”Why Do I Have To Pay When The Doctor Didn’t Do Anything?”
It is Friday afternoon. One of the chairside assistants called in sick this morning, so the remainder of the clinical team works together to pick up the slack. The Dentist is stuck in an operatory surgically removing the root tips of what was expected to be a simple extraction. Your crown prep that has already been waiting for a while, just announces to you that they have to leave to pick up a child in an hour. The handpiece in the hygiene room quit working all of a sudden, so the hygienist had to move her patient to another operatory to polish. There are instruments piling up and lab cases still need to be sent out. Will this day ever end??
The extraction is finally finished, and the hygienist just dismissed her patient. Just when the remaining assistants were starting to see a little light at the end of the tunnel, the Receptionist comes in the back to tell them that there is an emergency patient coming in. When the assistants ask her what the patient’s emergency is and she says “I don’t know exactly, they just said that one of their back teeth was killing them”. The assistants turn back to their mounting pile of instruments. Their blood pressure goes sky high. Nevertheless, they take a deep breath and start to gather the necessary items to see this emergency addition to the schedule.
The patient arrives, and the receptionist tells the patient that they haven’t been seen for over two years , so they need to fill out new paperwork. The patient was upset about filling out pages of forms and took almost 30 minutes. Finally, the patient is ready and the assistant seats them as soon as they have an available operatory. During triage, the patient states he has been in pain several weeks but only has been swollen for two or three days. He said that since the weekend was coming he thought he should get in. In reviewing his treatment plan, the assistant discovers that he has been non-compliant with the root canal treatment he was advised he needed and missed his last two recare visits. The Dentist views the x-rays and re-advises the patient of the diagnosis. He prescribes an antibiotic and pain medication and instructs the patient to schedule for the root canal the following week.
The assistant escorts the patient to the front and tells the Receptionist that the patient needs to schedule for the endo. When the receptionist asks what was done, the assistant says the “doctor didn’t do anything today”.
The Receptionist attempts to collect the patient’s co pay for an office visit and the patient argues that they shouldn’t have to pay because the “doctor didn’t do anything”. Now, the receptionist is stuck dealing with a sticky situation. Does this sound familiar? We have all had those days.
“The Doctor Didn’t Do Anything”… I cringe every time I hear a team member say that!! To begin with, this patient was an emergency call late in the day and was worked into an already busy schedule. Therefore, there was a disruption of the Dentist’s time reserved for treatment on regularly scheduled patients. There was a disruption of the assistant’s time because she had to review the patient’s health history, perform triage, take the necessary films, and set up the room for whatever treatment she anticipated the dentist will advise. Once diagnosed, she will need to provide additional explanation for needed procedures, obtain informed consent if necessary, give post-op instructions, dismiss the patient and quickly clean and disinfect the operatory and get set up for their next scheduled patient. There was a disruption of the financial administrator’s time to stop and give an estimate for the next visit and discuss financial arrangements. So, YES… The entire team “did something”.
This situation could run much smoother by just changing a few things. First and foremost there must be a clear procedure for handling emergency calls. Many times the front office team members have little or no clinical experience, so they lack the knowledge needed to properly triage the patient when they call. Having an emergency triage sheet ready by the phone, not only prompts the front office on the questions that need to be asked, that same sheet can follow the patient to the operatory so the assistant and the dentist have a basic idea of what the problem is before the patient is seen.
Rather than tell the patient to “come right over”, the receptionist should complete the triage sheet, pull the patient’s chart to see if there is any undone treatment in the area they are complaining about. In this case, the patient was advised they needed an endo but has not returned for treatment. The patient also said this pain has been going on for quite some time (not usually a true emergency.)
The receptionist is armed with this info and speaks to the assistant or the dentist. The dentist determines that since the diagnosis had already been made, it would be appropriate to call in an antibiotic and pain medication to get the patient through the weekend. This would reduce the swelling and pain, and the patient can schedule for the appropriate exam and update diagnostics to confirm that the tooth is still restorable. All necessary forms that the patient needs to fill out can be emailed or faxed to them to complete at their leisure and bring with them to the appointment.
In the event that a patient does have a true emergency , it is best to avoid using an office visit or limited exam code. Many insurance companies will consider these as a periodic exam then deny recare exams for frequency. By using D9110 Emergency Palliative code, you are providing a better benefit for your patient. The fee is usually higher, to compensate for the disruption in your schedule, so the dentist benefits as well. Just be sure to document thoroughly. X-rays are billed separately.
Always advise the patient on the telephone that the dentist is “working you in for an emergency visit, and your estimated portion will be $________ when you arrive” . Also, ask them to come at least 15 minutes early to update and to remind them to bring their current insurance information. I suggest that you collect co-pays when the patient arrives. This plants the seed that this is a serious situation with financial obligations. Perhaps this will help the patient to value the dentist’s time and treatment recommendations in the future.
Proper team training will go a long way in avoiding unnecessary emergency visits and will make your day run smoother.