The Art of Practice Management's Dental Pearls
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Determine Your Collectible AR Balance Before
Year End
Marianne Harper

If you are like me, you find it hard to believe that the end of the year is almost upon us. Not only do we need to finish up our holiday shopping, we in dental practices need to take some time to close out the present year, find out what worked and what didn't work, and plan some strategies to continue and improve upon the positives and to analyze and make changes to the negatives. As you know, one of my concentrations in my consulting is accounts receivable controls. So let's explore what we can do now to determine our true and collectible accounts receivables.
Let's get our magnifying glasses out and really look at the complete accounts receivable (AR) because dental practices should start off the new year with an accurate AR that shows a truly collectible balance. Leaving credit balances in the AR distorts the true balance. So look through the AR and refund patients who have credit balances, unless they are scheduled for treatment, and remember that credit balances are not supposed to be held any more than thirty days. Once the refunds are completed, you may believe that you have a more accurate AR balance. That, however, is not completely the case. A truly collectible AR is not a reality until you handle those accounts that are ninety days or more overdue. I teach methods of handling accounts before they reach that 90 day benchmark but, if you have not worked on these satisfactorily, then the time is now to do so. You must give these patients deadlines to pay the balance in full. This can be done with a final notice letter or a phone call. I prefer using a final notice letter but if you make phone calls, be sure to document that call. You can suggest companies such as Care Credit for patients to use to pay off their bills. However, if patients do not comply by the end of the year, then it is time to turn these accounts over to a collection agency. Typically the return on these accounts is only about 20% to 25%. However, if an account balance is relatively small (e.g. $25.00 or less) it is a waste of your time and money to send the account to a collection agency. My suggestion is to create bad debt write-offs on those accounts. Make sure to mark those accounts as ones with written off balances so that, if the patient should call to schedule in the future, it will be very visible that they still owe a debt to the practice. No one enjoys writing off hard earned production but, if your practice is an accrual based practice, at least those write offs are deductible.

By working on this immediately and informing these patients that they have till the end of the year to pay (typically 10 to 15 days from the expected date of delivery if it's a letter), and then you handle the results promptly, you can begin the year with a picture of what is truly collectible. And that's a great way to begin 2012.

Colleen Rutledge is unable to contribute to this newsletter due to her very busy schedule, so I have called upon one of the hygienists in the pediatric practice that I used to manage and asked her to contribute her sugar sheet. Shannon Wall, RDH uses this sugar sheet as an educational tool for the parents and children that she treats and was very willing to share it with my readers. Please feel free to use it too.
(Download as a PDF)
Sugar has become a huge villain hiding in our children's favorite drinks and foods. As parents, you must identify what foods and drinks will promote healthy teeth, and as a result, an overall healthy child.
Sugar mixes with bacteria in dental plaque forming acids that attack our children's teeth for about 20 minutes. This is how our "Sippers" and "Nibblers" get in trouble. Snacking and sipping on high sugar products frequently throughout the day allows acids to continue attacking the teeth and cavities to form quickly. Water and sugar free products, like Crystal Light and Fruit 2 O, are better choices for sippy cups.
Read the labels!

Products with labels that state "100% Natural" or "No Sugar Added" still have sugar in them, so check the back of the product for the sugar content. If your product says "Sugar-Free" you are in the clear!

Sample Juice Label (Please refer to Nutrition Facts included directly below to the left):
One serving (8oz.) has 34 grams of sugar

5 grams = 1 teaspoon

There are 7 teaspoons of sugar in just one cup!
Would you put 7 teaspoons of sugar in your cup of coffee?

Watering down juice by half still results in 3-4 teaspoons of sugar per serving, so a smarter choice would be to switch to sugar-free products.

No No's: Here are some foods and drinks that promote cavities because of their high sugar content. These are No No's.
Sweetened Juices
Juicy Juice
Sticky/Gummy Snacks
Chocolate/Strawberry Syrups
Hi-C Drink
Capri Sun
Junk Food
Soft Drinks
Yes Yes's (Drinks, Foods and Additives):
Fresh Fruits
Fresh Veggies
Wheat Thins

Flavored Water (sugar-free)
Sugar-free Juices
Sugar-free Cereals
Sugar-free Gum
Flavored Water (sugar-free)
Fruit 2 0
Crystal Light
Plain Milk
Our children love snacks! That's OK, but moderation is important. Brushing and flossing regularly combined with keeping snacks to a minimum will result in a healthier smile that will keep everyone happy!
  Insurance Alert
Begin the new year with an analysis of your insurance denials. Audit the denials and create a spreadsheet or report of the reasons for denials along with the number of times that you receive each type of denial. Once you ascertain the more common reasons, you can research the problems and make corrections so that you can decrease the number of denials which will then increase efficiency along with profitability.
Over the past few weeks I have been working with an attorney helping her defend a dentist who is accused of fraudulent billing. This is a very serious case dealing with a dental practice that filed with several medical plans. The main issues deal with filing procedures that were not truly medically necessary procedures and not having proper documentation of the medical necessity. I mention this as a big red flag to practices that file claims, whether they are dental or medical. At present, all medical claims must show a diagnosis to prove why the procedure was performed. It will not be long before dental practices will have to furnish diagnosis codes also. Medical necessity and dental necessity will have to be proved. My warning to you is that you need to be sure that you have thorough documentation in the patients' records as to the necessity of any procedure performed. Stay safe!
  Time Line
Update your cross coding manual – the 2012 update is now ready
For those practices that have purchased my cross coding manual, "CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding", please take note that it is now time to update your manual. Please order your updates ASAP by emailing Marianne at
July 5, 2011 – Medicare now requires that all physician and non-physician practitioners that submit Medicare claims must be enrolled in PECOS (Provider Enrollment, Chain and Ownership System) as well as all ordering and referring practitioners, or claims may not be paid. Practitioners can enroll online at
January 1, 2012 – Prior to this date, make sure that your software providers are prepared for the 5010 format. All covered entities listed below are required to upgrade to HIPAA 5010 Standards which are new sets of standards that regulate the electronic transmission of specific healthcare transactions including eligibility, claim status, referrals, claims, and remittances. Covered entities may use a clearinghouse to assist them with complying with the rules.







Additionally, even though software vendors are not included in the list of covered entities, in order to support their customers they will need to upgrade their products to support HIPAA 5010 and NCDPD D.0 as a business imperative.
October 1, 2013 – ICD-10 (medical diagnosis codes new revision)
2012 – Upcoming series of webinars that I will be presenting on dental-medical cross coding. Please check with Cross Country Education or my website for dates and times.

Favorite Quotes:
"Those who fair best when the heat is on are those who had already rehearsed the event in their mind."

Jim Cathcart

Oh my, the holidays and the extra pounds. It is so hard during the holidays to eat nutritiously, so here are a few tips:
If you are the host or hostess, plan to include some nutritious treats
Include water as a beverage

Don't accept every treat that comes your way – be selective and choose the ones that you like the best

Eat breakfast every day to ward off the hunger pangs that draw you to those goodies

During the hustle and bustle, don't skip exercise

Points of Interest:
"Decorated Christmas trees in homes date to 1605 in Germany. But the first American patent for a Christmas tree stand was not issued until 1876, and stands didn't hold water until 1899. The first electric Christmas tree lights were sold by General Electric in 1903. So strands have been tangled for more than a century."

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