We are not bankers!

June 1, 2003
Repeat after me: We are not in the banking business! So, what business are you in? Are you a product or service-based industry?

Tom Limoli Jr.

Repeat after me: We are not in the banking business! So, what business are you in? Are you a product or service-based industry? Do you make widgets or sell widgets? The answer is you are in the profession of dentistry and the business of health.

The common denominator of all business is COD or BOT. That means Cash On Delivery or Back On the Truck! If you deliver treatment without sound financial arrangements and a comprehensive benefit/eligibility assessment, you will have nothing but meaningless production with its accompanying collection headaches. Is there a better way to skin the cat without upsetting all the PETA people? Yes! The management of various reimbursement systems is a simple task if you will follow the path of prosperity rather than take the path of least resistance.

In this column, I want to discuss rules three and four of my seven keys to reimbursement success. Rule Three directs your office to "secure financial arrangements prior to treatment." Rule Four specifies that the "patient must acknowledge and agree to pay the total fee prior to insurance consideration."

Production is not collections. If your office-production figures were, in fact, collection income, then those dollars would be reflected in your daily bank deposit. Unfortunately, this is not the case.

Years ago, it was not uncommon to treat the patient and wait for the insurance to pay, prior to billing the patient's portion. In today's competitive marketplace, that old modality of patient administration is nothing more than an invitation to financial hardship and an an unnecessary increase in your accounts receivable.

Your patients must acknowledge and agree to be responsible for the total fee in the absence of insurance considerations. Start the conversation by explaining the total fee for the treatment plan. Help patients understand that their benefit plan is designed to help them offset the cost of necessary dental care. Does this mean that your office should stop accepting authorization for payment as well as assignment of benefits? Definitely not ... provided some simple rules are followed!

Like any goal that must be written down, patients must understand and acknowledge their total financial responsibility. Make patients accept ownership of their benefit plan. Do not apologize for any inadequacies of a specific benefit plan, and under no condition should you criticize a patient's employer for their plan selection. This creates unnecessary negative feelings.

Have written financial objectives established and agreed to prior to the initiation of treatment. This will help eliminate confusion and miscommunication. Ask patients to bring their benefit booklet with the specifics of their plan to the office. Uncooperative patients always will tell you that they never received or have misplaced all documentation about their plan. This is simply not true! When employees have money taken from their paychecks to help pay for a benefit plan, federal law (ERISA) requires the distribution information containing plan specifics. If you cannot obtain plan specifics in writing, do not waste your time and accept assignment of benefits, because there will be a wait for payment. Simply make other financial arrangements — period! Yes, this is a bold step to take and it may prompt some patients to leave your practice and go elsewhere for treatment. But, in the long run, your financial success and prosperity will be much more predictable and consistent.

As for calling the employer and/or administrator for benefit-plan specifics, this, too, is a waste of valuable office resources. This time can be better spent coordinating treatment. Remember: If you inform patients before treatment occurs, it's a reason to accept treatment. If and when they find out afterwards, it is nothing more than an excuse!

Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at www.LIMOLI.com.

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