By Maryann Bateman

The case was presented and you did a great job showing your patient, Mrs. Smith, the intraoral pictures and X-rays of tooth No. 14. Her tooth had a large, 30-year-old amalgam and a missing cusp. You and the hygienist convinced her she needed a crown. Without a crown, the tooth might break and she would then need a root canal or extraction. The patient asked when she could come in, and you directed her to the front desk to make her appointment. “Great,” you thought. “She needs to crown that tooth, and my production could use a boost this month.” One hour later, you looked on the schedule and saw that Mrs. Smith did not schedule.

You dashed to the front desk and asked Cindy, the scheduler, what happened to Mrs. Smith, and Cindy replied, “She decided to wait. I don’t think she can afford the crown. She runs a small business, so I don’t think she has the money.”

She decided to wait

Really? Since when did patients decide their treatment course? Why did Cindy decide Mrs. Smith could not afford it? How does she know how Mrs. Smith manages her money? Cindy does not know and should not make any assumptions. Many patients care about their teeth and like to avoid pain, so in reality, Cindy did not help Mrs. Smith, she actually hurt her.

This story explains how we lose sales on a day-to-day basis because one important team member does not do an adequate job of supporting the business. If only the story could end happily, with patients getting the treatment they deserve while your schedule is filled with great cases to support the business.

We think of “sales” as a dirty word, but like it or not, without sales your practice will not survive. In this case, you did a great job selling, but your staff did a bad job closing the sale. Your front desk staff or, as I like to call them, the business office staff must be prepared to close every sale. This is one of the most important steps in sales — the close. Being prepared with the correct order of how to close the case will keep your schedule full.

Your business office must be organized so that the best “salesperson” checks out all patients. Following a specific outline on how to close the sale will help your “salesperson/closer” fill the schedule. Cindy the scheduler now becomes the scheduler/closer. She needs to help the patient with the business side of her treatment. If Cindy had followed the steps below, she would have been successful in closing Mrs. Smith’s sale.

The business office’s closing outline is:

1) Transition to scheduler/closer — When the hygienist brings the patient to the business office, the scheduler/closer greets the patient and listens to the diagnosis from the hygienist.

2) Emphasize treatment — Upon hearing the diagnosis, the scheduler/closer says, “Wow. We need to take care of you right away. It sounds like you need a crown due to the missing cusp and large amalgam on that upper molar. I had a patient the other day who let it go only one week and now she is facing a root canal.” It is important to verify that the patient needs the treatment, that you tell her you will take care of her (not a thing or issue, you want to make this personal), and you help her get the treatment completed.

3) Schedule the appointment — Next, the scheduler/closer gets the appointment scheduled. This is critical before any financial arrangements are presented. The appointment step is the first thing done to close the sale. The scheduler/closer says something like, “Well, let’s get you on the schedule. What is a good day for you, Mrs. Smith?” Get the appointment scheduled rather than talking about the cost. Talk about cost second, but get the appointment set first. The treatment must be the focus of the closing conversation.

4) Financial arrangements — After the appointment is scheduled, ask the patient if he or she needs to go over money. “Mrs. Smith, would you like for me to go over your portion after insurance?” The patient can then talk about money if she wishes. Some do not care, so just place a note in the chart that they did not care to talk about money. However, most of the time, patients very much care about money.

Note: When discussing money, the scheduler/closer must be sensitive to who is nearby or can overhear. I suggest you have a private place to talk to patients. If it is a big case, ask a patient to join you in a conference room. In other words, make privacy a priority when discussing money.

Let’s suppose Mrs. Smith does not have the money up front to pay her portion of the crown. Your scheduler/closer should not fumble this discussion. Many patients just want to talk about how bad the economy is rather than about their treatment. They actually talk themselves out of treatment because of the fear of the economy. Your scheduler/closer should keep the patient focused on what treatment needs to be done rather than on the economy or the patient’s personal finances.

If the scheduler/closer gets caught up in the “woe is me” conversation, the patient will not schedule, or worse, will cancel later. The scheduler/closer should focus the patient back to the treatment by saying something like, “Yes, Mrs. Smith, times are tough. Now, back to your crown. I am very concerned about your health. Let’s figure out the money for you. We do not want you to go untreated because of money. We can work something out. Let’s try ...”

Assume the patient has the ability to pay and get the person on the calendar. Again, do not get caught up in a negative conversation about money. Keep the patient focused on his or her treatment and why it is important.

Sometimes your scheduler/closer must get creative to work out the financial arrangements. There are so many great payment options, such as Chase, CareCredit, and Springstone. That is the first option in helping patients with money. Also, monthly credit card deductions are a great option, or perhaps in-office payment plans. This is for your long-term patients, not for new patients. You may need to get creative concerning money, and do not present payment options too early in the closing part of the sale.

5) Dismiss the patient — Finally, tell the patient when you will see her for treatment. “Mrs. Smith, we look forward to seeing you on the 18th at 2 p.m. We will take very good care of you.” This is a good way to finalize your agreement to schedule the treatment, and you know the sale is closed. Once the patient leaves the office, document how the money will be handled and place the note with the appointment so if another business office person checks out the patient, that person will know what to collect.

Collecting the fee once the patient comes in for treatment is usually easy if all financial arrangements have been made ahead of time. Your business office must be clear with the patient that the payment is due the day of service. However, sometimes patients decide to change their financial commitments. When they are escorted up to the business office, they have conveniently forgotten their credit card or checkbook. Or worse, they say they would rather wait until insurance pays. They try to wiggle their way out of paying.

What do you do? Do you barrage the patient with “You promised to pay this amount,” or “I have to collect your fee today”? No, your business office must remind them that they committed to a payment structure so you say, “Let’s work out how we will pay your portion.” Also, you can ask the patient to call back with the credit card number or bring by a check later that day. If that does not work, many times you can offer a 5% discount if the person pays today. Many times this will get the patient to pay his or her portion.

Collecting on the day of service helps your business office keep tight tabs on the accounts aging. However, sometimes you will have accounts past due. I recommend promptness in dealing with the aging accounts. If an account is in “insurance world,” your staff cannot call the patient until insurance pays. Once insurance pays, it is game on. Following the steps below will assure your accounts aging will be up-to-date on a regular basis.

1) After insurance pays, send a statement to the patient indicating insurance has paid and the account is due upon receipt.

2) Allow the patient to pay within 30 days. Once the account gets to 31 days, call the patient as a friendly reminder that the account is due. It is imperative to be friendly in this call because it is not a serious confrontation at this juncture. Your staff should say or leave a message, “I noticed your insurance has paid on your recent treatment and you have a balance of $250 left on your account. You’re probably not even aware of this. I just wanted to let you know because I know you like to keep your account current. I am here all day today and if you would like, I would be happy to take your credit card over the phone to settle the account. Please call me at 555-555-5555. Thank you.”

3) Let’s suppose the account gets to 60 days past due. Sixty days is calculated from the day insurance pays (not the day of service). This is when your business office needs to get aggressive. If an account gets to 75 days, it is unlikely you will collect the money and will have to turn over the account to a collection agency. Your staff now calls the patient with a more threatening tone. “I hope you received my message last month about your past due account. Our accountant was looking at your account today and asked me to turn the account over to our collection agency. I asked him to please let me contact you one more time before we do that. Your account is at $250, so we need to work together on how to settle it. Please call me by X date at 555-555-555. Thank you.”

4) Wait until that X date and if the patient does not pay, turn the patient over to your collection agency. Your collection agency will have better luck in collecting if the account is in less than a 75-day window.

Continue to present cases to patients with confidence because your scheduler/closer will now be armed with a plan to fill your schedule, collect the fees, and keep your bottom line in the black. Your staff will be able to say the right words to close and collect with style by using the steps outlined above.

Yes, sales, closing sales, and collecting fees seem like the “dirty” side of running a business. But without it, you cannot pay the practice’s overhead.

Author bio

Maryann Bateman is a dental practice administrator in Charlotte, N.C. She has a BA in business administration and fine art from the University of North Carolina in Chapel Hill and a BA in architecture from UNCC College of Architecture. Maryann is a graduate of Sandler Sales Institute/Dunn Training. She continues to study how the dental and medical fields depend on sound business practices and sales/marketing. Maryann can be reached at mmbunc@gmail.com.