Th 152396

I Want Patients To Pay in Advance

June 1, 2004
Question: My financial coordinator knows I want patients to pay in advance of appointments, yet I still end up with patients in my chair who have not paid or even committed to treatment. What can you suggest?

Question:My financial coordinator knows I want patients to pay in advance of appointments, yet I still end up with patients in my chair who have not paid or even committed to treatment. What can you suggest?

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Kathy Larson, Organizational Expert: I suspect you have a busy front desk. Structuring your team for success prevents this sticky situation and keeps your money from walking out the door!

Separate the positions of scheduler and financial coordinator. One person cannot be effective in both areas. Your scheduler is primarily concerned with scheduling on the phone. Inform new patients of your payment policy at the time of scheduling. After the exam, closing summary, and treatment plan presentation, the financial coordinator — in an area away from the traffic of the front desk — schedules the next appointment and designs the payment alliance with the patient: No financial arrangements, no next appointment.

I am most concerned about why the problem continues to happen. Have you established this performance expectation in your practice? Remember, you must "inspect what you expect." The simplest way to do this is to review the status of every patient on the schedule at your daily morning team meeting. This takes 15 minutes or less. Ask your financial coordinator, "Have financial arrangements been completed?" If not, ask, "Why not?" and then fix the situation. You deserve a paycheck, don't you?

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Valerie Williams, Clinical Expert: Enlist the help of your hygienist! She can play an important role in ensuring a patient's commitment to treatment by using a "closing summary." This is essential to the patient's understanding of the treatment and the need for it.

Susan, we discussed a lot today. The most important thing to remember is that you have the early stages of periodontal disease. We are going to treat this with two periodontal therapy appointments. This is not surgery. You will be very comfortable, and we expect to see good results. The doctor also needs to replace the broken silver filling on the upper right. She has recommended a beautiful, natural tooth-colored restoration, an Empress crown, to be the best restoration for you. Do you have any questions or concerns? Is there anything you would like to discuss before we schedule these appointments?

With an effective closing summary, patients will be much better informed, more likely to commit to treatment, and more prepared to pay for it. Afterwards, make sure your hygienist follows through by accompanying patients directly to the financial coordinator and relaying the discussion.

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Mary O'Neill, Relationship Expert: Much time, energy, and frustration could be saved if we'd learn to ask for what we really want. It sounds so simple, but it's not always so easy.

You say that your financial coordinator "knows" what you want (and I'm assuming she wants to keep her job), so I'm guessing she's not perfectly clear about just how important the enforcement of this policy is to you. Many of us have the notion that once something has been communicated, we're all on the same page with it. But most of the time, that's just not so. People learn best through repetition.

To get your needs satisfied, you may need to go over this again. Be very specific. Ask for feedback. Find out if your financial coordinator fully grasps how critical this matter is, and be clear about what the consequences may be for not following through. Don't assume she understands; ask her to restate what you've said. This way you can be sure that the message you send is received in the way you intend it.

Once you have ascertained that your financial coordinator is clear about the policy, ask if she's comfortable with it. If she has any reluctance or feels awkward about asking for money, you'll need to address that right away. You can become a positive influence by helping boost her assertiveness and communication skills. There are numerous training resources available to help both of you.

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Linda O'Grady, Front-Office Expert: Has your financial coordinator had proper training? Is she comfortable asking for money? Does she lack confidence? These potential roadblocks all need to be considered. Your team member also needs to know that failure to follow your requirements could result in dismissal.

Secondly, if you don't offer financial options, you might want to start. Why not offer a 5 percent accounting reduction fee for payment in advance? Do you accept Master Card, Visa, American Express, or Discover Card? Have you considered outside financing? Having a formal, written financial agreement is essential. By signing it, patients are basically saying, "Yes, I want this treatment and this is how I plan to pay for it."

Lastly, no patient should reserve time in your schedule without having paid for those services in advance. Make sure your entire team is on board with this policy and remind them at the morning meeting. If a patient is not prepared to pay, reschedule him.

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Meet our guest, Glenda Payas, DDS:A 1986 graduate of Oral Roberts University, Dr. Payas maintains a fee-for-service, private practice in Tulsa, Okla. She is a mentor for Dr. John Kois' program, Creating Restorative Excellence. Dr. Payas has been using lasers since 1991, is a charter member in the Academy of Laser Dentistry and holds an Advanced Laser Proficiency in carbon dioxide lasers. She is also a member of the Pierre Fauchard Academy. You may contact Dr. Payas at [email protected].

Dr. Payas: Every team member must have the same focus and understanding of office policy. It's critical. Sit down with your treatment coordinator again and review the office policy and your expectations. Set clear parameters about what you will and won't accept. Do this in writing and state your desired results with the team member privately.

Clearance of any variance from the written policy should come only from you, in advance of the appointment being scheduled. Tell your team member this, put it in writing, and jointly review the policy. Additional training may be needed to meet your expectations. Remember, if you have provided proper training, clarified your expectations, and reviewed the team member's performance and you're still not satisfied, a poor-performing employee can be replaced with a more capable candidate.

"SheDentistry Speaks" is a monthly feature in Woman Dentist Journal to address your practice questions. If you have a question or concern you would like to address, please visit the What Does She Think? page of on the World Wide Web.