Episode 508: Is Your Practice Struggling with Collections and AR?

Question: Want an idea of what it’s like to have the Dental A-Team in your practice?

Tiff is on the pod to chat with Kiera about an office she just visited which needed some attention on its collections and accounts receivable. To give an idea of where this practice sits at, its collections are at 80% and case acceptance is at 56%. Tiff shares three points she touched on with this office:

• Three tactics to put into place to raise collections

• Establish tracking methods

• Spun complaints in a positive direction

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Transcript: 

0:00:05.6 Kiera Dent: Hey everyone. Welcome to the Dental A Team podcast. I'm your host, Kiera Dent, and I had this crazy idea that maybe I could combine a doctor and a team member's perspective, because let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner, and I have a team of traveling consultants, where we have traveled to over 165 different offices coaching teams. Yep, we don't just understand you, we are you. Our mission is to positively impact the world of dental, and I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress, and create A teams. Welcome to the Dental A Team podcast.

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0:00:51.4 KD: Hello, Dental A Team listeners. This is Kiera, and you guys, don't worry, we say we travel in The Dental A Team, and this time you might actually hear proof of it because I have the one and only Tiffanie Trader back on the podcast. She is getting ready to fly home, just finished up with an office, and we definitely got her to podcast while she's at the airport. So Tiff, where are you at today? How is this podcasting going?

0:01:13.3 Tiffanie Trader: Podcasting is gonna be fantastic because... It is. Because I put it out there in the universe. And I'm actually in DC, which is funny because... It's funny because I thought I booked a different airport, and I thought I booked an airport I have been to, and then on the way here, I was like I've surely never actually been even to DC. And anyway, it's been fun. This is how my life is.

0:01:38.8 KD: So funny travel story about Tiffanie and airports. We always giggle about this. Tiff, do you wanna tell about the one time... This is real life consulting 101 for you guys. Do you remember the time that you maybe missed your alarm? You set...

0:01:51.9 TT: Oh yeah.

0:01:53.1 KD: Like 25 of them.

0:01:53.2 TT: Oh, yeah.

0:01:53.3 KD: But that's fine, I've seen your phone, and they are seriously like "Wake up. No, like really wake up. No, like you've got to get out of bed." That's all your alarms that you have. But what happened that time, 'cause it was a really funny travel experience?

0:02:03.3 TT: So, here's the thing, Kiera. I just wanna point out that I am in Virginia right now. [laughter] The only state that I have ever, ever, ever had any travel mishaps of any sort have been either coming to or leaving Virginia.

0:02:19.0 KD: This is true. Virginia is your state.

0:02:19.5 TT: I have even gotten stuck here. And I've gotten stuck here on a layover, like Virginia just doesn't want me to leave, I think. So I slept through my alarm leaving New York coming to Virginia because my flight was at 6:30 in the morning, which is, if you know me at all, it's not optimal, wake up...

0:02:36.0 KD: That was a poor choice. That was a poor choice like... It's okay. It's alright.

0:02:36.5 TT: It was a poor choice, poor choice. It's never gonna happen.

0:02:40.9 KD: We all make decisions that we shouldn't have done. And I'll be honest...

0:02:42.8 TT: Yeah.

0:02:43.2 KD: Sometimes when we're booking the travel, we're like, "Oh yeah, that seems like a really good idea" until we actually have to live the travel we booked for ourselves, then we're like, "That was a really bad idea."

0:02:52.6 TT: It was a poor choice. So I slept through the alarm.

0:02:52.8 KD: So 6:30 AM. And Tiff, you were up late. I remember you were texting me late at night that night and I'm like, "Tiff, your freaking flight leave so early tomorrow" and you're like, "I'll be fine." [laughter]

0:03:02.3 TT: Yes, but... I was fine because I actually figured out that it was quicker to drive to where I needed to be than to fly anyway. So...

0:03:10.5 KD: Only after she missed her flight. So it was a win.

0:03:13.9 TT: Yeah, because I had to pivot. I had to be in an office that afternoon, and I was like, "Shoot! How do I do this?". So pivot or die is what we live and breathe by. So I mapped it, and I went and I got a car and the car rental guy was like, "Oh my gosh, this is absurd." So I drove a car from New York to Virginia, and it was by far my favorite road trip of working experience because it was beautiful, I got to see so many... I went through... It was fall time, but I got snow, I got fall leaves changing, I had every possible season.

0:03:47.6 KD: Its one of my favorite stories that I definitely feel like needed to be recorded for all of our posterity to hear and all of you listeners. So this might be mine and Tiff's journal time over here, but this is literally...

0:03:57.4 TT: Yeah. I think I've... I think I've now flown out of the... Today, I will have flown in and out of every airport in Virginia. [laughter]

0:04:06.7 KD: Well, I'm glad that you're able to get the last one knocked off your list today. But you guys, that's literally the day in life of a consultant. I think it's fun to point out the fact that in offices when things don't go as planned, I literally pivot. I know Tiff and I have many times, I mean, the time that I almost got deported out of Canada, hashtag I was literally a one-hour drive across the border, but no, I flew back down to New Jersey and then back trying to get across the border, and it would have been way better had I just driven. So I think also it's like looking at it, had we mapped it? Now, when people are booking travel, we're always thinking, "Could you drive there faster than flying?" 'cause...

0:04:45.1 TT: Yup.

0:04:45.1 KD: There's always alternatives. So I love it. Welcome to Virginia. I'm glad you're coming home. Glad your office was there. That's kinda like...

0:04:49.2 TT: Well, my office was in Maryland. I just... [laughter] It's fine.

0:04:55.2 KD: Everything is fine, everything is fine. We are totally competent in dental offices, and we're about 75, 80% competent traveling. We have got like 20% lack that we definitely are not great at so...

0:05:05.4 TT: I just needed to hate Virginia as a state this year, so I got it in. It's fine.

0:05:08.7 KD: Good job, Tiff. So actually let's like deep dive on your practice you just came from. This is not the topic we were going to go on, but I just realized like we're talking about you leaving an office. Kind of walk us through some of the things you just implemented in that practice that you were in, just so people can kinda get an experience of what it's like having a consultant in their practice.

0:05:26.1 TT: Yeah, I think that's fun. Yeah, so this was... And I love it. Pivot or die, I love it. [laughter]

0:05:31.7 KD: Don't worry. We had a totally different topic, but like why not... Why not just keep with this consulting traveling theme?

0:05:36.8 TT: I like it. So yes, this is my second time in the practice. This was... Ashley actually saw this practice probably a year ago, I suppose. So she saw them first, and Ashley is no longer with us [0:05:46.2] ____ no, apparently not.

0:05:48.5 KD: Yeah, she decided to get married and move away and become a practice manager, it's fine. That office got real lucky. Shout out to them.

0:05:58.9 TT: Yeah, so anyways, this is their third visit. So, it was really cool to see the progression and the growth that they've experienced, but then also the hold ups that they've had. So it's like, yes we've been consulting them for a little over a year now, but there's still so much to be done. So this week, what we did yesterday and today, was we focused really heavily on collections and AR, because they're just struggling a little bit in that area, and they're having a hard time dialing it in to where it's coming from. So it was really fun because we saw the issue, and then what I did was I kind of worked my way backwards, right, because I think in a new practice, you can find something that's wrong and then I can tackle that person, right. So I can go straight for the billing representative and the office manager and be like, "Why aren't you collecting, where's your money?"

0:06:49.9 KD: Mm-hmm.

0:06:51.8 TT: But it's not just them that are the only cause of that, so the only effect of the cause. So we backtracked, we looked at everything. We realized, "Hey, patients aren't always getting signed treatment plans, patients aren't even... They're not always getting told what they're going to owe in the first place." So then when they're coming in, it's a little bit more difficult to collect because I noticed we have a crown. A crown was in last week, and they paid $100. And so if you know anything about crowns and dental insurance, typically $100 is not going to be the copay required. So I thought, "Okay. Why is this patient only paid $100? Well, probably because this patient was not prepared to pay the $600, that he had owed when he came in." So we kind of backtracked. So we figured out, "Okay. Our collections percentage is low, it's about 86% for last month, and overall for the year, they're hovering in the mid-80s." I like to see 98% for my practices or higher. I usually tell my Medicaid practices, Medicaid/PPO providers, 93 to 95%, just because Medicaid takes so long. So 98% is what we're looking for here in this practice. So 86% was like, "Oh, my gosh. How are we paying the bills?" So we backtracked, and we started implementing... They did NDTR for us, like a boss. We've done that twice, two different visits, so they've locked that down.

0:08:19.8 KD: And if you guys don't know what NDTR is and you're new, that's a perfect hand-off. So next visit, date, time, recare, and I will say it's magic sauce when people do it. So good to know this office was... Which is great. It's good. Hey, Tiff, I love that you're breaking this down. And I think offices should do this. When you find a gaping hole, don't go after it, look at all the pieces that factor in to find out where is the true breakdown. So we already know that the hand-off and the doctor exam is spot on. We are crushing that, our hand-offs are good, our doctor exams are great. So that's not the cause of the collections being low. Good job, Tiff, of checking that box to ensure... And I hope people are able to see that, that that's what you're doing in this. You're assessing to find out where the breakdown is at.

0:09:00.4 KD: Hey, Dental A Team listeners, I'm so jazzed to invite you guys to Dental A Team's virtual team summit. That's right, guys. April 22nd through the 23rd, we are doing a virtual team summit. If you missed it last year, you missed out. Guys, we send you guys team swag boxes, we have your entire team involved all day with us Friday, they get CE, and then Saturday this year, we're doing all things leadership. This year is all about optimization and execution. So guys, increasing your case acceptance, improving your schedule, also helping your hygiene team ramp up, even though we've lost team members. And it's been hard with COVID. So guys, if you're ready to optimize, and you're ready to execute, take massive action today and join us at Dental A Team's virtual summit, April 22nd through 23rd. Head on over, right now, guys. Get your tickets today, don't wait. We made it ridiculously cheap, so you and your entire team can get the CE and optimize this year. Head on over to thedentalateam.com, and I will see you April 22nd and 23rd.

0:10:02.6 TT: And I think that's... Sorry, and as you're saying that, it made me think of treatment planning. So doctors, you go in the arbitrary and if you just looked at it tooth and you saw this piece of decay, no X-ray, nothing else, you just look at the tooth, you're like, "Okay. There's decay there, we need to get it out. Let's do a filling." Okay, so you do a filling, you get in there 'cause you haven't looked at the X-ray yet, you get in there, and you're like, "Holy cow, that's not the only problem." So I think of it as like, you go in, you look at the tooth, but you also look at the X-rays and all of the other evidence that you have, you look at oral photos, you look at structure, all of these items, to assess what the patient needs on that tooth. So if you look at the X-ray, maybe the X-ray shows, oh, this patient's pain is actually stemming from a huge abscess at the root of the tooth. Had we not looked at the X-ray we might have just tried to fill it. So I kind of think of that of something like that when I got into practice. So I do see, okay, there's an issue. So we're bleeding money. So there's an issue, but what's the root cause of it? So I think that's great what you said, Kiera, because it made me think of that.

0:11:09.5 TT: It's really we go in and we dig for the root cause. So overhead is high, collections are low. So what's the root cause? So hand-offs are working great, the diagnosis is there, the treatment's there, the schedule's pretty full. They're producing 120 grand with two doctors and two hygienists, that's not bad, per month. So we really diagnose. So we ramped up treatment planning with the front office, ramped up treatment planning, which should ramp up over-the-counter collections, and then we tackled cancellations, which I think, cancellations across the board, across the country in all of my practices have been really high lately. I think it's just a product of the mentality that we're living in right now, and a product of what we've become.

0:11:56.4 TT: So that aside, we just set some new goals. So over-the-counter collections and collections in general, I set them another goal. So their goal now is 98% by the end of the year. Okay, and remember they're at about 86% now. Case acceptance, they're doing dollar for dollar, so case acceptance dollar for dollar, 75% is their goal. They're hovering at about 56% right now. And then I wanna see cancellations at less than 10% every day. So they'll do that by week, and they're tracking all of those items. It is actually really fun to hammer in the collections, because the corner office ladies are like, "I don't know what... I don't know why she keeps saying, 'Collections, collections.' Why are you saying collections is an issue? We collect the money, we collect all the money over-the-counter, we don't let patients leave without paying." And so I said, "Okay. Totally fine."

0:12:45.9 TT: So what we did was we set... We created a new tracker. So I created a new tracker for them for over-the-counter collections. If they do not collect in full from a patient, they've got to put it on the tracker. So it's just in my Google spreadsheets, something the office manager can check in on but it's gonna hold them accountable. So number one, I saw that we had a few patients we weren't collecting over-the-counter 100% from. So there should be some names on there. Number two, they're not gonna want to fill out the tracker, and they're not gonna want anyone to see your name on there. So hopefully it will ramp up that over-the-counter collections. But then also, they had a good point. If they feel like they're collecting over-the-counter correctly, maybe it's on the back-end, where it's like, "Our claims... Our treatment plans are not accounting for downgrade, and so maybe our claims are coming in, EOBs are being paid, and we're left with balances, it will show."

0:13:44.1 TT: So I checked the problem, diagnosed what needed to happen, implemented three items, and three different goals that should help, and then allow them the grace and the space to say, Okay, fantastic. We're gonna push real hard on these items to ensure that your over-the-counter collections is happening exactly how you're saying that it is, just because I want you guys to kill it. And the proof will be in the end, right? So if I see the over-the-counter questions is better. And now our overhead is decreased, and our collections is higher, then I know we've tackled the problem. If it's not, and it stays where it is, and we start seeing, okay, it's actually leftover after insurance, we actually tackled that problem as well, because we... We have our insurance... The team is doing the insurance verifications, are gonna start... They're putting downgrades in now. So that should be resolved as well. But it was kind of fun to see where it's like, sometimes we think we're doing something, and we can say like, I always do this thing, which always and never are never accurate. [chuckle]

0:14:45.4 TT: Right. So like, whenever I think like, I always do it, I'm like, okay, so I don't always do it, so I need to like back off and [chuckle] take a look at the area where I probably could improve. So as soon as I hear something that I'm like, Okay, I totally get it, it's like it's a defensive space, and we do feel like we're killing it in that area. And it's great if we are, you might be, so we're gonna put this into place to see that, to show it. So let's prove that you are doing the things, and it's not you. On the opposite side of the spectrum, we're putting attention on it, and so no matter what, whether you were doing it before, and you're doing it... Now you're doing it even more, or you're doing it the same as before, or you weren't ever doing it, it's going to improve no matter what because you're paying attention on it.

0:15:26.3 KD: And I love that.

0:15:28.5 TT: So...

0:15:28.5 KD: I love it so much.

0:15:28.6 TT: Yeah, that's what we did in this process.

0:15:30.5 KD: So I think there's like quite a few pieces I wanna highlight from it, is number one, I love that you talked about how you see an issue. But that issue is usually a symptom of a bigger problem. And so it was collections aren't low until you found three other areas to fix. I also love that you put tracking into place. And I also love that you took what people said about always collecting and spun it into a really positive way 'cause some people be like, Okay, well, I get that you say you're always doing this, but the reality is we're not collecting. You didn't make them wrong, you said, Hey, I hear you. Let's actually track this and prove that you guys are really doing it. So like I'm on your team, versus I'm making you wrong.

0:16:07.0 KD: And so I hope a lot of people listened and heard that. And I think that that's one of the beauties of coming in person, because over the phone, I can't... We can't move and navigate as easily as we can in person. In person, we're able to see, okay, here's this broken piece, let's go fix. Let's look at the whole way up the chain to see where is the broken link. Because down below we know something further up is broken. But then we can get the entire team working on it. So you see quick, fast changes in our practice that are usually sustainable. So Tiff, I thought you did so many awesome things in it. And I know you tackled so many more pieces. Like that's just a quick... I mean, we're talking 15 minutes synopsis right here, where you're like, Hey, I was there for a day and a half. But let me give you a quick 15 minutes.

0:16:46.2 KD: But I hope people took that. And so I'm like digesting this in for an office of how do you take this and make this applicable to you, is number one, when you find a problem look to see like what are all the pieces up ahead of that problem that got there? To get to collections, what has to happen before collections? Insurance verification, inputting information, sending claims, getting the checks back from insurance, are they getting lost in the mail? Do we have EFT setup? How are we posting it? What about downgrades? What about our write offs? Then you also looked at like, okay, what creates that copay amount for the patient portion? That's treatment plans. Are we giving every patient a treatment plan and having it signed and putting that copay amount or the amount that they owe in the appointment box, so that way, everybody knows that we just collect that?

0:17:27.7 KD: Then let's go back even further and say, first and foremost, how's our case acceptance, like, are we even having good handoffs to get the treatment that's diagnosed, to get the case acceptance, to get the schedule to be able to then send it out. So that's why we love what we do. Like I just broke all that down. I'm like, that is what we freaking do and we love it. We love it so much. But I hope you guys take it and diagnose that. And if you have a hard time seeing up that chain, Tiff and I are really good at seeing like, Hey, here's the billing system. Here's the case acceptance system. Here is our new patient... System. Like here are all these systems that could be impacting your collections. Let's look to see where it's at. Let's come up with some tracking. Let's give your team goals. And then let's see magic happen. So if you guys are needing help with that, always email us [email protected]. But gosh, Tiff, like, way to kill it at that practice. I love, I love hearing your recaps after a practice.

0:18:16.9 TT: Thank you. Yeah, and you're right. We did a ton more firstly on the collection side. But yeah, I love it. And I love the diagnosis piece, I'm really seeing like the light bulbs go off and doctors and teams too. So and I think you're right. I think that it can be done over the phone. It just takes a lot longer. And I think we do miss pieces because it's a biased opinion. I'm relying on the team or the doctor to provide me the information. I'm not seeing it firsthand. So it is much more effective when we're able to get in practice. And probably I'd say the first one in office is like, Okay, this is a good starting point, second, and third in the office are really where we really, I mean, we dig deep on those suckers because we know we know the practice at that point.

0:19:01.3 KD: Totally.

0:19:01.8 TT: Yes, I love it.

0:19:02.2 KD: I love it.

0:19:02.8 TT: It was fun.

0:19:03.4 KD: So fun. Well, Tiff, as always, I love you heading to offices. I love you representing our company. And it's fun to see. So I hope you guys like take this into yourself, put on the Tiffanie, Kiera Consultant hat, look at your practice, see if you can uncover those spots and where it might be broken further up the chain. And if you can't see it, or you also want to pick our brains, email us [email protected]. And as always, thank you all. Thank you, Tiffanie. Thank you all for listening. And we'll catch you next time on The Dental A Team podcast.

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0:19:31.8 KD: And that wraps it up for another episode of The Dental A Team podcast. Thank you so much for listening, and we'll talk to you next time.