Thriving without support staff

Dr. Reed Boyd and his two team members tell you how their office gained efficiency by using real-time claims technology.

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By Reed Boyd, DDS, Jessica Krolewski, RDH, and Elaine Winfree, DA

How one small practice gained efficiency using real-time technology

For more on this topic, go to www.dentaleconomics.com and search using the following key words: real-time technology, dental insurance, case presentation, collections, patient satisfaction.


Three clinicians serving patients without any front- or back-office support staff might seem like a difficult operational design for many dental practices. But it has worked nicely for Boyd Unique Dental Care, where our team - one dentist, one registered dental hygienist, and one dental assistant - provides highly personalized care to 1,300 active patients.

Our primary mission is offering quality oral health care to patients in Petersburg, Va. We recognize, however, that we cannot do so without a strong revenue cycle keeping the practice doors open. Efficiency is of supreme importance given our small staff size, so we are always looking for tools to help us seamlessly integrate both the clinical and financial aspects of patient care.

Until recently, many of the practice's financial duties were the responsibility of our secretary/receptionist. She submitted electronic and paper-based claims, then typically waited a month or more to receive insurance payments. In the meantime, just as in many dental offices nationwide, she made numerous calls and mailed frequent statements to follow up with payers and patients to secure reimbursement. When she eventually decided to leave the practice, we questioned whether this "business as usual" arrangement provided the best possible clinical and financial benefits for our patients.

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From left: Elaine Winfree, Dr. Reed Boyd, Jessica Krolewski

It was difficult, for instance, to hold comprehensive discussions about treatment options without the corresponding financial details. Patients naturally hesitated to schedule procedures before knowing how much their insurers would reimburse, yet we usually had to wait four to six weeks to receive insurance pretreatment estimates.

Only then could we call the patient, discuss the reimbursement information, and try to schedule the necessary care. During this critical time lapse, some patients decided to put off or forgo essential treatment.

With about $100,000 on the books at the time, we also desired a more robust balance sheet. In order to gain both clinical and financial efficiency, we believed we needed the ability to: 1.quickly assess the amount due for each treatment from the payer and the patient, and 2.simplify claims and payment tracking. After seeing some demonstrations, we became convinced that both goals were within our reach through the use of real-time transaction technology.

Improved collections

To be honest, we embarked on our pursuit of real-time claims technology a little hesitantly. We launched a search for another receptionist to handle our billing functions, but within a few months realized that our new approach allowed us to manage efficiently without one. We never hired a replacement.

We implemented our real-time claims technology from Mercury Data Exchange in March 2010 in less than one day. Since then, the automated communication with payers has transformed our front- and back-office processes.

The $100,000 in outstanding accounts sitting on our books has dropped dramatically - to less than $30,000, with the difference collected instead of written off. We are ahead of last year's production and collections numbers, and we have seen declines in both our A/R and delinquent accounts.

All of these financial benefits stem from the fact that communication with payers and patients now occurs at the point of care. Patient conversations are no longer a disconnected, two-step process in which we first talk about clinical issues in the office, then hold separate discussions over the phone about financial matters.

Instead, for those insurers participating in real-time transactions, we now can accurately inform patients of their out-of-pocket costs right at the time of service. It is a fairly simple process: We log into the system and enter the proposed procedure and amount. Within a minute or so, we receive a precise pretreatment estimate straight from the payer's system that breaks down the amount insurance will reimburse and the patient balance. For us, the biggest drawback is that some payers are not yet automated.

Because we can access the technology from our operatory and other caregiving areas of the practice, our financial conversations truly dovetail with our clinical efforts. The hygienist retrieves information for patients while waiting for the dentist, for example, or the chairside assistant looks up pertinent details while talking with her patients in the operatory. This integration of the clinical and financial aspects of patient care has improved both workflow and cash flow.

It used to be easy for patients to say, "Let me see what insurance pays first, then I'll send you my check." Now, we can show them detailed EOBs. We inform them how much their next treatment will cost before they leave the office. Because we are able to tell them exactly how much their insurance will pay, the majority of patient payments now are collected at the time of service. Insurance reimbursement turnaround also has been enhanced by the automation, with payments typically received within one week.

Our patients have a better opportunity to ask questions and understand their benefits more clearly while we are creating a treatment plan. In addition, immediate access to relevant financial information eliminates the time-consuming need for follow-up phone calls and mailings to patients and payers. As a result, we have actually reduced our paper and postage costs.

More importantly, however, the ability to work closely with patients to simultaneously address their clinical and financial needs enables us to spend more time providing care and building patient relationships.

Enhanced patient satisfaction

Over the years, we have come to understand that there are two main reasons why people fail to schedule and keep dental appointments: 1.fear and 2.finances. We work hard to assuage the fear factor through extensive patient education and compassionate care. We try to alleviate the financial worries by using our transaction technology to eliminate the unwelcome "surprise" of dental bills.

We tend to use real-time benefits predetermination as an educational tool to jump-start critical conversations that inform patients of their financial responsibility for future treatments within moments of arriving at a care plan. This up-front dialogue allows us to quickly gauge any financial constraints that might limit a patient's care.

Thus, we have the opportunity to help our patients manage both payments and treatment. Perhaps it means customizing a payment plan, or scheduling treatments to coincide with payday. With a pretreatment estimate in hand, patients feel much more comfortable about scheduling treatments before they leave the office. For them, knowledge is power.

Every time a patient leaves a consultation without knowing how much the recommended treatment will cost, you increase the likelihood that the service will never be scheduled. The result is a net loss for the patient, who fails to receive the necessary services, and for the practice, which strives to establish optimal and ideal oral health for its patients.

More personalized service

It all comes down to truly personal patient care. No patient should have to delay treatment or make a half-informed decision due to lack of financial information. Since we turned to real-time claims technology, our patients no longer delay. When they come in for consultations, they receive the clinical recommendations and pretreatment financial estimates that allow them to comprehensively plan treatment and reimbursement options; there's no "sticker shock" and no large bills hanging over their heads.

In our office, perhaps one patient every few weeks chooses not to complete recommended treatment. We believe this testifies not only to the personal quality of our service, but also to the efficiency with which we offer a holistic approach to the clinical and financial aspects of patient care.


Dr. Reed Boyd practices full time in Petersburg, Va., at Boyd Unique Dental Care, and serves as a part-time faculty member of the Virginia Commonwealth University, Medical College of Virginia School of Dentistry. Jessica Krolewski is the registered dental hygienist at Boyd Unique Dental Care, and Elaine Winfree is the dental assistant and patient care coordinator. Contact Dr. Boyd at doctorboyd@verizon.net.

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