Smart Systems Get The Patient To Yes

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Smart Systems Get The Patient To Yes

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Dental Consultant Tip: Insurance Best Practices

Insurance is the patient’s responsibility. It is their insurance after all however, quickly and accurately verifying insurance is an opportunity to provide patients with excellent customer service. 

Staying on top of insurance every day is crucial. It is vital that insurance does not backlog. Backlogs cost you time and money and reflect poorly on your practice. 

When a patient receives a bill from the practice due to insurance denial it can cause an upset. Sometimes it is a front desk error, however the upset is often partially or fully due to the bill being unexpected because the patient had not been effectively educated on how dental benefits work. 

By following this protocol your patients will be prepared. They may not be happy about a bill should they get one but, they will be more likely to blame their provider than you.

Before Patients Are Seen

  1. Benefits change. Keep PPO fee schedules up to date in your practice management software. 
  2. Real Time Eligibility is widely available, saves time and increases accuracy. 
  3. Accurate and complete patient insurance info is vital otherwise you cannot verify accurately.
  4. Always verify a new patient’s benefits before they arrive. The new patient should be called prior to their arrival with what to expect as far as their co-pay. 
  5. Update benefits prior to existing patient appointments.
  6. The Treatment Coordinator re-enforces the clinical education the patient received in the back, creates an honest sense of urgency to make financial arrangements and scheduling smoother but, first the Treatment Coordinator needs to educate the patient on how dental insurancebenefits work including details of the patient’s specific plan. Key points to go over with all patients:

 Dental insurancebenefits can be compared to a “gift card” from Target or Best Buy. You need a new cell phone that costs $1,000.00. You have a gift card worth $100.00. Guess who pays the difference?

Patients need to know insurance companies are not exactly their friends as insurance companies frequently deny claims. The patient should also know the patient’s benefits are not negotiated by your practice. They are typically negotiated by the patient’s employer.

The Treatment Coordinator should make known to the patient any restrictions, such as frequency limitations, etc.Going over the patient’s verified benefits helps avoid unexpected news for the patient later on.

You are the patient’s insurance advocate so to speak.It is you plus the patient against the insurance company. Let the patient know the way you advocate for them is to educate them on how their dental benefits work and to submit the claim completely and accurately. If the claim is denied you will send an appeal but, at the end of the day, if the patient’s insurance company refuses to pay, the patient is responsible for the balance. 

Ensure all patients sign their treatment plan and your financial policy and that the patient receives copies of each. 

  1. A “Co-Pay Estimate” is different than a “Pre- Determination” or “Pre-Treatment Estimate”. 

A “Co-Pay Estimate” is generated by the practice. 


A “Pre- Determination” or “Pre-Treatment Estimate” is generated by the insurance compant and is NOT a guarantee of payment as insurance companies often “change their minds”.

Do not offer a “Pre- Determination” or “Pre-Treatment Estimate”. If the patient requests one, that is fine but, then schedule the patient far enough out (not too far) to give enough time to receive the “Pre- Determination” or “Pre-Treatment Estimate” back from the provider. 

  1. For existing patients, when they come in, ask for any change in their insurance. If changed, verify. 
  2. The morning huddle should include a review of the day’s patients to ensure benefits have been verified. 
  3. File claims the day of the procedure along with all required documentation. You do not want to backlog claims. Unfiled claims can quickly pile up increasing the probability of denial due to time limitations. It is also very poor customer service. 
  4. Follow up on claims. With electronic filing many offices follow up after 20 days. Never go more than 30 days without following up. 80% of claims should be collected within 30 days. 95% within 90 days. 
  5. Employee accountability is vital. Assign insurance to a specific employee otherwise you will have no accountability. 
  6. If you have any large companies in your drawing area, group patients by the company. 
  7. Track outstanding claims on a weekly basis. Daily is even better and highly recommended. 
  8. Resubmit denied claims after proper research. 
  9. Every month, send accurate statements but, only to patients with balances. Make sure pending claims are noted. 

When Patient Are Seen

  1. Ensure needed documentation is included with claims (narratives, images, etc.) when required (restorative, perio, implants, endo, dentures, etc.). Send claims and documentation electronically. Doing so is a huge time saver. 
  2. Double or triple check all codes so you don’t mistakenly use an old code. Use the latest edition of “Coding With Confidence” by Dr. Charles Blair. 
  3. If code history is required (D4910 as an example), be sure to include. 
  4. When submitting a claim double and triple check to ensure all information is correct. If you don’t, you substantially increase the probability of a denial wasting valuable time and energy. 

After the Patient Leaves

  1. Track claims EVERY day. Your PMS will produce up-to-date reports if you have real-time access. If not, you can get the needed reports from each providers web site. 
  2. Review daily:
  3. Clearinghouse Claim Submission Report: Can give you an early warning if attachments are required or if claims have been denied so you quickly get the claim fixed and resubmitted which is excellent customer service.
  4. Unsubmitted Claims Report. Complete and submit ASAP.
  5. Review weekly or daily: Insurance Aging Report. Providers have different deadlines. Always work on the oldest first. The clock is ticking. 
  6. Get educated on how appeals work for each provider. Verify adjustments. Fight for your patient as you would want someone to fight for you if they were processing your insurance. See if you can determine if there is a fix to get claim approved such as:
  7. Deleted codes
  8. Codes requiring history 
  9. Overuse of codes 
  10. Omitted documentation/images
  11. Contract provision 
  12. Missing tooth clause 
  13. Frequency 
  14. Wait periods 
  15. Maximums 
  16. Preventive deductibles

    Kevin Tighe, Cambridge Dental Consultants, Senior Consultant, got bitten hard by the business and marketing bug during long summer days working at his dad's Madison Avenue ad agency. After joining Cambridge as a speaker in the mid-1990s, Kevin went on to become Cambridge’s senior consultant and eventually CEO. Cambridge Dental Consultants is a full-service dental practice management company offering customized dental office manuals. Frustrated? High overhead? Schedule a chat with Kevin at 

Dental Consultants Tip: Calling Patients
Dental Consultant Tip: Do Patients Understand?

Intelligent Dental Consulting


Your Dental Consultant

Shane Blake DDS Coudersport, PAMy name is Kevin Tighe. I am Cambridge's owner and senior consultant. Before joining the Cambridge team I was in charge of setting up workshops for large nonprofits throughout the United States and Canada. During that time, I was fortunate to receive mentoring from several world-class business consultants, including a dental practice management guru, which led to a position at Cambridge as their seminar organizer. In time, I began crisscrossing the country delivering seminars myself for the better part of a decade. Subsequently, I moved up to senior consultant and eventually owner.  Contributing writer to Dental Economics/DIQ, JADA, AGD Impact and Dental Town Magazine.


Client Reviews

Dr. Jacob Masters, DDS, Indianapolis, IN

CEO 1 Cambridge Dental ConsultantsI started with Cambridge in 2018 after 11 years in practice. My results have been great! I have been able to decrease the number of days I work per month and have finally improved my practice much more than I could do on my own! I highly recommend Kevin's on-target coaching! 

-Dr. Jacob Masters, DDS, Indianapolis, IN


Dr. Shane Blake, DDS, Coudersport, PA

Shane Blake DDS Coudersport, PAI have owned my dental practice since January 2005.  The practice is a rural solo provider practice.   The practice has always been successful but something was always lacking.   I did not manage the practice by the numbers and its shortfalls were overcome by sheer determination and hard work for both myself and the staff. 

My motivating factors to sign up with Cambridge in January of 2017 were that I had reached a point in my career where time with my family was worth more to me than the professional fulfillment that dentistry can provide.  The practice was so micromanaged that it required most of my time and I didn’t understand how to motivate both myself and my staff beyond the sheer nose to the grindstone path to success that had guided us the prior 12 years. 

Our consultant was instrumental in educating each staff member in what expectations are and how performance for each position is measured.   Staff members became more aware of their part in the overall success of the practice and doing their part.  Ultimately this led to a less stressful and more productive average day which decreased management stress and headaches and allowed life to be enjoyed just a little bit more with a little more time. 

We have had many changes in the practice after our initial integration over the last 1 ½ years.  Cambridge has been helpful in navigating those planned and unplanned changes.  My only regret is I had not called Cambridge sooner.


Dr. Kristin Rushing, DDS, Nashville, TN

Dental Consulting Client TennesseeI used Cambridge as well, it gave me a good foundation for employees to know what was expected of them as well as very detailed job descriptions that could be used to train new employees if I needed to replace a staff member. Mike also is good about coaching you so that you are knowledgeable about what your numbers and percentages should be but also things to look for when they are off.

Everyone is accountable for their numbers and communicate better as a team. We all want to be more productive and time was spent looking into my specific concerns as well as reviewing all facets of the business. Everything was reviewed including input from staff on ways to improve the office. I feel the morale in my office has changed and we are overall headed in a much better direction. As a side note, I've used a different consultants previously and their moto was simply to increase production. Patients felt pressured and we still had communication issues among the staff.


Dr. Jeremy Johnson, DDS, Monroe, WA

Dental Consulting Client WashingtonI'm extremely happy with my decision to utilize Cambridge’s services. My consultant, Mike, has been awesome! I love that I can call or email him whenever and always get a quick response. He even calls and checks in if he hasn't heard from me for a bit. My production increased immediately after the first in-office visit and has continued to climb. The initial investment was recouped in increased production about seven weeks after our first meeting.

My average per day production for the first four months I worked with Mike has been 20-25% higher than the prior two years. In fact, all of the four months have had higher average per day production than ANY month in the two years prior to working with Mike.

Last month I produced more than I ever have in one month since starting my practice in 2003. On top of that is the fact that my staff is driving all of this growth! They tell me which op to go to and when, then they get all excited when we exceed our goals! These four months have been the best months of my career!

That's a lot of exclamation points! This is all to suggest that you give Cambridge a call.


Dr. Andrea Mulholland, DDS, Columbus, OH

Dental Consulting Client OhioI have been the owner of a general dental practice for ten years now. I work four days a week and have an associate who is with me for three days.

The practice has always done well but I knew there were many aspects of it that needed improvement but I didn't know how to proceed. I researched several practice management companies but decided to go with Cambridge because of their good reputation and because I didn't feel pressured.

Mike is the consultant that I have worked with for the past year and a half and he has helped my practice tremendously. He really knows the ins and outs of a practice but I appreciated that he didn't use a cookie-cutter approach. He really treated my practice like the individual practice that it is and I didn't feel pressured to follow any suggestions that I wasn't comfortable with.

I know there are a lot of management companies out there. I just really feel like Cambridge is one of the best and was the best for me and my practice.


Dr. Jeffrey D. Weaver, DDS, Port Royal, SC

Dental Consulting Client South CarolinaWe have been using Cambridge since Dec 2013. We are really just getting started, but so far everything has been great. They really have given us the tools to quickly get our team focussed, and have created systems and measurable statistics for each area. YTD for 2014 compared to 2013, our production is up 12% (over $20,000).

Our office felt "stuck", like we simply did not know what we should be doing to get better. We knew the potential was there, but did not know the next steps to take. What we liked from the start is that Cambridge has been in every type of office and seen every type of problem/issue there is. Their ideas are proven and, so far, we have been very happy with the results. Our team is really pleased with the direction we are going.

We built our office in 2007 and, had we known, would have started with Cambridge much sooner. Good luck with your decision. I think you will be very pleased with Cambridge.


Dr. Ron McHargue, DDS, Moses Lake, WA

Dental Consulting Client WashingtonI was fresh out of school when I bought my practice in 2012. It came riddled with staff issues and I had no knowledge of business. I thought I could handle it and went for a year and a half before really coming to the realization that I was in over my head. I was stressed completely and needed help with staff issues and business advice.

I contacted Cambridge because of what I read on Dentaltown and because of their fair price and money back guarantee. Mike was very helpful in getting me over a couple of big hurdles dealing with staff. I now have a direction and a good plan for tracking numbers and keeping a pulse on my practice. I was hesitant to even hire a consultant, but I am very glad I did and wouldn't hesitate to get Mike back and work with him again.


Dr. Ed Warr, DMD, Ashland, OR

Dental Consulting Client OregonMy experience with Cambridge has been great. In June of 2014 I was very concerned as my year was down by about 6% from the previous year. I had used consultants before and hadn't liked any of them. But, I knew I needed help with what I did not know - I went to school to earn a DMD, not an MBA.

After researching several and having several phone conversations regarding their methods, I committed with Cambridge.

Their money back guarantee was a nice touch to lower the risk factor for me. So, I finished 2014 up 8% over 2013. In six months, Mike had helped me introduce practices that helped me have a 14% turn around in six months. I whole heartedly recommend Cambridge and their services.


Dr. Chris Burke, Pedodontist, Lexington, TN

Dental Consulting Client TennesseeI have used Mike Kittelson with Cambridge since I opened from scratch in 2009. Having no background in business, management or marketing he has helped us tremendously. Not only has he taught us which stats to track, he has coached us through employee issues, marketing programs, strategic planning for the future, and served as therapist and friend. He has also proved to be a wealth of information on helpful computing programs that have made certain tasks easier and improved employee productivity. I would recommend talking with Cambridge before making your final decision on which group to go with.


Dr. Dustin Snyder, DDS, Lewisburg PA

Dental Consulting Client PennsylvaniaWhen I initially contacted Cambridge, I was open for about a year and the production graphs were trending down, quickly. My Cambridge coach met with me, offered several ideas specific to my situation, and two years later, I'm having annual growth over 20% and we're already at record annual production with one and a half months left in the year.

I am now busier than ever, even under the previous owner! The best dental office manual I've ever used. I can't say enough positive things about what Cambridge has done for my practice!


Your Dental Practice Mangement Consultant and Coach

Shane Blake DDS Coudersport, PAMy name is Kevin Tighe. I am Cambridge's owner and senior consultant. Before joining the Cambridge team I was in charge of setting up workshops for large nonprofits throughout the United States and Canada. During that time, I was fortunate to receive mentoring from several world-class business consultants, including a dental practice management guru, which led to a position at Cambridge as their seminar organizer. In time, I began crisscrossing the country delivering seminars myself for the better part of a decade. Subsequently, I moved up to senior consultant and eventually owner.  Contributing writer to Dental Economics/DIQ, JADA, AGD Impact and Dental Town Magazine.


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