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What’s Up Front Counts.....

March 1, 2007
Imagine the most skillful juggler performing for you, tossing balls, knives, and batons of fire, never getting burned and never dropping a single implement.

By Cindy Ishimoto, CDPMA

Imagine the most skillful juggler performing for you, tossing balls, knives, and batons of fire, never getting burned and never dropping a single implement. Now that you have that picture in your mind, substitute the picture of the juggler with a picture of the business assistant. The business team juggles daily patient service, insurance management, the financial system, chart management, computer input, and on and on and on. They ensure the integrity of your systems and patient care by not dropping any details.

For years the consulting world has encouraged practices to know that the person or persons in the business office must be highly skilled in a variety of systems, fabulous communicators, technologically savvy, and flexible enough to change on a moment’s notice. Who you have on the business team and the systems you have to support them really does bring meaning to the saying, “It’s what’s up front that counts.”

Committing to ownership of the service and business systems in 2007 will, for the business team, be about ensuring the integrity of those systems, improving their efficiency and effectiveness, and, above all, decreasing the stress and increasing the happiness factor for the entire team.

Communication Is Key

Communication is the foundation of every system and evaluating and improving this system will have a positive impact on the rest of the practice.

Morning huddles are the place to begin positive communication each and every day and should be led by the business team.

A well-organized and well-run morning meeting will help to decrease the stress level of the practice. You will know what is planned for the day, where to anticipate challenges, and understand what is expected of each staff member to help achieve a successful day. The purpose of this meeting is to achieve open lines of communication between the administrative and clinical staff, preparing for the exceptions of the day. It will help you to serve your patients at the very highest level.

We have found that with a good morning huddle, a practice can increase productivity and collections about 10 percent. We know a huddle will organize the day, the paperwork, and the charts, improve tomorrow’s and next week’s schedule, improve collections, and improve patient retention and treatment plan movement.

A good huddle begins by having all patient charts pulled, prepared, and organized for use with current schedules printed for each team member. Following an agenda is mandatory and helps to keep the meeting focused. The huddle should take approximately 10 to 15 minutes depending on the number of patients being seen that day.

The business assistant begins the meeting with a review of statistics that the practice agrees are important to share daily (i.e., production & collections from the previous day, comparison to your goals, and the same statistics for the current day).

Next I recommend you discuss any voids (openings) in the schedule, asking for suggestions for patients who might be available to fill the void or suggestions for advancing the treatment of patients already in schedule.

The next agenda item would be to share the next available (long appointment) primary procedure time on the schedule and the next available hygiene opening. This allows the rest of the team to assist the business team in filling those openings.

Another item to include on the agenda would be to ask the clinical team where they would like their emergencies added in for that day. The business team will, of course, honor those times and if they have more calls than was planned, everything will be done to accommodate the additional emergencies without interrupting the schedule dramatically.

Next, review the new patients in the schedule, pronounce their names, share with the team who referred the patients to the practice their reason for coming to your practice, and any questions or concerns the patients shared with the business team.

Finally, I recommend the business team share any concerns about patients in the schedule who will need to be seen by them prior to treatment to take care of their financial needs.

The facilitator now turns the meeting over to the doctor, hygienist, and clinical team to discuss the clinical and management needs for their patients.

The entire team should now provide information from their chart review including things like patients and family members who are past due for hygiene visits, patients who need necessary radiographs, and patients who have any incomplete treatment. Plan who will discuss all of these chart audit findings with the patients, provide education, take intraoral images, etc. This chart audit is important in continually following up on patient care needs. Morning huddle should include these things on top of reviewing what services will be provided that day.

Finally, it is important to always end the morning huddle in a positive way. Some offices end with a thought for the day, a quote, joke, or prayer. This brings closure to the meeting and begins the day on a positive note.


The second system to focus on in 2007 is the scheduling system, as it is one of the most difficult and intricate responsibilities in the practice. Successful scheduling is the responsibility of everyone on the team and the goal is to engineer the ideal day.

The scheduling system is the business team’s ultimate responsibility and requires juggling, flexibility, and above all, patience with the patients. The smoothness of your days, your ability to provide excellent care for your patients, and your ability to produce the necessary amount of dentistry each day are dependent upon your scheduling strategies.

Appointment books or systems are like a jigsaw puzzle with lots of pieces, except our puzzle pieces are blank - no pictures to match and no edge or framing pieces. There are a number of pieces you need to know before you can even put your ideal day puzzle together.

Production goals for providers must be established and procedural analysis templates need to be designed for the entire team to understand how much time is needed for the clinical team versus how much time is needed for the doctor. These templates and goals will help to develop your ideal day puzzle.

The practice should also establish a template for each day that allows the doctor to practice the dentistry the way he or she wants to. If the doctor is a morning person and wants to do the bulk of his or her productivity before lunch, then the template should match those desires. Each day must incorporate enough productive procedures to reach the goals, yet also have those procedures that are smaller in productivity blended into the day. The template must also include the number of new patients the practice plans to see daily, the number of anticipated consultations, and possible emergency times if this is something you choose to include in the template.

The business team will develop a beautiful picture of an ideal day if the clinical team provides them with enough puzzle pieces. Inputting the treatment plans into the computer or writing them up is the foundation to designing the puzzle pieces. Once that is accomplished, patient education is a must. Use of the intraoral camera on every patient makes that education easier and assists the patients in understanding the value of the dentistry and urgency of proceeding with their care.

The financial options will be provided by the business team. Once they have been secured, scheduling of the accepted dentistry will be accomplished. The successful scheduling will utilize the procedural analysis templates to ensure appointments are only overlapping assistant time with doctor time. Yes indeed, the business team understands that the doctor can only be in one place at a time!

The Financial System

Along with communications and scheduling, the business team must weave into their day the financial system of the practice. In tennis, the person who serves the best usually wins the game. This is also very true in collections. The business team has to understand how to collect, what to say, how to handle insurance, how to follow up on insurance, how to follow up on past due accounts, and of course, the billing system itself.

Practices that establish solid financial guidelines for their patients and then follow those guidelines consistently decrease the need for the business team to do follow-up. The costs to the practice in time and money increase when collections are not completed at the time of service.

Financial guidelines might include options such as:

  • A savings for payment in full before treatment begins, an option to pay half to reserve the appointment and the other half at the first appointment, or the use of health-care financing.
  • I recommend that all practices include health-care financing, such as CareCredit or CapitalOne, as a part of their financial options for patients. Financing a patient’s dentistry within your own practice is a treacherous pathway filled with labor-intensive follow up and a negative spiral that is difficult to stop. By forming a partnership with a patient financing company, the practice receives its money right away and your patients can start their dental care right now. They will enjoy the benefits of improved oral health and a beautiful smile today. It will also spread their payments over a period of time appropriate for their budget.

The insurance management system is one that can be labor-intensive for the business team, and constantly changing demands from insurance companies require that the business team be well-educated. It is important for practices to be insurance-aware, but not insurance-driven.

For many dental practices, 50 percent of the practice’s income comes in the form of an insurance check. In other words, approximately half of the collections of the practice come from insurance. Thus, it is imperative that the insurance aspect of the practice be managed and monitored with extreme dedication.

Management systems in the dental practice need to be both time- and cost-efficient. The insurance management system is no exception. Insurance has been, and will remain, an asset to dental practices.

Paying attention to the details of insurance benefits and ensuring that information is current will keep the insurance system efficient and effective. If your practice is a participating provider or accepts assignment of benefits, then your system must include verifying eligibility, benefits, limitations, reviewing coordination of benefit clauses, deductibles, etc., at least two days in advance of appointments. Treatment plan estimates should include this insurance information and financial arrangements should be secured for the “guesstimated” patient portion of the treatment, including collection of the deductible amounts, any non-covered services, and any amount over the maximum allowable.

I recommend that practices consider incorporating a guideline for the management of secondary insurance plans. This recommendation is that practices file the secondary claim on the patient’s behalf but not accept assignment of benefit from the secondary company. Patients that have two plans would pay as if they were covered under one plan and the secondary claims will be filed once the primary pays. The guesstimation process for one insurance plan takes a vast amount of work by the business team. Adding in all of the variables from a second plan can be time-consuming and not an effective process for the practice. This one change in your insurance management system can dramatically improve the efficiency of your business team.

Keeping It All in the Air

The dictionary defines juggling as “managing or alternating the requirements of two or more tasks, responsibilities, activities, etc., so as to handle each adequately.” A good business assistant knows the art of juggling and understands that it is necessary to maintain the mission, vision, and standards of the practice. Flexibility is a part of the daily requirements of each business assistant. Understanding the practice’s patient care and business systems, their guidelines, and being empowered to implement what is necessary to work those systems creates flexible, stretchable business assistants.

What’s up front really does count. Dentists should help their front-desk assistants be all they can be by providing education, tools to make their jobs easier, training, and support. If they are given what they need, the practice will have a great up front team!

Biographical Sketch

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Cindy Ishimoto, CDPMA, brings energy and powerful information to dentists and teams every day. With 30 years of experience, she is a well known speaker and management consultant. Cindy has been a featured speaker at international, national and state conventions; her lectures are focused on helping practices establish systems that balance serving patients, profitability and enjoyment of profession. As a member of the Jameson Management consulting team, she works in offices with clients all across the United States and the United Kingdom. She may be reached at [email protected] or at (877) 710-6545.