If You’re Not Collecting, You’re Probably Not Asking By Rick Kushner, DDS

Collections. Ugh. Most dentists struggle with questions like these: “How can I get the patient to pay off their balance after we’ve sent five statements?”, “How can I get that first-time patient to pay for the initial exam when he doesn’t seem interested in coming back?”, “How can we recoup the small outstanding balances that aren’t worth all the time and resources we spend collecting?”

If you routinely ask yourself how to get patients to behave more responsibly, then I challenge you to stop blaming your patients. The first step toward successful collections is the realization that you, the Doctor, must accept complete responsibility for getting paid. You must take responsibility for structuring a collections policy that is designed to pay you faster and more completely. You must also take responsibility for sticking by your policy to make it work. You cannot change patient behavior, but you can change the effectiveness of your policy.

I won’t lie—it’s hard collecting from patients. But my policy actually gets us paid. If your own collections efforts don’t often result in payment, it’s time you consider the policy I’ve developed. If you implement my policy in the purest way, your practice will have no outstanding balances on accounts other than for first visits, outstanding insurance claims, and small post-treatment expenses that weren’t billed during treatment. The vast majority of your work will be paid for.

Rule #1: Don’t ever send new or existing patients account statements again. Sounds crazy, right? How else can a practice remind patients of past-due balances? Statements are wasted paper and rarely result in payment. Hypothetically in my system, only first-time patients should be carrying balances. Use the phone—it’s an opportunity to get the patient back in for another visit.

Rule #2: Don’t ask new patients for payment on the first visit. When new patients come in for an initial exam or for an emergency, we don’t ask for a payment. Why? Because our goal is to get that patient into a complete treatment program, and the best way to get a patient to return to your practice is to avoid any payment issues during the first visit. We follow up on the phone to facilitate further treatment and we collect the first visit payment during a subsequent visit.

Rule #3: Don’t lose the money and the patient—keep one! When we follow up with first-time patients on the phone, our goal is to get the patient to return for a complete treatment program. Our first couple of calls will suggest that we need to follow up on our findings from the first visit and we try to schedule another appointment. Only after we determine that we can’t re-activate the patient do we ask for payment from the first visit. If they don’t pay, then we may sue or turn it over to collections. But before taking that step, always ask yourself, “Do we have a chance to re-activate the patient?” If so, try to get them to come back and don’t yet pursue collections.

Rule #4: Collect upfront from existing patients for all inexpensive procedures. Establish an arbitrary but reasonable dollar limit that quantifies “inexpensive”—perhaps you decide that “inexpensive” means services rendered costing less than $300. Our policy is: payment is made when services are rendered. It’s that simple. We ask existing patients to pay when they come in, often before they are even treated. When we set the appointment on the phone, we clearly explain that our policy is to collect payment during the visit, and we ask that the patient commit to this. So, if a patient shows up but can’t pay, we don’t perform the procedure until they can.

Rule #5: Offer flexible payment options for expensive procedures but ensure you still get paid in full for services rendered. For services costing more than the “inexpensive” limit, I offer three payment options: 1) a pre-treatment percentage discount for payment in advance, 2) 12 months interest-free payments carried by a finance company that pays your practice upfront at a discounted rate, and 3) pay-as-you-go for services rendered. These require some explanation, and I will discuss each option in detail in next month’s column. The important point is that all three options ensure that you collect a full or slightly discounted amount for all procedures.

This is a simplified overview of the collections policy I developed for Comfort Dental and I will get into details about payment options in my next column. Remember, it’s not the patient’s fault—it’s your responsibility to structure and enforce a collections policy that ensures you get paid upfront for services as often as possible. The only time we make an exception is for first-time patients, and this is strictly because it makes better financial sense to make sure a new patient returns for further treatment. Don’t send statements—make phone calls and get delinquent patients back in for another visit. If you follow these rules, you shouldn’t need to send statements to existing patients, because each payment method outlined here (excluding new patients) is designed to eliminate outstanding account balances altogether. And most importantly, don’t be afraid to ask for payment at the time of service. It’s amazing how many practices don’t. Follow these rules, and you’ll be on your way to a higher collections rate than ever before.

Contact: Aaron Ferstman of GD&A Public Relations for Dr. Kushner and Comfort Dental Inc., 303-623-2529, aaron@gda-pr.com