The administrative appointment

May 1, 2000
Problems with no-shows, prompt payment for services, and patients that show up late are all issues that we have faced during our dental careers. They reduce your productivity, increase overhead costs, and throw you behind schedule, increasing stress levels for both you and your staff members.

Mark T. Shehan, DDS

Problems with no-shows, prompt payment for services, and patients that show up late are all issues that we have faced during our dental careers. They reduce your productivity, increase overhead costs, and throw you behind schedule, increasing stress levels for both you and your staff members.

It`s a little misleading to be proud of a 98 or 99 percent collection rate, when a significant portion of your overhead results from staff time, billing costs, and attorney`s fees associated with collection costs. How nice it would be to reduce or eliminate this all together! We have developed a way to do this through what we call "the administrative appointment."

We initiated this system about three to four years ago and it has been an immediate and resounding success. We would not consider returning to the old system.

Here`s what we did. We created a separate appointment to handle all administrative issues - including fee collection - prior to rendering treatment. This is based on a model many businesses and hospitals use today. Let me reiterate - this is a prepayment, informational appointment, not an appointment to simply discuss financial arrangements. Although we are a specialty practice, we also have seen this system work in general practices.

I would first like to review how this is done in a specialty practice and then how it is applied to a general practice.

Specialty practice application

As a specialist in oral and maxillofacial surgery, I often see a patient for an exam visit, a treatment visit, and then a follow-up visit. Following the exam visit, we establish an administrative appointment three to five days prior to the treatment date at a time that is convenient for the patient. We do this whether the patient has insurance or not.

At the administrate appointment, we do the following:

(1) Review the treatment plan and answer questions. In many instances, it may have been awhile since the patient`s last visit.

(2) Collect the fee either in its entirety or the balance the patient will owe based on insurance pre-estimates.

(3) Review any specific pretreatment or post-treatment instructions.

(4) Have the patient sign the appropriate permits.

(5) Schedule follow-up appointments.

These responsibilities are delegated to a very competent staff, so rarely is the dentist involved. As in all dealings with patients - especially financial dealings - it`s critical that those handling the administrative-appointment responsibilities be well prepared, understand the treatment to be rendered, and understand the goals of the appointment. By establishing these criteria and delegating the responsibilities to an excellent staff, there is little reason to distract the dentist from focusing on treatment. The beauty of this is that if the patient doesn`t show, cannot prepay, or has other pertinent issues that would interfere with treatment, the actual treatment appointment can be canceled and we have three to five days to fill that time slot. This has eliminated down time, making us even more productive. This also allows us to maintain a very timely schedule.

When the patient comes in for treatment, we don`t get bogged down with extraneous paperwork and problems. Patients are amazed to actually see the doctor at the appointed time! They also are better prepared for treatment.

The administrative appointment has virtually eliminated no-shows. Once patients have prepaid for their services, they show up for the treatment appointment! Finally - and most importantly - this has considerably reduced the stress and strain we all have felt in dealing with these problems. It`s incredible how good you feel knowing a patient has been adequately prepared and that payment has been finalized prior to treatment. It allows you to focus totally on the work..

General practice application

Generalists can take two approaches to implementing the administrative appointment in their practices. The first method is procedure-specific, and works much like the administrative appointment with specialists. The second is total treatment-specific. The choice of which approach is right for your practice is based on many factors. These factors include type of treatment needed, the patient`s previous history, concern over collectability, etc.

The procedure-specific administrative appointment, as with the specialty practices, is set three to five days prior to the procedure. Treatment usually involves endodontic therapy, complex restorative procedures, or periodontal services. The administrative appointment date is set at the same time the treatment appointment is set. This allows the patient to choose the most convenient time for the patient.

At the administrative appointment, appropriate information regarding the procedure can be explained to the patient, along with finalizing payment for the treatment. If the patient doesn`t show or payment is not rendered, this gives you three to five days to fill that one- or two-hour appointment slot.

The total treatment-specific administrative appointment also is conducted prior to rendering any treatment. This appointment often follows the return of an insurance preauthorization for treatment, and the patient pays the amount that will not be covered by insurance. By making his or her copayment upfront, the patient is more motivated to complete the treatment in a timely manner. Remember, this appointment is not for setting up a payment plan, but to actually complete the payment process prior to treatment. If payment plans have been established, that doesn`t negate the need for an administrative appointment. Prepayment, will actually reduce your paperwork and costs, especially those relating to collections.

I know what you are thinking: Patients will be angry, revolt, or won`t cooperate if they have to make a special trip in to handle paperwork and prepayment. That same concern was certainly a significant consideration when we implemented this procedure. But I can truthfully tell you that this has not manifested itself.

Patients now are programmed to the concept of multiple physician visit and hospital preadmission appointments fostered by the growth of current HMO systems. They have actually come to expect this. It`s only in dentistry where - for issues I won`t debate at this time - we have lagged behind other industries in the concept of prepayment for service.

In summary, the administrative appointment is designed as an informational and pre-payment appointment in preparation for future treatment. It should be scheduled three to five days before treatment at a time convenient to the patient. Properly executed, the administrative appointment will significantly decrease collections, paperwork, overhead, and no-shows. At the same time, it will increase productivity, allowing you to maintain a timely schedule and reducing your stress and frustration.

It would behoove us to adopt this strategy throughout dentistry. Pre-payment should be the norm. Bringing this concept into your practice is really no different than starting any new program. It may seem foreign at first, but once you start and reap the benefits you will not go back. I encourage you to adopt this and spread this message to your colleagues. Once this becomes the norm in dentistry, just as in other industries, it`s simply seen as the way business is done.

For more information about this article, contact the author by phone at (336) 765-9550 or visit the practice Web site at A biography of the author appears on page 10.