Endo Mastery


Collecting patient payments on the day of service is something that every endodontic practice should strive to achieve every day. When time-of-service collections don’t occur, it leads to ballooning accounts receivable and sometimes months of follow-up statements and calls. Learn the top 3 reasons that collections don’t happen (and how to fix it).


“Your financial responsibility today, taking into account your estimated insurance, is $648. We accept cash, personal check, debit and major credit cards. Which method would you like to use today?”


Every patient appointment should conclude with the above matter-of-fact question. And ideally, every patient responds to that question by simply choosing a payment method and paying their estimated full balance. When that doesn’t happen, the reasons are rarely about what happened at today’s appointment, and more about what didn’t happen before the patient even arrived. Here are the top reasons and tips for your team:

Every patient should know in advance of their appointment what their expected financial responsibility for treatment will be. This is why it is important to talk directly to the patient, even when the referring office calls to make the appointment.


Many referrers downplay clinical concerns to patients when they refer to a specialist because they don’t want to be the bearer of bad news. They might tell the patient, “I want Dr. Goerig to take a look at your tooth.” To the patient, it sounds like a consultation only. This is why your team must speak to the patient so it is clear that if root canal treatment is diagnosed, it will be performed immediately. And that means patients must be prepared in advance for their full estimated co-pay for treatment by giving them clear understanding of their estimated financial responsibility.


It also means the patient must have total clarity about their insurance, so your team must also accurately determine and communicate the patient’s expected insurance benefit prior to the appointment. That can mean calling the patient back after you have contacted their insurance provider about their coverage status.


Remember to always quote the expected insurance coverage slightly lower if you have any uncertainty, and the patient’s co-pay slightly higher. It is always better to refund the patient later for a small difference rather than chasing down the patient for a minimal balance owing.

There is a 90% chance that the financial policies in your practice are different than those in the referring office. You primarily have a one-time treatment event with the patient, after which you may never see them again. A GP office, by comparison, is very motivated to keep patients returning for hygiene and ongoing care for years, even if that means accepting some financial irregularities along the way.


As a result, you should assume that referring offices may have a more flexible financial policy, they may enforce their policies more “lightly” day-to-day practice, and very often patients learn that there is unspoken availability of in-house financing and flexible payment schedules if they ask for it. Unless you tell patients otherwise, they are going to assume that every dental office is the same, including yours.


Your team must be able to communicate your financial policy in a short patient-friendly way, along with acceptable payments, over the phone. Another option is to take advantage of online registration procedures and build your financial policy into the online forms. You can then simply say to patients:


“The financial policies in our office are a little different than what you may be accustomed to in your GP’s office. We will estimate your insurance coverage, collect your estimated co-pay and bill your insurance company. In the event your insurance pays less, we will send a statement. If your insurance pays more than expected, we will issue a refund right away.”

Preparing the patient individually and clearly communicating financial policies in advance of appointments will conquer almost all collection issues on the day of service. However, sometimes a patient might say they forgot their wallet or checkbook, or they left a particular payment card at home.


If genuine, you have to accept it but don’t leave it open-ended. An issue with a payment card should result in setting up a telephone appointment with the patient later that day or early tomorrow, so the card details can be communicated and processed at that time. For a checkbook issue, give the patient an addressed stamped envelope and set a telephone appointment in three to four days to “confirm with you that we have received your overdue payment.”


Sometimes though, it is not a genuine reason. They are covering up for the fact that they don’t have the ability to pay in full right now. If you probe them a bit, they will usually admit it. In these cases, your strategy now is to prevent an accounts receivable problem. Collect what you can from the patient and then use third-party financing for the balance, such as Care Credit (or Varidi if they do not get approved for Care Credit). Tell the patient, “Oh, I have a great solution for you that pays your balance today and takes all the pressure off so you can make payments easily.”

These steps, executed with empathy but firmly, should form the basic foundation of your system to ensure payments on the day of service. In return, you’ll enjoy a controlled accounts receivable, fewer follow-up calls and a reduced need to resort to collection agencies.

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