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CDA answers dentists’ most commonly asked practice management questions

January 13, 2021 1118

Quick Summary:

To address member concerns about how the pandemic is affecting daily business operations, CDA has compiled the most recent, commonly asked questions about reducing employee hours and wages, managing delinquent accounts, patient dismissals and more.

As dentists and dental teams begin a new year amid the pandemic, how to safely manage COVID-19 in the dental office remains a major concern. While questions surrounding the COVID-19 vaccine and workplace safety protocols have been the focus of most calls, CDA Practice Support and Risk Management are also receiving calls from member dentists concerned about how the pandemic is affecting daily business operations.

To ensure all member concerns are addressed, CDA has compiled the most recent, commonly asked questions from member dentists about reducing employee hours and wages, managing delinquent accounts, patient dismissals and more.

I received a refund demand from a dental benefit plan stating that my patient was not eligible at the time of service; however, my staff called the plan the day of the patient’s appointment and verified they were eligible and the plan paid for the treatment. Is this legal? 

Many people have lost their jobs and employer-sponsored health benefits due to the COVID-19 pandemic. Unfortunately, not all employers report these changes to the dental plan in real time. Due to this delay in reporting, there is no guarantee that the information a dental office receives from the dental plan is current.

When a patient arrives for treatment, it is best practice to ask if there have been any changes in their dental coverage and job status. Practice owners should train their staff to listen for keywords such as:

  • Laid off.
  • Left a job.
  • Loss of job.
  • Leave of absence.
  • Reduction in work hours, such as going from full time to part time. 

CDA Practice Support’s Dental Benefit Plan Handbook has additional information in chapter 3, page 5 on refund demands from dental benefit plans.

My patient has a past-due balance and is refusing to pay. What should I do?

If a patient refuses to pay an overdue balance, the dental practice has several options to consider. The practice owner could choose to:

  • Defer the overdue balance to a collection agency.
  • Report the delinquent account to a credit bureau.
  • Take the patient to small-claims court.
  • Have an attorney send a letter to the patient.

Some practices choose to manage delinquent accounts in-house and to work with patients to get them in good financial standing or dismiss patients who are not willing to make payments. If a practice owner chooses this route, they should set a clear policy of how accounts will be managed and do their research to understand the laws pertaining to dentists who engage in debt collection on their own behalf.

As best practice, the financial or treatment coordinator should communicate all financial options and complete a financial agreement and consent form with patients prior to the day of treatment to ensure the patient fully understands their financial obligations.

Recommendations to help dental practices determine patient financial options are available in the Practice Support Resource Library.

I have a patient who has rescheduled multiple appointments due to COVID-19 safety concerns. This patient has been in a provisional crown for six weeks, and I’m concerned about the consequences of further delaying care. Can I dismiss this patient from my care?

The Dentists Insurance Company encourages dentists to inform patients of their office’s COVID-19 safety protocols and how their practice is responding to the pandemic to help them feel more comfortable with returning for care.

If a patient refuses to return for permanent cementation, prior to dismissing the patient from care, the office must follow up and educate the patient on the risks of remaining in a provisional crown for an extended time.

Whether the patient missed a routine check-up or an appointment to complete treatment, consider the following as standard office protocol:

  • Call the patient to determine why they missed or rescheduled the appointment.
  • Document the conversation in the patient’s chart.
  • If attempts to reach the patient are unsuccessful, record the date, time and phone number that was used to reach the patient for each attempt.
  • Note any messages that were left for the patient.

Dentists should then follow up with a letter detailing the patient’s missed appointment, the potential risks associated with delaying treatment and the practice’s attempt to reach them. Consider sending the letter by certified mail and request a return receipt. Place the signed receipt along with a copy of the letter in the patient’s chart. For patients who repeatedly fail to keep appointments, TDIC recommends sending a failed appointment letter.

Give the patient a reasonable response time to resume care, which is typically two weeks. If the patient still has not resumed care, it may be time to dismiss the patient for noncompliance. By allowing noncompliant patients to remain in the practice, dentists could be at risk for future allegations of supervised neglect.

I’m experiencing a decline in patient volume due to the pandemic and need to reduce my employees’ hours. What do I tell my employees?

CDA recommends monitoring other costs before reducing employee wages and hours. If a practice owner believes it is still necessary to reduce wages and hours, they should communicate with their team and explain the reasons behind their financial decisions. Practice owners should meet with each team member to answer their questions individually and address any concerns.

It is recommended that practice owners explain to employees that any reduction in hours or pay is a qualifying event to be eligible for unemployment insurance and provide the required documents for employees to seek unemployment insurance, including the Notice of Change in Relationship and the Unemployment Insurance Guide.

The article “Layoffs, furloughs and wage reductions: Considerations for dental practice owners heading into 2021” offers additional guidance for practice owners who may be faced with this decision.

Additional practice management and COVID-19 resources can be found in the CDA Practice Support and Back to Practice centers.