret it, and I don’t understand how! Typically two to three times a month we send people away because they’ve told me they’ve eaten or drank something in the previous 8 hours. And I won’t put them under sedation when that’s happened.

Now my bigger concern is these are the people who tell the truth, there must be some who just don’t tell me! I worry about how often that happens.

The other area I regularly see patient communication issues arise in is with financial agreements. This is especially true with implant patients. In our office we run into problems with patients starting the process with us; they’ll tell us they want to work with Doctor A so we reach out to that doctor. Doctor A coordinates with us and tells us they will do X as part of the procedure. So we plan accordingly and do the Y and Z parts of the procedure. We then provide the patients with an estimate based on the Y and Z parts we are doing.

But then the patient will come back to us and tell us they’ve changed insurance and changed doctors. So rather than working with Doctor A who we’ve already been in communication with and coordinated with, they now want to work with Doctor B. But Doctor B doesn’t do what Doctor A does so now I have to do doctor A’s work and charge for it, it’s an additional fee.

So of course the patient gets upset about it, even though the fee changed because the patient made a change of doctor.

Along those same lines an issue often arises when we talk to our patients about their payment options. With some patients we let them pay in increments, and we have the conversation and discuss their options. Later on they act as though the conversation never happened and they don’t know about the payment plan we discussed and agreed upon.

To help with this we’ve developed consultation sheets that explain everything. The form specifies what we talked about and then we have them sign and date it, so even if they say they didn’t agree to the payment options we now have a signed and dated form that says otherwise. It has helped a bit.

In general, I try to break communication down into simple terms. Can you think of anything else that can be done? Where do you see patterns with patients forgetting communication or complaining about something, and how do you address it? Any ideas you have I would love to hear, leave a comment below or email me.

Tweetable: “Documentation is key.”

Episode Resources

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Back In The Saddle

Episode 065

Yes, I’m still alive and well. Thanks for asking. After several weeks I’m back in the saddle with a discussion on unsolicited credit offers, Tricare dental, an idea on alternative financing for new practices, and my answer to a hiring question. Hear it all on episode 65 of the Business of Dentistry. Thanks!

More About This Show

The first thing I want to talk with you about is the mail, specifically offers for credit cards and lines of credit. Recently I was going through the mail at my office, after my staff had pulled out all the insurance-related pieces, when I noticed a plain white envelope. I thought it might be the new replacement debit card I have been waiting for. My old card had expired and I was waiting for the new one to be mailed to me. I thought they may have made a mistake and sent it to my office instead so I opened it up.

When I did I found it wasn’t the new debit card, but it was an offer for a line of credit. It was an offer that was completely ready to be used – it had my name on it, an account number, an expiration date and a security code on the back! And it had a little sticker for activation by phone. The line of credit was for a substantial amount of money.

Now I didn’t ask for it, and didn’t apply for it but there it was in the mail anyway. My first thought was to ask how they could send me this, and if this was even legal? Then I got suspicious and wondered if someone else was trying to get a line of credit in my name.

I shredded the offer but am sharing it with you so you can be aware. If you haven’t seen an offer like this come to you it could be in the future. Be sure to look at your mail and watch for credit cards and offers for lines of credit like this one, and shred the material when you get it if you don’t want the offer and don’t want anyone else to get your information!

The next topic I cover on this episode is the Tricare fee schedule changes.  We are still on the look out for ours but I have heard it’s going to get worse as they move to United Concordia from MetLife. I’ve been able to be profitable as a PPO office and I believe you can be to a certain point.

However there’s a tipping point where your reimbursements are so low you can’t maintain a profitable business, so you have to draw that line in the sand. One of the ways I’ve drawn that line is to look at the state Medicaid program. If you’re a commercial insurer and you pay a lower fee schedule then the state Medicaid then I won’t participate in your network. Otherwise you are paying to work!

Speaking of fees and being profitable, I’ve been seeing a lot on social media about student loan debt for new dentists (and by new I mean those who are 3-5 years out of school). Some of these people are unable to get loans to start their own practices because they have so much student loan debt. And others who do get loans are getting terrible deals, or what I call “predatory lending” with sky-high interest rates.

Which made me wonder why can’t we – the established dentists – become the lenders for these guys and gals? I don’t know how we’d do this exactly, I’m just throwing it out there because it’s been on my mind. I’ve been thinking about how to fund new practice owners and help them out as lenders. I don’t know if this is even possible but it came up in social media so it got me thinking about why or how we could do this for our fellow colleagues.

I’d like to believe there is some way to create a mutually supportive situation that helps new folks get better loans and helps those of us who are established to grow our financial portfolios. If you’ve got some ideas I’d love to hear from you, even if it’s to tell me this would never work!

Lastly I wrap up the show with an email I got from a listener who needed a new front office desk member. You’ll hear me talk about the pros and cons of hiring a lesser-qualified person who seems to be a better team fit. I also talk about the best places and strategies I’ve found for hiring staff members, and whether or not I include my team in the hiring process. Listen and let me know what you think of episode 65 of the Business of Dentistry!

Tweetable: “I tend to hire on character and train on skills.”

Episode Resources

Episode 48: Identity Theft and Personal Finances
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