Accounts Receivable. Just the mention of the term raises our blood pressure on both sides of the slash! But it doesn’t need to. A couple years back I visited the practice of a dentist friend to whom I had recommended his Office Manager. I asked to see her insurance A/R report for everything over 30. And there it was. One page. One claim. Who says you can’t whittle down that report to next to nothing?
There are only two reasons your practice has aged accounts.
Reason # 1. We didn’t collect an appropriate amount at checkout.
Sounds simple, doesn’t it. When your patients go to the grocery store, they pay the correct amount. When they go out to eat, they pay the correct amount plus a tip. When they go shopping, they pay the correct amount.
For several years I worked with private dentists in the UK and Ireland (not the government, NHS variety). These were dentists who largely were Pankey-trained, Dawson-trained and LVI-trained. They came to America to gain the best clinical training in the world. But there was one thing they did not need to be trained to do: collect money. When a patient visits the dentist in England, Scotland, Ireland and Wales, they pay for their services on the day of the appointment. The key reason they can do this is because there was no insurance to cloud the picture or get in the way.
Not so here in the States. We’re not sure if the deductible applies or we’re not sure if they’ve met their deductible. Was the surgical extraction at 80% or was it at 50%? Will the LImited Exam be covered for non-trauma situations? The patient makes a wild guess at when her existing crown was placed and we think that replacement might be covered. It turns out that it isn’t. Maybe I should have collected the entire fee.
In most cases, we’re going to ask the patient for more money or we’re going to write them a refund check at the end of the month. Imagine the grocery store or main street diner operating that way.
Reason # 2. We expect insurance to reimburse something that it won’t.
The second reason often relates to the first. If the crown won’t be replaced and I know it, then I collect the full fee on the prep date. If the surgical extraction will reimburse only 50% of the surgical extraction of #12, then I collect $86, not the $34.40 I would have collected if it was 80%.
Or it could be more complicated because of carrier-specific processing guidelines. Can I do four quads of SRP on a single date of service and what documentation do I need to provide? Will the composite on #30 be downgraded or will it be reimbursed at the 2391 fee? Will the plan cover debridement under any circumstances at all. And how about the occlusal guard – covered? not covered? only after osseous surgery? only for bruxism?
Making Matters Worse. If I didn’t get the documentation right or didn’t send the claim to the correct electronic payor ID, then we go around in circles at least 3 more weeks. If it takes a while to get the documentation we need, then it’s 6-8 weeks before most practices will bill the patient. By that time, the patient has pulled together all his disposable income to put a deposit on a beach house for Memorial Day weekend.
One Way to Solve Both Problems:
And only one way.
Get a comprehensive benefit breakdown, with processing guidelines, eligibility and history before the patient’s first appointment… and use it!
Collecting an appropriate patient portion requires such a breakdown. The only way to know what insurance will reimburse and not spin your wheels for weeks wrestling with a pesky claim requires such a breakdown. Get it. Use it. Collect your money correctly at walkout. Post the estimated insurance 5-10 days later. Close the claim. Send the patient a statement with a zero balance.
Or keep chasing money.
Suzie’s one, single Over 30 claim proves that it can be done. You want to be like Suzie. Your doctor wants you to be like Suzie. Maybe you’re already like Suzie. If you’re not, there’s always room for improvement. Focus on some of the matters mentioned above, one at a time in your office, until you have them where you need them to be.