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.

A well trained insurance administrator and treatment coordinator are very valuable members of the dental team. They can usually assist the Dr. with increasing monthly production by several hundred to several thousand dollars. Just think of what that would do for your practice!

Only the Dr. can diagnose and treatment plan. However, once the treatment plan is complete, the Insurance Administrator can add valuable insight in respect to sequencing and timing of specific treatments. The key is open communication between Dr. and team. What I am saying, is, that by making a few little adjustments and using the correct code, you can get legitimate reimbursement for the procedures   that  you already perform.

Patients are always looking to stretch their dollars.  It is important that the patient has an experience that exceeds their expectations and has a greater perceived value of your services than they would have at another office. Dentists have no control over most of their overhead. However, they do have control over their perceived value.

Clear communication with the patient is essential to the success of the practice. Not only should team members be able to effectively speak to a patient, they must also hear what the patient has to say. Most patients are less concerned with the type of treatment needed, and more concerned about out of pocket expense, time off work, etc.

The team must be able to address the patient’s concerns in calm, understanding manor. There is a difference between listening and hearing. You must learn to listen to what your patient is (or is not) telling you.

Seating a patient on time, having a caring, well trained and knowledgeable team, explaining the patient’s benefits to them , educating the patient on their treatment plan, having simple financial policies , and building relationships, are a few things that patient’s place a high  value on. By exceeding a patient’s expectations you will build a base of desirable patients, you will have fewer missed appointments, better case acceptance and your practice will benefit. Your patients will feel respected and appreciated, and will be happy. They become loyal to your office and will refer their family and friends.

It has been my experience over the last 30 years of working in and with dental offices that the ones that take the time to review the patient’s charts, use route slips properly, and have an informative morning huddle are more successful than those who don’t.  It is not productive to gather around and just read the schedule.

It is easy to have tunnel vision & only deal with what the patient is coming in for that day, but when we do that, we miss some significant items.  The biggest culprit of lost opportunities to provide optimal care is the morning huddle. There are important questions to answer….  Does the patient have undone treatment? Did they see the specialist that you referred them to? When was their last complete exam, perio evaluation and diagnostics?  Did they express an interest in teeth whitening that was never followed up on? Do we have a patient on today’s schedule with special needs that will require the use of a specific operatory or wants only a certain assistant?  Does this patient require antibiotic premed and have they been reminded to take it? Will you run out of instruments if you have back to back procedures?  Does this patient only come in when they have a toothache? Is there a balance we need to collect before the patient is seated? By taking the time to prepare your charts for the next day and discuss the day’s schedule, you will be more productive, better prepared and less stressed. You lose credibility when you appear unorganized.

Nothing is worse than having a patient stand at the counter after treatment is done and says they “didn’t know they had to pay today” or “I don’t have my wallet, can you bill me?” Would they go to the grocery store, a restaurant, hairdresser, etc. without expecting to pay?  Could you image asking your car repair shop if they can bill you?

Patients are less receptive to accepting large treatment plans because of the out of pocket costs. It’s not that they don’t understand or disagree with the presentation; it’s that they are usually budgeting their dollars very carefully. Most patients can’t write a check for $1000.00, but they could probably afford $30.00 per month.

This is where your  Financial Administrator or Office Manager helps the patient find a payment plan that fits their budget. Most offices have a variety of long term payment options available for those patient’s that need to stretch out their financial obligation. These can include obtaining an authorization from the patient to do a monthly auto draw on the date that the patient helps determine, from the account of their choice.

Positive changes like this start off small & must start with the Dr. taking  the lead.  It can take some time to get everyone on the same page, and there are always tough choices, but in the end, you will have a much smoother running office, as well as a more profitable one.