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21st Century Financial Arrangements

July 1, 2004
A sound financial policy promotes case acceptance. And payment options make it even easier to present treatment and collect payment.

A sound financial policy promotes case acceptance. And payment options make it even easier to present treatment and collect payment.

Congratulations! You have a beautiful office. You spent a lot of time visualizing exactly how it should look, and it turned out just as you imagined. You have a great team; everyone is on board and ready to follow your lead. Your team shares your vision and philosophy of care. Your clinical skills are refined. You are not only thorough, but pretty fast and efficient too!

So, what's missing? Are your patients paying you for the treatment you provide? Or are they saying "Bill me," and happily walking out the door so you have no idea when or if you will be paid? If this has ever happened in your practice, read on.

This article will give you tools to make it easy for patients to pay you, easy for your business assistants to ask for payment, and easy for your clinical team to understand their role in financial arrangements.

A financial policy is a MUST!

Prior to being seated in your operatory, your patients should be informed that you expect to be paid and that they are responsible for any charges incurred. In addition, your business team will know what your expectations are for collecting payment and that you view this as a very important part of each team member's job.

The easiest way to incorporate compliance of a new financial policy form is to attach the form to the health history and HIPAA forms that all new patients are already filling out. Tell patients of record that you would like to update their health history and give them the same packet. Most patients are happy to comply with your request if you let them know that by doing so you will be better able to care for them.

Now that patients know they have to pay you, what options do you have for them?

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Cash or check — Cash or check is great for you, but fewer than 20 percent of your patients can actually write a check for more than $300. Do you have an option for patients who are in this position? If not, it is imperative that you set something up! You are letting thousands of dollars of dentistry walk out your door every week if you do not have payment options available for your patients. Other common pitfalls of not having convenient payment options are last-minute cancellations, no-shows, or those patients who say they "need to get back with you." You may not even be aware that these problems are happening. It is important to know if your patients schedule another appointment with you. Your business assistants can easily track this information and give you a report each day.

Credit cards — If you don't already accept Visa, MasterCard, and Discover, get this into place immediately. The fee that these credit card companies charge for using their services is minimal compared to the benefits you get in return:

  • You receive payment today.
  • You know that the amount has been verified and approved by the credit card company.
  • You do not need to send a statement, saving your business team time and saving you money. This is a win/win situation!

Finance company — While cash, check, and credit cards are great, large treatment plans may require more creative payment options. CareCredit and Dental Fee Plan are excellent options to offer your patients. If you prefer a local company, that is fine too. You do not need all three; however, having at least two of these options is a good idea since sometimes one company won't approve your patient but the other one will.

Third-party financial institutions are excellent for several reasons:

They usually guarantee that you are paid with no recourse if patients default on their loan. (Be sure to ask about this when signing up.)

You can sign up for direct deposit into your bank account.

Payment is usually received within two business days.

(NOTE: If patients are denied credit from both financing companies and they don't have a credit card, do not finance them yourself! You are setting up yourself — and them — for failure. Patients appreciate that you give them options, but they also appreciate that you don't add to their already existing financial difficulties.)

Prepayment — I'm sure you are asking, "What if some patients don't get approved by any finance company, and they say they don't have any money?" The final option you should have in place is prepayment. There is nothing wrong with telling patients that you would be happy to accept whatever payment they can afford each month and put it on their account. Once they have reached the amount needed to have treatment completed, you will be happy to schedule an appointment and get them healthy! Individuals who have no other options will happily accept this plan. If they do not follow through, rest assured that they probably would not have followed the payment plan after you had completed the treatment either. With the prepay plan, you are not providing treatment for which you won't be paid.

Financial presentation options

Now that you have established options for all patients in your practice, how you present these options is the next most important aspect of financial arrangements. There are many ways to present treatment to patients:

Computer form — If your computer system allows you to print a treatment plan, you should be able to modify, as the default, a standard phrase or comment. Have your team members use this to present treatment, and have both the patients and team members sign the form. This helps patients commit to treatment because they have agreed that the treatment is necessary. See the sample form.

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Monthly payment discussion — For most dentists, getting commitment for "necessary" work is fairly easy. It is the "cosmetic" or "optional" treatment that becomes difficult. One method that seems to be very successful for many practices — and which will work for any type of treatment — is talking to patients in terms of monthly payments.

For instance, if you have CareCredit as an option and your treatment plan is $10,000, your clinical or business team could say to your patient, "Your investment for the treatment the doctor has just described to you can be as low as $210 per month. Is that something that would fit into your budget?" Then allow patients to ask questions. By starting with the smallest possible dollar amount, you are allowing the conversation to continue. Then you can find out if they prefer to write a check for the whole amount, if they need to finance, if they prefer to put it on a credit card, or whatever their particular circumstances require.

The worst possible scenario would be to say to the patient, "This is going to cost $10,000, your insurance doesn't pay for it because it is cosmetic, and I expect to be paid in full at your first visit." You will never be successful with this approach!

Team approach

Generally, financial arrangements are the responsibility of the business assistants. However, it is important to take a team approach and make sure your clinical team members are also aware of the financial policy so they can encourage compliance. During each visit and before treatment begins, chairside dental assistants should be able to ask patients if they have discussed the financial arrangements with the business assistants and if they have any questions. This will at least bring the subject up prior to starting any treatment and making any last-minute decisions as to what treatment should be completed during the visit based on their expected payment. At the very least, if a patient says, "I know I'm supposed to pay $200 today, but I only have $100 with me," the doctor and business team can discuss it and decide whether treatment should be altered or if financing options need to be discussed with the patient again.

Always be pragmatic, not dogmatic, in your approach to financial arrangements. Firm financial arrangements are extremely important; however, occasional exceptions may be necessary to keep your practice productive. By implementing a sound financial policy in your office, you will be more successful at getting patients to accept the treatment you recommend. Further, it will be easier for your team to present treatment and collect payment when you have options in place.

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Kristi Reece, CDA
Ms. Reece, a certified dental assistant, has spent more than 17 years in dentistry. Currently, she is a regional administrator for Heartland Dental Care, and she teaches at The Institute at Heartland Dental Care in Effingham, Ill. You may contact Ms. Reece at kreece@heart