Whether you’re opening a new orthodontic practice or have been working in the same space for 20 years, the systems you have in place are the backbone of your practice.
While good, solid systems are important in every dental office, they’re paramount in an orthodontic office. It’s much too easy for appointments, collections, insurances, scheduling issues, referral maintenance and overhead to slip through the cracks while you’re dealing with the day-to-day patient load.
- Each day, most orthodontic offices see a patient load that would sound impossible to the staff in a general office. These patients all need regular appointments scheduled for anywhere from one to two years while their parents make ongoing payments.
- All insurance claims need to be processed, and many also need to be reprocessed on a monthly or quarterly basis to keep payments flowing in.
- The schedule needs to be tweaked and monitored carefully to assure a smooth flow all day, every day.
- Another hat is worn by the staff member keeping the referral dentists in the loop on their patients’ progress. If that job isn’t done adequately, the practice can easily lose referral sources.
Add to all this the need to maintain a reasonable overhead while still keeping sufficient product in the office, and you have a lot of jobs and a lot of hats.
Let’s take a look at some of the necessary systems and discuss how to implement them all without feeling like “the faster we run the behinder we get.”
Appointment / patient monitoring
In our current litigious society, no orthodontist can afford to let a patient slip through the cracks. Very few orthodontic offices don’t have at least one or two horror stories of patients lost in the system.
These are the patients you track down for weeks to schedule, only to have them cancel on the answering machine and force you to start the whole process again. Eventually they can get lost until the patient’s mother calls and you realize it’s been months since you’ve seen them.
They can also be the retention patients who never return after their braces are removed and they’ve been given their retainer. The next thing you hear about them is a frantic call from a parent who noticed teeth have shifted and wants to know why you didn’t follow up on retainer checks.
Both these situations can be avoided with proper systems in place. The computer software most offices use can generate the needed reports and letters – but the trick is to make sure someone is designated to use that software.
First, every patient who leaves your office should have an appointment or a recall scheduled (with the exception of patients completed and dismissed from retention). Once every month, without fail, the office manager or receptionist should be running a list of active patients who are not currently appointed.
The type of recall you use will make it simple to know if you need to get them in as soon as possible. These patients need to be called and those calls need to be documented. If there’s no response after a reasonable period of time, a certified letter needs to be sent.
The same goes for the retention patients. You’ll need to set them up for regular recalls during their retention phase, send recall reminders, and finally send an “MIA” letter after a designated number of reminders go unheeded to let them know you will stop following up but would still like them to come in to be checked.
These are jobs that staffers often consider too time-consuming and feel wastes too much of the day. Still, they are jobs that need to be done. You as the doctor being on board with the importance of systems is the biggest piece in altering this perception.
Monthly payments
Payments are another area that can go awry very quickly without good systems. There’s no reason why any orthodontic office should have any less than a 98 percent collection ratio; many have more than 100 percent because patients pay in advance.
The 30-, 60- and 90-day overdue reports need to be run twice monthly without fail. If the office/financial manger is on the phone as soon as payments go more than 15 days late and is backing up her calls with twice-monthly billing when necessary, collection ratios never need to get into the 60 percent to 90 percent range. This system is important because an account that has gone 90 days overdue is an extremely difficult account to get current. The parent has already come to expect that payment need not be made, and changing that mindset is very difficult.
In many offices, braces are removed if the payments fall too far behind. It’s a public relations boon to never have to take that step because your staffers never let collections get ahead of them.
Insurance billing
The system involved with insurance billing can awaken an office manager in a cold sweat in the middle of the night. It’s impossible to keep all the insurance billing in an orthodontic office in place without good systems. Every Monday, the office/financial manager should be using the software discussed previously to run a report listing every procedure done in the past week that could possibly generate a charge. That report then needs to be reviewed to be sure all insurances are promptly filed and notes are made to generate the filing of secondary insurance claims when applicable.
All insurances that need quarterly/monthly billing must be set up in a tickler file (much easier now than when offices used to keep an expanding folder for them) and billed promptly.
One office manager who just took over a new job was horrified at what she found. There were secondary insurances that had never been billed and had gone past the time frame when insurance companies would accept them. She found primary insurances billed but never followed up upon when incorrect denials came in. She found quarterly billings ignored until the claims were closed. All these system failures represented money lost by the office because going back to the patient after the office error would not be ethical or advisable.
Schedule maintenance
Even the most carefully tweaked schedule can fall apart because of neglect. There needs to be a designated staff member who checks the schedule 8 to 10 days ahead regularly, and months ahead periodically, to be sure nothing out of the ordinary needs to be adjusted. The best example of how this pays off can be found in the first two days after the office returns from a long holiday weekend. If extra spots in the schedule weren’t blocked out for emergencies on that day and all slots are filled, chaos will be inevitable. The same applies to weeks where most of the local schools are on break. If your schedule is allowed to become totally filled weeks prior to the break, you’ll spend an entire week running after emergencies (and pseudo-emergencies) instead of using a system to plan ahead and keep things running smoothly.
Referral communication
Unfortunately, many orthodontists see communication with referral dentists as a low priority and thus give it little attention. Your office treatment coordinator must get letters out to these referring doctors to let them know your findings, keep them in the loop if the orthodontic treatment poses any unexpected challenges, and to let them know when their patient has successfully completed treatment. Anyone who still feels this system is not all that important should speak with general dentists and hear how often they decline to use a referral source because of lack of follow up regarding their patients. You’ll be truly surprised!
Overhead and inventory
The supply-ordering and inventory system keeps your day-to-day office functions running smoothly. This job cannot be left to the least trained assistant as a rite of passage for being the “new girl.” Every office should have a top-notch, well-trained assistant keeping an inventory spreadsheet and maintaining a good ordering system. This will both keep the office supplied and the inventory in check. Problems arise when a new person takes over every six months or so and takes advantage of all the “specials” the vendors offer. These specials get carefully packed away, forgotten and reordered on a regular basis. When one practice moved to a new space a few years ago, the doctor and his consultant were horrified at how much product had been “stashed” and never used.
A final word
The job of establishing all these systems sounds very daunting if they’re not already in place in your offices. Be assured, however, that they can be set up and used efficiently with a little diligence and perseverance.
The first step is to set up a “systems meeting” in your office. Brainstorm and list every system you think you have in place or want to have in place. Next, put names next to each system currently being worked by a staff member. Finally, delegate the rest of the systems to other staff members.
It will take about six monthly follow-up meetings to be sure everything’s in palace and getting done — but the results in terms of productivity and stress reduction will amaze you.
