Practice Rescue: 5 ways to decrease your accounts receivable

Practice Rescue: 5 ways to decrease your accounts receivable

By Jill Shue, contributing writer


January 4, 2018 — Is your practice thriving at the level you’d like, or are you looking for some help in a specific area? That’s where you need a Practice Rescue. Jill Shue of Custom Dental Solutions offers practical solutions gathered from years of experience with practices like yours.

Does this scenario sound familiar? Patients are frustrated with financial surprises when they receive their bills. This leads to unhappy patients, your team having to constantly make difficult collection calls, and a decrease in cash flow. What can you do to decrease your patient accounts receivable?

  1. Educate and inform

Many patients are not aware that dental insurances are only a benefit or a contribution, not a guarantee of payment. Instead, they expect their insurance to cover everything.

Patients must be told that they are responsible for the full balance, regardless of the contribution from their insurance. Your patients do not know the costs of procedures, nor do they know the expectations of when payment is due, unless you or your team tells them.

When presenting financial information to patients (we’ve found that this information should be presented before their scheduled appointment), make sure you provide them with three items:

  • The total fee
  • Their estimated out-of-pocket cost
  • Their estimated portion due on the day services are rendered

This presentation should be provided in writing and stated in a way your patients will understand. This may mean that you will need to alter your templates and printed presentation.

  1. Options

While we recommend that you offer financing options to your patients, don’t force yourself into being a bank. Present two or three companies (CareCreditLendingClub, and the like) that patients may use to assist in paying their dental bills.

If they are unable to make a payment in full, it does not mean they must forego treatment. Show them the available options to split up their payments to make them more affordable. Being able to offer your patients options will increase your case acceptance as well.

  1. Scripting and team approach

Your clinical and administrative teams must use the same terminology. The entire team should know which phrases to use and which to avoid.

“Being able to offer your patients options will increase your case acceptance as well.”

“We’ll bill you” cannot be an option if you expect to lower your accounts receivable. When was the last time you went to a grocery store and had the option to be billed?

Your patient has received a service and is expecting to make a payment. If you don’t ask for payment, how will he or she know what is expected?

Use language like the following: “Your estimated out of pocket is $500. We’ll send the remaining balance to your insurance for their consideration. Should there be anything remaining, we will send you a statement.”

When collecting payment, do not ask if the patient would like to make a payment; instead say, “How would you like to pay today: check or card?” Never assume a patient is unable to pay.

Whichever scripting you use, speak confidently and concisely. If you are asking a question, be sure the patient responds. Don’t let the silence win. Your patient, at this point, should have already been informed of the costs and expectations.

  1. Systems and consistency

Create a protocol and timeline for collecting accounts. Send statements every 10 to 15 days for outstanding accounts (avoid the conventional 30-day billing cycles) — the more frequent the better.

How many statements will patients receive before they get a “warning” letter? How many letters will they receive before the account is turned over to an attorney or collection agency? Your patients must receive consistent statements each month with eventual escalations for you to be successful in obtaining payment.

  1. Be kind

At the end of the day, remember to be kind. Kindness truly does go a long way. You are providing your patients with financial information prior to them having work completed as a courtesy, so they know what to expect. You are not giving them this information because you are a money-hungry dentist. While, yes, we do have a business to run and jobs to do, we genuinely care about our patients and their well-being. When a patient sees that you care, you generate value, respect, and loyalty from that patient.

Collecting payments does not have to be a dreaded task. If it’s done with each appointment, you will have fewer of these frustrating duties and will be able to focus your attention on taking care of your patients. After all, you did not choose this profession to hound patients for money.

Jill Shue is the administrative and insurance lead trainer for Custom Dental Solutions. She can be reached at

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.


Are you Hiring Smart??

Are you hiring Smart?
is your hiring process going?  Are you
finding the best of the best to work for your dental office? It is true the war
for talent is getting more challenging, but who are you attracting?
initial job posting will express your culture. 
For instance, if you are a fun office and want to add a positive person
with a high sense of humor, make sure to use words that contain high energy and
fun!  If you want to attract a dental
hygienist with a strong interest in professional growth and adding new patient
treatment options; offer continuing education reimbursements and incentives.
the words of Steve Jobs, “It doesn’t make sense to hire smart people and tell
them what to do; we hire smart people so they can tell us what to do.”

Holiday Ho-Down

Holiday Ho-down
Happy Holidays!  It is
the most wonderful time of the year!  No
doubt you have made your plans for the Office Christmas party and discussed
with the accountant the bonus amount you are handing out to your team.  A few thoughts on this time:  Be sure to invite the team to the dinner or activity.  If this event is required, then an hourly
wage expectation should be fulfilled. I advise the holiday gathering be a
non-mandatory event there so no expectation of being paid an hourly wage.  It is also a personal touch of sincere
appreciation to physically hand each employee their bonus envelope.  Please verbalize how they make your practice
better and how you look forward to working together in 2018!  Merry Christmas and Happy New Year!
~ Corey

Is constant employee turnover dooming your office?

Image result for employee turnover

Building the right team is the goal of every dental office. You make the effort to screen applicants and implement the best interviewing techniques, but is the dream team you are seeking falling apart? Are there any great employees left out there? Is there a way to prevent hiring the wrong person for the job?

Prior to working with offices in business solutions and training, I owned a dental staffing company. I heard the woes of dentists and managers who simply felt hopeless that they would find permanent, stable, qualified employees for their practices.

A few of my clients mentioned they used personality profiles as part of the interview process to save time and effort, so I decided to check them out and use them myself. If many large, successful businesses use profile screenings, why couldn’t a dental office?

A retired dentist from Florida told me he used a “surefire way” of hiring and kept most of the same team for 30 years by using the “personality shapes assessment.” This simple test asks each person to write down the first shape that comes to mind: a circle, square, triangle, or squiggly line. Each shape shows what type of personality you are and facts about you. For example, the square shows you are detail-oriented, logical, and dependable.

Several options

There are several companies that offer personality profile tests and analysts for employers to use. The DiSC (dominance, influence, steadiness, and conscientiousness) assessment, Myers-Briggs type indicator, Kolbe test, and Culture Index are just a few of the profile tests available. Each has a unique set of questions to assess personality style on various levels. Some studies indicate that a personality test coupled with an intelligence test is the most accurate method, whereas most human resources experts agree the personality test is simply a good tool when looking through the candidate pool.

Implementing a personality test may be an easy solution to finding the characteristics you are seeking. Let’s say you would like a fast-paced, experienced dental assistant for your busy practice. Wouldn’t you want to know before you wasted interview time if the interested assistants naturally possessed a fast-paced quality? The Culture Index assesses several qualities including the level of natural energy and speed at which the individual likes to work.

A large general private practice in Michigan uses the Kolbe test when interviewing all potential candidates. They then use color-coding on the employee’s name tag to remind co-workers how that person prefers communication and information. The doctor told me it changed the atmosphere in the practice so much that the teamwork and growth have been more than he could have imagined.

I use DiSC most commonly with my clients. It is an easy test, and it has a fun feature where it shows the entire team’s personalities on a graph. It enhances the communication environment of an office and helps convey both the values of individuals and how they like to work.

At war

Recently, I worked with an office where the administration managers and the hygiene department were at war with the schedule. After completion of the DiSC test, there was an understanding of why the groups communicated and valued the topic the way they did. With much laughter, both groups were able to reach a solution for addressing the hygiene schedule logically.

“If your team turns over regularly or employee disunity is a stressor for you, I encourage you to try a personality profile exercise.”

So, are personality profiles a magic bullet? Our science brains want to know if they are accurate and if it is even legal to request that employees/potential employees complete the test. To be fair, experts in personality profiling differ on the substance of the personality test; however, there are studies out there to support the use of these tests from many standpoints.

If your team turns over regularly or employee disunity is a stressor for you, I encourage you to try a personality profile exercise. Perhaps you will discover that there are individuals in the wrong positions or reveal areas within the practice that need to be addressed.

It is important that this be presented as a tool or an option for the team to take. If someone feels they were eliminated or prevented from being offered a job solely because of a personality profile, it may legally become a discrimination concern.

Regardless of the personality profile you choose, I believe it is not the end all to hiring. It is simply a tool to facilitate better understanding and communication and even to help find the best fit for the position you are looking to fill.


Are the holes in your schedule haunting you?

It’s that time of the year again with lighter schedules, last-minute patient cancellations, and the dreaded no-shows, which means team members walking around the office acting like zombies and seeking “something to do.”

There will be holes in your schedule if you allow the following five devaluing phrases said to patients and attitudes into your practice:

  1. “Do you want to reschedule?”
  2. “What time works?”
  3. “If you can’t make it, no problem. Just give us a call.”
  4. “You can wait to have that procedure until next year.”
  5. “Do you want to just call us?”

It is the entire dental team’s responsibility to prevent the scheduling holes and evaluate how the scheduling communication is occurring. The commitment to patient retention and engagement while desiring full schedules at all times should be the obvious office goal. Being aware to “create the appointment demand” and to “build off the schedule” will lead your patients to respect their appointed time, and your day will end with a successful and productive schedule.

Best practices

The best way to implement the expectation that appointments are to be scheduled in advanced is to start with new patients. The new-patient letter should detail your appointment expectations and how you provide reserved appointment times as a courtesy to the patient’s schedule.

“It is the entire dental team’s responsibility to prevent the scheduling holes and evaluate how the scheduling communication is occurring.”

Establish the scheduling of the next appointment as the norm by leading all patients into scheduling at the patient walkout/dismissal. In a friendly tone with the importance of their time emphasized, ask your patients, “Now, let’s get you scheduled for your next visit. Do you prefer a morning or an afternoon appointment?”

Once the first appointment of the day is established, build off your schedule by offering the best fit for your patient’s request while simultaneously filling your schedule.

Get into the habit of knowing your patients’ work and personal schedules, so it is easier to lead the appointment conversation. Someone who is a stay-at-home parent or a retiree may have a more flexible daily schedule and could be scheduled at those hard-to-fill appointments times, such as 10 a.m. or 2 p.m.

Building off the most popular times is the best way to fill your day. For example, if you look at a certain day and notice your 7 a.m. and 4 p.m. slots are already filled by consistently reliable patients, offer the 8 a.m. and 3 p.m. and so forth.

Time frames

Continue to set patterns by scheduling patients in the same time frame. For example, keeping the continuing care appointments the same day and same time six months apart will establish the long-term date, such as creating the standard Tuesdays at 11 a.m.

Setting a behavior pattern also ensures a more successful remembrance by patients and makes a cancel or no-show less likely. You can also use a third-party system, such as Solutionreach or Lighthouse 360, to kindly remind patients of their scheduled appointment time, while meeting the patients’ preferred electronic communication style.

Emphasizing the “busyness” of your office schedule is important. Whether you are incredibly busy or not, it doesn’t matter. It’s important to create the demand and teach patients to understand how important their reserved appointment time is. They should understand that it may be challenging to get another visit scheduled with their favorite hygienist if they cancel.

Options for scheduling

Your team has to let patients know the standard in the office is scheduling hygiene visits. Remind them that the office does this for all patients as a courtesy so that the most convenient time for the patient can be secured.

The following are good options for moving the conversation forward:

  • “We can always follow up and can provide a reminder if you need one.”
  • “Let’s get you scheduled, and then would you please kindly check your schedule and call me back tomorrow if that date and time does not work for you?”
  • “I would be happy to call/text/email you tomorrow. When would be a good time to discuss your appointment?”

When patients say, “I don’t know where I’ll be in six months,” your staff can say something playful, such as, “I know where you will be. Here again with me, same place, same time. Now let’s get you scheduled.”

No matter the scheduling conversation, it is imperative the clinical and administrative teams communicate through both detailed chart notes and verbally with the patient at the end of the visit. This will ensure excellent customer care and that no questions are left unanswered.

Because you value and respect your patients’ time, teaching them the value of respecting the scheduled appointment will prove to be an effective way to diminish the holes from your schedule.


3 reasons why your associate isn’t producing

Image result for frustrated dentist

You’ve hired an associate for your practice. Congratulations! There have been newsletter announcements, patient meet-and-greet events, and practice specials for any treatment given by the new dentist.

You believe you have set up the new dentist for success, but the only problem is this new dentist is not producing like you do. This is frustrating, as you see the production numbers decrease and your dreams of more free time fade. Let’s explore three reasons why your associate is not like you.

  1. Lack of instruction

Most offices have protocols and systems established for what constitutes standards of care and treatment. Most likely, you have spent years putting the perfect system and management theories in place. The new associate may simply not have your experience, and he or she really needs your mentoring.

The most important exam a dental office can give is the new patient exam. This time is set aside for the dentist and team to take a complete medical history, take intra- and extraoral photos, obtain radiographs, and complete charting and assessments in service of preparing a recommendation for treatment. The financial and insurance team members are also collecting data to give the patient, so they have informed information when pursuing treatment. This is where most dental practices make the most production.

You begin to notice that the new patient exam is not producing the treatment that you are used to seeing with new patients. When you check the radiographs and chart notes, you see many deficiencies, as well as details missed by the associate. Perhaps the patient’s chief complaint was not addressed, and the four-surface resin planned for treatment should have been a crown.

At this point, take the time to sit down with the associate and go step by step through the photos and radiographs. Show him or her what to look for, and how not to be afraid to give the best dental treatment plan for the patient.

Depending on what environment this new associate is from, the dental school or previous office may not have had the same technology as your practice, so he or she simply may not be aware that you can do same-day Cerec crowns in your office, or that you keep all endodontic and simple extractions in house. The person needs to be taught these systems and your office protocols. Do not expect the associate to know how to do dentistry the way you do.

  1. Lack of confidence

“The new associate may simply not have your experience and really needs your mentoring.”

Because of a lack of exposure and education, the new associate may lack the confidence to do many of the procedures you do regularly. Take the time to have him or her not only watch but be involved with the simple extractions you do, or give the associate the easier root canal treatments so he or she can continue to become experienced with bigger production cases. Offer hands-on courses for the associate and allow enough time to learn the clinical systems.

It is also a great idea to have the new dentist role-play patient conversations with you or with the treatment coordinator. This will help the associate become more confident with interactions and patient-level terms. Continue to encourage the positive, and show the team members how to look to the associate as a leader in the practice as well. This will reflect on how patients perceive the new dentist and their level of comfort in seeing a new provider.

  1. Does not share your philosophy

Studies show that people are on their best behavior for 30 days on the job, thus the reason for a 90-day review. You selected this associate for a reason. Did the person wow you in the interview process, only for you to discover that he or she does not seem to accomplish what was discussed? Perhaps you have found that the associate undersells to the patient or does not work well with your team. Does the person seem engaged and excited to be a part of your organization, or does he or she seem frustrated and bored?

If it’s within the review period, it is acceptable to cease the contract and go your separate ways, should philosophical differences be the reason for a lack of production and engagement.

Remember, if you are seeking a high-producing associate, a personality trait that should be sought after is one with a business spirit with a touch of sales. If this is what you seek, the new associate will be set up for success, and your dream of slowing down in the practice will be a reality. Good luck!


3 practice and retirement strategies to consider

So, you’ve been thinking about retirement and reflecting on all you’ve done to build a

Image result for retirementfantastic practice. Is it time to bring in an associate? Perhaps sell the practice to a competitor or a corporate chain? Maybe even consider bringing your practice to a graceful end?

Many questions need to be considered as you determine which option suits you best.

  1. Hiring an associate

Many doctors feel hopeless when they start interviewing a potential associate who may purchase the practice. It is challenging to emotionally disconnect from the business they have worked so hard to build and prepare it to become a sellable business. There is much concern about with whom and how to leave the patients and the dental team, as well as how to assess the actual value of the practice, including but not limited to the patient records, equipment, and building.

Many decisions need to be made in regard to an associate’s salary. Do you hire the associate as an employee with a daily or hourly wage? Do you have a sweat-equity plan in place as the associate is compensated from a percentage of production or collections? Perhaps the associate buys in immediately, and you agree to stay for a certain amount of time before riding off into the sunset. The negotiations and possibilities are endless.

Unlike the nonencouragement old-school education approach most baby boomers received in dental school, millennials are told how wonderful and valuable they are to the dental community, sometimes skewing a realistic view of their financial worth prior to proving work ethic and commitment to a potential practice. Several dentists have expressed that this is one of the biggest barriers to obtaining the right associate fit.

  1. Selling your practice

In the Midwest, a dentist is looking for a favorable exit plan, but he feels frustrated with what he thinks are the unreasonable upfront compensation requests from new dental graduates.

“It is challenging to emotionally disconnect from the business they have worked so hard to build and prepare it to become a sellable business.”

Dr. Howard practices near the Iowa/Minnesota boarder and stated, “In our area, new graduates are being told by their dental school-appointed financial advisors to ask for $150,000 to $200,000-plus as a starting annual salary (32-hour workweek) along with full insurance coverage, 401(k), vacation, and continuing education per diem.”

“Twenty-nine years ago, my wife and I both worked 40-plus hours a week for several years to pay off my dental school student loans, while building a practice from scratch,” he said. “It was our hard work that brought us to the point of considering bringing on an associate, so we can cut back on clinical days, but the gamble and price tag is too steep.”

Dr. Howard is now looking toward getting his accounting and assets in order to sell to an existing practice of an experienced younger dentist a few miles down the road that desires more growth.

Dentists like the one interested in purchasing Dr. Howard’s private practice are, in my experience, part of an evolving trend who either want to “fight the invasion of corporate dentistry” or create their own private practice chain for maximal financial potential and eventual sale. These forward-thinking dentists are focused on obtaining the optimal “dream team” style of dentistry and pride themselves in excelling with customer care and the latest patient treatment options.

For some existing practice owners, another option is the corporate or large group investor.

Corporate dentistry is not the big bad wolf for many sellers. With the average dentist practicing 35 years, some are simply tired and want the least amount of hassle as they end their careers. Corporate dental buyouts often offer consistent, proven transition plans and top-dollar price tags. Some dentists stay on with the new owners and enjoy employee status, while assisting with the transition.

  1. Closing up shop

The last option for retirement is simply coasting to the finish line. It often begins by not accepting new patients and not proposing extensive treatment plans. Often, the dentist is doing “patch-work dentistry” and changing the practice hours to part time, while tentatively targeting a date to close up shop. ADA legal guidelines need to be adhered to if this is your plan. As always, consult your practice attorney and refer to the “Guide to Closing a Dental Practice” on the ADA website.

Whichever “break out” option you decide is the best fit for you, please seek out a reputable practice transitions consultant and legal counsel prior to any contract negotiations.