Achieving 100% Collections Udell Webb, DDS
Director, Udell Webb Leadership Institute

Yesterday, I received two phone calls with similar problems that prompted me to write this article. One of the doctors who contacted me, called with a question concerning Delta Dental of California (Delta) and one of his patients. The patient had just accepted a “Smile” treatment plan for $10,000—ten units at $1,000 each, a ‘normal’ fee for this type of treatment. As a provider with Delta Dental, his “allowed charge” is $650. Even though the total amount exceeds the annual maximum, he wanted to know if he still had to write off $350 per unit. The answer to this dilemma lies in knowing whether a procedure (code) falls within the ‘denied’ vs. the ‘disallowed’ category. You must know the difference, or it could cost you $3,500 for one case, and if you do several cases a year, this error could add up to some serious money. In this particular case, the doctor really does need to charge his ‘allowed’ amount but that isn’t always the case.

The Ugly Staff Meeting
The second call I received was from a front office staff member. The employee told me, “The doctors have threatened to replace us all if we don’t get better on collections.” The doctors in this particular practice had set the acceptable collection goal at 100%. The problem with that goal is that the doctors are billing out as production their “normal” fees for services. Although it is very inspiring to see production numbers increasing every month, these projections may not be an accurate reflection of the practice’s true financial status. The managed care status of these cases requires a discount. This practice will never legally collect the full charge so how can the staff reach the established goal of 100% collections under these conditions. What about the good indemnity plan? It is essential for the staff person to know or have access to information that establishes exactly what the UCR is for that policy.

Creating the Perfect Staff Member
I remember the day I met Dr. Omer Reed, a prominent dental leader and lecturer, for the very first time. Dr. Reed asked, “How do you feel about money?” I thought he was a seer of some sort because my answer was “Not very good.” I have since learned that most dentists do not feel very good about money and the majority have a true aversion to asking for it in the office. Hence they delegate, instructing someone else in the practice to take care of money issues. Good idea but the person responsible must have tools to help them succeed. If they do not know what UCR really is, how can they make successful financial arrangements? If they do not know the difference between “disallowed” and “denied” at Delta, how do they stay within the contract and at the same time collect the maximum? If your total financial future is in their hands, shouldn’t they have as much training in their field as you have in yours? The tools are out there, invest in your staff, invest in your practice, and invest in your personal finances by ferreting out the best training you can get. The rewards to you will be measured in the hundreds of thousands of dollars.

Predetermination Myths
Seventy percent of the “predetermined” dentistry in America is never started. When patients ask for a predetermination of benefits before they begin their treatment, they are telling you that you or your staff didn’t sell the case. The patients are escaping and predeterminations are not binding, not to mention, meaningless, useless, worthless and NOT required. Today, you only use predeterminations for the bigger cases, for instance the potentially profitable ones, right? The insurance companies know that if the patient must wait a month or two they will not go back for the treatment. You must know what the insurance company will pay at the time of the treatment presentation. One hundred percent collections are based on knowing, not guessing, what the financial boundaries are for the insurance portion and the patient portion. You CAN however know what the insurance policies will pay, in less than 45 seconds, without waiting months and losing the case with a UCR table.

Third-Party Verification and Support
If it is in writing, people tend to trust it more than just oral communication. If a non-involved, third party tells the patient about the limitations and restrictions of their insurance, it is more believable. There are good pamphlets available to assist your staff in explaining the financial limitations of insurance to a patient. The pamphlets shift the focus from your fees and financial arrangements to the limitations of the insurance policies purchased by the patient’s employer. Everyone knows that insurance does not “pay 100%” as so many of our patients would like us to believe. Since the discussion of money is often stressful for both doctors and their staff members, utilizing printed material will diffuse some of this avoidance and provide the patient with clear and concise information on which to base their decisions.

The winning formula
Know what your fees are and what the insurance portion will be. Train your staff to use the best tools available. Use written, dependable, and reliable procedures when making financial arrangements. Reduce the stress and tension, for you, the staff and the patient. It’s a win-win!

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Udell (Del) Webb, DDS, is a nationally recognized expert in the area of dental insurance management. He is not an attorney, an insurance company employee or licensed by any group or agency to answer insurance-related questions. His answers are based on 25 years of painstaking research into the dental insurance issues that dentists face. If you seek legal advice, contact your favorite legal expert.

Dr. Webb is a 1976 graduate of Baylor College of Dentistry, Dallas, TX. Del is married and has seven children. Contact Dr. Webb at: (877) 628-3366.