#1 – Handles collection of past due accounts

#1 – Handles collection of past due accounts

Welcome to this training on managing your collection system! This organized, comprehensive approach to collections provides a billing manager with the tools needed to follow up on past due accounts from start to finish. One unique characteristic of this collections approach is that it shows you what to do to finish working with each and every account – and then we will show you a tracking system for how to record your success.

Objectives of this trainingDental practice finance for solo or group practices

  • Increase collections through efficient follow up
  • Virtually eliminate over 90 days amounts past due
  • Establish a system for handling collections in your office
  • Set specific timelines for sending statements, making calls and sending letters to move patients through the collections process
  • Communicate with patients to resolve financial disagreements quickly
  • Increase cooperation between the billing manager and the administrative team to improve collections

With this organized system, you can accomplish each one of these objectives. This training is separated into sections.

Sections of this Collections Training

  1. Reports to run
  2. Coaching for the front desk team
  3. Calls & Letters
  4. Collection Agency or Financial On Hold Decision
  5. Tracking
  6. Ortho Collections
  7. The Collections Process in EagleSoft

 

Philosophy

Your job is not to be the “point man” in a mini collection agency. Your task is to find a way for your clients to keep their self respect, pay the fee owed to us, continue in our recall system and maintain a positive relationship between our practice and the clients. This reminds me of the discussion:

Office Manager: “I’m sorry, but I can’t schedule another appointment for you until you have paid your outstanding balance.”
Client: “Well, cancel that appointment. I can’t wait that long.”

You aren’t expected to be a heartless villain harassing people. You will need to be a counselor, salesperson, public relations specialist, who is dedicated to our practice. Don’t be too upset with slow payers. Look at a dental bill from their point of view.

1. An unplanned expense
2. Undesirable service
3. High cost
4. Not planned into the budget

You’ll need to love people, be flexible and be a student of human relations. As you begin to deal with clients in this very sensitive, emotionally charged area, you’ll see how valuable good financial arrangements are. It’s much easier to say “no” to treatment than to collect from someone that didn’t value the treatment or doesn’t have the resources to pay. Help the other administrative team members to understand how much they can do through good financial arrangements to make your job easier.

Don’t look at this as just bad clients trying to trick us out of our money. A financial agreement is a two way street. We must take at least equal responsibility. I believe that the front desk team should bear 100% responsibility for any amount over the cost of the first visit. Initial visits and emergency appointments are designed as get acquainted visits. They are not “money makers.” We do not want money to be the focus of the discussion for new clients.  The emphasis during this appointment is on caring, quality, and timely treatment. When this first appointment is over, it’s time for you to collect the money. This may be a problem. I understand that. However, no further treatment should be scheduled until a financial arrangement has been made. There should never be a time when this failed relationship costs us more than the cost of the first visit.

Use these guidelines:

  • 85% of our open accounts receivable should be 30 days old or less.
  • None should be over 90 days old.
  • Plan on collecting 98% of the annual production.
  • Accounts receivable should not be more than 1.5 times monthly production.

Money is not the driving force of our practice. Your job is not to collect money at all costs. Your job is to:

  • Determine why the client refuses to pay
  • Make an acceptable financial arrangement
  • Determine their inability to pay
  • Maintain the client’s goodwill
  • Keep them in the recall system if possible

Having said this, we are a small business. We need to make money to pay our bills (and your salary). Industry data talks about how much money is lost to a dental practice through uncollected fees. We lose money three ways:
1. The actual money lost by not collecting
2. The time lost when doing this procedure instead of using this time to treat clients that would have paid
3. The loss of our admin team’s time in trying to collect the past due payment.

Approach these contacts with the point of view that the client sincerely wants to pay the account.

For folks who sincerely cannot afford dentistry, we give them a sheet of “Dental Care Options” – You can create a list of the options that are available to patients in your community – other dentists that accept Medicaid, foundations that may help provide funds or other sliding scale dental offices or schools.

Are You the Right Person?

Do you wonder how you’ll do? Using the Myers Briggs personality inventory  (The book is titled: Please Understand Me, if you want to borrow it from your local library), I or E types are usually most effective in collecting past due accounts.

Now, think again about the conversation between the patient with the past due balance and the office manager. How would you feel about our practice if you had been that patient? Here’s a better way to handle this:
Secretary: “Oh, Mrs. Jones, I’m sorry you’re having this dental problem. I see that you have an outstanding balance from ______. Did you know about this?”
Client responds.
Secretary: How can I help you clear up this balance so I can get you scheduled to solve (problem)?

Even though some personality traits make someone a more “natural” choice for collections, anyone can become effective if they develop poise, confidence, and powerful body language for the face to face encounters.

Section #1: Reports to Run

In Dentrix, we will run:

  • Aging Report
  • Collections Manager report – just to look for people we may have missed
  • Outstanding Claims report

Run the Aging Report for each Billing Type in Dentrix:

  1. Go to Office Manager screen – Click on Reports – Click on Ledger
  2. Click on Aging report
  3. Select guarantors – from A to Z
  4. Select Billing type
  5. Leave all other options as they appear on screen – Click Okay
  6. Highlight report on the Batch Processor Screen – Click print icon

Instructions to run the Collection Manager report in Dentrix:

Run the Collections Manager report to find amount due over 30 days. The prior month must be closed before you can run the CM report – results will be inaccurate if you run it before. To check if prior month is closed go to the Office Manager and click on the Practice Analysis icon.

  • If prior month is NOT closed – a box will pop up and tell you that the previous month is not closed – do not run the CM report until you check again the next business day.
  • If prior month is closed – the practice analysis screen will appear – you can then return to the Office Manager screen to run the CM report
  1.  Go to Office Manager screen
  2. Click on Collections Manager icon
  3. Choose A to Z patients
  4. Minimum balance should read $5.01
  5. Choose billing types: standard billing & insurance billing types only (you can hold the control key down to select any billing types you like)
  6. Do not check any of the 4 boxes on the right side of screen as these will eliminate certain groups of patients
  7. Leave default at 0 or more payments missed and over 0 minimum days insurance past due
  8. Select over 30 minimum days past due – this is in the lower center of window screen
  9. In last box of payment agreement – make sure all is checked
  10. Click OK

CollsMgr

How to work the Collection Manager Report

The Dentrix Collection Manager report is a great way to make sure no one slips between the cracks. to work this report, you will simply compare the names on this report with the names on your aging report. Often, you will find a few patients that you haven’t sent statements to or just haven’t shown up in your aging at all! Now that you’ve found these stragglers, you can include them in your collections system.

 

How to work the Aging Report

Once you have the aging report in front of you (with a few extra names added from the Collections Manager Report), you will begin to make your calls. We will review calls in detail in the next section, so for now, plan to call the first person on your list and then (unless they pay you by credit card over the phone) you will print an extra statement to place in your 1-31 day file to follow up.

1-31 Day File
Even in today’s very digital world, I find it easiest to manage a collections system using a good, old 1-31 day accordion file. Here’s one you can buy at Amazon:

You will put papers into this 1-31 day file on the day you want to follow up with your patient – these papers come from:

  • Statements you print from calls made
  • Front desk staff when patient doesn’t pay their portion in full day of
  • Financial arrangements made with the family
  • Patients found on the Collection Manager report

Instructions to work the 1-31 day file
a. Papers are filed in the system based on the day the payment is due plus 2 days for the mail (example – payment due 5/3/14 – paper would be found behind the “5” divider)
b. Open the file to the date (example – 5th divider for the 5th day of the month)
c. Look in the ledger of each family with paper in the file

  1. If they have paid the balance – trash the paper and delete the billing statement note
  2. If the insurance has paid and there is no balance– trash the paper
  3. If they have made a partial payment but are not on a contract – make note of the date of the partial payment and the amount paid and refile the paper in the file behind the date for 1 week plus 2 days
  4. If they have made a payment on their contract – make a note of the date paid and the amount paid; make note of new amount due and refile paper behind the date for 2 days after the next payment is due
  5. If they have not made a payment – check the guarantor notes for any update on the account since the statement was sent – if there is a note (like they called in and told someone that they would pay at a later time – put the paper behind the appropriate divider); if there is no note – go to the family screen and CALL the family

a. If you reach an adult – let them know why you are calling – and then wait for their response; make note of all of this in the guarantor notes
b. If you reach a child – leave a message for parent to call you
c. If you get an answering machine – leave a message for them to call you but do not say why (privacy laws)

Occasionally a client will come in for an emergency exam and the doctor will be able to do treatment the same day. The client is expected to pay at least 1/3 of their portion at checkout. Some clients may not be prepared to pay that amount and make a smaller payment and go on a contract for the balance. The account is then to be flagged for a quick turn-around (only 1 call and 1 letter) instead of the normal collection process since they are already behind.

Next, we will run the insurance aging report and work this into our collections system.

Run Insurance Aging report

  1. Office manager
  2. Reports
  3. Ledger
  4. Insurance aging report
  5. Select patients A – Z and Dental report type
  6. Under Minimum days past due select over 30 and All carriers
  7. Click okay – this sends the report to the office manager batch
  8. Select your report from the list & print
  9. Repeat these instructions to print the Minimum Days past due over 60 and then again for over 90 – then you will have 3 separate reports for: over 30, over 60 and over 90

InsAging

Quickly scan this report to try to catch simple mistakes:  ID number on the insurance plans start with the same letter – look at the insurance aging report over 0 days to just scan to see if the ID numbers are correct.

To close a claim: Click on a claim in the ledger, Click enter payment and click Total payment only, then click ok/post, then add a note into statement note (insurance has paid on this claim) and update the insurance claim status.

When you run the insurance claim aging over 0 days, look for $26 or less – this is probably fluoride that insurance won’t pay for. So you can go ahead and close these claims and send statements to the patient. Also look for $400 and over to see if the insurance needs anything (x-rays, narrative, etc.) – this just helps to keep things moving quickly.

Weekly schedule:
Focus on >30’s and make insurance calls
Focus on >60’s and make insurance calls
Focus on >90’s and make insurance calls
Tackle the >30’s again

Procedure for Insurance Aging Report
Work these claims on the same schedule as collections (see Weekly schedule above). Call the insurance company to find out why the claim was not paid and when we can expect the claim to be paid. They may need us to send them additional information (such as a perio chart or xrays), do this, document the date sent & then follow up in 2 weeks.

Review PreTreatment Estimates  – Run the PTE Aging Report weekly
When we send x-rays or narratives, make a note in the Remarks for Unusual Services section of the claim to document when this was sent.

If the billing manager also keeps track of secondary insurance for PTEs – you may want to use a separate folder to keep the primary insurance claim until the claim is paid.

Section #2: Coaching for the front desk team

As you are working through your aging report, calling patients and printing statements to go into your 1-31 day file, you will discover gaps in how the financial arrangements were handled or you may find insurance changes. As the billing manager, you should contribute to the regular administrative team meetings by reviewing collections accounts that could have been avoided with the team. Look for the following to help coach your team:

Why is there a balance?

  • Was the insurance estimate off? Why?
  • Did the administrative team member forget to collect their portion? who checked them out?
  • Did their insurance terminate? Copy of insurance cards in chart?
  • Were financial arrangements set before treatment scheduled? Who made appointment?
  • Was there some mistake in recording the treatment?

Share the over 90 days report

Another way to coach the administrative team is to print and share the over 90 days report. This is simply a report showing the names of the patients who had an over 90 days past due balance.  Since our collection process is designed to be completed within 90 days, we see any patient that fell beyond this time as a concern. By assembling a report of the patients who have exceeded this 90 day timeline, we may identify opportunities to improve.

 

That being said, there are often patients who were making payments for a few months and then stopped paying that end up on this list. So, just because a patient is on the list, it doesn’t mean we failed to collect or follow up in a timely manner.

To use this report to coach your team, you may want to type up additional notes including the patient name, balance due, treating dentist name and any coaching comments to avoid this delay in the future.

As the billing manager, it can be tough to share the list of patients that fell into this over 90 list with the front desk team – especially when you are pointing out ways they should have prevented these collections problems. So, in addition to reviewing the failures, here’s a game to put a positive spin on handling collections properly.

Collections game

This “game” is open to all the front desk personnel. It is based on collections done at the front desk. When a patient checks out, the front desk person requests any payment that is due and prints 2 copies of the walkout statement. One copy is given to the patient for their records and the 2nd copy is used by the front desk person to record how much was paid or not paid.

  1. If they pay their portion in full – just note that on the walkout statement, put your name on the sheet and file
  2. If they paid only a portion of the amount due – note amount paid, when they plan on paying the balance, put your name on the sheet and file
  3. If they make no payment on the amount due – note the reason, when they plan on paying, put your name on the sheet and file
  4. Several times each week, have someone collect these sheets, tally the dollar amounts collected by each front desk person and give the amounts to the collections manager. Also give the billing manager any walkout statements that did NOT collect their portion in full. The collections manager will then be able to follow up with these on a timely basis.
  5. The total dollars collected by each front desk person are totaled for each month and saved. (I recommend creating an excel document to save this information.) At the end of each month, the collections manager will present the Winner with a small token of appreciation and the bragging rights for that month.

Review Financial Arrangements Policies

Financial Arrangements
You must believe that our policies are fair. If you don’t, get with the doctor and discuss them. You can’t collect this money unless you are in 100% agreement with our practice. Here is a sample financial policy for your review.

Our Policy
Treatment must be 2/3rds paid and arrangements made for the balance before the treatment will be done for all amounts over $250.
For amounts under $250, the client can pay day of appointment.

Patients can choose the type of financial arrangements that work best for them. For future treatment on the patient portion there are several options for financial arrangements.
Our preference in order of what costs us the least:

Option #1 – Pay in full with cash, check or credit card in advance of treatment
Give 5% discount if paying in full with cash or by check to schedule appointment
Give 3% discount if paying in full when using a major credit card to schedule appointment
Give 10% senior citizen discount if paying in full

A patient can only receive 1 discount – never add the discounts together. For example, if a senior citizen also qualifies for the 5% discount level in our long term client discount program, they cannot add up their 10% plus 5% discounts to receive 15% discount. They get to choose the discount they want – so a senior citizen would choose their 10% discount.

Prepare the treatment plan from the Tooth and Presenter Screens
If have insurance-the discount applies to their portion only (not the entire amount).
If patient cannot handle the above payment options – turn them over to the billing manager for further financial arrangements (CareCredit or other)
Follow-thru: Patient signs the treatment plan / financial arrangement sheet – scan & save into the document center, collect money and schedule the appointment.

Option #2 – Pay half to schedule and half the day of the appointment.
For example, if the client’s total fee is $1000, insurance will pay $500 and they owe $500. They can pay $250 to schedule and then pay $250 the day of their appointment. They can get a pay in full discount only on the amount they pay in advance of the appointment.

Option #3 – Pay in full with CareCredit Patient Financing card
For example, if a client with a formal treatment plan of $3000 and no insurance chooses to use CareCredit then you would go ahead and charge out the entire treatment plan amount at the consult. Then you can schedule the following appointments immediately.

Option #4 – Automatic payments on credit card
For example, if the client needs a root canal and they owe $600 and have no insurance, then they could pay $100/month on a credit card. To follow our policy, they must pay 2/3rds before the treatment can be done – so they would make 4 months of payments and then they can have the RCT done after their 4th payment and continue the last 2 payments to clear their balance.

Option #5 – Pay as you go – Send us a check or call in credit card regularly

For example, if the client needs a root canal and they owe $600 and have no insurance, then they could pay $100/month by mailing in a check or dropping off a cash payment. To follow our policy, they must pay 2/3rds before the treatment can be done – so they would make 4 months of payments and then they can have the RCT done after their 4th payment and continue the last 2 payments to clear their balance.

There is a service by a company called Electronic Lockbox that is a partner of Renaissance eclaims that provides automated payments to patients. You can set this up for your patient in the office or the patient can sign up for this online. This is an easy way to set up automated payment plans.

Okay, if you don’t have any questions, let’s look at our collection procedure. It is designed to be flexible, informational, not involve the doctor, and support you in your efforts.

You are now responsible for keeping our collection percentages in line with our goals. You won’t be able to do this alone. Everyone at the front desk, as well as the dentist, chairsides, and hygienists must help you. Each time you have a collection problem, determine the cause and discuss it with the other front desk staff. Help them to understand what they need to do to avoid collection problems. This is your single most important task as our collection agent. Here are guidelines:

  • Talk with patients in person to set up financial arrangements that work for them and meet our guidelines
  • All appointments less than $100 should be paid in full day of appointment
  • Credit cards should be used often particularly for multiple payments

Goals for collections

I have recommended a goal that if less than 1.3% of total collections is unpaid (going to a collection agency and put on financial hold). If this goal is achieved, then the billing manager earns a bonus of $200 each quarter. At an average quarterly total collections of $500,000, less than $6,500 per quarter needs to be unpaid in order to earn a bonus.

We also have set goals that over 90 days Accounts Receivable is less than 2% of the total accounts receivable. This goal is worth $200 per quarter as well.

Section #3: Calls & Letters

Let’s discuss letters vs. telephone vs. face to face communication. When you are new at this, a letter will seem like the “easy way out.” It is. It’s easy because it doesn’t work. Since communication is minimal, misunderstanding can be great. Collection letters usually generate a 5 – 15% response. Your success in the office is based on effective communication, not just going through the motions and making excuses. You have worked hard to develop your communications skills and your understanding of dentistry. Use these skills for everyone’s best interest. A telephone call is 12 times more effective than a letter, because it:

  • Gives you critical information immediately
  • Personalizes the process
  • Let’s you assess their honesty through tone of voice
  • Let’s you know if they are sincere or just dodging you
  • Allows each person to be treated as an individual
  • Avoids miscommunication

Listen closely to what the client tells you. Do they have a good point? Are they in financial need? How can we help them? Even though this debt will seem important to you at this moment, don’t lose sight of the fact that it’s really the client who counts. The average client will spend $350 with us annually and stay with us for ten years. That’s $3500. Can we afford to be flexible on what they owe us when we can expect $3500 from them over the long run? Sure we can!

Collection Procedure

  1. First Phone call today – if you leave a message, move this statement to tomorrow in the 1-31 day file.
  2. Mail 1st collection letter – then put statement out 2 weeks in file
  3. If the balance amount is under $100.00 and they are a “regular” patient (meaning: has been coming here for a few years for cleanings) – then they do not get a 2nd phone call or 2nd letter – we just put them into the financial on hold billing type and set an alert to collect at their next visit.
  4. If the balance amount is under $100.00 and they are an “emergency” only patient – then they would continue within the procedures.
  5. Phone call #2 – if you leave a message, move this statement to tomorrow in the file
  6. Mail 2nd collection letter – then put statement out 2 weeks in file
  7. Decide to place on financial hold or send the account to the collections agency

As you can see, I’m recommending $100 as the cut off amount for how patients are handled. I also like this $100 cut off for deciding whether to send this account to collections or put them on financial hold.

Collection Letters

Here are the two collection letters you can use in your dental software as part of your collections communication with patients. If you are using Dentrix, these are already set up with the correct formatting so you can simply save as quick letters.  Just click on each link to download these letters:

Collection letter 1

Collection letter 2

Meet with your dentist to decide on the guidelines for which patients to send to the collections agency and which patients to put on financial hold. When you want to discuss a specific patient’s account, keep in mind:

1. How long has the client been in our practice?
2. How honest the client has been with our collections manager?
3. Have they been a collections problem before?

The general guidelines are:
1. Under $100 place on financial hold
2. Over $100 send to collections agency

These letters can be used as the final communication with patients to let them know that either you are placing their account on financial hold or you are sending them to a collections agency. If you are using Dentrix, these are already set up with the correct formatting so you can save them as quick letters. Just click on each link to download these letters:

Financial On Hold Letter

Collections agency letter

As you can see, this is a relatively rapid process. There is no excuse for accounts more than 90 days past due. The longer we hold an account the smaller the chance we will be paid and the more time you will have wasted on the account.

Another situation that creates collection problems:

We only receive a partial payment instead of payment in full. A telephone call is made to discuss the remaining payment. The client will either set a date for payment in full or go on a contract to pay the balance in weekly or monthly payments. Emphasize to your client that the account is significantly past due and that these accounts are usually sent to collections. However, as long as they make their payments on the agreed upon times, they will avoid collections. In any case, this is the last call they will receive.

If you cannot talk with the client, decide whether to forward to our collection agency.

Phone Call-Procedure and Situation

If you have a current telephone number, it’s time to make your first contact. Plan to call after 4:00pm. Try to get yourself mentally prepared. This task will at times force you into a conflict with another person. Take a deep breath and discipline yourself to stay calm and businesslike. You can’t predict how a client will respond to your call. Most will understand. Some will appreciate the call so the account can be straightened out. A few will get upset (and would have to a letter also).

A debtor expects to be called during normal hours. Normal hours extend up until 7:00pm, so you have plenty of time.

Contrary to what many people think there is nothing illegal about calling a workplace and leaving a message; however, this should be done with discretion. Name and phone number and that’s all. It’s fine to let the receptionist at the business know that you are from the dentist office and ask them to pass along the message to return your call.

Since people have a basic right to privacy of financial matters, be sure not to tell anyone about patients who have a balance with our practice. When you reveal the nature of your business with a friend or family member, you can cause embarrassment, hurt a possible promotion, or loss of pay, or even cost a patient his job. If you do any of these, the debtor has a legal cause of action against our practice for damages to his reputation and or income.

This collections approach is not intended to be a legal guideline – for state-specific laws on collections, please contact an attorney.

TELEPHONING TIPS

  • Do not make collection calls when you’re tired or grumpy you’ll come across as harsh.
  • Make these calls from a private office (or when there are no patients in the office). If a call comes in at the desk, excuse yourself and take another line – in the private room. Privacy improves concentration, and protects the client’s confidentiality.
  • Have the client’s account open and review it and the payment history in the patient summary before the call.
  • Ask for the patient by first name and try not to identify yourself until you are talking to him personally.
  • If you can’t reach pt. during the day stay late one evening but get it solved!
  • Don’t be embarrassed; if you are, the client will be.Don’t destroy an excuse, no matter how flimsy, allow the client to save face.
  • Impress on the client you’re on his side and want to help.
  • Never say the doctor asked you to call.
  • Make collection calls daily if necessary. Don’t neglect this. Set up a specific time of the day to make calls.
  • Never call before 8 a.m. or after 9 p.m.
  • No more than one call per week to a delinquent client is allowed.
  • If client requests you not call him/her at work, you must comply.

Characteristics to use
Be confident, sound like you know what you’re doing, demand respect
Be businesslike, state facts with assurance, be courteous, firm, dignified
Be flexible, keep your sense of humor
Be yourself, act in the client’s best interest
Don’t talk like you memorized your speech. Talk like a real person.
Concentrate on what the client is saying, not what you are going to say next.
Be true to yourself.
Have empathy for the client.
Have loyalty for our practice.
Have respect for yourself.

Make notes in the computer during your conversation.
Use active listening. Ask questions. Make sure you clearly understand what the client is telling you. “If I understand you correctly, you feel. . .”
Don’t jump to conclusions. Go slow. The client is right until s/he proves him/herself otherwise.
Use phrases that help the client feel good and keep talking “yes”, “I see”, “uh huh”, “ok”, etc.
Don’t threaten anything you aren’t going to do (credit bureau)
When you talk to your client, stress the benefits of paying.
Maintain personal pride
Maintain peace of mind
To be fair to us
Keep a good credit rating (a bad debt ruins a credit rating for 7 years)
Be able to allow us to continue seeing them for treatment
Keep a good reputation

Ok. It’s time to make the call. Go to a private office and follow these steps:
1. Read the account. Be familiar with treatment, dates, client comments, fees, etc.
2. Look in the account and also in the Guarantor notes from past collection efforts.
3. Has the client complained about the treatment?
4. Is the bill correct?
5. What was the total treatment charge? Has anything been paid? Partial payment shows an effort toward good faith.
6. Is there insurance? If so, has it paid? Could there be double insurance?
7. Has the client ever been slow in paying before?
8. Was a financial arrangement made?
9. Is this a new client or someone we’ve known for several years?
10. Who is the correct person to talk to? Who handles the finances?

Here are some phrases not to use:
“Did you receive our statement?” Clients use this excuse enough without us volunteering it.
“Is there a problem with the bill?” This starts clients thinking (inventing) a problem to avoid paying.
“How are you today?” It’s okay to be pleasant, but this will probably sound forced and fake to the client.
“Is there a reason you haven’t paid?” Of course there is and they’re going to tell you whether you ask or not.
“I need payment by the end of the month.” This forces the client into an upset, defensive position.
“I don’t know.” (Try That’s a good question, let me find the answer)
“No, we can’t do that.” (Try Let me see what I can do for you.)
“You’ll have to..” (Try Here’s how we handle that)
“You owe us” (Try – “Our records show” – The problem may be us, not them)

When you make the call, follow these steps:
Talk only to the debtor.
Identify exactly who you are and what you want.
Ask for payment in full or at least specific payment arrangements.
Listen and take notes. The next person who talks loses.
Look for solutions that allow the client to save face and still pay the account. Be empathetic and flexible. Never blame the client.
Work out a payment plan you are both comfortable with.
Spell out the details exactly.
End the call on a positive note.
Record your call date on your walkout statement.
File the statement under the day you expect payment.

Scripts to follow

“Hello, Mrs. Slow? This is Jamie from Dr. Smith’s office. Our records show you have a balance of ____ remaining on your account. When could we expect payment?”

Silence: Do not speak. If you speak next you lose! The more you talk the worse your chances. Now it is the clients turn to explain:

If you cannot reach the patient, you can leave them a voicemail message. Since most clients need a next appointment, whether that is for treatment or for their next cleaning (even if they aren’t due for a couple months!), this is a great “excuse” to use to get them to call you back. Your voicemail might sound like this, “Hi this is Jamie at HealthPark Dentistry. I see that you need to have some treatment completed and I would like to talk to you about getting that scheduled. Please give me a call at 667-2417 so we can get this treatment done for you. Have a great day!”

You can also use email as you are trying to contact your clients. An idea for an email you can send when you cannot catch someone by phone:
Subject: Dental Cleaning
“Hi Tom, Just wanted to touch base with you about getting you set up for your next cleaning. I tried to reach you by phone, but no luck. Please give me a call at 667-2417 so I can help you maintain your warranty by keeping you on schedule for your cleanings. Have a great day – Jill Nesbitt, HealthPark Dentistry, www.healthparkdentistry.com”

How to Handle Difficult Financial Situations

Much of the time your client will have a reason for not paying. Here are responses to most of these situations:
A. Can’t pay that much – Then discuss and set up new financial arrangements. If you do have to fill out a new financial arrangement, tear up the old one. Make out a new one and have the client sign it.

B. Will pay but forgot, etc. –  “Good Mrs. Slow, let’s see, today is Monday, so if you put your check in the mail today, I’ll certainly have it by Thursday (allow 2 mailing days). I’ll make a note in the computer that we can expect 57.00 by Thursday. Thank you. “You must decide on a specific day. This is the secret to timely collections. If you don’t you’ll never know exactly when to make the follow up calls.

C. Upset with us and refuses to pay  – Do Not Defend! Use good listening skills and find out what we can do to make her feel better about us. Think what you would do if you were working at Zappos, money back, the customer is always right. Can’t we be as good as Zappos? Often the client won’t directly say they are mad at us. Listen for irritation, a snappy answer, disgusted or snide response. When you sense a problem ask “Mrs. Miller, you sound upset, is it something we did?” Listen. Often the client only needs to have someone listen to their problem. They often solve them themselves. The only way they had to show dissatisfaction was to not pay the bill. Ask her to give you the information over the phone. Remember, it’s hard to stay mad at someone who is doing everything possible to help you. Assure her our office manager will contact her promptly.

Review General Level 3 “Understanding People’s Moods” for how to handle clients when they get upset. Most folks natural, immediate reaction is to apologize. This is the wrong way to handle an upset client. Matching the client’s mood is the right way to go – review this mood coaching to improve your collections skills.

Put yourself in the past due clients position. She hates the spot she’s in as much as we do. She knows she owes us. She’s sorry they’re behind. She wants to catch up, she’s not sure how. She needs help and you can do it. If you develop this attitude clients won’t think you’re a “mean Scrooge”, because you won’t feel that way.

D. Client wants to talk with the doctor – “I’m sorry Mrs. Slow. The doctor has placed me in charge of the accounts. He doesn’t keep track of individual accounts. This is my responsibility.”

E. Client says s/he never received a bill – “Oh Wow! This is the address I sent it to. Is this correct?” If it is, then check the office journal and read through the dates that you sent statements and letters. Offer to send another by certified mail and continue the process then or try to resolve the outstanding balance on the phone.

You can handle most situations by:
1. Showing a genuine concern for the client
2. Emphasize the value of good credit
3. Avoid arguing
4. Partial payment is better than no payment

F. “I’m divorced and my husband is responsible for the bills.” – Get husband’s telephone number. Call him. If he says no, thank him and hang up. Call the ex wife and advise her of the conversation.
If each spouse says the other will pay
a) Tell our client that s/he is liable unless we hear otherwise
b) Be sympathetic, but don’t get caught in the middle. In some divorces, one spouse will run up bills to hurt the ex.
c) Set up a new account for the spouse who is our client

If Mom wants ex-husband/Dad to pay for the kids existing balance, then:
1. No more appointments for the kids until the account is paid. Remind Mom of our warranty.
2. Work out financial arrangements with Mom.
3. You can try to contact the ex but the person that brings the kids in is responsible for the bill.
4. No need to give us divorce decrees. If Mom and/or ex do not pay the bill, then they go to collections (we send the person who signed on the Responsible Party line in our children’s health history.)

G. Begs for sympathy: Out of work. Long illness. Heavy debts. Don’t judge this person. Acknowledge their personal problems. Ask them to pay what they can (at least $5 a month) to show good faith and put them on a contract. Continue to track in your 1-31 file as usual. If they cannot pay any amount, then pull their charts and discuss the situation with Dr. Dr can allow some people to go on “Hardship” accounts – which means that they can delay paying on their account for 3-9 months (Dr  will decide length based on each situation). Once that has been determined – contact them again and advise them of their delay; change account to billing type ‘on hold’.

H. Client says “Don’t ever call me again!” and makes no financial arrangement. Write up the complaint form and give it & the chart to the office manager.

I. “Your fees are too high!” Don’t defend our fees. No one knows better than you how reasonable they are, but as soon as you start to make excuses or justify you’re in trouble. 

J. “I sent my check, it must have been lost in the mail.” Ask the client to send another check and you’ll tear up the first one if it ever arrives. Don’t ask the client to put a stop payment notice with the bank. We would have to pay for this if it was our suggestion, and the cost is $20 to $25. Also, put an alert on the account “Check #_____ missing in mail. Sending another. Do not deposit both.” Then, manage this account correctly.

K. Check not signed – check with our bank. Many banks accept unsigned checks if you write on the front “see reverse” on the signature line and on the back write “absence of a signature guaranteed”

L. “My spouse takes care of that. Please call him/her.” Sure, when you see him/her would you ask that s/he give me a call tomorrow to let me know when I can expect payment?

M. “The insurance company was supposed to pay everything.” “I’m sorry you’ve been disappointed by your insurance company. Actually, they only administer the benefits your company has paid for. In your case, your company chose a number of limitations on your coverage. However, they did pay $____ that only leaves you with a responsibility of $_____. When could we expect this $_____.

N. “I got a letter from my insurance company that says your fees are too high.” “Every insurance company sets its own limits. We don’t have this problem with other companies. Let me send you a copy of a letter you can send to your insurance company to get to the truth of this matter. The state insurance commission is looking for insurance companies that are misrepresenting themselves. This may very well be a case they will be interested in. Please save all your communication with your insurance company. We’re as disturbed with this kind of letter as you are.”

O. Deceased Client
a) This is a very sensitive issue. Use common sense and tact.
b) When we find out, send a sympathy card signed by at least one of the dentists.
c) Pull recall notice out of computer and make them non-patient – then archive.
d) Make sure no further statements are sent
e) Write off any balance of $100 or less. “As a small token of our sympathy, we have written of Mr. ________’s outstanding balance.”
f) If the balance is too large (over $100) to write off, then review with Dr .Smith. He may decide to wait one month and call the spouse or person responsible for the account. “Hello, this is Ginny from HealthPark/Dentistry. We were so sorry learn of Mr./Mrs. _________’s passing. I’m sorry to bother you but we wish to submit the outstanding balance on Mr./Mrs. ___________’s account to the estate for settlement. May I have the name and address of the appropriate party?
g) If our statement is returned “deceased, return to sender” then review with Dr. Smith.
h) If the estate is probated, wait 30 days to show respect and file a claim with the probate court in the county where the will is being probated. Most stationary stores carry this standard form.
i) Send the form and stop all billing
l) Expect payment, but it may be up to a year in coming

P. Accident case held up by litigation
a) State that the doctor is not involved in the suit, but we will cooperate and do expect payment whichever way the case is settled.
b) Supply all information the lawyer needs

R. Client goes on Welfare after we extend credit
a) Don’t write off this balance
b) Acknowledge clients financial problems and request a monthly “good faith” payment so we can continue treating him/her (at least $5 a month)
c) Allow them to keep their dignity
d) They should not receive a statement place in hardship account – after discussion with Dr.

S. Your client sends partial payment and writes “Payment in Full.” Accept the check and write below your stamp “Check is accepted as partial payment.” Finally, you must be consistent with your calls. If an account is past due on the 20th call on the 20th. Don’t put it off. This is the sort of put off that will come back to haunt you. The best time to call is 5:00 to 7:00 P.M. during the week. Set aside enough time to make your calls.

T. Your client receives the insurance payment even though it was assigned to us and now won’t pay us. Stress to them that this payment is not a tax-free windfall. It is (unless paid to us) taxable income. As such it must be reported to the insurance company and to the IRS. The following letter is a good way to handle this:

March 1, 2012

Dear ,

Your insurance company has informed me that the check that you assigned to come to us was mailed to you by mistake.

This makes your account of $_______ past due and subject to our billing fee. I also wanted you to be aware that

1. As long as this amount is unpaid, it may not be deducted as a medical expense on your tax return.
2. The insurance payment you received is considered reportable income by the Internal Revenue Service.

If your balance of $_______ is not paid by ____________, I will have to send a letter to your insurance company. Your insurance company is then required to report this income to the IRS.

U. Collecting during the Christmas season. Work very hard in November and stop all collection calls and letters after December 20th. In the holidays, you’ll collect more complaints than money. People who owe us in December and can’t afford to pay will have a lot more trouble paying in January when their December bills come due. Plan to do lots of paperwork the last two weeks of December.

V. Collecting from co workers in the practice
1. Confirm dental benefits for employees have been given.
2. Give the statement to the employee
3. All employees are set to Billing type of Temporarily on hold – run report at the end of the month
4. Collections manager talks with staff who have a balance after insurance, saying “I see you have a balance – how do you want to take care of that?”
5. Often she sets up financial arrangements and allows the employee to have payroll deduction.
6. If no payment from the employee in 2 months, then give the statement and notes to the dentist to find out instructions.

W. Bad checks client’s check returned NSF (nonsufficient funds)
b. Bank returns check marked “insufficient funds”
c. Contact the bank to see if funds are now available.
d. If funds are now available, re-deposit the check.
e. If still “insufficient funds”, start the collection process by placing the first phone call and then following the rest of the collection procedures.

The client wants you to accept the insurance portion as payment in full. Explain that his is illegal – dental offices are not allowed to regularly discount off the portion the insurance company doesn’t pay. Instead, focus this patient on how this balance can be taken care of – and then we can always submit a pre-treatment estimate in the future so the patient has a better understanding of what the insurance may cover.

Handle an Upset Client

If any call turns sour, where the client starts to get angry with you, then our first task is to neutralize your client’s negative feelings. For example, you explain how the insurance works & they defend their insurance company & get upset. If you can diffuse & stop the conversation from continuing in an angry manner, that’s better – try saying:
“You know, you really sound upset. I think I am just making you angry instead of helping you, which is what I want to do.” – Allow them time to respond
“So, you have a couple of choices – First, I can let you talk with our Office Manager and let you two work this out. Or We can get together if you think that seeing the numbers together and talking face to face might help. Which way do you want to go?”

Other phrases to use when your client is upset:
1. “Yes, that is true.”
2. “I’ve upset you. I’m sorry, I didn’t mean to do that.”
3. “That’s a good question. Let’s see if I can answer it for you.”
4. “I certainly can understand how you feel.”
5. “I wish I could do it that way for you.”

Now is the time to stress the benefits of paying. “If I can show you a way and work something out with you to keep your account current in a way that:

You can afford financially
Maintain your credit rating
Give you peace of mind
Allow you to continue receiving care from us

Would that be worth your time?”

Other phrases that can help are:
“Here are some options you could try …”
“You might want to try …”
“Did you know you can …”
“May I suggest …”

Try to avoid:
“But” (use “and”)
“However”
“Yet”
“May I ask”
“This is the only”
“You are past due” (better – “your account is past due”)

No matter what the client has said, keep control of the conversation. When you have the information you need, thank them for their cooperation and hang up. Don’t prolong this conversation. Finish the conversation with: “Fine Mrs. ____, (I’ll expect $ ___ by ___) Thank you for your help.”

X. You get an unsigned check in the mail
a. Check with bank. Many will accept the check If you write “absence of signature guaranteed” on the back above our endorsement.
b. If the bank won’t accept this, then call the client to see if she / he will come in and sign it.

Collection Sequence – First Telephone Call

Nothing shows up on the day agreed to, then call the client. “Hello, Mrs. Slow, this is Zelda from Dr. Smith’s office. I was going through our records and I noticed that you have an outstanding balance with us.”
Silence (the first to speak loses) – the client responds:
1. Oops, I meant to pay you – “Great! I can take a credit card payment over the phone and I will mail you a receipt.”
2. Can’t pay right now – Then set up financial arrangement (Mrs. Slow will send us a check and we will receive it by x date) – then note on the walkout statement & refile in your 1-31 day book.
3. Refuse to pay & is angry – Write up complaint & give to the office manager – Wow, Mrs. Slow, you sure sound upset. From what you’re saying, you have several concerns ranging from how the insurance paid to how your appointment went. I know my office manager would want to talk with you to learn more about what problems you are having, if it’s okay with you I’m going to have her give you a call to discuss everything.”
4. No answer & you leave a voicemail, “Hi, this is Jamie with Dr. Smith’s office. Mrs. Slow, please give me a call, my direct line is 667-5282 x___.” Send your first collection letter.

Remember, every 30 days that an account goes without a payment we lose on the average 14%.

Collection Sequence – First Letter

1. Open the family file in Dentrix, select the guarantor’s name, click the quick letter icon and select Collection letter 1 and print.
2. These letters need to be signed by the collections manager and folded with a small return envelope and both stuffed into a window envelope to be mailed that day.
3. Note on the walkout statement the date you sent the letter & refile 2 weeks later.
4. Note in the G note that you sent the letter.

Collection Sequence – Second Telephone Call

Same exact script since if you are making this call it means that you missed the client on the first try & mailed the first letter. – “Hello, Mrs. Slow, this is Zelda from Dr. Smith’s office. I was going through our records and I noticed that you have an outstanding balance with us.”
Silence (the first to speak loses) – the client responds:
1. Oops, I meant to pay you – “Great! I can take a credit card payment over the phone and I will mail you a receipt.”
2. Can’t pay right now – Then set up financial arrangement (Mrs. Slow will send us a check and we will receive it by x date) – then note on the walkout statement & refile in your 1-31 day book.
3. Refuse to pay & is angry – Write up complaint & give to the office manager – “Wow, Mrs. Slow, you sure sound upset. From what you’re saying, you have several concerns ranging from how the insurance paid to how your appointment went. I know my office manager would want to talk with you to learn more about what problems you are having, if it’s okay with you I’m going to have her give you a call to discuss everything.” Send your second collection letter.

Collection Sequence – Second Letter

1. Open the family file in Dentrix, select the guarantor’s name, click the quick letter icon and select Collection letter 2 and print.
2. These letters need to be signed and folded with a small return envelope and both stuffed into a window envelope to be mailed that day.
3. Note on the walkout statement the date you sent the letter & refile 2 weeks later.
4. Note in the G note that you sent the letter.

Collection Sequence – Partial Payment

If client pays only part of what they agreed, then call “Thank you for sending $____ as part of your payment.” “When can we expect the balance of your account?”(pause) Find out why only part. Set up a definite financial arrangement. If you do not reach the client, then leave a general voicemail “Hi, this is Jamie with Dr. Smith’s office. Mrs. Slow, please give me a call, my direct line is 667-5282 x___.”

And mail the partial payment letter: Partial Payment letter

Note on the walkout statement & in G note and file this 2 weeks out in your 1-31 book.

Sometimes you won’t be able to reach your client by phone. Try various times. A personal contact is much better than a letter. A letter can be misunderstood. A phone call allows you to hear the client’s emotions and alter your responses to meet their needs. If you have trouble over the phone, offer to arrange an appointment for him/her at our office.

Our letters are designed to be as warm and personal as possible.

LETTERS ARE EASY. PHONE CALLS ARE EFFECTIVE.

Section #4: Collection agency or Financial on Hold Decision

In general, we try to avoid sending anyone to a collection agency. Not only is the collection agency’s badgering of our client a negative, but the feelings (and comments to their friends, etc.) this experience generates about us aren’t worth the few hundred dollars we might collect.

My past experience is that if someone wants to avoid paying us they will. At best we seem to collect less than 1/4 of the money clients owe us that are sent to the collection agency.

So you’ll know. If we were going to be “hard nosed” the “proper” collection sequence would be:
1. In office collection attempts
2. Collection agency attempts
3. Small claims court

Again since the collection agency usually has so little effect, they then recommend small claims court. This means calling, arranging a hearing date, having the court contact the “debtor” to confirm the date, going to the hearing (yes, a representative of the office must be there), usually the client doesn’t show and you win by default. Occasionally the client shows up and you and the client can argue your respective cases before the judge. If we win (and we would almost always will), then we can garnish (impound) a certain amount of the employees income. Was it worth it? I don’t think so.

Another thought is that the more aggressive we become in our collection procedures, the greater the chance that we will push our client into a countersuit a malpractice accusation. Even if it is totally false, the notoriety is still extremely destructive.

Most failures fall into 1 of 4 categories:
A. Pre-Treatment Estimate should have been sent for major treatment when no payment history was available for that insurance coverage.
B. Financial Arrangements should have been done and payment made before scheduling appointment.
C. When they don’t pay the estimated amount then a note should have been given to the collections manager with the reason why not paid in full and date when we can expect payment is noted.
D. Patients with certain Insurance plans that pay benefits to the subscriber instead of the dentist should have paid for treatment at time of service.

What happens when a client calls us that we’ve sent to the collection agency and says they want to pay us, not the collection agency? I would recommend, “I’m sorry Mr.______, if only you would have been able to work with me I’m sure I could have helped you avoid the credit bureau. Now it’s out of my hands, I hope things work out for you quickly.

If you are the collections manager, then I encourage you to delegate parts of this task to save your time for calling patients. In Secretary Level #3 section 7 – this task is outlined as a support task for the collections manager. It is also described here so you can oversee this task.

For sending people to the collection agency or putting their account on hold, here is the system:
Decide which accounts will go to collections and which will be placed on financial hold every week. The collections manager prints a statement and writes F for Financial on hold or a C for collections agency.

To place an account on Financial on hold:

  1. Go into the family file and pull up the guarantor, click on the quick letter icon and select Financial on hold letter and click print.
  2. Next, add a Guarantor note in Dentrix to alert everyone that this account must be paid before further treatment can be performed. This note can include:  insert dateline and write “Placed on financial hold $45.00 JN”
  3. Next, Change the billing type to financial on hold for the patient & everyone in the family
  4. Add a flag to each family member to alert “Placed on financial hold $45.00”
  5. Go into the Ledger and pull up the guarantor – click the “enter procedure” button. Charge out a no fee code (perhaps you could use D9998 and change the description to Outstanding balance).

To send an account to the Collections agency

  1. Go into the family file and pull up the guarantor, click on the quick letter icon and select collection agency letter and click print.
  2. Next, add a Guarantor note in Dentrix to alert everyone that this account must be paid before further treatment can be performed. This note can include:  insert dateline and write “Sent to collections agency $245.00 JN”
  3. Next, change the billing type to collections agency for the patient & everyone in the family.
  4. Copy and Paste guarantor note and add a flag to each family member to alert (collection and $$ amount)
  5. Delete any treatment plans and cc dates for all family members.
  6. Delete any future appointments – be sure to inform the client
  7. Go into the Ledger and pull up the guarantor – click the “enter procedure” button. Charge out a no fee code (perhaps you could use D9999 and change the description to Account to collection agency).
  8. Change to inactive patient status in the family file

Transmit data to the collections agency – usually the agency will have a website that you can access with an ID and password to enter the account for your practice. Submit your patients – fill in every field of requested information (the best way to collect is to provide ALL necessary information).

Bankruptcy

Bankruptcy is a very sad occasion, but its not the end of the world. It only means the courts are going to give them a second economic life by reducing how much they have to pay the people they owe.

There are three types of bankruptcy.
1. Chapter 7 means that most assets are turned over to the court to pay the creditors. The court sells these assets and the proceeds are distributed among the creditors. There is no need to submit anything to the bankruptcy court for this type.
2. Chapter 11 means the debtors want to keep their property. The debtor will try to avoid bankruptcy and gradually pay off the debts. We rarely see Chapter 11 in our office.
3. Chapter 13 means that the court has consolidated the debtor’s outstanding debts, and will pay a certain amount monthly until they are paid off, usually in a three year period, maximum of 5 years. To get anything, we must submit a written proof of claim in duplicate to the bankruptcy court. Payments to creditors are handled through a court appointed trustee. Often the arrangements mean we’ll get less than what we’re owed.

When the bankruptcy notice arrives – stop all collection activities, and put the account into the financial on hold billing type. If we continue to press to get our debt paid, we’ll be in trouble with the court. Make a note in the computer documenting:

1. Type of Chapter filed
2. Date bankruptcy filed
3. Case number
4. Attorney’s name and phone number

Follow these steps to get some payment:
1. Verify the bankruptcy. We should get an official notice if the client included us in the list of creditors. Occasionally a client will leave our name off the pledge to pay us in full at a later date. We will honor this. Place the client in a hardship account for six months. If we are kept off the list, ask for the name, address, and phone number of the attorney so we can “confirm the status of the account”, not “make sure you’re telling the truth.”
2. Stop all collection efforts (including any collection agency).
3. Contact the bankruptcy court and request a “proof of claim.” If it did not come with the bankruptcy notification.
4. Fill out and return the form to the court if Chapter 13.
5. We will receive something (if Chapter 13) and something is better than nothing.
6. “Notice to Appear” will be sent to us for Chapter 13. Ignore it.
7. “Bankruptcy Dismissed” means the debtor’s petition for financial collection was rejected and you can continue our collection process.
8. All further dental care must be on a cash at time of service basis.
9. Occasionally, a client may owe us a large amount and want to eventually pay it off to remain in the practice. We would file a Reaffirmation Agreement with the bankruptcy court. This agreement removes our name from the list of creditors and we can draft a payment arrangement for the completion of current treatment. This payment arrangement must have specific amounts at certain dates and notarized signatures (client and ours) by a member of the bankruptcy court.

Payments from a Collection Agency

Here are characteristics we can use in selecting a collection agency
1. An agency with local connections
2. Avoid agencies that only mail letters
3. Ask them to see their first notice and any follow up material they send
4. How quickly do they get us our share of the money collected
5. We can submit everything online
6. No legal action or threat of legal action will be taken without our consent
7. Will they let us know if a client has special problems requiring special treatment
8. What do the agencies reports to us look like

We allow patients to volunteer in exchange for $9/hour against their dental balance. Read our collection agency letter to see how this is communicated with our clients. Your job is to answer client questions about this – confirm, that yes they can work off their debt to us by documenting the number hours worked in a charity and having that signed and sent to us. Then we will enter that amount as a payment in their ledger.

When we receive a check from the collection agency, it is entered as:
Ledger – Transaction – Enter Payment – Type – Collection agency payment

BWC – Bureau of Workers’ Compensation

The BWC exists to spread out the risk of compensating workers that are inured on the job. Some jobs are more risky and some injuries are more costly so the BWC uses a federal system that assigns every business a classification and an associated annual cost. When we treat a person who has been injured on the job, we are compensated on a scale based on another federal scale.

The procedures detailed for processing claims for BWC must be followed to the letter or we will not receive payment. To receive payment, the dentist must actually be listed as a BWC provider.

Here is the procedure for treating a patient who has been injured on the job.
These are the important things to find out:
1. Have they been treated anywhere else before coming to our office, such as the emergency room, or surgery for a broken jaw, etc? If they have a claim number, bring it with them. If their first treatment was over a week ago, they should have a claim number. If they went to the emergency room first and then are coming right to our office they won’t have a claim number yet.
2. Is their employer self insured (if so, who is the contact person and phone number) or do they work with an MCO (Managed Care Organization)
3. If they use an MCO, find out who it is, and look them up in the BWC manual to get their address and phone and fax numbers.
4. Depending on the extent of their injury, you can schedule them for an emergency exam and necessary x-rays, or a thorough exam w/ the dr, and a CMS. These are the only procedures (plus any required to get them out of pain) that can be scheduled without authorization. We need to ALWAYS send at least take a PA of the affected tooth. BWC will not approve any treatment without an x-ray of the injured area.

These are the four situations for working with an injured worker:
A. We are the first provider to see the patient, and the employer is self insured.
B. The patient has seen another provider first, and the employer is self insured.
C. We are the first provider to see the patient, and the employer uses an MCO.
D. The patient has seen another provider first, and the employer uses an MCO.

A. We are the first provider to see the patient, and the employer is self insured.
1. We need to complete the form called “First Report of Injury” (FROI-1). Sometimes they will bring this with them from work, but usually not. There are four sections on this form. We will complete the first three sections:
a. Injured worker info
b. Injury info
c. Treatment info
The last section is employment info, that the employer has to complete and certify that they agree that this is a work related injury. If the employer has not already completed their section, we will call and establish our contact with their company (usually someone in personnel or human resources) and send it to them, preferably by fax to speed the process.
2. When they come in for their visit, be sure that the description of the accident or injury is detailed on the treatment sheet including the date of the accident/injury and what happened in the patient’s words.
3. Complete the C-9 form after the doctor sees the patient and has completed the treatment plan. You can fax this form to your contact. Also include a Dentrix treatment plan with the tooth chart. We can do no treatment until we receive authorization.
4. Fax a dental insurance form for the original visit. Make sure the diagnosis code is on every form, and the BWC provider number. Also note on the claim in Box 30 that the treatment is the result of an occupational injury and enter the date of the injury and a brief description of the injury.
5. When you receive authorization from the employer you can schedule the treatment.
6. Fax dental insurance forms for completed treatment to your contact.

B. The patient has seen another provider first, and the employer is self insured.
1. Complete the C-9 form after the doctor sees the patient and has completed the treatment plan. You can fax this form to your contact at the company of their employer. Also include a Dentrix treatment plan with the tooth chart. We can do no treatment until we receive authorization.
2. When they come in for their visit, be sure that the description of the accident or injury is detailed on the treatment sheet including the date of the accident/injury and what happened in the patient’s words.
3. Fax a dental insurance form for the original visit. Make sure the diagnosis code is on every form, and the BWC provider number. Also note on the claim in Box 30 that the treatment is the result of an occupational injury and enter the date of the injury and a brief description of the injury.
4. When you receive authorization from the employer you can schedule the treatment.
5. Fax dental insurance forms for completed treatment to your contact.

C. We are the first provider to see the patient, and the employer uses an MCO.
1. We need to complete the form called “First Report of Injury” (FROI-1). Sometimes they will bring this with them from work, but usually not. There are four sections on this form. We will complete the first three sections:
a. Injured worker info
b. Injury info
c. Treatment info
The last section is employment info, that the employer has to complete and certify that they agree that this is a work related injury. If the employer has not already completed their section, we will call and establish our contact with their company (usually someone in personnel or human resources) and send it to them, preferably by fax to speed the process. We need to have the employer return the FROI-I to us so we can submit it to the MCO.
2. When they come in for their visit, be sure that the description of the accident or injury is detailed on the treatment sheet including the date of the accident/injury and what happened in the patient’s words.
3. Fax the FROI-1 to the MCO as soon as possible, preferably within 24 hours of the patient’s first visit.
4. BWC assigns the claim number within 24 hours from the date of notice from the MCO.
5. BWC will mail the claim number to us as well as the injured worker, his employer and the MCO. Also, the MCO usually notifies us of the claim number.
6. As soon as we receive the claim number we can complete the C-9 and send it to the MCO. Also include a Dentrix treatment plan with the tooth chart. We can do no treatment until we receive authorization.
7. Fax a dental insurance form for the original visit. Make sure the diagnosis code is on every form, and the BWC provider number. Also note on the claim in Box 30 that the treatment is the result of an occupational injury and enter the date of the injury and a brief description of the injury.
8. When you receive authorization from the MCO, you can schedule the treatment. This can take anywhere from 2-4 weeks and is determined by BWC.
9. When treatment is completed, fax dental insurance forms to the MCO.

D. The patient has seen another provider first, and the employer uses an MCO.
If they already have been treated, they will already have established a claim number, the first 2 digits of which are the current year. Things will go quicker if they already have a claim number.

If they have been treated elsewhere first and have a claim number:
1. Schedule them w/ one of the doctors for a thorough exam and CMS or an emergency exam and necessary x-rays. This is the only treatment that can be done without authorization from BWC.
2. Request they bring any paperwork they have:
a. From their employer, which confirms that the injury occurred at work.
b. The name, address and phone number of the MCO (Managed Care Organization) that the employer has signed up with.
c. The claim number.
d. Any reports from previous health care providers.
3. When they come in for their visit, be sure that the description of the accident or injury is detailed on the treatment sheet including the date of the accident/injury and what happened in the patient’s words.
4. Complete the C-9 form after the doctor sees the patient and has completed the treatment plan. You can fax this to the MCO. Also include a Dentrix treatment plan with the tooth chart. We can do no treatment until we receive authorization.
5. Fax a dental insurance form for the original visit. Make sure the diagnosis code is on every form, and the BWC provider number. Also note on the claim in Box 30 that the treatment is the result of an occupational injury and enter the date of the injury and a brief description of the injury.
6. When you receive authorization from the MCO you can schedule the treatment.
7. Fax dental insurance forms for completed treatment to the MCO.

Treatment Plans
On the treatment plan we need to add the claim number, Dr’s ID number, and also the Diagnosis code. Each of these three things is vitally important. We also need to fill in the procedure codes next to the description of the service. The first character of the procedure code needs to start w/ a D. (Therefore a PVC would be D2750).

Here is a list of the most common Diagnosis codes:
873.63 Broken tooth or teeth
522.1 Necrosis of tooth pulp
784.0 Headache
728.85 Spasm of muscle
848.1 Sprain of jaw
873.44 Open wound to jaw, uncomplicated

BWC Fee Schedule
1. BWC last updated their fee schedule on ________.
2. By agreeing to be a BWC provider, we agree to accept the fees BWC pays and will not charge the patient any extra amount.
3. Fees can be looked up on the internet, 7 codes at a time. Web address is www.ohiobwc/com/bwc/scripts/feeschedule/feelu2.asp
4. Following is the most current fee schedule. The fees for x-rays and exams are higher than ours, but most treatment fees are lower. Be sure to use the higher fees as shown to supplement the lower fees.

About Your Workers’ Compensation Claim (letter to claimant)
You have indicated that treatment for your medical condition is covered by Workers’ Compensation. Although we often process insurance claims for our patients, we cannot guarantee insurance payment, coverage or particular benefits. It is your responsibility to be sure that appropriate Workers’ Compensation forms and filings are completed. Your assistance in obtaining timely payment from your Workers’ Compensation carrier is appreciated.

Some employers are not required to maintain Workers’ Compensation insurance. If you have not already done so, you should contact your employer without delay and verify that (1) your employer has a Workers’ Compensation insurance policy, and (2) you are covered under the policy. You will be held financially responsibly for payment of all services if no policy is in effect covering you. Our office charges 1.5% service charge on all accounts not paid by 60 days following treatment. When Workers’ Compensation payment is later than 60 days, you will be responsible for the service charges.

Treatment for unrelated conditions
A worker injured on the job can have illnesses or injuries not related to the on the job injury. You are financially responsible for any medical treatment not related to your Workers’ Compensation injury, illness or condition. Your doctor should be able to advise you whether particular treatment is related to your Workers’ Compensation injury.

Agreement
I agree to pay for all medical/dental services not covered by Workers’ Compensation insurance, all charges for treatment unrelated to my Workers’ Compensation illness or injury, and all service charges for late payment by Workers’ Compensation.

I have read this notice and I acknowledge that I have received a copy.

_________________________________________ _______________________
Signature Date

Workers’ Compensation Authorization Form

Please give care to our employee (name) for injury received and reported while at work on (date of injury).
Employer name ______________________________________

Address ____________________________________________

Telephone __________________________________________

Authorized by ______________________________________

Date _______________________________________________

Insurance Information

Insurance carrier __________________________________

Address ____________________________________________

Telephone __________________________________________

Claim Number _______________________________________

Sample Letter of Appreciation
Dear Ms. Supervisor,
Recently, I had the opportunity to communicate with (name) on an outstanding workers’ compensation claim. This is just a note to commend (name) for her helpfulness and politeness. I have experienced the opposite end of the spectrum before, and I find it immensely gratifying to deal with a representative who actually tries to be helpful in resolving a problem. Perhaps, knowing her skill is appreciated will help her keep that smile in her voice.
Sincerely yours,
Financial Manager

Section #5: Tracking

We should collect 98% of our accounts.
1. Front desk record how much collected on day of service (by playing the Collections Game) – problems include:
a. Treatment plan/financial arrangements not followed through
b. Poor front desk verbal skills
c. Not getting client’s portion of insurance immediately
d. No downpayment in large cases

2. Accounts receivable over 90 days are not acceptable.
a. Financial arrangements not effective
b. Old uncollectable accounts not written off
c. Slow insurance turn around time

Develop Collection Report

At the end of the month, you want to see the aging for total accounts receivable and the insurance outstanding aging. You also will check the collections manager and run aging for each billing type to make sure you are keeping all patients moving through your collections system.

At the end of each quarter, you should review the amounts in the billing types (or account types) that have been placed on financial hold or sent to collections.

To see how much was sent to collections:

a. Go to office manager
b. Choose letters, Collection tab, Collection number sent – click edit
c. Edit procedures completed beginning code D9999 to D9999 (this is the sent to collection agency code)
d. Select procedure date – from beginning to end of month dates
e. Select billing type for sent to collections agency
f. Edit data fields to include last name, first name, billing type, balance, last payment date and last payment amount. – Click ok
g. Choose Create merge, create data file only, then ok
h. Copy to Excel
i. Sum the balance column to find Total amount sent to the collections agency for the month

To see how much was placed on financial hold:

a. Go to office manager
b. Choose letters, Collection tab, Outstanding balance number sent – click edit
c. Edit procedures completed beginning code D9998 to D9998 (this is the outstanding balance code)
d. Select procedure date – from beginning to end of month dates
e. Select billing type for Financial on hold
f. Edit data fields to include last name, first name, billing type, balance, last payment date and last payment amount. – Click ok
g. Choose Create merge, create data file only, then ok
h. Copy to Excel
i. Sum the balance column to find Total amount written off for the month

To see how much the collection agency paid – Run a report on their website or contact their rep to send you this report quarterly.

To see how much was paid from patients placed on financial hold:

a. Go to office manager
b. Choose letters, Collection tab, Outstanding balance – amount paid – click edit
c. Edit procedures completed beginning code 99998 to 99998 (this is the outstanding balance code)
d. Clear procedure date
e. Edit last pay date from beginning to end of month date
f. Select billing type for placed on financial hold
g. Edit data fields to include last name, first name, billing type, balance, last payment date and last payment amount. – Click ok
h. Choose Create merge, create data file only, then ok
i. Copy to Excel
j. Sum the payment amount to find Total outstanding balance paid for the month

To find total $ written off & sent to collection agency:
__________________ Amount sent to collection agency
__________________ Amount paid by collection agency – subtract this amount
__________________ Total sent to collection agency

__________________ Amount placed on financial hold
__________________ Amount paid by financial on hold – subtract this amount
__________________ Total on financial hold

__________________ Add the amount sent to collection & amount placed on financial hold

To find total income for this same timeframe, run a day sheet for the same dates and note the payments.

__________________ Total $ placed on financial hold & sent to collections agency
__________________ Total Income
__________________ % Collections/Write offs of Total Income

Sample Tracking

This is a sample of the tracking I recommend so you can monitor your aging and insurance aging performance on a monthly basis.

Tracking

Section #6: Ortho Collections

We collect for the Orthodontic accounts based on several factors:

1. Coupon/down-payment method:
a. at the Records appointment – $250.00 is due regardless of insurance coverage
b. at the Banding appointment – $500.00 is due regardless of insurance coverage
c. coupons are given at the Banding appointment based on the total treatment fee less the 2 previous payments and divided by the number of months Dr  estimates for treatment.

Example with out insurance: 4500.00 total treatment fee
– 250.00 paid at Records appointment
– 500.00 paid at Banding appointment
3750.00 balance divided by 24 months of treatment

Example with insurance: 4500.00 total treatment fee
– 250.00 paid at Records appointment
– 500.00 paid at Banding appointment
-1000.00 lifetime ortho insurance coverage
2750.00 balance divided by 24 months of treatment

d. contract payments are due on the 15th of each month
e. they can either send in the monthly payments or we can set up their credit card to do a monthly credit charge the 15th of each month and send them a receipt

2. Payment-in-full method:
a. we will extend a 10% discount if they would like to pay their portion in full
b. if they have insurance this discounted amount would be based on the balance after the insurance value is subtracted
c. obviously, this is the easiest method with little to no follow up required

3. Procedures for late-payments for those with coupons:
a. since they will be in every 4-6 weeks for their follow up visits, it is always in everyone’s best interest to ask for the monthly payment at that time (saves stamps, etc.)
b. after the 25th of each month, run an Aging Report for ortho accounts only.

c. to run the Aging Report:
1. go to Office Manager Screen
2. click on Reports
3. scroll to Ledger and click on Aging Report from drop down list
4. Select Guarantor – from zz _______ to zz zz ______ – this will give you all the zz accounts. (We use ZZ in front of the last name of the patient to identify our ortho accounts.)
5. Select Billing Type for ortho only
6. those are the only sections you need to change for the report
7. click Okay
8. Highlight Aging Report on the Office Manager Screen
9. Click on the Print icon

d. Review the Aging Report (Go through the entire report on the first week of the month & determine if they are on track, overdue or deserve a refund):
1. Look at the last payment amount/date column
2. If we received a payment that month, they you can cross off their name – you do not have do follow-up with them as they are current
3. If they have not made a payment that month, pull up their ledger in the system to see if the amount is all due from insurance (check the guarantor notes) – then you can cross off their name
4. Highlight any name with a refund balance – see instructions below to handle refunds.
5. For folks who are overdue – follow the ortho collections procedure.

Ortho Collections procedure

1. If patient behind on one contract payment – 1st Phone call today – if you leave a message, move this statement to tomorrow in the book. If this client is scheduled within 7 days and they are one contract payment behind, then do not call, just put the note in the appt & the alert.
2. Mail Ortho late payment agreement letter – then put statement out 4 weeks in book and Put a note in the next ortho appointment “Collect $150” Also create an alert for this patient Subject: Date of next appt and Content: Collect $150. Also send an email.
3. If patient behind on two contract payments – Phone call #2 – if you leave a message, move this statement to tomorrow in the book and tell Dr.
4. Mail Collection Letter 2 quick letter – then put statement out 2 weeks in book. Put a note in the next ortho appointment “Collect $300 or do not reschedule”. Also create an alert for this patient “Collect $300 before scheduling ortho”. Also send an email.
5. If no payment is received within 2 weeks, then meet with Dr. to decide to write off or send the account to the collections agency –
a. If the braces are already off and the balance is under $100, then Dr. may decide to courtesy adjust this amount to bring the balance back to zero.
b. If the braces are off and the balance is over $100, he may decide to send this account to the collections agency.
c. If the braces are still on and the balance is under $100, then Dr. may decide to continue treatment and try to collect the balance at the final appointments, but agree to courtesy adjust whatever is unpaid.
d. If the braces are still on and the balance is over $100, then Dr. will have us mail the Ortho Removal letter (this letter needs significant personalization) and follow up on that. Then let Dr.  know if we have had any response from the family & he can decide if we should send to our collection agency.

Ortho contract late payment letter: Ortho late payment letter

Timing & Who Responsible for Ortho Collections
Last day of month – __________ will Run Aging report
First week of month – Calls made by ____________ and Letters mailed, Alerts set & Appointment notes by Ortho Coordinator
2nd week of month – Ortho coordinator to meet with Dr.  for all folks who have received both calls & letters and still have not paid to determine if headed to collections agency or not. At this time, the account is 2 ½ months overdue and we will mail the ortho removal letter (which gives 30 days to pay). For folks that received the ortho removal letter last month, then any unpaid accounts will be sent to the collection agency. These will be sent to the collection agency by the time they are 3 ½ months overdue.

To clear out any credits you find on the aging report – We have to research this account to see if they are due a refund or if we need to edit the charges to bring the account back to zero.
1. Pull the chart and review the original contract – how much was the total fee for braces & what was the contract set up for?
2. Check the ledger to see if this matches the original contract. Did the client make all their payments?
3. Did the client transfer to another orthodontist? Do they still need anything charged out?
4. Once you have the account figured out, send a refund check or make an adjustment to bring the account back to zero.

Section #7: The Collections Process in EagleSoft

1. Patient receives a statement – payment due in 2 weeks
2. If not pay, call & if leave a message, then send Collection letter #1 (friendly reminder) by email & US mail – wait 2 weeks
3. If not pay, call again & if leave another message, then send Collection letter #2 (tougher language) by US mail only – wait 2 weeks
4. Send to collections agency or place on financial on hold.

Account types

In the account screen, Preferences, Account types:
Standard – Most of our accounts use this account type
Bad Debt – To Collections
Bad Debt – Placed on Financial Hold
Payment Agreement – Use for patients making payments
Barter services – Use for patients trading services

Instructions to send statements in EagleSoft

1. Home screen – Activities
2. Statement Wizard
3. Click Next & Yes the last batch processed correctly
4. Create statements for “Accounts that have not rec’d a statement in 28 days” and “Accounts with a balance greater than $5.00”
5. Include item detail and set to three months back to include the detail, next set your Due Date for 2 weeks from today and leave the default messages set to default: statement; >30: statement; >60: 60 Day; >90: 90 day – click next
6. You can apply billing/finances charges on the next screen – click Finish.
7. Now you should have a list of patients that will receive statements, scroll through the list to see if any catch your eye as a problem & you can uncheck the box to not send them a statement.
8. Now – document that you’re sending statements in our end of month reports: Document the date sent (today’s date), the date due (2 weeks from today), the number of statements – you can see that in EagleSoft “Marked ___”
9. Back in EagleSoft click the Process button – and Yes, you’re ready to process statements now. Now it will create a statement for each patient – this takes a few minutes.
10. In the next window, click Ok – this connects to the internet & sends the statements to the clearinghouse. When this is done, the list of patients receiving a statement will automatically print. And the screen shows “statements are completed.” Click ok to clear the list.
11. If there were any patients you unchecked to not receive statements, they will be left on your screen. Click the Remove all button to get rid of these.
12. Click ok to close the statement window
13. On the printed statement list – in the top right corner write the due date, then staple the list & save it for 2 weeks.

To follow up on statements 2 weeks later – Collection letter #1

1. Check the account of each patient and if they paid, then check them off.
2. If the patient didn’t pay, then call – try the cell, home, work and check SmartDoc for other possible numbers. Its okay to leave a message, “This is Jill with Dr. Smith’s office. Please give me a call at 615-123-1234.” – if they are overdue for their cleaning, then you can mention that, but you cannot say that you are making a collections call.
3. If you leave a message, then print “Collections letter #1”
4. To email & print this letter – go to the Account screen, right click in the top right below the icons. Click Send to – In touch
5. Click the box “Send to email” – and then Click Yes to “also print letters” in the pop up window.
6. Select the letter by typing in “Coll” – and then choose Collection – 1st letter
7. This brings up the template of the letter – fill in the blank line to enter the date for when treatment was completed. Then click Process and click Yes, ready to start processing letters.
8. If the patient has an email, then a window will open from Microsoft Outlook saying a program is trying to send – click Allow.
9. The letter will print and then click Ok to the alert that letters processed successfully. Then click No to the alert to print envelopes.
10. Next, go to SmartDoc & print a second copy of the letter and put this into your 1-31 day file out 2 weeks.
11. Continue to check each patient that received a statement and move them through the collections process.

To work the 1-31 day file – Collection letter #2

1. Each day, open the 1-31 day file to today’s date.
2. Pull out any collections letters or statements and move the patient to the next step in the collections process.
3. Often, this means you will be sending Collection letter #2
4. Check the account of each patient and if they paid, then pitch the letter.
5. If the patient didn’t pay, then call again.
6. If you leave a message, then print “Collections letter #2”
7. To print this letter – go to the Account screen, right click in the top right below the icons. Click Send to – In touch
8. Select the letter by typing in “Coll” – and then choose Collection – 2nd letter
9. This brings up the template of the letter – fill in the blank line to enter the date for when treatment was completed. Then click Process and click Yes, ready to start processing letters.
10. The letter will print and then click Ok to the alert that letters processed successfully. Then click No to the alert to print envelopes.
11. Next, make a note of the date you sent the Collection letter #2 on the collection letter and put it back into the 1-31 day file out 2 weeks.
12. Continue to check each patient that has a letter in this date and move them through the collections process.

Instructions For Collections and Financial On Hold – When patients still don’t pay

In the 1-31 day file when you find a patient who has received both collection letters and still hasn’t paid, then its time to either send them to the collections agency (or the attorney) or to place them on financial hold.

To send accounts to the collection agency:

  1. Select the letter by typing in “Coll” – and then choose Collection – To collection agency
  2. This brings up the template of the letter – fill in the blank line at the very end to enter the date one week from today. Then click Process and click Yes, ready to start processing letters.
  3. The letter will print and then click Ok to the alert that letters processed successfully. Then click No to the alert to print envelopes.
  4. In the patient’s account notes – Make a note “Sent account to collections, Set to no statements – Patient must pay off balance before scheduling”
  5. In Preferences – uncheck Receive statements, finance charge, billing charge; Change the account type to “Bad debt – To Collections” – Save
  6. In Edit patient – Add a $ to Preferred name

To place accounts on financial hold:
1. Print a letter – go to the Account screen, right click in the top right below the icons. Click Send to – In touch
2. Select the letter by typing in “Coll” – and then choose Collection – Financial on hold letter
3. Click Process and click Yes, ready to start processing letters.
4. The letter will print and then click Ok to the alert that letters processed successfully. Then click No to the alert to print envelopes.
5. In the patient’s account notes – Make a note “Account on hold, Set to no statements – Patient must pay balance before scheduling”
6. In Preferences – uncheck Receive statements, finance charge, billing charge; Change the account type to “Bad debt – Financial on hold” – Save
7. In Edit patient – Add a $ to Preferred name

 

Your Turn

Congratulations! You’ve made it all the way through this training on setting up your collections system. Now, it’s your turn. Here’s a checklist you can use to set up the collections system in your practice:

  • Meet with your dentist to talk through your plans for improving your collections system – gather approvals for the cut off dollar limit guidelines to send accounts to the collections agency, show your dentist the letters you plan to use for any edits and agree on regular follow up to show your performance
  • Purchase a 1-31 day file (you can use the Amazon link above)
  • Run your aging report (and collections manager for Dentrix users)
  • Run your insurance aging reports for over 30, 60, 90’s
  • Set up your letters in your computer system
  • Make your first calls, send your letters – and actually use your 1-31 day file
  • Meet with your administrative team so you can begin to gather walkout statements from patients who do not pay in full at checkout – and perhaps start the collections game
  • Create your tracking in excel
  • Work each and every account through to financial on hold or to the collections agency
  • Meet with your dentist to show your success!

Feedback

Please share your experience in working with this collections system with me. I’d love to hear how it is working for you – or if you ran into any roadblocks. If there is anything I can improve in this training, please let me know!