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.

More About This Show

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.”

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