The 3 Most Common Battle’s between the Front Office and the Back Office

The Battle of the Appointment Book

Scheduling is a chess game, it takes skill and planning to make just the right moves so that at the end of the day you are not in checkmate with the entire team backing you into a corner wondering what you did that caused total chaos of the schedule.  The schedule is the one thing in the dental practice that affects every person in the office and it is often not taken seriously.  The problems I find in the dental practices I work with are totally fixable with a little planning.

  • Front Office: “Too many people are scheduling appointments and my appointment book is a mess”.

My first response to this is “Well it’s not your appointment book it belongs to the entire office, but you can take back control of it.”  I think that it is a good thing when you have clinical teams that can multi-task and schedule appointments,  they just need direction.  You, as scheduling coordinators, need to tell them what can be scheduled where.  The clinical team does not have time to (or do not have the visual skills) look over 4-8 columns of treatment rooms to see if they are scheduling the appointment in an appropriate place.  Map out the Appointment Book for your clinical team so they can schedule an appointment easily and correctly.

Most practice management software has a way of pre-blocking out areas of the appointment book so that the clinical team can quickly see an open spot that fits the parameters of what kind of appointment they are scheduling.  Some examples for pre-blocking are; emergency time, crown seats, ortho checks and other non-productive appointments.  These non-productive appointments are important to block time for because they cannot be scheduled in high productive time blocks.  If a clinical team member does not know where to schedule a crown seat they will just stick it where ever and you know that will cause a problem between the front office and the back office.  If you map out your appointment book and your clinical team sticks to the plan you will not hear the question “She just didn’t schedule that there did she?” in your office any more.

  • Back Office: “All the front office is concerned about is production and I need to get this patient in this week.”

This is a tough one because you are responsible for taking care of your patients needs and making sure the office reaches its production goals.  Like I said above “It’s not your appointment book, it belongs to the entire team.”  This applies to the clinical team as well.  If you have a patient in your chair that requires an appointment this week and there is not a pre-block that fits your needs then it is up to you to talk to your scheduling coordinator.  If you and your scheduling coordinator can look at the appointment book together and she understands the severity of scheduling the patient in this week then the two of you can come up with a solution together and the scheduling coordinator can make adjustments in her goals for the rest of the month to hopefully make up for the disruption in her plan.

There will always be exceptions even when you have your schedule mapped out.  When the front office and the back office can discuss it together is when the magic happens and the teams can schedule harmoniously together.

The Battle of the Handoff

The patient handoff at the front desk sets the patient’s expectations for the next visit.  The hygienist or clinical assistant has just spent an hour or so with the patient and is the keeper of the information.  This information must be transferred to your front office so please don’t send your patient up to the front desk alone.

  • Front Office: “It drives me crazy, they just drop the patient off and I have no idea what to schedule or what we did today.”

Unless the clinical team is checking the patient out in the treatment room, collecting money for today’s visit, reviewing treatment plan estimates for the next visit and scheduling the next appointment there needs to be a systematic approach to passing the patient off to the front desk.   The front office needs the information not only so they can now take care of the patients needs but also the patient can hear that everyone is communicating the same information.

  • What did you do today – the front office needs to know what procedures were done today so the insurance claim can be created, any attachments can be added to the claim and the patient’s portion of the appointment can be collected.
  • What is next – are you referring the patient to a specialist, does the patient have a new treatment plan that needs to be reviewed, does the patient just need their next hygiene visit scheduled?

These two pieces of information is critical for a proper handoff between the front and the back and even though we all know it is critical it is one of the most frequent mis-steps in the dental practice.  Don’t keep the front office guessing. How can we fix it?

  • Use Patient Route Slips – Now if you know me you know that I am not a big fan of using paper, however a patient route slip can be a very useful tool. It can be a great non-verbal way of communicating these two critical pieces of information to your front desk especially if the clinical team member is running late and can’t spend a lot of time at the front desk.  On the Patient Route Slip from the Dentrix software it lists the procedures that were scheduled today and lists the patients current treatment plan so the provider can easily just circle what was done and then number the treatment plan so the front office knows what was done today and the order of the treatment plan for what is next.
  • Verbal Hand-off – A verbal hand off is great because the patient can hear the communication between her treating provider and the front office person. The patient can observe the transfer of information and knows that it was communicated accurately. Now since there is nothing written down the front office team member must have a good memory or may need to write the information down on a piece of paper so she can now take care of the patients scheduling.
  • Back Office: “I don’t have time to fill out a route slip; the front office can read the chart and get the information.”

Wouldn’t you like to avoid getting that note slipped under the bathroom door that reads, “Did we take x-rays today?” Like I said above, please don’t keep the front office guessing.  If there were x-rays on the appointment for today and the front office doesn’t read it in your note they will question it.  It is the front office’s job to make sure that all those details are addressed so that nothing is missed.  Let’s avoid those questions by communicating the details with our front office team during the handoff even if it takes an extra 1-2 minutes of your time.

The Battle of Treatment Planning

If you have read any of my treatment planning articles or watched the video interview I did with I feel very strongly that there needs to be clear expectations set in the office about who enters the treatment plan, who presents it and who schedules it.  Let’s review a couple typical scenarios.

  • Front Office – “They bring the patient up to the front and say ‘Ms. Taylor is ready to schedule her crown’ and then walk away. Then I open up the treatment plan and there is nothing there. It is so frustrating.”

This is such a common problem amongst dental offices.  At your next team meeting, I am asking you to talk about these issues.  Here are my recommendations.

  • Who should enter the treatment plan procedures – The person that is in with the doctor during the exam should be the one entering the treatment plan into the patient chart. It is the doctor and the doctor alone that has the credentials to diagnose and since there needs to be a diagnosis attached to the procedure code being treatment planned this is the most efficient way.  If you leave this up to your front office they will inevitably need to hunt down the doctor for the diagnosis so it is best to do it right the first time.
  • Who is responsible for presenting the treatment plan – She who schedules the appointment is the one who reviews the treatment plan, fees and makes the financial arrangement. In my opinion, if the patient doesn’t have a financial arrangement the patient doesn’t get in the appointment book so if you are squeamish about discussing fees then leave it up to your front office.
  • Who schedules the treatment – If you know that the patient has a firm financial arrangement and your appointment book is mapped out so you know where an appropriate place is to schedule the appointment then go for it! I am a huge fan of cross-training and multi-tasking if it is within your security rights at your office.
  • Back Office: “I don’t have time to treat my patient, write up my clinical note, turn my room over and also enter the treatment plan.”

You might not like this answer, but you better find time.  According to a 2007 ADA study on mal-practice claims among dental providers, lack of treatment planning documentation was the number one error.  Writing up the treatment plan with the diagnosis is one of the most important clinical charting requirements. You are putting your office and your doctor at risk when you neglect to make this a priority.

How can your team help assist you with making sure the patients treatment plan gets documented?

  • Have someone help turn your room over for your next patient or seat your next patient if your patient is already in the office
  • Call the front office to help with perio charting if you are running behind during your hygiene visit
  • If the doctor is available ask him to enter the treatment plan into the patient chart. It is okay to delegate to the doctor, he wants to help he just needs to be asked.
  • If you are using computers in your office try using a voice activated charting system like Dentrix Voice Pro.

When there is turmoil between the front office and the back office your patients can feel it.  They can sense the frustration and see it on your face when you are disappointed in one of your team members.  Work on these issues during team meetings and create systems in your office that address these issues and set standards in your office so patients walk away feeling like you office is a well oiled machine.