Jill Nesbitt is a practice administrator & dental consultant piloting a comprehensive dental staff training program in Nashville after managing a group practice with seven dentists, 20 staff, and 18 operatories for 16 years. Jill has an MBA and writes a weekly blog, www.dentalpracticecoaching.com. Jill is passionate about helping other office managers develop their careers and helping their dentists run successful businesses through her consulting practice.

Jill Nesbitt

Pop quiz: What are the different staff positions in a dental practice? How different people and organizations answer this question may surprise you.

Here are some answers you would probably give:

Now, imagine we asked this same question to the ADA? Here are its probable answers:

American Dental Association’s website page “Dental Team Careers”

 you can see that they’ve left out the dental office manager completely. As far as the ADA is concerned, the dental office manager is not a dental team career. I think we would all tend to disagree.

The career of a dental office manager may look something like this:

Beginner: New to the field, a dental office manager often starts out as a receptionist, hired to answer phones, schedule appointments, and collect payments at the front desk.

Runs the front desk: With experience, now our dental office manager asks few questions. She understands the flow of lab cases, how to handle emergencies, refers to specialists easily, and enjoys chatting with the patients throughout her busy days.

In many solo practices, this career has a short path. However, as dentists continue to work together and form group practices that even expand into multiple location offices, a career may continue toward:

Team leader: Responsible for the team of administrative staff, creating the schedule, and dividing the duties for the group. The team leader is also responsible for training and managing her team, so leadership and problem-solving are necessary skills for success.

Practice manager: Now managing the administrative team, assistants, and hygienists, the practice manager expands her people skills and understanding of dentistry. Often the dentist works closely with this manager and the practice enjoys an organized business structure.

Regional manager: Usually this position exists in corporate dental practices where a manager is responsible for six to 10 dental offices as a middle management position. Extensive travel is required and pay scales are drastically increased as a result.

So why does the ADA not include a dental office manager as a career in dentistry? Here are my guesses:

The ADA is full of dentists who are clinical. They share a common background with hygienists and assistants who experienced the study of biology, time spent in labs, and hands-on patient care. None of this is shared with a dental office manager who is primarily responsible for the business side of the practice.

Again, state board members are 100% clinical primarily dentists with one hygienist thrown in for good measure. These bodies make decisions about certifications for dental staff and clarify the training required to provide each type of patient care. Since these boards don’t regulate certifications or training for dental office managers, this position may simply be off their radar.

Obviously, the dental office manager is a dental team career some might argue the most important position in the practice. Even in the career path described above, the dental office manager can advance to a position responsible for all other dental staff in the office, so beyond simply existing in a dental practice, the dental office manager has the opportunity to influence the activities and the performance of the practice overall.

In my next article, I will share thoughts on future opportunities for the career path of a dental office manager some that don’t even exist yet!

Articles

What does the career path of a dental office manager look like?

, we established that the dental office manager is a dental team career path (even though the ADA doesn’t recognize it as such). With this in mind, what will this critical position look like in the future of dentistry?

the ADA has its eye on some “New Proposed Dental Careers”

 of Community Dental Health Coordinator and Oral Preventive Assistant. A Community Dental Health Coordinator is a future career path for a hygienist. Often targeting underserved communities, this person coordinates dental care through social workers and other medical professionals through existing state-funded programs. The Oral Preventive Assistant is an even newer concept, offering an alternative career path for dental assistants who prefer the people-side of dentistry to the surgical side. Both these positions recognize the wider role of healthcare and are an attempt to include oral health in the mix.

So, what about a future career path for dental office managers?

One of the hottest careers today in the medical world is Healthcare Informatics. Described as the intersection of information science, computer science, and healthcare, this person helps to improve patient care through technology. I highly recommend reading 

 by Burning Glass Technologies published May 2012, here are a few of their findings:

Check out this amazing graph! Burning Glass did a study of the online job postings over five years and discovered that healthcare informatics-related jobs were growing at an unbelievable rate of speed during one of the worst recessions our country has experienced in its history.

Another great thing about healthcare informatics work is that you can get into this field with as little as a 2-year degree and you can continue to advance your career through certifications and even up to bachelors, masters level work. Check out this visual to see the 10-year career map available to someone in the healthcare informatics field.




Take a minute and you can see this for yourself. Just go to your favorite job board and enter “Healthcare Informatics.” You’ll be amazed by the opportunities you’ll find.

Okay, so how does healthcare informatics relate to dental office managers? I’m glad you asked. You may have noticed the trends affecting dentistry these days:

The financial pressure of PPO plans on dentists fees

The effect of online reviews on selecting a dentist

Government involvement increasing through HIPAA and the Affordable Care Act including dental care for children

I believe the upshot of all these trends is that dental offices are following medicine, but we have the opportunity to stay more in control of our practices (compared to physicians, who were eaten up by hospitals and have lost their independence). To survive, and thrive in the future of dentistry, more dental group practices will be created. Since dental school graduates cannot afford to start their own practice due to school debt of $250,000, they will continue to join group practices. As a group practice, dentists have a better chance of negotiating PPO fees, of hiring smart marketing firms, and they will also need to hire talented dental office managers, who are also known as administrators when the practice size grows substantially.

So, as we look at dental administrators for these large group practices we also recognize the trends of the healthcare informatics profession. A dental office manager is effectively acting as the “medical coder” for the practice. Using valuable resources such as 

, a dental office manager is responsible for entering codes on patients day-in and day-out to receive reimbursement for treatment. At a higher level of business management, a dental administrator can use the coding information in order to provide analysis to dentists to help them make better decisions about their practice. For example, let’s say you’re working in a group practice with an oral surgeon and a general dentist, and they coordinate together to place and restore implants. The administrator can (and should) create an analysis by looking at the codes being charged out for each provider, then match up the associated lab and implant fees for each in order to show the gross profit per procedure. When I did this analysis for a group practice, the owner-dentist realized how upside down the profit margin was the periodontist placing the implant only had to pay for the implant while the general dentist was responsible for the abutment and crown plus taking time to create the surgical guide for the surgeon! Since the referrals also were primarily generated by the general dentist, the specialist was motivated to maintain the relationship and supported a more equitable allocation of costs as well as the addition of a fee for the surgical guide which went directly to the general dentist.

As the regional group practice model evolves, have you heard of The Summit conference? This small conference offers dentists an opportunity to meet and learn how to organize together to create a multi-location group practice in order to increase their buying power and reduce common expenses. Dental administrators are needed to run these groups, and dental office managers with solid experience and some business training can take these opportunities. If you can make Dentrix and Eaglesoft sing, you’re way ahead of a retail-trained person who has been brought into dentistry to manage based on their background because you understand the clinical care center of dental practice.

I believe another position for dental office managers will be created in the future dental information manager. This person would work for a large group practice and be responsible for using the data created in each office to improve clinical care, patient experience and dental insurance reimbursement. Dental insurance plans are already looking for outliers on the overtreatment side dentists who place crowns unnecessarily and these dentists are required to jump through additional administrative hoops in order to maintain their membership in that PPO. This is happening today in dentistry. In medicine today, hospitals are not paid if a heart attack patient is readmitted to the hospital within 30 days after treatment. This translates into the PPO having the power to not pay the hospital for additional treatment because they are moving into paying for wellness, rather than constantly paying for sick care. Think about that for dentistry. What if dentists were not reimbursed by the PPO beyond the first filling done on a tooth? How will dentists be paid for wellness?

The Dental Quality Alliance is starting to ask those questions. Once clinical standards are established in dentistry, profit-driven dental insurance plans will be looking for new ways to cut their reimbursements. These clinical standards will be a new opportunity for the PPO to market themselves to employers by saying they have a dental wellness product just like the medical wellness product the employer has already purchased. The good news here is that our interests will be aligned the dentists who improve patients health will also be reimbursed at a higher rate, while the inverse will also be true, dentists that simply patch and crown with no overall approach for their patients to improve their oral health, will receive a lower level of reimbursement.

So, who do you think is going to have the skill set to understand the clinical care of dentistry and combine that with the knowledge of dental codes and add that into the business analytics skills to show dentists what their performance is compared to these new clinical standards? It’s the dental information manager. I can imagine this person translating national quality standards into comparable statistics for the dentists in their group, perhaps working with clinical teams to provide the results of the care provided so dentists, hygienists, and specialists can make changes to protocol and then again, see the measure of their success. Perhaps the dental information manager develops a strong relationship with the dental practice software company so that the fields available for tracking make sense and are easy to access. In this position, a dental information manager can have a significant effect on the health care of those patients without ever having clinical training.

As the business of dentistry evolves, the opportunities for dental office managers will explode even if today the ADA doesn’t recognize that we exist! Already, we know the difference we make in the dental practice. Soon, our roles will expand as the trends in healthcare informatics meet the new normal of dentistry where dental group practice follows the lead of medical wellness. I look forward to seeing you there!

Part 2: What does the career path of a dental office manager look like?

I recently gave a presentation at the Yankee Dental Congress on “Growth using National Quality Standards.” Although this title sounds like a snoozer (I’m open to suggestions), the concept is revolutionary.

The guts of the Baldrige National Quality Award is to:

1. Set a vision for what you want to achieve

Yes, it starts with a vision what do you want to accomplish with your dental practice? Even if your entire vision is to make as much money as possible, that’s still a vision that you can set a plan to achieve.

Try to avoid a generic vision like “I want to be the best” how do you define "best?" Maybe best to you means clinical perfection, which might be measured by the number of remakes in your lab cases. Maybe best to you means to serve the largest number of people in a certain zip code.

You can have multiple layers to your vision as well. Profitability probably plays a part, clinical care, perhaps community service? The great thing is you get to make it up and as you grow and develop your practice (and your life experience), you get to change it! For those of us who are parents, our vision for our children may start as simple as, “I pray they have 10 fingers and 10 toes,” and evolve into, “Let my 6th grader survive middle school,” then change again into college and career dreams.

Once you have your vision and a plan to achieve it, figure out how to measure your success. This is the revolutionary part. Every dentist I know is using Dentrix or a similar dental practice management software, yet they are not demanding the reports and information this software will provide to give the feedback necessary to monitor success. For example, every dentist I know would like to increase the number of new patients. How many dentists are running a report at the end of every month to look at where that month’s new patients came from? This takes a few minutes to run this report and, guess what, I’ll bet that you’ll discover some blanks, meaning that some new patients do not have a referral source documented! Make it the responsibility of your dental office manager or dental receptionist to ask every new patient, “Who may I thank for referring you to us?” Then, document this in the dental practice management software.

Tracking your new patient referrals allows you to determine your return on investment for marketing. Dentrix tracks this for you as long as your team enters the referral source. Then, at the end of the year, you can add up the total production generated from each referral source. Compare that to what you spent on each marketing activity. You should be generating 3:1 (for every $1 you invest in marketing, you should generate $3).

This is just one example of tracking for your practice. I’m a big fan of the Dentrix Office Manager Letters function. You can run just about any report you can think of using these fields. Since you can always make up a new code (and set the fee to $0), you can literally create a tracking system for anything you need. The more you measure your performance, the more know what is working or failing! I’ve listed my Top 10 Measures for a Dental Practice and, for Dentrix customers, I’d be happy to run those reports for you if you’re interested. 

The business of dentistry is becoming more challenging. Tracking your performance is just one way to run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog. One of the biggest challenges to managing a dental practice is 

. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s world of online reviews, 

 well is essential. As your practice grows, 

 becomes more important. With more than 16 years of dental practice management experience, I’m open to your questions to help you run a successful dental office.

How vision and tracking numbers can lead to a successful dental practice

Sat with my family watching a “30 Under 30” documentary on Maurice Clarett last night. Amazing what he is doing with his life after some incredible ups (as a freshman, he helped Ohio State University win its first national title in 38 years) and some devastating downs (spent three years in prison for gun and theft charges).

Now he is talking with kids through churches and youth programs and visiting prisons to share his story and how people can turn their lives around no matter their circumstances.

 This story of intentional living through difficult setbacks matches up perfectly with Malcolm Gladwell’s new book, 

. As always, Gladwell takes an assumption that everyone knows to be true and then proves why it’s false. In this case, it is the idea that going through a difficult experience (such as having dyslexia or losing a parent at a young age) actually causes people to develop their personalities and skills in a unique way that results in amazing accomplishments.

Gladwell shares stories of individuals with painful childhoods that shape them into “disagreeable” people (they are willing to take risks and disagree with their peers and supervisors) and they go on to help cure cancer, build successful companies, or become president!

So, what does all this have to do with dentistry?

Running a dental practice is tough and there are times when you feel like a failure. You work hard to provide the best denture you can for your patient who then refuses to pay you. You love your team and know they would like a raise, but insurance keeps paying less and you just don’t have the profits to afford an increase.

If you are facing serious challenges and setbacks in your practice, then taking some inspiration from Clarett might be helpful. Focus on your purpose in this life. Maybe now is the time when you will more clearly define your dental practice vision?

Dental practice management can be a challenge

As the American Dental Association identifies trends that suggest that dentistry will continue to be challenging in the future, this feeling that running a dental practice is harder than it should be (or than we thought it would be) may affect more dentists. Facing serious challenges in private practice, dentists will have the opportunity to have this experience shape who they are and then choose what they will do next.

One great example of this is a dentist I know who suffered an experience of embezzlement in her practice. The financial and emotional impacts of this experience were devastating and she will be handling the financial impact. One day, she shared with me that she had a patient in her chair for a crown prep. Obviously, she must have diagnosed that in the past but, looking now, she saw no reason to place a crown. So, she sat the patient up and told her she didn’t a crown today.

For a dentist working to cover payroll week to week, this was a difficult financial choice. However, she felt such pride knowing that, despite her personal challenges, she could do the right thing. This gave her strength to face the reality of running her practice and the confidence that she could make those tough decisions and be true to herself.

Overcoming adversity is just one way to run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog. One of the biggest challenges to managing a dental practice is managing dental insurance.

With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 16+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.

Have a clear vision, overcome adversity, and run a successful dental practice

“A new normal.” That’s what the American Dental Association (ADA) is calling it. Thanks to the strategic plan committee for commissioning an environmental scan, we have a hint that big changes are in store for dental practices. The top three takeaways from this evaluation include:

Dentistry has experienced structural changes.

Now is a critical moment for dentistry to define its future.

For dental office managers who have worked in dentistry for more than five minutes, you know the “structural changes” we’re talking about:

Dealing with multiple PPO plans and patients who expect us to be an expert on their plan even when they don’t have a card or any information themselves!

How online reviews can make or break the flow of new patients into your practice

The financial pressures of running a practice that end up translated to office managers as “fill the schedule with crowns!”

There are some new trends headed our way:

Although children are now included in the Affordable Care Act, adults are not and forecasts show a continued trend of fewer and fewer adults going to the dentist.

Dentists are not rebounding after the recent economic upturn in fact, dentists overall continue to have excess capacity and this is not forecast to improve for the next 10 years.

Patients will expect more value for their dental dollar and PPO plans will become increasingly selective.

So, how will this “new normal” affect your practice and your dentist?

First of all, things aren’t going to get easier. The continuous battle to fill the schedule isn’t letting up any time soon. Hopefully, your dentist enjoys seeing children because as the Affordable Care Act mandates dental and vision coverage for kids, this is an opportunity to add new patients. The challenge will be to convert their parents into patients as well.

Next, if fewer adults will have dental benefits and therefore, fewer adults will go to the dentist and competition for these adult patients will shoot up drastically. Your practice will be faced with the challenge of attracting these patients over the dentist down the street. Why should these patients come to your practice? This could lead to some difficult discussions among the dentist and team members about what differentiates you over your competition. Even worse, if you do nothing and the dentist down the street creates this value for patients, then what happens to your schedule?

Finally, if PPO plans become more selective, what happens if they drop your dentist? Right now, we expect that if we have open time in schedules, there’s always another insurance plan we could join to increase patient flow. But, what if that changes? For the dentists selected to participate, it could mean a first step towards the meaningful value described above. But in a culture where patients choose their dentists off the list and now, your dentist isn’t on the list how will you fill the schedule?

The ADA is calling these trends the “new normal” and, although change can be frightening, it also provides incredible opportunities for dentists and teams. So, as the office manager for your practice, encourage your dentist to go onto the American Dental Association website and read these reports they are available on 

. You should read them as well, then talk with your dentist about his or her thoughts on the practice. What is the dentist’s vision for the future, especially considering the massive changes ahead?

The more you, as the dental office manager, understand about what is going on in your field, the more you can prepare yourself on how to manage your office and manage your career. If you’re working in a pediatric practice, you may be preparing for a significant increase in patient volume. If you are working for a general dentist who prefers not to see children, you may need to prepare for more difficulty in filling the schedule. Your creativity and support in helping your dentist to add real value to a patient’s dental visits may make the difference between financial success and struggle.

The “new normal” and its effect on dental office managers

How many times have you met a new person and answered this question? Most likely, you just tell him or her you’re an office manager and the conversation moves along.

But when is the last time you stopped to think about what you really do? And what’s more, have you thought about how rapidly your job is changing right now?

Some of the responsibilities of a dental office manager never seem to change. There will forever be appointments to schedule, patients to call, prescriptions to call in and insurance to submit. We all have learned one form or another of dental practice management software and how to juggle phones, patients and staff when they demand our attention simultaneously.

Well known in our practices for being the one with ‘extra time’ since we don’t see patients, we are often responsible for keeping track of the cleaning company and the landscaping maintenance while also changing out the computer monitor that just died in the treatment room.

While some things never change, other things move so fast it’s hard to keep up. You probably dropped your yellow pages advertising within the last few years and started working with an online confirmation company.

The patient financing options and case acceptance methods you’re using today probably include many more choices than even one year ago. Are you staying updated through webinars and responsible for maintaining regular posts on the practice Facebook page? When did these tasks sneak into our job description?

Before we talk about the future of the dental office manager, let’s consider a few of the latest trends in dental practices today.

    •    Dental insurance is growing - Just five years ago, many dental practices could say they were 100% fee for service, accepting only out-of-network dental plans. Now, most practices are closer to 30% - 50% PPO plan patients.

This is a drastic change in a very short period of time. This increase in members-only dental plans has not only reduced fees, but increased office manager time in managing each plan properly.

    •    Technology is changing – Even though only 1% of dentists nationwide are chartless, we know the ADA has set a goal of 2014 for us to have electronic health records in dentistry.

You may have an iPad or kiosk in your lobby, you definitely have digital X-rays in your operatories and everyone is expected to be computer literate. As the cost of computers continues to drop, it’s easy to replace a slow PC and add new printers, label makers, scanners, etc. – practices need someone on staff who can manage this constant change of new technology.

    •    Marketing – Again, only five years ago, marketing a dental practice was relatively easy. Run your ad in the yellow pages, send a direct mail postcard to new movers and watch the new patients roll in.

Today, keep updating your website (heard of the Google Panda update?), post weekly on your Facebook page, work the booth in your local town festival and start thinking about how to join the mobile marketing revolution. The sheer time involved with interacting with patients through social media is a drastic change in our work schedules that we never had to plan for.
	
	Beyond taking responsibility for dental insurance, technology and marketing, the dental office manager of the future needs the ability to manage the practice. Imagine that you confidently and correctly handle the variety of business decisions that occur throughout your practice – from handling upset patients to making financial arrangements, to running the practice’s marketing budget and even helping negotiate new technology purchases?

On top of saving the dentist time so he or she can be focusing on clinical care (and production), what if you, as the organized, well-trained, office manager, could implement the dentist’s ideas and help accomplish goals while your dentist appreciates and supports you?

You can become the business professional your dental practice needs. Most office managers feel that they want to do their very best for their dentist. They see the many demands on the dentist and appreciate their job – but they don’t know what to do.

They don’t know how to get the training they need so they can be a real asset to their dentist and the entire practice. As the field of dentistry changes, just look again at the 3 trends we reviewed, now is the time for dental office managers to step up and get the training that will take them to the next level.

There are a variety of ways for a dental office manager to gain the necessary training. From the AADOM annual conference to online forums to DANB courses, an office manager can take her career into her own hands by signing up for the classes she needs. There are also several online training courses available by simply searching ‘dental office manager training’.

Often there are groups you can join through your dental practice management software – look for local users groups to join. Simple networking through Linked In or by chatting up your dental supply representative to find other office managers who might like to meet for lunch can be a great way to get started. Finally, there are community colleges and online classes for specific business administration degrees.

As the dental office manager takes responsibility for her career development, she can invite the dentist to invest his time to help her develop these skills. Ask your dentist to meet with you to find out what skills he would like to see you add and how you will improve the practice. Your dentist will appreciate your initiative and most likely will encourage you by including you in his new ideas and plans for the practice.

As the office manager and dentist continue to work together – the office manager is transforming into a real business manager. She eventually will bring ideas and programs to the meetings that the dentist never considered. She will begin to read dental journals and participate in online forums and learn about dentistry outside the walls of the practice.

That will lead to even more new ideas and opportunities - and if the dentist likes the new idea the office manager presents, he already has the person in place to implement! This also takes the stress off the dentist as he or she feels they have another intelligent, caring person to bounce ideas off of and together they can start to become partners that share the burden of running the practice.

As dentistry changes, we need business professionals in practices that can successfully manage the office. These office managers play a major role in reducing overhead, evaluating dental insurance plans and managing the fast-changing world of marketing.

The office manager position becomes full of variety and challenge – and makes a difference in the lives of not just the dentist and staff, but also the patients and the community. A successful dental practice serves a vital role in the community – and the well-trained dental office manager is at the heart of this practice.

Nesbitt is a dental consultant and practicing office manager for a multi-specialty private dental group. Nesbitt has managed the practice for 14 years, has state-level quality training, and  coaches dental teams to improve the business-side of their practices.

The changing role of the dental office manager

We won the lottery! Woo hoo! Lucky us! Okay, not so much, because the lottery we won was to be selected to receive an audit for unclaimed funds.

What, pray tell, is an unclaimed funds audit, you ask? Allow me. Apparently, the state of Ohio has decided that any money businesses owe back to their customers should no longer be kept as a credit on those customers’ account.

Instead, this money should be sent to the state of Ohio. Then, the state will add their information into their unclaimed funds website, where, if they can find this website and provide the proper identification, they can receive this money.

To accomplish this, Ohio has hired auditors to spend a day or two in the business to identify any unclaimed funds for the last 3 years.

To produce this information, we ran reports to find credit balances.

Then, we had to manually review each one to make sure the patient wasn’t scheduled for an upcoming appointment (or more often, the patient’s family member) or, that the credit had been requested to be left there by the patient as he or she was building credit for major treatment.

Ohio’s rules are that if the credit amount is more than $50, then we are to send a letter to the patient letting he or she know this credit exists and without a response, we will be sending this amount to the state.

Then we had to fill out a special form along with this amount as well. For amounts less than $50, we are to add up the amounts of the credit, write a check to the state and create a final adjustment to bring the patient’s balance back to zero.

There are four auditors for Ohio and we were lucky enough to be selected for this audit. Bring on the Powerball tickets!

Why it’s important to keep track of refunds

In my opinion, the state is gaining nothing by auditing my practice for credit balances. We have a strict collection procedure that asks patients to pay their portion promptly-and we make collection phone calls and send letters to anyone past due even a few weeks.

With this type of collection policy, we feel it’s our duty to also keep track of our refunds. If we expect to be paid on time for the work we do, then we understand that patients expect to receive their refunds in the same timely manner.

		Run an aging report and look for all credit balances, especially those over 30 days.

		Call every patient due $50 or more to ask those patients how they would like to use this money-maybe this is a step toward saving for whitening or maybe they have a few kids overdue for checkups and we want to leave that on to cover their co-pays-or maybe they want a refund. They choose and we do it.

		Send letters to patients with $50 or less. We use the DENTRIX quick letters to automatically include their next continuing care date due and again, we give them options. The DENTRIX Office Journal records the date this letter was mailed.

I assume every state has its own version of unclaimed funds audits, but chances are, you won’t be as lucky as we were. However, even without an audit, it makes sense to have an organized system for handling refunds to patients. This can help to avoid patient complaints in the future. 

Handling credit balances properly is just one way you can run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog.

is a dental consultant and practicing office manager for a multi-specialty private dental group. Nesbitt has managed the practice for 14 years, has state-level quality training, and coaches dental teams to improve the business-side of their practices.

In this month’s From the Office Manager’s Desk column, Jill Nesbitt describes her practice’s experience with an unclaimed funds audit and explains why it’s important for every practice to have an organized system to handle patient refunds.

Beware the unclaimed funds audit

, Jill Nesbitt tells you how to use your ledger to manage and increase case acceptance in your office.

Think about the most recent large case you presented. Did the patient nod and smile at you while you described the steps involved in bringing her mouth back to health? Did she say that she wanted treatment right away? Now, are you wondering why you haven't seen her in your schedule?

Being successful at gaining case acceptance on large cases is critical for running a successful dental practice. Most general dentists enjoy the challenge of tackling a complex case so they can use their skills to the fullest.

It's also personally rewarding to bring a patient up to an acceptable level of health and watching that patient develop more self-confidence and pride in her appearance. It's also financially rewarding. As Stephen Covey might say, the large cases are the 'big rocks' that help fill schedules and fill bank accounts.

Check out one of Jill's favorite videos from Stephen Covey:

You can use the ledger to manage your case acceptance. Our group uses 

Dentrix dental practice management software

, which makes this tracking easy. First, you need to charge out your case presentation-create a no-fee code with the description "Consultation" or "Conference" because this will print on a walkout statement. Then, treatment plan this code in the appointment when you plan to present your large case.

At the end of the month (or week) run a report to find everyone who has been charged out for this code. Look to see if there is a large credit on the account, indicating the patient paid some amount down for future treatment. Check to see that this patient has either completed the first steps of treatment or is scheduled to return.

At the end of each month, compare the number of patients that had a case presentation with the number moving forward with the treatment plan. If you present 10 cases and 8 accept, set up financial arrangements and schedule their first visit, then you can count these 8 as accepted and in progress. So, 80% would be your average. Calculating the average for each dentist in your group provides valuable feedback and is an indicator of successful dental practice management.

The dentists can discuss their successful and failed cases and exchange ideas to improve. They also can use the failed cases as a call list to try to fill schedules later.

It makes a difference when the dentist calls. By simply taking the time to call the patient to say "I'm following up on a conversation you and I had last month where we talked about dental treatment for you-I wanted to offer to answer any questions you might have if you're still thinking about getting that dentistry done-can I answer anything for you?" Usually, this starts a very nice conversation and hopefully the dentist wraps up by offering to have his treatment coordinator set up financial arrangements and schedule the visit.

Want more top-notch practice management advice? 

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Orthodontists can use this same approach to track their success at gaining different types of cases. By charging out code D8000 Ortho initial exam or D8001,2 Ortho re-eval, again at no fee (most orthodontists aren't charging for new patient visits anyway) and tracking the kind of case presented and accepted, the orthodontist can see his success rate with Phase 1, full braces, Invisalign, etc.

Some of this work is manual-looking to see if treatment has been started or scheduled takes time, but the feedback for the orthodontist is worthwhile. If a trend starts to develop-for example, if you’re successful at starting 70% of full braces cases, but only 30% of phase 1 cases then it makes sense to look at the phase 1 approach to look for ways to improve. 

Another way to use the ledger is to track pediatric oral and IV sedation cases. Again, I'm targeting these cases because they are generally more complex and expensive than regular treatment plans. When you charge out D0150 comprehensive exam for children and compare that with the oral sedation and IV sedation codes, you can see your success rate for doing these types of cases.

This same approach makes sense for oral surgeons as well. Charge out the D0150 comprehensive exam for wisdom teeth extraction and then look in the ledger at the end of month to see if the case is completed or scheduled. Again, for cases that do not schedule, your oral surgeon can take these patient names and make a follow up call to answer questions and try to get these patients into your schedule.

 and provide feedback to dentists is one of the most valuable coaching mechanisms available in dental practice management software. It can be easy for one dentist to blame a patient's finances for his lack of success with these large cases, but when another dentist in the same group has a markedly better track record the conversation usually changes to asking "How do you do it?"

Because the reality of our economy is that patient finances really do affect large case acceptance, spending time looking at the black and white results also can open up some conversations about financial arrangements policy and options. Dentists may want to start to offer phased treatment and then again, track their success.

I've been tracking large case acceptance for every general dentist and specialist in our group for more than 6 years using Dentrix, so if you have any questions about how to set up this approach in your own office, 

I want to help you to run a dental practice successfully. A dental office manager has an opportunity to go above and beyond by establishing this type of tracking and then providing an end of month report to her dentist or specialist. I would be happy to share my sample spreadsheet for the codes we track depending on the type of dentist you're working with.

 is a dental consultant and practicing office manager for a multi-specialty private dental group. Nesbitt has managed the practice for 14 years, has state-level quality training, and coaches dental teams to improve the business-side of their practices.

As part of DPR’s From The Office Manager’s Desk Series, Jill Nesbitt tells you how to use your ledger to manage and increase case acceptance in your office.

How to use your ledger to improve case acceptance

 series, Jill Nesbitt tells us what products she’s most excited about after this year’s Midwinter Meeting.

With an entire showroom floor full of clinical products and equipment, why would a dental office manager attend a dental tradeshow like the Chicago Midwinter Meeting?

There are so many reasons. Here are the ideas I learned at the show and plan to incorporate into my practice:

 Dentrix updates from Henry Schein Dental. Because we use Dentrix practice management software and I know Dentrix brings their best trainers to the show, I always stop by their booth to ask what’s new and to ask specific questions. This year I learned a trick with the Document Center that will help us edit and resave documents by using the export/import feature.

 New Dentrix products. Dentrix released two new software products in Chicago – Viive for Macs and Ascend, which is cloud-based and great for multiple locations. If our group ever decides to add a separate location, it’s nice to know that we can stick with the Dentrix product that our staff and dentists already know.

Demandforce updates. I’m a DemandForce customer and I always stop by their booth to ask what’s new. This year one of my most rewarding discoveries was that DemandForce can set up my Facebook account so that every time a patient shares a survey or review it will automatically show as a post on our practice Facebook page. Because I post a weekly update to our blog and Facebook page, this will drastically increase our Facebook presence-with no more work!

 Inventory follow-up. Last October we purchased three new handpieces for our practice and were told we would receive one free. We kept waiting and waiting, then we started emailing and calling with no luck. So, I brought a copy of the invoice showing our purchase, talked with our rep at the show-and voila! We received our free handpiece three days later.

DEXIS updates. Our group purchased three new DEXIS sensors and software a few months ago and ended up with an error code that stumped their tech support staff. Thanks to our great sales rep, Marty, I talked with an upper level tech support person who shipped me a brand new sensor, which solved the problem.

At the show, Marty pulled together management and another high-level tech support rep and we all discussed the situation and agreed how we would handle any problems in the future. Plus, I received a copy of the newest software, which allows images to be shown on an iPad. This was one of my more valuable meetings at the show.

 Interior designers for dental practices. My pediatric dentist would like to “fun up” his side of the practice and we’ve struggled to find an interior designer that understands dental. At the Chicago show, I met three different vendors that offered to help. My favorite is Nancy Higgins, a designer who works with Henry Schein and has 15 years experience in dentistry. In fact, she already emailed me some photos of a pediatric practice she designed-plus she handed me a card at the show for 50% off her design services!

CareCredit updates. It’s always nice to meet with reps that can go over our applications and credit used in our practice last year. Plus, when you spend the time to review this information, they give you a special gift. This year it was a pillow pet-which we took home and gave to our pediatric dentist, of course!

Colgate rules change. We used to buy our toothbrushes, floss and paste from Colgate but they had a category purchase requirement that ended up driving us away because we just didn’t need the products in the third category. After chatting with a rep at the show, she told us Colgate did away with this category requirement! So we’re going to re-evaluate our toothbrush purchase.

Plus, a group sales rep was also at the show and said he could get us better pricing because we’re a large group! Without the face-to-face discussions at the booth, we never would have known.

 SEO vendor. I’m working on updating our practice website now and our next marketing decision is to choose an SEO vendor. The fellows at Everyday Health spent a great deal of time with me showing me their dashboard and services. The refresher was helpful and their report showing me how many directories our practice isn’t listed in properly was revealing.

 Dear Doctor purchase. We rarely buy at the show because we want cooler heads to prevail, but this was such a good deal we couldn’t turn it down.

This product provides dental articles and videos that can be inserted into your website by using a widget-the idea is to educate your patients on your own website and keep them from Googling ‘dental implants’ and ending up somewhere else.

Because our group is big into video marketing, having professional videos available to us that can be placed on procedure pages in our site, and used on our blog, is super valuable. My goal has been to post one video each month on our blog to increase our SEO-with this investment, I can almost assuredly meet that goal.

Likeable Dentists Facebook expertise. I almost walked by this booth because I handle our Facebook posts and with the scoop from DemandForce, I don’t need to pay someone else to post on my FB page. However, I’m so glad I stopped!

This NYC group is super knowledgeable on all things Facebook. We talked about the new Facebook Graph and running ads. Within the last few weeks, one of my dentists mentioned that yet another dentist was retiring from a small town nearby-and we realized that left only one dentist still practicing in that area! We agreed that would be a perfect target market for us-but how to let that community know about our group?

Not enough people read the newspaper, TV and radio are expensive and hit or miss, and the town is so small, I don’t think they would use their own city name in a Google search for a dentist. Enter a Facebook ad. I can target this small town in particular for our ads-and the Likeable Dentists company said they would manage this ad for me and we can track the results.

If this works, I finally know how to target specific areas for our marketing-and could increase patient volume in a specific geographic region. Good thing I went to the Chicago Midwinter!

Afdent franchise. This is new. I read an article about Afdent last month, and in the last row at Chicago, I recognized the owner standing in their booth! On Saturday no less when most top dogs have long returned home.

Dr. Roger Pecina was a super nice fellow and invited me to have a seat and chat (after 3 days of standing/walking, just sitting down was a treat). He shared that he has an approach to dentistry that gains his one location, gigantic group practice more than 500 new patients each month! He invited us to visit him and see for ourselves how he provides high quality care to such a large patient volume. We’re definitely planning this trip.

Beyond these specific ideas, I also walked the aisles with the dentist owner of our group. As he chatted with the clinical product vendors about zirconia crowns or stronger composites, I am listening in, picking up the language and understanding the value of the new products. Because I have no clinical background, it is helpful when vendors come to visit the practice-I know who to gather for lunch & learns-and I can help compare pricing as well.

Thanks to the investment my practice made in sending me to the Chicago Midwinter Meeting, I will improve our online marketing, get the dentists a free handpiece, avoid technical support problems in the future, begin the redesign of our pediatric practice, perhaps switch back to the toothbrushes we really liked and visit a practice adding 500 new patients a month. Do you think it will be worth sending me to visit the Afdent franchise? What ideas could I bring back from that experience?

Another major benefit to the dentist owner for sending me to the Chicago Midwinter- he didn’t have to tackle any of these topics. He could focus on the clinical products that he enjoys, knowing that I’ve got all the marketing, software, business-side handled.

So, if you’re thinking about inviting your dental office manager to attend a dental conference, have her read this article. She can visit similar vendors and bring back ideas to improve your practice as well! Enjoy your next meeting!

  As part of DPR’s From the Office Manager’s Desk series, Jill Nesbitt tells us what products she’s most excited about after this year’s Midwinter Meeting.  

The top 12 things I learned at the Chicago Midwinter Meeting

Do you have a specialist practicing part time in your office? Most specialists these days are traveling to more than one office to increase their productivity by reaching out to new patient populations. This approach works!

Specialists who travel and spend a day working with a general dentist enjoy a significantly higher productivity level than those who work in just one location. This is also a successful approach for the general dentist who hosts the specialist-benefits include higher patient compliance for referrals; more coordinated and complex cases can remain in-house; and it provides a new stream of income for the practice.

No matter whether you are a general dentist hosting a specialist or a specialist traveling to other offices, you want to increase production for the specialty practitioner this year. Here are 5 tips that can help make that happen.

Formal and informal lunches together are essential to maintain good communication between professionals. It’s fun to discuss cases and talk with patients together to present complex cases-and even more fun to congratulate patients on successful outcomes. It’s important to talk about staffing, equipment, treatment rooms, financial policy and insurance coverage as well. The more the specialist and general dentist have regularly scheduled meetings, the easier it is for them to tackle difficult situations.

Now is the perfect time to review a specialist’s 2012 performance. Print a few reports and meet with your specialist to look at:

You should create an excel spreadsheet for your specialist and keep track of how much she has earned in production/collection since she began seeing patients in your office. What is the trend in production? Are you maintaining a 98% collection ratio for your specialist?

Tracking large case acceptance gives your specialist excellent feedback on how successful she is at motivating patients to accept significant treatment plans. Providing this type of feedback can be a valuable learning tool she can use to improve in her own office as well.

Reviewing a procedure mix for your specialist is a valuable conversation starter. When your specialist sees how many of each procedure code she has completed in the last year, she gains a feel for the type of treatment she gets to provide in your office-and she can set goals for the future. 

, an easy way to see the procedure mix is to go to the Dentrix Office Manager, click the practice analysis icon, choose Reports and select the specialist and the dates for the year, then checkmark Production Summary (uncheck by category/include cross coding).

With your Dentrix Production Summary in hand, specialists can look at the procedure codes they’re doing most often and also look at the ones they enjoy and want to increase. For example, my senior dentist and I recently met with our periodontist for our strategic planning meeting. During this meeting, our periodontist evaluated her goals and performance for 

Thanks to our reports, she could see the number of implant exams completed as well as the number of implants placed over the last 5 years. Understanding that implant exams come from both 

Do you have a specialist practicing part time in your office? Most specialists these days are traveling to more than one office to increase their productivity by reaching out to new patient populations. This approach works!  