“Statements would upset the patients” – How to catch up on dental billing

“We don’t send statements. The dentist is afraid that would upset the patients.”

Some dental practices struggle to manage their billing systems. There can be many reasons the dental billing system has crumbled, such as dental office manager turnover, lack of training with the dental practice management software, or even embezzlement. No matter what the reason for a disorganized, occasional billing system, the problems caused are the same. Patients that don’t understand or trust the accounting. Staff cannot explain why a balance or credit exists. Giant accounts receivable exist especially in the over 90 days category. Financial problems for the practice. Enormous outstanding insurance outstanding amounts – again, in the over 90 days category. You get the idea.

So – what do you do when you’ve fallen off the wagon with billing?

How do you reinstitute an organized dental billing
Forex Money for Exchange in Currency Bank system?

Send dental statements

That’s right. Just get back on the wagon and send your statements. The key is to add a custom statement message to address those patients that will receive a statement and have not come into your practice in several months or years. Your custom statement message may read “For balances over 90 days, please contact us at if you have account questions.”

For Dentrix users, here is a kickstart to sending statements:

  1. Go to Office Manager
  2. Select Reports
  3. Select Billing – this pops up  a window
  4. Statement date for today; then enter in the date you sent statements last month
  5. Select your guarantors, all providers
  6. Select your billing types – if you use a billing type for patients that have balances that are either on hold or send to the collections agency, be sure to avoid those
  7. Minimum balance to bill – choose your minimum (often $10)
  8. Include credit balances? Do NOT check this box.
  9. There are several other options on this screen – read through each and decide if you want to checkmark the box or not.
  10. Add a statement message, such as “Balance due September 10, 2013. Thanks!”
  11. When all looks correct, click OK to send this to the Office manager for processing.

Call patients

Expect to receive many, many phone calls after you send out statements for the first time in several months. Please allow me to stereotype for a moment, but many seniors pride themselves on keeping up with their bills. This is a good thing! When you receive phone calls from patients upset that they received a letter stating their account balance is older than 90 days, they may feel offended and come across as angry on the telephone. The simple fact that they care enough about paying their bills and took the time to call you is a wonderful situation.

Manage upset dental patients

My introductory line to patients when I return calls regarding statements is, “Hi this is Jill and I’m returning your call – since you were so kind as to call us when you received a statement. How can I help you?” This sets the tone for your conversation. Even if the patient intended to be furious and tell you how awful you are – it’s hard to yell at someone who just said you were kind! Usually, the patient is shaken to a kinder tone by this intro and then they will explain they received a bill that they didn’t expect and they want to know what this bill is from?

Before I call a patient, I have spent a few minutes on their account to clarify where they balance came from. I’m a big fan of creating a ‘financial breakdown’ that reflects the total fee, less the insurance payment. less the insurance withhold (for PPO subscribers), less the patient payment. By putting this breakdown into excel, patients can easily see the financial details of each appointment. This makes it easy for you to see where the balance came from as well. If your patient continues to be upset, now you need to be prepared to handle your upset patient.

Resolve the balance

Sometimes you’ll discover that the patient actually paid – and they can produce a cashed check. So, you will apply a patient payment to the account to set it back to zero. Other times you may discover that the insurance withhold was not applied – and again, you will apply the proper adjustment to the account and clear the balance. In some situations, you may be able to quickly determine that $197 of the $202 balance is actually due – and in the interest of saving time, you may send the patient your financial breakdown where you can justify the $197 bill. In talking with the patient, its okay to come to an agreement where the patient will pay you the $197 and you discount the $5 difference. Again a zero balance is gold.

Deal with missed appointment fees

Most dentists apply a missed appointment fee – and many patients end up with a balance from this fee only. Often, these problem patients do not return to the practice – and they do not pay the missed appointment fee. So, you can end up with a large volume of patients that you are spending $0.75/e-statement to send a bill for a $50 missed appointment fee and they haven’t been in the practice for years! This is throwing good money after bad. Most dentists aren’t interested in earning money off their missed appointment fee – they simply want to discipline the patient to keep his/her appointments. Often, the way you discover these patients is that you will receive your statements back in the mail marked Undeliverable due to no forwarding address.

Talk with your dentist to set a policy on how you will handle these patients. If you work with Dentrix, you could easily set them to a separate billing type – this maintains the balance in case they ever want to return, but doesn’t wreck your A/R (as long as you exclude this billing type in your lookup). Obviously, if you don’t have a good address, stop sending statements to that patient! If you end up in conversation with a patient that owes this amount – your goal  is to communicate the problem this creates for the practice and you can allow the patient not to pay this time, but clarify the guidelines for the future.

Moving forward

As tempting as it may be to spend hours and hours cleaning up old accounts to make sure everything is exactly right, the best way to catch up on your dental billing system is to establish guidelines for collections moving forward. Determine that you will send statements monthly from now on. Set up a regular collections system of phone calls and progressively more serious letters that you will send to patients that ignore your statements.

Talk with your front desk team – ask them to tell the patients as they check out what their entire balance is. Not just their current balance from today’s appointment. Some patients will simply pay the bill and be done. Others may want to review the account in more detail. Train your receptionist on how to handle these patients. If you are available to talk with the patients onsite, great. If you cannot, then the receptionist should add this patient name and contact information to a list of patients that would like to review their account. Have the receptionist let them know there will be a wait, but not to worry because we will sort out their account. Then, your job is to simply work your way down the list.

Want a collections system for your practice?

If you’d like to have a comprehensive system for handling collections in your office, click here:

Managing a dental billing system is just one way to run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog. One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 16+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.

Feel free to email me.

AUTHOR: Jill Nesbitt
  • Job

    I am working with Dentrix, the billing statements are not descriptive of the procedure that pt’s are getting. Although the coding does provide with the appropriate procedure most people don’t automatically know what prophylaxis may be for example. Is there a way select other names for the codes, e.g cleaning –filling etc instead of the statement reading prophy, coposite etc.
    Thank You
    Job Maritnez
    Orange, California

    March 8, 2014
    • Dr. Martinez,

      Yes there is! In the Dentrix Office Manager, go to Edit Procedure Codes and you can change the names to anything you like. This is also the same section where you can edit fees and you can add new codes for procedures you want to track, even if they have a zero fee.

      I completely agree with you – we changed the descriptions long ago to ‘patient-friendly’ language.

      Warm regards,

      March 21, 2014