Janice Keller has 25-plus years of experience in dentistry clinically, and as an office manager and software trainer. Now, as a practice management consultant, she provides high-quality, customized practice development and education to clients and their teams. Jan is certified by human resource experts Bent Ericksen & Associates in employee law compliance, and also certified by the Institute of Practice Management. She is a member of the prestigious Speaking/Consulting Network, and the Academy of Dental Management Consultants. Reach her by email at jkeller@jankellerassoc.com.

Jan Keller

	Finding and retaining top teams is one of the most difficult challenges any dental practice owner faces.

	But, yeah! You’ve done it. You’ve just filled the position for a new dental assistant (or other position) and finally have great hopes for success. He or she seems perfect for the job and excited to be a part of your practice. You, on the other hand, are just relieved the hiring "ordeal" is over and are looking forward to practicing more dentistry again.   

	Fast forward 85 days to the point at which your new hire is just about to complete your three-month orientation and training period. Let’s see how things are going.

 The new hire, we’ll call her Angela, is working out exactly as you’d hoped. She is excited to be a part of your practice and developing into a productive and positive member of your team. Patients respond well to her open and caring personality.

 Angela is doing OK but not anywhere near as well as you’d hoped. She does her job but without enthusiasm or enjoyment. She seems uninterested in getting to know her fellow team members or how their jobs align with hers. She’s been late a few times. She is polite to patients but nothing more.

Related reading: The 3 big reasons why your team members are quitting

	If your outcome is A, congratulations. The first few months are often the hardest so if Angela is working out well at this point, chances are good she’s going to be a successful hire and stay with your practice for a long time.

	If your outcome is B, you’re not alone. It’s common for high hopes for a new employee to fizzle out within months, if not weeks, and for that person to exit the practice through what can seem like a constantly revolving door.

	Which leaves you wondering what went wrong-again.

	While it’s inevitable you’ll lose, or fire, employees unexpectedly during your career, it doesn’t have to be the norm. There are procedures you can put in place to keep that from happening on a recurring basis. This is even more important for a new dentist because the sooner you learn the steps, the better chance you have of avoiding common personnel mistakes that are guaranteed to cost you dearly over the years-not only in money but time, energy and stress.

Fire right: 3 steps to legal, humane employee termination in the dental practice

	Step 1: A position-specific orientation and training plan

 Give Angela the best start possible. Allow several hours for orientation during which time you should provide her with information on practice philosophy, the practice personnel manual, her personal file and her step-by-step training plan. Clear time in your schedule to make sure you are involved in this process.

 Prepare and commit to a training plan that is shared with fellow team members and helps Angela excel at a rapid pace. Use your job description as a guide for making a list of all tasks and responsibilities expected from this position. Schedule training sessions and include with whom, when and where. Include HIPAA and OSHA, employment forms and performance reviews.  

	A good job description will include job title, job summary, job qualifications, experience and education, certificates, licenses and registrations, skills/competencies and duties and responsibilities.

	All employees should have a confidential and a regular file that contains a signed acknowledgement of their job description, completed I-9 and W-4 forms, copies of relevant licensure, emergency contact information, signed acknowledgement of agreed benefits package (salary, time off, vacation, etc), Hepatitis B information and consent and payroll banking instructions.

	This is at a minimum. Because requirements vary by state, you must make sure to include everything your particular state(s) require. 

	Do not skip this step for any employee regardless of their position in the practice. Failing to properly train a new employee in OSHA and HIPAA compliance can be a costly mistake for your practice-not to mention a potential safety hazard.

	Whether or not it’s Angela’s job to use your PM software every day, she needs to know how she can best use it to fulfil her own responsibilities, as well as helping her teammates as needed. If there is no one in your office who is comfortable or competent in this kind of training, contact your software vendor to help. It may or may not charge for this, but if it does, it will be money well spent.

More on training: 5 essential staff training strategies within the dental practice

	Step 5: Communication of practice values with new hire and team

	When hiring new staff, dentists often forget to clarify their own values and ensure the candidate they choose shares those values. If you have not covered this step in the hiring process, you must do it now during the training and orientation period. Make sure Angela knows and understands your vision for your practice and how you choose as individuals and a team to communicate that vision to your patients.

	A script may be needed. This can be something as simple as how you answer your phone or return phone calls. (Even if that is not Angela’s main job, she will likely be asked to do it from time to time.) Or, for instance, how do you discuss patient payments? What words or phrases do you use? Which ones do you avoid? Your values affect every aspect of your practice and how it runs, and your entire team needs to understand them and how to articulate them with patients and each other.

	The temptation to let a new hire like Angela "learn on her feet" is powerful once you’re all back to the normal craziness of a busy day, but she deserves better. Give her regular and constructive feedback as she learns. Address any questions or concerns quickly. Don’t wait until her three-month review to tell her she is doing a good, not-so-good or bad job. Be her advocate, support her progress and make sure your team does as well.  

	Follow these six simple steps, and you’ve got an excellent chance of making Angela a great hire with a great future in your practice.

Related reading: Important lessons about dental staff compensation

Articles

Finding and retaining top teams is one of the most difficult challenges any dental practice owner faces.

6 Easy Steps to Making Sure Your New Hire Becomes a Great Hire

	Regardless of your practice philosophy regarding insurance management, you are bound to have heard this kind of statement from patients many times in the past.

	Helping your patients understand their dental benefits and, more importantly, what they are and are not responsible for paying themselves, is a difficult task. After all, even dental professionals are often confused about what insurance carriers will and will not pay for and the seemingly endless changes that take place year after year. (Translation: insurance carriers paying less and less while asking for more and more from the dental provider.)

	What is important to communicate to patients, however, is that if prescribed treatment is in their best interest, insurance coverage should be looked at as benefit and not as the reason for declining or delaying needed care.

More on insurance: Why insurance coordinators need to be flexible in today's dental world

	Having a system in place to communicate insurance benefits with your patients starts with having internal credit guidelines in place that allow your treatment coordinator to present payment options based on the cost of the treatment and anticipated insurance contribution. Even if you are one of the lucky offices that does not accept insurance payments, this is valuable information to know as you will most likely be asked these questions anyway!   

Helping patients understand what "dental insurance" really means

, recommends communicating with patients about their dental insurance benefits using verbiage such as, 

We’re happy to help you maximize your benefits, but please understand it is our experience that some dental benefit providers are making changes that may or may not be communicated to you. We promise to be fair and consistent with all our patients, but we have no control over what insurance companies ultimately do or don’t cover and at what rate.”

Video: What does the future hold for dental insurance?

	Additional measures to ensure patients understand what might happen with their insurance carriers are to make sure patients know:

			What the anticipated insurance payment will be

			Their insurance may not pay it all even if it states the procedure is covered 100 percent

			There may be a remaining balance, which will be the patient’s responsibility

			The anticipated patient portion will be collected on the day of service or prior to scheduling the appointment. (Remember, patients are less apt to cancel an appointment if they are financially invested.) 

Video: How to save time on dental insurance verifications

	Review the following common questions and answers in your next staff meeting. If your team is armed and comfortable with these answers, the stress level for all will be greatly reduced.

Why doesn’t my insurance cover all the costs for my dental treatment?

	Dental insurance isn’t really "insurance" at all. It is actually a benefit typically provided by an employer to help employees pay for routine dental treatment. The employer usually chooses a plan based on the amount of the benefit and how much the premium costs. Most benefit plans only cover between $1,000 (an "average plan) and $2,000-$2,500 (an "excellent" plan) of dental costs per person per year.

Related reading: 5 facts you should know about dental insurance coverage

My plan says my exams and certain other procedures are covered 100 percent. Are they?

	That 100 percent is usually what the insurance carrier 

 as payment toward the procedure and not what your dentist, or any other dentist in your area, may actually charge. For example, let’s say your dentist charges $90 for an examination. Your carrier, however, may only allow $60 as the 100 percent payment for that examination, leaving you with a balance of $30 to pay.

If my plan doesn’t really cover procedures at 100 percent, why does it say it will?

	Benefit plans are often difficult to understand. If any part of your plan is not clear to you, or if you are unsure as to what your plan actually does and does not cover, contact your employee benefits coordinator or the human resource department where you work for more information. This could end up saving you a lot of unpleasant surprises down the road.

Related reading: Why are some insurance companies excluding dental care? 

How does my insurance carrier come up with its allowed payments?

	Many carriers refer to their allowed payments as UCR, which stands for usual, customary and reasonable. UCR is a listing of payments for all covered procedures negotiated by your employer and the insurance company. This listing is related to the cost of the premiums and where you live. UCR in New York City will likely be very different than UCR in North Platte, Neb. Your employer has been given the chance to select an allowed, or UCR, payment that corresponds to the premium cost they are looking for. Think of your plan’s UCR as a negotiation between the insurance company and your employer.  

Because the payments are negotiated, does this mean that there will always be a balance left over for me to pay?

	Yes, typically there is a portion that is not covered by your benefit plan.

Featuring Jan Keller: 24 practice management ideas to improve your dental practice ... in 90 seconds or less

If I always have a balance to pay, why have insurance at all? 

	Even a benefit plan that does not cover a large portion of the cost of needed dentistry pays something and reduces what you have to pay. Even if it’s not a lot, everything helps!

I received an explanation of benefits from my insurance carrier that says my dental bill exceeded the UCR. Does this mean my dentist is charging more than they should?

	Remember that what insurance carriers call 

 is really just what your employer and the insurance company have negotiated as the amount that will be paid toward your treatment. It is usually always less, sometimes even much less, than what any dentist in your area might actually charge for a dental procedure. It does not mean your dentist is charging too much.

More on dental insurance: New bill before Congress targets dental insurance plans

Why is there an annual maximum on my benefits?

	Maximums limit what a carrier has to pay out each year. Despite the fact that dental tends to rise a little each year, annual maximum levels for dental care have not changed since the 1960s.

Why do some benefit plans require me to select a dentist from a list?

	That list will include dentists who have agreed to a contract with the benefit plan. These contracts have restrictions and requirements. If you choose a dentist on the list, you typically will pay less toward your dental care than if you choose a dentist not on the list. Not seeing your dentist on the list does NOT mean there is something "wrong" with the dentist or the office. It simply means your dentist has not chosen to participate in that particular plan.

Why does my benefit plan only pay toward the least expensive alternative treatment?

	To save money, many dental plans allow only for the least expensive method of treatment. For example, your dentist may recommend an implant with your insurance only offering a benefit towards a crown. This does not mean you have to accept the crown. The good news is that some benefit (money) will be paid; the bad news is that more of the fee will be your responsibility. Remember, it is your dentist’s responsibility to prescribe what is best for you while the insurance carrier’s responsibility is to control payments.

Related reading: The top five things you need to know about dental fees

Why won’t my insurance pay anything toward some procedures?

	Your plan contract specifies how many of certain types of procedures it will pay for, or partially pay for, during a one-year period. For instance, it limits the number of X-rays, cleanings and gum treatments it will cover because these are the types of treatments that many people need more than once or twice a year.

My insurance plan doesn’t go into effect until next month. Can my dentist do my treatment today but send in the claim next month so the insurance will pay?

	Nope. State and federal laws regulate these issues, and it is considered insurance fraud to change the dates of service on a claim. Both the patient and the dentist can be prosecuted.

More on insurance: How to streamline the insurance aging report

What should I do if my insurance doesn’t pay for treatment I think should be covered?

	Because your insurance coverage is between you, your employer and the insurance carrier, your dentist does not have the power to make your plan pay for something you, or the dentist, thinks should be covered. It is important to remember that you are responsible for the total cost of treatment if your insurance does not pay. Sometimes a plan may pay if patients send in claims for themselves. Patients, as consumers, may also lodge complaints the state insurance commission.

Where can my employer find out what typical UCRs are for our area?

, and use this as a guideline when negotiating with insurance carriers.

	If you would like help with handling the "dreaded" insurance question, please 

. We can talk on the phone (with my Coffee Break Consulting services) or plan a day to work with you and your team.

Related reading: The myth that patients should know their benefits

Regardless of your practice philosophy regarding insurance management, you are bound to have heard this kind of statement from patients many times in the past.

The dreaded “Why do I have to pay?”

. Surely two of the most boring words ever invented (when used one after the other, of course). That “thing” you’re supposed to do before the end of the year as a smart business owner so you can go into the New Year feeling confident that you have all your financial ducks in a row and the upcoming year will be wonderful and stress-free.

Believe me, as a dental consultant I know how you feel about annual planning:

Here’s the good news. Putting together a plan for your practice for the next 12 months that gives you a road map showing where you are and where you need and want to be can actually be a very satisfying process, even fun. Your accountant will be happy, too, because he or she is not (in general) a practice management advisor, but rather a tax and investment advisor. Working together is a win-win for all. 

Whether you’re an established dentist with a full schedule, a great team, and a fully funded retirement plan, or a newbie who’s just starting out, the need for an Annual Plan is equally important.

Dr. Established, chances are good you didn’t get where you are today by putting your head in the sand and “hoping for the best” when it comes to financial decisions and at this point in your career you certainly don’t want to sit back and assume all the hard work is done. You’re on the right path. Stay there.

Dr. Newbie, now is the time to get your practice off to a strong start with a financial plan in place for the upcoming year that keeps you from making ill-advised financial decisions because someone asks a question and you don’t know whether to say yes or no. In my experience, more often than not, you’ll just guess, or take the path of least resistance.

Without a plan in place, for instance, how would you address these common office scenarios:

It seems like we need another hygienist, but I’m not sure the schedule can support that salary.

My staff is collecting more than 90% of our outstanding A/R. Is that good enough?

We seem to have a lot of cancellations and no-shows. Is that normal?

Our computers are 3 years old. When do I need to upgrade?

How many days a year do I need to work to support my salary of X?

I have a staff member who is causing friction in the office. What should I do?

I don’t have anyone on staff to handle social media. Do we even need to bother with that?

Questions 6 and 7 might not seem “financial” in nature, but they have financial consequences, and are, therefore, appropriate to consider when developing your Annual Plan, as are many more like them. Think of your annual plan as a treatment plan for your practice. Diagnose the issues, then decide on a course of “treatment” that best suits the practice’s financial needs and goals.  

Give yourself and your practice a great holiday gift and put a solid plan in place for your practice that takes the guesswork out of financial decisions, and serves as a road map to helping you achieve your goals for the coming year and beyond. Whether you’re established, a newbie, or somewhere in-between, this is a process you can’t afford to ignore.  

Editor's Note: For more information on the Academy of Dental Management Consultants, 