Is your admin team unproductive? Before blaming them, look at the systems you have! To show you what a productive team looks like and how you can achieve it, Kirk Behrendt brings back Ariel Juday, one of ACT’s amazing coaches, with systems to help you support the backbone of your practice. To create processes and systems that everyone can understand and follow, listen to Episode 645 of The Best Practices Show!
Links Mentioned in This Episode:
Get your free copy of ACT’s Managing an Accounts Receivable and Collections System
Set clear expectations and processes that your entire team understands.
Have systems for insurance verification, billing, collections, and budgets.
Go above and beyond to create a review-worthy patient experience.
Have designated billers for insurance and for patient billing.
Keep your collections percentage at 98% — at minimum.
Create systems to keep a full schedule.
“The admin team are the ones that don’t necessarily have the most training. They don’t always have the most support. But really, they are the glue that holds the team together. If you can have a profitable and productive admin team, things will go so much smoother. The doctors and dentists, they need to know and understand how they can support their admin team and go off of the facts and not just the feelings.” (2:18—2:48)
“Let’s look at our processes and our systems first before you go blame the team member.” (5:04—5:09)
“You need clear systems and processes, and you need to be able to see these. As a dentist, you don’t need to be able to understand them. You don’t need to be able to do every step. But you need to be able to ask them, what is the system? I would say a couple of the most important ones is a streamlined patient intake process. How is your admin team member getting patients their information on the phone? How are they getting them through the door? And then, taking it one step above, not only are we getting their new patient forms because, yes, everyone needs that, but once they get to that really productive level, are your admin team members tracking how long patients are waiting? Are they keeping an eye on those patients if they are waiting? Are they offering refreshments? Do they stand and greet them by name? So, not only are they getting them in and getting their paperwork, but how are they making them feel? And is that intake process — does everyone know the expectations?” (5:17—6:21)
“[Dentists are] like, ‘Oh, I’m on time.’ Great. Are you really? And then, let’s say you’re behind three minutes. In the grand scheme, three minutes isn’t a really long time. But could you imagine if you and I stared at each other for three minutes? They’re going to be like, ‘What’s going on?’ It would feel like an eternity, versus, we said, ‘Hey, we’re going to take a three-minute moment of silence.’ Everyone knows they can look at their watch. And it’s the same with patients. If you’re running five minutes behind and we can tell them that when they walk in the door, then they are more willing, and it doesn’t feel [as long]. But if they’re just waiting, they’re seeing other patients being taken back, and other patients are leaving, and now they’re looking at their watch — it feels much longer when you don’t know how long you’re supposed to be waiting.” (7:11—8:06)
“[You] have to have a clear system and expectations of who does what, when, because you’ll see that the insurance verification is one thing that really will sneak up on team members, and it can really hinder or enhance a patient’s visit. Not because we tell the patients, but it’s how prepared we can be by letting them know, ‘We were able to verify your dental insurance is active. This is your coverage.’ When you’re going over their treatment estimates, you’re able to bring in their personalized benefits. And so, we have to have that verified before the patients arrive — when possible. I know not every patient will give you the information. They don’t even always know who they have, and that’s okay. But when possible, have it before they arrive. And you want to know what information needs to be verified. Some practices will do a very detailed breakdown. Others will do a simplified version. It really depends on their practice and what the expectations are. And then, even take it one step further. Where do I put that information? Having it verified is one thing, but who needs to be able to have access to it? I would say this is an area of opportunity for most practices.” (8:54—10:22)
“If you’re going to make one investment for your admin team members, online insurance verification is very helpful. It’s definitely an investment, but it saves the team members so much time. Because, doctors, if you’ve never had to call an insurance company, be prepared to wait a minimum of 30 to 45 minutes before you get in contact with someone — and that’s just hoping that that person will be able to answer your questions.” (10:55—11:27)
“Once you have a good insurance verification process, now you can have a better billing process. One thing I would say is, ask your team members when claims are being sent. If you’re an admin team member listening to me, I would tell you this. There is no reason that claims should not be sent on a daily basis. They are electronic. It’s a push of a button. Yes, you have to review. Yes, there are things. Yes, you have to do attachments. There is no reason that they should not be sent on a daily basis. Sure, maybe you miss one day here because, who knows what happened? But I would say claims should be sent the same day or next day. That’s including with attachments, and that’s including following up on denied claims. You have to have a clear billing process on, who sends the claims? Who creates the attachments? Where are the narratives coming from? Do we have the appropriate X-rays? Do we have the appropriate photos? Where is all that? So, when I say, yes, send your claims — yes, that’s the easy part. It’s the whole process in the system leading up to how claims get sent.” (12:07—13:21)
“You can’t just say, ‘We collect at time of service.’ Great. I hope you do. And if you are, we can talk about some of the over-the-counter collections and that KPI to track. But what happens when a claim is paid, and insurance didn’t pay what we were expecting? What is your collections process for a patient that comes in and someone on their account has a balance? You have to have a clear collections process. So, as soon as those claims are being paid and balances are being created, who makes a phone call? Who sends a statement? When do they make that phone call? When do they send the statement? If you have your billing person or your collections person and they say, ‘Oh, I send statements once a month,’ it’s not enough. You have to be doing it more.” (13:43—14:35)
“I highly recommend your billings and your collections person be separate. Checks and balances. I don’t ever like the same person following up on insurance claims and following up on patient balances. They go hand in hand, yes. But I think that’s where you need two individuals as a team. It really helps with the checks and balances.” (14:38—15:02)
“I want to know that my patient is going to take care of that balance before going back and getting more treatment done — because they don’t want to talk money. Patients don’t want to. They know that’s okay. However, it’s a better dental appointment if they can get the collections out of the way and focus on their dental care. We’ve always said try to separate the appointment and the finances. Same thing with collections. No one likes to owe people money. So, if I can get it done and get it taken care of, they’re not dreading that dental appointment. They’re not dreading the end of it when they have to come and talk to me. I can get it taken care of ahead of time. I know that they’re going to pay because they’re not increasing. And yes, every now and then, you have the patient that says, ‘Oh, I didn’t know,’ or, ‘I couldn’t afford this,’ or, ‘I can’t.’ Now, you can make the call of, ‘Okay. Should we reschedule this patient?’ Because you don’t want to be doing dentistry for free without knowing it. That’s what happens to teams. They let the patient go back, they get the treatment done, and then they come up. And what do you do? You’re kind of handcuffed when the patient says, ‘Well, I can’t afford that.’” (15:43—16:58)
“Over-the-counter collections — yes, literally over the counter. Let’s not do anything under the counter. Over the counter on the same day as treatment. So, yes, they can come back two days later. However, in my mind, that’s us being thankful that the patient was a good patient and a good person, coming back to pay their bill. There’s no difference between me sending them a statement or giving them a phone call and taking that over the phone. And so, it’s on the day of what I should be collecting. So, it’s, ‘This is insurance. I’m estimating this is what insurance is going to cover.’ What is my patient investment? That’s what I should be collecting on the day of service. Or if you’re really good, at the time of scheduling.” (17:55—18:45)
“[If your over-the-counter collections is not growing], that means your team is doing a lot of work on the back end, and the strength of having the comfortable conversations of collections is not there. Your team is focused more on sending those texts to pay, focused more on sending those statements. So, just because your overall collections may be good — that means you actually have a good patient base that is loyal, and they pay their bills. If you have a good over-the-counter, that means you have a good system and process in place, and that your admin team are really taking care of business.” (19:06—19:44)
“If a dental admin team is highly productive and profitable, they understand the budget of, ‘When can I order specific supplies? When are the specific supplies that I need coming up on sale?’ and looking for deals. They’re not just ordering a ream of paper here, a pack of highlighters, a pen. They have a process in place. I see this a lot with teams, is the supply budget is one of the ones that is the easiest to get out of hand, but it’s also one of the easiest to control. Not that you have to pinch pennies all the time, but if your admin team knows every September is back-to-school, they can get some of those deals. And if they’re looking out for your overhead, then it’s going to return to them in the long run. That takes your admin team to a whole other level, is when they’re looking at what goes above and beyond their job description or their day-to-day.” (21:22—22:31)
“Have designated billers for both insurance and patient billing, not only for checks and balances, but because one person, really — that would be a lot of time. If you want your patient billing and your insurance billing to be followed up on a regular basis, you need multiple people doing that. As we talked about, the length of getting an insurance verification, following up on unpaid claims, that’s a lengthy process. Yes, you can see the status online. But most of the time, that does have to be done by phone call in order to see, what documents did you not receive? What do you need to do? Who can I send this to? Sometimes, you can get direct contact information and say, ‘If I fax it to this number, can it get processed today?’ And the same thing with patient billing, is you want one person working on it on a consistent basis. I would say at least have blocked out time, weekly. But really good, productive teams have a process that it’s part of their daily process.” (22:41—23:49)
“We talk about block scheduling for the clinical side. Same thing with the admin team members. They need to have some kind of designated block scheduling. Because if you can imagine, you’re trying to create a good patient experience, and you want to spend the time talking to them about where their balance is coming from. But you have patients coming in, checking in, checking out, and you’re doing other things on the back end. The patient knows that, and they can feel that. And so, not necessarily that they will be able to step away, but maybe they know, during the lunch hour while doctor and the clinical team is on lunch, this is my hour that I can spend on following up on patient collections. Insurance, if I’m following up on insurance claims, you need to know what time of day you can call. Because if you’re trying to call in the afternoons or evenings, you’re not getting through. So, that’s something that’s like, first thing in the morning, I know I need to call to get in the queue early. They have to have that blocked time because if they’re just going to work it in, we know — I mean, if I say, ‘I’ll get it done today,’ it’s not a priority. And this is something that needs to be a priority, just as much as taking care of the patients in the office.” (24:11—25:28)
“At a minimum, [your practice collections percentage should be] 98%. If you’re at 98%, 99%, 100%, your team is doing what they’re supposed to be doing. Anything lower, there’s a breakdown in your systems. Your admin team is not as productive, or they’re not as profitable as they can be. And like I said when we started this, don’t blame the team member. Let’s look at the system and the process first. It also might be a team member is uncomfortable with talking about collections and collecting. So, we need to know that. And then your AR, your accounts receivable, over 90 days should be 10% or less. And I will say our top performing teams that I see are five percent or less because they don’t let the balances get that far. That’s where they have the process.” (26:32—27:24)
“If you have a good process in place and you’re calling [patients], you’re sending their statements, their letters, they know about this balance. Now, if you have a bad process in place, and let’s say it’s 90 days, and they’re just now receiving a statement, that’s also very hard to collect because now you have to explain to them, ‘Why are you just now telling me about this? I planned for this months ago.’ And sometimes, yes, insurance — I know it takes a long time, and that’s something that we can educate them on. But once you get a balance over 90 days, you’re just gambling and you’re honestly crossing your fingers, hoping that it’s going to be collected. There’s a good chance that it won’t be.” (28:32—29:17)
“Not only are your admin team members getting people on the schedule, getting the confirmations done, but what you don’t know — or maybe you do know and we just don’t always acknowledge — is your admin team is working consistently on keeping that schedule full. So, yes, it’s very easy to start out the day or start out the week with, ‘We’re at 100% capacity.’ What does that day look like throughout the day? Are your admin team members following up on unscheduled treatment? Are they looking for same-day opportunities? If someone does fall off the schedule for whatever reason, how are they getting that appointment block filled? So, this is telling you, do they have good processes in place? Because if they just say, ‘Oh, we’ll just fill it,’ but what’s your system? What’s your process?” (31:23—32:16)
“One of the fun parts being an admin team member is they find a lot of the same-day opportunities that the clinical team overlooks when they’re presenting treatment. They know this person is running late. They know that this person got done early. So, they see it in a different way. I always tell the admin team members, ‘If you think we can do something today, go to the back, ask a clinical team member, hey, can we get this done?’ Especially nowadays with digital scanning, there’s no reason we should ever treatment plan an occlusal guard and have them come back for that. We can say, ‘Hey, can you get this done today?’ ‘Give us five minutes and we’ll figure it out,’ because it’s a scan. It’s easy. And I say that’s where the admin team members can help, because they know the schedule like the back of their hand.” (32:19—33:11)
“If you think about it, the patient starts with your admin team, whether that be on the phone, or literally starting their appointment by walking in, and how they were greeted, and how they end their appointment. There’s little that a clinical team can do to make the appointment so great and amazing, and the admin team member can easily derail that appointment. So, the patient retention, the good online reviews — are those coming because the patient had a good experience? I hate to say it, but a lot of the reviews come because they had a poor experience with their admin team members.” (36:40—37:22)
“One, you have to ask for [reviews]. But before you ask, you have to ensure that your patients are receiving an experience worth leaving their review. I know leaving reviews is not hard, and today we’ve made it super easy with QR codes, and text, and it goes straight-to. However, it still takes time from a patient’s day, and they’ve already left their appointment. So, they’ve left their appointment. They’ve left your office. Maybe they’re still in the parking lot. Are they still thinking about that visit though, or have they moved on to the next? A lot of us are busy. Our appointment is over, and we’re moving on to the next. So, for the patients to write the review means that something happened that they went above and beyond, that they were still thinking about us, willing to take the extra 30 seconds. And sometimes, if a patient doesn’t know how to leave reviews, it takes them a little bit. So, for them to do that, it’s not just having a good experience. It’s not, ‘Oh, I came in, I got my teeth cleaned, paid my bill, and I left.’” (38:40—39:50)
“As a dentist, take time to learn what your administrative team’s daily focus items are so that, one, you can trust that they’re doing what needs to be done. And with trust, that’s where the KPIs come in place. But then, how do you support your administrative team? I can tell you it’s not by helping them rearrange the schedule. It’s by understanding and knowing their systems, and how you, as a clinical team member, have an impact on their day. I think that helps close the gap between our admin and our clinical team members, is when we all know what each other does and how we can support each other.” (41:17—41:57)
2:05 Why this is important for your practice.
5:11 Set clear systems and processes.
6:45 Communicate with patients when you’re running late.
8:41 Have a system for insurance verification.
12:01 Have a system for your billing process.
13:33 Have a system for collections.
17:30 Over-the-counter collections, defined.
21:13 Have a system for ordering and budgets.
22:32 Have designated billers for insurance and patient billing.
23:50 Have time blocked out for admin.
26:20 The ideal practice collections percentage.
31:14 Have a system for keeping a full schedule.
36:29 Create an above-and-beyond experience.
41:07 Last thoughts.
42:01 About ACT’s Managing your AR and Collections resource.
Ariel Juday Bio:
Ariel has a master’s in healthcare administration and several years of dental experience in all aspects of the administrative roles within the dental office. Her passion is to work with dental teams to empower team members to realize their full potential in order to better serve patients, improve office systems to ensure a well-functioning team/office, and to help everyone have fun in the process!