#23- Checking Clients Out Following Treatment

Check Out Procedure
When a client has completed their appointment, they will be relieved, often numb, but almost always anxious to leave. Your objective is to help them finish whatever business is necessary pleasantly, efficiently, and with as little hassle as possible. Try to limit this check out procedure to five minutes. The client will be escorted by a staff member who will introduce the client to you. Look up and smile. Greet the person by name. Quickly scan the folder or router to make sure it’s accurately filled out. This is a very appropriate time to make some positive comment on the client’s treatment. This serves two purposes:

1. Shows you are interested in the client.
2. Shows you know what’s going on.

Comments about the client as a person help to improve your relationship with this particular client. The more the client likes you and appreciates our treatment, the more flexible they will be to you in making appointments and payments.

Take the folder and read the treatment accomplished on this date. The well filled out treatment sheet avoids mistakes. It has these advantages:

1. avoid verbal misinterpretations
2. increases efficiency
3. helps communications among staff
4. organizes diagnosis and treatment
5. provides information for financial arrangements
6. provides information for insurance processing
7. provides information for collection procedures
8. tracks client referrals
9. aids in appointment scheduling
The assistant will tell you what was accomplished and say good bye to the client

If you are busy follow this procedure:

1. On phone – look up with good eye contract and a smile to the client. Say to the telephone caller “Excuse me for a moment.” Then say to the client “I’ll only be a minute with this phone call. “Would you like to have a seat in the reception room and I’ll come get you then?” Complete the phone call and then get up and go to the client in the reception room.

2. You are checking out a client and the phone rings – look up with a smile and good eye contact and a smile saying “Would you excuse me a moment while I answer the phone? “Then say to the caller “Hello This is Jill at HealthPark, I can help you. I’m currently with a client could I call you back in 5 minutes?” Write down the caller’s name and address in your telephone log. Complete checking out your client and return the telephone call.

Sheets in the client folder:

1. Initial Treatment Sheet
This information is ideally filled out during the initial new client exam with the doctor.
If the client chooses to have a cleaning by the hygienist instead of a thorough exam this section is often not filled in. This chart shows existing restorations and missing teeth.

2. Medical History Sheet
This is where you will find name, address, and insurance information.

3. Treatment Scheduling Sheet
This shows the treatment recommended by the dentist.
what procedures will be done next
how much time is needed
who will perform the services
how soon the next appointment can be scheduled
When you schedule an appointment, make sure to write the appointment date in the box.
The assistant crosses off treatment that is completed on the salmon sheet.

Checking out a patient in Dentrix:

Open the schedule module in Dentrix
Click once on the patient’s appointment – this will select it
Click on the blue checkmark (Set Complete) button at the top – this will bring up a window listing the treatment scheduled for the appointment.
Make sure the treatment listed is what was completed – if so, click ok
If additional treatment was performed (x-rays or fluoride) then click ok and go to the ledger
Select Transaction, Click Enter Procedure
Click on the double arrow button next to Procedure and select the category (usually diagnostic or preventive) and then select the treatment and click okay
Make sure you are listed as the provider
Click Add, then Click Ok/Post
Finally, look at Today’s Charges and write this amount in the chart in pen with a checkmark

Walking out a patient in EagleSoft:

  1. Clinical staff hands the receptionist a router- review it to make sure the treatment on this paper match the codes treatment planned for this appointment in the computer.
  2. In OnSchedule, click once on the appointment
  3. Click on the Walkout icon – this brings up the account window (you’re on the walkout tab) – enter in any additional codes that are needed. Be sure to enter the correct provider – dentist for restorative, or choose the hygienist’s name for a dental cleaning / perio visit.  If you add restorative codes, be sure to enter the tooth number.
  4. Click save (bottom right) and a new window comes up “Do you want to process walkout?” – click Yes
  5. Next, go to the account payment tab (to the left of the walkout tab) and select the payment type
  6. For a credit card payment, choose the type of credit card – Visa, Mastercard, etc.  and enter the amount that will be paid.
  7. Next, click on the icon of the card – this brings up a new window
  8. Swipe the credit card – you’ll see that the card number and expiration date automatically populate in this open window.
  9. Next, enter the zip, address and the 3 digit code on the back of the card (you can find the zip and address on the router so you don’t have to ask the patient again). Now, click ok to close this window.
  10. Next, be sure to checkmark Print payment receipt and then click save on this account payment tab. This will process the payment and print a statement reflecting the payment that you will hand to the patient.
  11. Finally, in this account screen, click on the tooth icon to open the tooth chart – look for any red treatment – this means that it has been proposed or accepted. If you see nothing red, then this patient has no treatment needed. If you see red treatment, then look at the date it was proposed – anything within the last few years should be printed.

To print a treatment plan in EagleSoft:

  1. In the tooth chart – click on the Tx plan button at the bottom of the screen (to get there from other screens, click the Tx button in the top task bar)
  2. This brings up a window that may have treatment listed – you can see the date that this treatment was pulled into a treatment plan and presented to the patient. Or, this window may be empty and if so, the question will pop up “Would you like to create a new plan?” – go ahead and say yes.
  3. This brings up a new window labeled “New Treatment Plan” – enter today’s date (for new treatment charted today) as the description (for example: 8/15/13) and click okay to close this little window.
  4. Now, you’ll see a list of all treatment proposed or accepted and you can see the dates that each procedure was entered.
  5. In the far right column, you can also see the appointment date connected with any treatment as well.
  6. You can Mark All or highlight specific procedures and Mark one at a time until you have selected the treatment you want to print. Generally, select the treatment from today’s date that was presented.
  7. Click okay – this closes this window and allows you to choose a checkbox for Print treatment plan. When you checkmark this box, then you can choose to print today’s treatment plan (or any other date as well). Or you can choose to include all items.
  8. Click okay – now your treatment plan will print. You can share this with your patient and ask if they have any questions about their treatment plan.
  9. Review the total fee, the insurance estimate and their estimated portion with the patient. This gives the patient informed consent – they can see in advance how much their next visit will cost and what exactly will be done (outside from any unexpected changes that occur during the visit, of course).
  10. Next, look at your schedule to see when you could fit this appointment in  and say to the patient “I have time on Thursday, August 20th at 10am if that works for you?” Hopefully, you can schedule this appointment for the patient.
  11. Next, say to the patient, “So, your portion will be $___ – how would you like to pay for that?” – we offer a 5% discount for paying in full by check or they can pay by credit card or CareCredit. They do not have to pay in full in advance to schedule, but you do need to confirm that they will be prepared to pay a certain $ amount on a certain date.

 

Financial Arrangements Choice: __________________________________________________________________________________________________________I understand that this is an ESTIMATE which is valid for 90 days. This estimate is not a guarantee of insurance payment. To obtain a more accurate insurance estimate, you must obtain a pre-treatment estimate. I understand that the full balance not covered by insurance is my responsibility.
Pre-Treatment Estimate (PTE) for Dental Insurance
I understand that if there is no time to receive a PTE, that I am fully responsible for the entire fee as if there were no insurance.
_________________________________ _______________
Patient Signature Date

It is okay for you to collect money from clients while you are in this level. When you check out a client, please say “Mr. Jones, the total fee for today was $100, we estimate insurance to cover $70 and your portion is $30. How would you like to take care of this?”

Front Desk Collection Conversations

-If the client says, “no problem to pay for this with credit, cash, or check”, you’re all set.
-If on the other hand, the client seems uncomfortable or wants to make payments, you should ask the client if they would like to speak with a treatment coordinator who can work out financial arrangements for them.

If the client says: “I’ll wait to pay after insurance pays” you should respond by looking in Dentrix (Insurance Payment Table) to see if we know what their insurance pays for that procedure and letting them know you are doing this. If we know what should be paid, tell the client “We already know from our computer what your insurance company will pay. It really helps us if you would pay your portion now so we can avoid sending you a statement in 3 weeks. Here’s your statement now.” If there is no history for that procedure in the Insurance Payment Table, then say “Okay” and note this on the walkout statement copy for the person in the office that follows up on insurance payments.

If the client says: “Your estimates are usually off. I want to wait to pay until after the insurance pays.” You should respond: That’s surprising. Our computer tracks your insurance and updates your coverage every time you are in if we’re off. If you’ve been in more than 3 times, there are only 3 reasons we might not be accurate:
– You have a new employer and we don’t have a history with the insurance company.
– You have a new insurance company
– We’re not sure if you’ve used up your yearly deductible.
Do any of these situations apply to you?

If the client says: “My H.S.A. account will pay once the insurance has paid”. You should respond: “That’s great! It really helps us if you would pay your portion now. Then you can just deposit the H.S.A. account monies when you receive them and not have to write us a separate check. We have a dental credit card called Care Credit that is a 6 month/no interest type. If you would like to apply, I can get an upper level secretary to help you.”

As you work with patients, we will draw a distinction between collecting money and making financial arrangements. It is okay for you to collect money, but “making financial arrangements” indicates a more trained approach, which you must be checked off in level 4 secretary.

Sometimes it may seem that the dentist is special friends with a client. The dentist may even say something about making sure we take care of his friend or being sure to schedule this patient right away. The dentist does not mean to suggest that you should not collect money or make financial arrangements with this patient! If the patient tells you, “Oh, Dr. Smith is a friend of mine and he said I didn’t have to pay,” then you should say, “That’s great – let me go and confirm with him exactly what your special financial arrangements are.” Expect that the dentist never said this to the patient – your job is to help the dentist maintain an excellent relationship with the patient – and to always remain “the good guy”. Your job is to collect money and make financial arrangements before the patient gets scheduled, so always do this.

When a client needs a series of appointments and a financial arrangement, handle both at the treatment conference (usually a level 4 secretary). Put one appointment in the schedule and project a second appointment at the preferred time of day and at the interval between appointments indicated on the green treatment flow sheet. This means that when the client has completed the first appointment and is brought to the front desk with the folder all you do is check to make sure there is no change in the next appointment time or procedures and hand them the confirming card. No talk of money or which would be the better time. You are in control. You save yourself much time.

Making Appointments

Be sure to offer the client a choice of 1 morning and 1 afternoon appointment. Don’t ask them:

“When would you like to come in?”
“What’s the most convenient time for you?”
“Would you like to make an appointment?”

One of your primary responsibilities is to keep the schedule filled. Clients will almost all ask for a time after 4:00 p.m. Most will choose one of the times you have offered them. Be positive! State your appointment times in a tone that says I’m sure you’ll take one of these two appointments. Say “The doctor can see you on … Which one would you prefer?” don’t say, “I have an opening….” It’s easier for them to say no to your opening than to the doctor’s schedule. You will have made your life easier! Enter the appointment in the computer, making sure to enter in the correct procedure and Dr. and asst time. Be sure to verify the client’s phone number. If you need to update the phone number, go to client information and update the phone number first, and then enter the appointment in the electronic scheduler in the computer. Don’t forget to give your client an appointment card when you are finished.

If this is a stand – alone appointment (recall cleaning, emergency, etc.) state the fee.

If they have insurance check the computer screen in the family file of Dentrix and ask the client if the employer & insurance information we have is still correct. If the information has changed, be sure to get the correct new information, (new employer or new insurance carrier) and enter it into the computer right then. Don’t rely on other people doing this for you.

Check in the computer to see what their insurance will cover, you can find this by looking in the Ledger, choose options Treatment Plan, then click on the Treatment Presenter.

Try to avoid predeterminations when possible. Sending a predetermination to an insurance company delays treatment for 3-4 weeks. Also, this allows the client to get “out of the mood.” In fact, statistically, 50% of predetermined treatment is not accomplished because the client loses interest. There is seldom a reason to submit an estimate for fillings, a root canal, or a single crown. However, every case involving over $600 of care or when a client firmly requests it should be sent in.

To avoid uncomfortable situations when checking out a client, if a client needs extended payments, have a level 4 secretary help. Tell your client “We have a number of payment arrangements. “Come with me so you’ll be comfortable and I’ll have someone discuss the options with you.”

Other Thoughts

When you have a client who wants to leave a check to be deposited on a later day – put an alert in the computer on the account. The person that deposits the check will delete the alert. This makes sure that no one else in the family will also be asked to make another payment on the same amount. Please realize it is illegal for someone to physically post-date a check, as signing a check on a day that has not yet occurred is fraudulent. If they want to write a check that we are not immediately able to deposit, have the client write today’s date on the check, then put a post-it on the check, as well as putting the alert in the account.

Always encourage clients to pay on the day of service. Tell them how much trouble it saves us. Don’t ask them if they want to pay, because then if they say no, you’re stuck. Ask them, “How would you like to take care of your balance?”

Always inform a client what a fee will be before the treatment is rendered. Crowns, bridges, dentures, TMJ splints etc. should have the fee quoted and an acceptable financial arrangement completed before s/he is scheduled for the initial appointment. The TMJ pillow should be paid for at the time of receipt. It can be returned for full refund if the plastic is left on the pillow.

TMJ splint insurance coverage is difficult to project. Some insurance companies have specific exclusions for TMJ and pay nothing. Have the client give you medical and dental insurance forms if there is TMJ treatment. Make a financial arrangement with your client that assumes the insurance company will pay nothing. Assure your client we will do everything possible to help them get coverage, but make sure that it is possible that they will receive nothing. We will reimburse the client if payment from the insurance company is greater than the amount they owe.

When clients have an abscessed tooth, make sure they understand that the fee they have been quoted is for the root canal only. Later they can decide, with their doctor’s help, how they want to restore the tooth. All bridges should be pre determined with the insurance company before scheduling the appointment, unless the client is prepared to pay the entire amount himself.

_____________________________ ____________________
Secretary Date

Credit or Debit?

Every time someone hands you a credit card, you must ask “Is this credit or debit?” If they say debit, then ask if they would enter their PIN number – just put the credit card processing terminal up on the counter and they can enter it themselves.

1. If it is a debit or check card, we would like to have the patient enter their PIN number as this saves us a considerable amount of money on each transaction. This is an example of what our savings would be: This is the absolute best cost savings for us ever. It is a straight 75 cents, not a percent. For example, if the payment was $500 – the charge to us would be:
a. 8.90 if the patient does not enter his PIN number.
b. 0.75 if the patient does enter his PIN number.
c. Statistics have shown that 80% of patients will enter their PIN number if asked.
2. Ask the patient if they would please enter their PIN number. There is no extra charge to the patient when they enter their PIN number.
3. If they don’t agree, just swipe the card normally.
4. If they do agree then you press the ATM credit key on the terminal. Then swipe the card. Follow the prompts after this – whatever information it asks for. After you have finished your entries, then give the PIN pad to the patient to enter their PIN number, and then press enter.
5. If the PIN pads are used, there will be a separate category on our monthly statement showing these transactions.

Front Desk Collections

Sec says, “Your treatment plan fee is $400, how would you like to take care of that?”
Pt says, “What are my choices?”
Sec says “You can pay in advance and receive a 5% discount if you pay with cash or by check, or a 3% discount if you pay using a major credit card, or one of our treatment coordinators can set up payment options for you – which would you prefer”?

Idea being – Sec can still present options to patients, but if they choose payments, then a higher level secretary will make these arrangements – Higher level sec will work with them to fill out the Care Credit application to get 6 months same as cash, if denied, then will handle w/out having to check with anyone.

CHECKING OUT AT THE FRONT DESK

1. Hand off from back staff or hygienist
2. Say “Hi Tom, I’m Jill & I’ll take care of you today.” Talk to your patient. Compliment their smile if they’ve had any treatment done on their front teeth.
3. Verify underlined treatment in chart is same in the system and set complete.
4. Verify that the doctor noted in the chart is the same as the ledger.
5. Verify current and correct insurance in system and send to queue. Ask the patient: Is __________ insurance still correct for you?
6. Give any applicable discount (senior citizen, etc)
7. Print 2 walk out statements. Give 1 to them and note on your copy the collected amount and any notes of partial payments for the secretary that follows up on insurance. If there is already a balance on the account from a previous collections or write off amount and they don’t pay that in full, place a note on the copy of the walk out statement for the account to get into the collections system faster.
8. If no insurance, collect in full for appointment
9. If insurance, collect their “estimated” portion for appointment
10. Write the treatment total on the treatment sheet with your initials
11. Colored charts signify patient longevity in the practice: Gold 15+ years; Purple 10+ years; Green 5+ years. If any colored chart patient wants special payment arrangements b/c of their longevity then note this on a copy of their walkout statement and give to Jamie.
12. Put in Doctor’s review bin

Quality Control Checklist for the Secretary Team

Chart review
Are there secretary initials?
Does the chart match the ledger?
Does the doctor in the chart match the ledger?
Does the salmon sheet have initials by the next appt date?
Does the future appt have a collections note?

Collections review
Is there a walkout statement for the secretary that follows up on insurance and handles collection for every patient? (Either paid in full or note to f/u on collections)

PT. Info review
1. Address/phone # correct?
2. Employer/Insurance is correct?
3. If new pt. make sure birthdates & SS number is in system.

WHEN FUTURE TREATMENT IS NEEDED:

1. Verify that treatment plan is in Dentrix – use the treatment plan presenter to see insurance estimates.
2. Check the payment table in family file to see how confident we are of our insurance estimate – if the procedure is not listed in the payment table, then reduce the insurance estimate to be conservative.
3. Review collections – Say, “The total fee for this treatment is $700, we estimate your insurance to pay about $300, so that leaves $400 for your portion. How would you like to take care of that?” Always round to the nearest $10 when discussing insurance and their portion, never discuss pennies.
a. Cash, Check or Credit card to Pay in full in advance of appt to receive discount of 3% (if treatment over $250)
b. Pay ½ down to schedule appointment with the other ½ due day of
c. Or, they can speak with a treatment coordinator to discuss monthly payments.
4. Send a PTE for major treatment, especially when you have at least 3 weeks before the appointment, this will confirm our insurance estimate.
5. Look at your schedule for the first available time & say “My first available time for this treatment is ______” Do not ask them when they want to schedule – your goal is to control the schedule & fill open times first.
6. Write the appt date and time on salmon sheet with your initials.
7. Insert a note in to the appt date with the collections arrangements.
8. Print the dentrix tx plan & date & note the collections arrangements, then fold & insert into the left front pocket.
9. Warranty work: all redo’s need to be scheduled with the original doctor or hygienist.

How to handle clients that do not pay their balance in full at the front desk
1. Give your client a walkout statement & show them the amount due.
2. Say, “We usually expect payment at the time of service, but since you can’t pay today, I’ll give you this statement and a stamped, self-addressed envelope for you to mail your payment to us. Can we expect your payment within one week? (Allow client to agree) Great! Then, I’ll make a note that we can expect payment by June 7th”
3. If the client agrees, then print an extra walkout statement & note this date due and give to our collections person.
4. If the client disagrees, then say “So, you feel that it will take you more time to pay this outstanding balance? That’s okay. Let’s work out a financial arrangement that works for you.” (Remember our policy that no more appointments can be scheduled until this balance is paid.)
5. Talk to the client & work out the date we expect to be paid. Write this date & amount & any relevant notes on the walkout statement & put into the file marked “Walkout statements” at the front desk. The administrator of the ideal day is responsible to make sure that every client has a walkout statement in this file by end of day.

Never say, “you can wait to pay until your insurance pays”. Our goal is that from the date of treatment, their balance is paid before 30 days elapses. So you understand our schedule for follow up:
Day 1 – Treatment
Day 7 – We expect payment of the non-insurance portion (this is from the secretary conversation at the desk)
Day 9 – Our 1st phone call
Day 10 – Mail our 1st collection letter
Day 17 – We expect payment (this is from the date due on the letter)
Day 19 – Our 2nd phone call
Day 20 – Mail 2nd collection letter (this threatens us sending them to the collection agency and is sent by registered mail)
Day 27 – We expect payment (this is from the date due on the 2nd letter)
Day 29 – Collection person brings this account to her meeting with the dentist to decide whether to send it to the collections agency or to write it off.

The reason we must complete this entire collections process within 30 days is that statistically, we will not collect almost 15% of the accounts once they are overdue by 30 days. So, you can see, that if we wait for insurance to pay – this takes from 2-4 weeks alone! We lose the first 30 days and significantly reduce our chances of collecting. In fact, if we lose 30 days waiting on insurance and another 30 days for our collection process, statistics show that we will only collect 87% of the amount due after 60 days!

The Dr. may say “Go ahead and work out flexible financial arrangements for this patient” or he may tell the patient while in the chair, “Don’t worry, I know our secretaries can work out a financial arrangement that works for you” – What he is expecting is for you to still follow the guidelines of our financial policies. He is maintaining a relationship with the patient, and knows that you’re responsibility is to make solid financial arrangements. If the patient feels that Dr. meant that they deserved special treatment (and therefore could pay us whenever they feel like it without making a financial arrangement) its best to get a treatment coordinator (lev3+ secretary) involved and if need be, then ask Dr. to come into this conversation.

When serving a client, avoid these “no” statements that upset anyone:
1. Our policy is
2. You’ll have to call back because
3. That’s not my responsibility
4. We’ve never done it that way
5. You must be mistaken
6. Most of our patients like it done that way
7. I don’t see why that’s a problem for you

One of your most difficult and emotionally uncomfortable tasks will be to ask for payment at the end of appointments. Although you won’t find money to be the driving force of our practice, it is obviously important. About 40% of our monthly collections come from insurance, 50% should be paid at the time of service and another 10% is billed to the client. We collect about 98% of the amount that is billed. This 2% amounts to $15 $20,000 per year. Add to this the labor and material necessary to send the statements ($3100 $3500 per year) and worst of all, the time and long distance calls and correspondence used to try to collect past due accounts (another $3100 $3500 per year) and you get a grand total of $24 $30,000 lost annually.

These statistics show the value of collection at the time of service.
Paid by % collected
30 days 93.8%
90 days 73.6%
180 days 57.8%
365 days 26.6%
Some of this expense is unavoidable, but you can limit it by asking for the fee at the time of service. When the client is escorted to the front desk say “The fee for today’s appointment is _______. How would you like to take care of this today?” If your client hesitates, make sure s/he knows what the payment is for. It’s hard for a client to value treatment that’s not understood. If you can’t explain it clearly, ask a chairside assistant to help you. NEVER say “Would you like to pay today?”

Eliminate Pay As You Go

The easiest (and least effective) payment “plan” is pay as you go. The clients come out. You tell them the fee. They tell you what they will pay. Done. However, there are some problems

1. Some are surprised by the size of the fee.
2. Some don’t pay and end up as a collection problem.
3. Some don’t show on the day of their treatment since they can’t afford to pay.

Our rule of thumb is:

NEVER APPOINT A CLIENT FOR SIGNIFICANT TREATMENT UNLESS YOU HAVE QUOTED THE FEE, THEY HAVE PAID A PORTION AND YOU KNOW HOW THEY INTEND TO PAY THE REMAINDER.

Your body language is as important as what you say. Watch that you:
1. Maintain direct eye contact.
2. Sit or stand erect.
3. Speak clearly.
4. Sound confident.

Credit Cards
By 1992, 55% of dentists accepted credit cards. Although it costs us a 1.8% service fee when a client pays by credit card, we are paid within days and this avoids sending statements or, worse, having a collection problem
When the client pays with cash, give him a written receipt. The receipt books are located ____________________________________. The client gets the original and we keep the copy. Even if the client says “I don’t want/or need a receipt,” make one out anyway for our records, and if he still doesn’t want it, throw the original away, and our copy is kept in the book. Also, make sure that you fill out a cash receipt, date, name, account number and amount received. Paper clip this receipt to the money and put it in the locked cash box. All credit card transactions are conveniently handled on our electronic terminal.

Electronic Terminal
1. Swipe the card in the “reader” slot. If the black magnetic stripe is unreadable, key in: patient’s card account number (enter), card expiration date (enter), amount due (enter)
2. After the transaction approval code is displayed, have the patient sign the receipt. If the transaction is declined, ask if the patient has another card.
3. Give the patient the CUSTOMER copy. Keep the remaining copy on file in accordance with your merchant contract.

Write off or Collections Client

If a family has been written off or sent to collections:
1. the billing type will be either “9” (collections) or “10” (write off)
2. there will be an alert for each family member that indicates that they were either written off (with the date and amount) or sent to collections (with the date and amount)

3. you are to check the system (Dentrix) BEFORE scheduling anyone in the family
a. check the billing type on the family ledger screen or the family file screen
b. the amount due will still show as the balance
c. an “8” means bad debt, at risk – this means that the family charts have been pulled and are in the collection secretary’s office to prepare to meet with Dr to determine if they are to be written off or sent to collections
d. a “9” means bad debt, sent to collections – charts have been broken down
e. a “10” means bad debt, written off – charts are re-filed

4. families with write off balances are to pay that balance off at that 1st scheduled appointment
5. families sent to collections are to pay that balance off PRIOR to making any appointment
6. Exception – they call in for an appointment because they are in pain – then you can schedule for emergency exam but let them know (and the back staff/DDS) that there is a past balance that must be taken care of before any treatment is done
7. Transfer to the collections secretary when questions about the account, going on a contract or insurance
8. Transfer to the office manager when a PR problem

Warranty:
When a treatment is done that is under warranty, it will be noted on the yellow treatment sheet with a W with a circle around it. This means you will go ahead and charge out for the DDS who did the redo work and then enter a warranty adjustment. The treatment covered under warranty should be done by the original treating provider. If it is not, the new provider will get the amount of the treatment adjusted off of their production.

To enter the warranty adjustment: Go to the ledger, click adjustment, choose warranty credit, put in the name of the DDS who did today’s work (should be the original dentist), make a note of the date of the original treatment, what the original treatment was, who did the original treatment, and your initials, and click okay. Do not send the warranty treatment to insurance.

If you have any questions or are simply unsure about handling a warranty, please let your dentist know so she can confirm that things are charged out correctly.

Co Pays and Deductibles
Even though clients have insurance, they will still need to pay part of the fee themselves. All co-pays and deductibles are due on the day of treatment. If these fees aren’t paid, they should be handled exactly like an open account. If you’ve added a new insurance plan to the system, change the expected % from 80% to 50% on restorations since we do not know the coverage for ones new plan.

Courtesy Adjustment
If the client qualifies for a reduced fee (5% discount for avoiding billing, or 1.00 off for paying on day of service, etc.), don’t use the term “discount.” It sounds cheap. Use either “professional courtesy” or “bookkeeper’s allowance.” Always say “fee” rather than cost, charge or expense. If the amount is over 1000.00 you may want to call it an investment.

Excuses
If the client says, “The doctor said I didn’t have to pay today.” Check with the doctor.

If your client says, “My insurance covers it!” don’t accept this. You can say, “That’s wonderful, Mrs. Boring! However, most insurance only covers part of the treatment. Let me look up your company’s profile in the computer just to make sure. I wouldn’t want you to be disappointed!”

Protecting us
Don’t allow the client to leave and be billed. Go ahead and print out a walkout statement. Put this in a stamped, addressed envelope and give it to the client. You can say, “Here, Mrs. Boring. You can help us keep our costs down if you would just send your payment to us this week. Every little bit helps!”

Never make an appointment for a crown, root canal, TMJ, splint or any procedure that will cost more than $100 without estimating the cost for the client and making a financial arrangement, using the green sheets kept on the shelves above each desk. If you aren’t checked out on this procedure, have someone else do it for you.

Interruptions
If the phone rings while you are with this client, ask another secretary to answer it. Focus on the client. If no one else is available, you’ll have to excuse yourself and answer the phone, but realize that this isn’t ideal.

Current Financial Status
Make sure the account is up to date. Have they been a collection problem in the past (requiring payment today)? Do they have an existing contract that will need to be added to? Has their dental insurance recently been changed or dropped? Have they “no showed” for previous appointments?

Financial Arrangements
As a level 1 secretary, you neither have the time, the training or the location to discuss extended payment plans with a client. Acknowledge to your client that we have ways to extend payments, excuse yourself, and alert a level 3 or higher secretary that your client wants financial arrangements. She will escort the client to the financial arrangements room to discuss our extended payment options.

No Credit Allowed
This is a very uncomfortable situation, but you must protect the office and avoid a collection headache! Try saying this “Mrs. Cox, in reviewing your history with us, I see that we’ve had to send you several cards and make several phone calls to remind you send your payment in. If we are going to be able to treat you in the future you’ll have to help us by paying for your treatment on the day of the service. Here’s your statement, I’ll make a note that we can expect your payment by __(1 week)__. I hope you’ll help us so we can continue meeting your dental needs.

Now is the time to become comfortable with money. As your career develops, you will be given more and more monetary responsibilities.

When you have developed the habit of asking for payment, have the task verified by a secretary at level 3 or above who is working with you.

Here are a few stereotypical examples of people who could be a collection problem. Sometimes these people will have several of these characteristics:
a. Unemployed, or they are kind of fuzzy, “just started working for..”
b. No business phone, and maybe no home phone.
c. Live in an apartment, move around a lot.
d. Motel, boarding house, friend’s house, etc.
e. Changes doctors frequently
f. Doesn’t want us to ask for records
g. No insurance
h. Leaves blanks on client information form
i. Answers on client information form aren’t clear
j. Self employed
k. Says worker’s compensation will cover
l. Single clients 18 22

“Just Bill Me”
Please say “Mr. Jenkins, in order to reduce our costs and keep your fees down, we like to send as few statements as possible. Our computer makes it possible for us to estimate the insurance payment right now. In fact, we estimate your portion to be $______. Would you prefer to pay by cash, check, or credit card?”

If your client is still adamant that he wants a statement, go ahead and give him the computer read out. “Mr. Jones, here is your statement and an envelope for your payment. Is this okay with you?” If yes, then, “I’ll make a note that we can expect your payment by (ten days). Is that okay?” If no, then, “I certainly don’t want to make you uncomfortable, but in the future if you could help us keep our costs down, I’d appreciate it.” Give the collections secretary a copy of statement with payment date noted so she can follow-up.

“I’ll be getting my income tax return monies soon”

Please say “Mrs Jenkins, that’s great. We will be able to schedule that next appointment for you when we’ve received your down-payment. I’ll put it in my day-planner to follow-up with you – when do you think you will receive your income tax return monies?”

Then be sure to put into your planner (or the day box) to call her to follow-up on the appointment. Put notes in the system for the unscheduled treatment secretary.

DISCOUNTS
We have a new patient discount for new clients. If an existing client wants to use this discount, you can say, “This is an introductory fee to be offered only to our clients on their first appointment with us, but you’ve been such an excellent client that I’d be glad to reduce your fee 10.00 just because we enjoy having you in. Don’t tell anybody about this, okay?”

It’s important that your client be asked to pay in a professional manner. Here are some suggestions:
1. If the client has any questions, bring them into the small conference room to privately discuss their concerns. Keep this room relatively clutter free.
2. Keep a stack of stamped self addressed envelopes to give to clients to send in their payments.
3. Keep the counter stacked with a current calendar, appointment cards, and welcoming brochures.
4. Spread clients out along the counter as much as possible. Speak clearly, but quietly so others won’t hear.

If the client becomes upset over the fee, don’t try to justify. Use one of the following phrases and get help from one of the more experienced staff.
1. “I can understand how that would upset you. Please tell me what happened.” (Take
notes)
2. “Thanks for bringing this to my attention. Let me see what I can do to help.”
3. “So that you are never inconvenienced in this way again, may I suggest . . . ”
4. “That’s a good point. Let me discuss this with Dr _______ and I’ll get back with you
tomorrow.”
5. “What would you like me to do to correct this for you?”

You must enter a note in the appointment for your patient that records their financial arrangement decision. For example, if a patient is scheduled for a crown, a note in their appt might say “Paid in full, give 5% discount at appt. JN” – then if you were checking out the patient, you would know to give them the discount & that everything else had been paid.

Part of the secretary team’s ideal day is to check the appointments (generally $250 or more) to make sure there is a financial arrangement note in each expensive appointment. If there is no note, then you need to call the patient to confirm what treatment they are expecting at that appointment and make a note of how they prefer to handle the fee.

The script for this call is: Hi, this is Jill with HealthPark Dentistry, I am reviewing our upcoming appointments and wanted to confirm your treatment with Dr. Smith on Tuesday at 9:00am to make sure you do not have any questions about your treatment or finances. You can reach me at 667-2417.

If you leave this message, then enter this note in the appointment “3/3/05 – lmom re FAs. JN”

Calculates correct discount
We offer a cash discount for our patients that pay in full in advance of their appointment. They receive a 3% discount for paying with a credit card and 5% for paying with a check. The sequence of events is:
1. You discuss financial arrangements with the patient & they decide to take advantage of the pay in full discount.
2. We calculate their pay in full discount and their portion.
3. They pay us.
4. We enter the pay in full discount in their ledger.
5. The patient comes in for their appointment.
6. You print a walkout statement for them – it will show the payment they made, the fees from their dentistry and your discount – then, for clients with insurance it will show the insurance outstanding only.

Steps to follow to handle a Pay in Full Discount:
1. Print the dentrix treatment plan
2. Ask the patient how they plan to pay in full (Check for 5% or Credit card for 3%).
3. Write at the bottom of the Dentrix Tx plan – To pay in full by Check to receive 5% discount.
4. Write the patient portion (not the total fee for clients who have insurance) – for ex. $735
5. Write the % discount ($735 x 5%) = $36.75
6. Subtract to find the amount the patient should pay ($735 – 36.75) = $698.25

Here’s how this should look:
$735 Your portion
– 5% discount ($36.75)
= $698.25 Amount to write check for

7. Accept their payment – by check or credit card – run the amount after the discount is given.
8. In the ledger, select Transaction, Enter adjustment – this brings up a box to choose from.
9. Select Cash Discount from the list, Type in the amount of the discount, Select the provider that you will be scheduling the treatment with, Select the family member. Click okay
10. Keep the Dentrix tx plan folded in the front left pocket of the chart.

To automatically calculate this discount in Dentrix
(For patients who do not have insurance only):
1. After you set the appointment complete in the appointment book
2. Go to the ledger and click fast checkout button
3. Then click on the calculator icon – “Enter Tax/Discount”
4. Select the cash discount you want
5. Select who to Calculate for – Current patient, Entire family or Selected procedures – Most of the time you will select Current patient.
6. Select the provider (who you are charging out for today)
7. Click okay
8. This automatically calculates the discount for you.

WALK-OUT STATEMENTS

We’ve mentioned walk-out statements through out this section. That you make 2 copies – 1 for the client and 1 for the collections secretary. Her copy is to have notes about what was collected at that appointment whether in full or partially and when we can expect the balance. The greeter reviews the walk-out statements to see who has paid their portion in full, paid only a portion or who has not paid. She gives all those that didn’t pay their portion in full to the collections secretary as well as any walk-out statements that have notes from the secretaries. She then reviews why and places the walk-out statement in the 1-31 day book for follow-up. When the client pays the balance as agreed, she removes the walk-out statement from the 1-31 day book and it’s shredded. If the client does not pay the balance as agreed, then the collections/write-off process is begun (as outlined in Level 5 Secretary).

Part of the collections/write-off process in Level 5 Secretary entails a weekly meeting with Dr to determine which clients should be written off or sent to collection agency. Dr has requested that each client’s chart be reviewed to determine the reason for non-payment on the account. This requires using not only the chart but the appointment book and walk-out statement notes to get a complete picture of the reason for non-payment. This can then determine if the secretary that checked out the client needs to be coached on how she collected money at time of checkout or before scheduling the client’s treatment appointment.

Dr and the collections secretary use the walk-out statements at their weekly meeting to help determine if the client should be sent to collections or it the account will only be written off.

The collections secretary passes out the weekly report to each of the Doctors and the secretary team. They are to review each of the client’s collection stories. The secretaries bring their copy with questions to the next secretary team meeting to discuss the coaching directives.

A sample copy of this report is in the sleeve at the end of this section.

Asks for payment at end of appointment. I have found that ____________________ routinely asks for payment at the end of client’s appointments.

Anytime a client needs to spread cost over time, refer to a senior secretary for a financial arrangement

Can answer basic insurance questions
-Listens to insurance tape
-Creates tape explaining insurance to clients

_____________________________ ____________________
Collections Secretary                                           Date

_____________________________ ___________________
Dentist                                                                     Date