In this presentation, Rick Kushner outlines a firm‑but‑fair collection policy for dental practices, emphasizing that a clear policy is essential for financial health and patient relationships. He distinguishes a true collection policy from a simple billing schedule and argues that elective dentistry should be tied to upfront payment arrangements rather than post‑treatment statements. The core of the policy is a three‑choice payment framework for cases above a practice‑specific dollar threshold (typically around $300): (1) an 8 % pre‑treatment discount for full payment at the start of care, (2) interest‑free financing for up to 12 months via a third‑party billing company, and (3) a pay‑as‑you‑go option, which he advises against because it can delay treatment and compromise results. For smaller services (under the threshold), he recommends collecting payment at the time of service and never sending statements, as delayed billing erodes cash flow. He discusses handling of insurance cases, preferring to accept assignment and keep the majority of accounts receivable with insurers, while offering the same pre‑treatment discount only to patients (not insurers) to stay compliant. He also addresses charity dentistry, noting it should be a conscious choice by the practice, not a default for unpaid patients. Throughout, he stresses the importance of cash flow, low overhead, and the psychological benefit of patients having already paid for their care. Anecdotes illustrate that simply asking for payment and offering modest discounts dramatically improves collection rates.
Topics
Defining a True Collection Policy vs. a Billing Schedule
Rick differentiates a collection policy (firm, enforceable, tied to treatment) from a billing schedule (statements, reminders, attorney involvement).
Three‑Choice Payment Framework for Elective Cases
For procedures above a set dollar amount (≈$300), the practice offers: (1) 8 % pre‑treatment discount for full payment, (2) interest‑free 12‑month financing via a billing company, (3) pay‑as‑you‑go option (discouraged).
Handling Small‑Balance Services at Point‑of‑Service
Procedures under the threshold are paid immediately (cash, check, or charge card); no statements are sent to avoid loss of revenue.
Insurance Assignment and Pre‑Treatment Discount Compliance
The practice accepts assignment, keeps most receivables with insurers, and clarifies that pre‑treatment discounts apply only to patients, not to insurance carriers, to stay within contractual rules.
Cash‑Flow Rationale and Overhead Calculations
Rick explains why modest discounts (5‑25 %) can be financially viable given low marginal overhead on already‑covered monthly expenses, and how discounts improve case acceptance.
Charity Dentistry as a Deliberate Practice Choice
Charity work is presented as an optional, conscious decision by the practice, not a default response to unpaid patients.
Practical Anecdote: Asking for Payment Increases Collections
A story about the author's wife demonstrating that simply asking for payment at the desk dramatically boosts cash collection.