Sweeping Collection Problems Under the Rug = Major Stress Down the Road

I t was all good—or so this doctor thought—until his CA took another job. She"d been with his practice for four years, and everything "seemed" to be running more or less smoothly. However, when he moved a back-office employee up to the front desk to fill in until he could find a replacement, that new set of eyes saw things he hadn't. By the time he called us. he'd learned, much to his dismay, that his patients were in the habit of coming out of the treatment rooms and simply leaving without paying. What? When the temporary front-desk staffer asked patients what was going on. they would say something such as. "Oh. I have it worked out with Man (the previous C A)." It was clear, how­ever, that these patients weren't entirely sure what it was they had "worked out." After checking the books, the doctor found that patients simply didn't pay very often, nor did they seem to understand what they should be paying or why. It's not that he hadn't noticed that collections were down, but he'd trusted Mary, so he'd assumed tliat she had it under control, which she assured him that she did. Now he was realizing that there were giant holes in the collections process. It was clear that Man may not have known what she was doing and there may even be more, scarier problems with the practice than he had ever suspected. He was feeling frustrated, hopeless, and more than a little panicky. He wanted to know how bad it was. and what in the world should he do about it. We went into forensic detective mode, but it didn't take Sherlock Holmes to figure out what had gone so wrong. Upon deeper investigation, we found that the practice essentially had no written policies or standard operating procedure (SOP) whatsoever. The CA in question clearly hadn't been trained properly, and neither had the patients in what their financial responsibilities were regarding treatment. There was a general, often unspoken assumption that everyone would wait until in­surance paid, and then they would all somehow "work it out." but that glorious day never quite arrived. The doctor simply focused on his patients, and rightfully so. Where he went wrong was tantamount to leaving the "inmates (i.e.. untrained staff) running the asylum." An end-of-day bal­ancing procedure would have let the doctor know within 24 hours that something was amiss, but there were no financial reports being filed and no accountability built into the front desk system. Man probably believed that she knew what she was doing—after all. the practice hadn't been audited and hadn't gone under, right? Unfortunately, in so mam cases like this, the operative missing word is "yet." This wasn't a problem with a single easy fix. but the steps toward finding and plugging the holes, and instituting proper procedures arc. in and of themselves, simple and manageable when taken one at a time. Triage demanded that the first order of business was to stop the financial hemorrhaging. So first, the doctor as well as his staff had to be trained in tighter new-patient financial procedures and scripts to get each new -patient financial relationship off on the right foot. Whether it's a phone call from a shopper or a new patient with an appointment, there needs to be a basic script and a form to fill out regarding the pa­tient's financial resources (do they have insurance? Medicare? Will they be paying cash?). In addition, any front-desk staffer should be able to explain what insurance will and will not cover and offer assistance, such as information about membership in a discount medical provider organization like ChiroHealthUSA, if the practice participates. Front-desk personnel should also make sure patients know what charges are their responsibility and when to pay (hint: before they walk out the door!). Once new patient procedures were in place, it was time to slowly go back and liandlc the existing patient roster, one per­son at a time. If you need to do this in your office, simply talk plainly, politely, and directly to them, find out what they think about their balance, and work out a payment plan. The rare patient will get angry or refuse to pay. Most of them probably felt somewhat uneasy about the past loose) -goosey office style and the attendant grow ing—and perhaps unknown—balance looming over their heads. Finally, the mess described earlier could have been avoided had there been standard end-of-day reporting procedures in place. Organizing and balancing the charges and sign-ins at the end of the day protects the practice, its staff, and the doctor by providing immediate flags if something has gone wrong. One of the most important procedures in keeping your financial system running smoothly is to make sure you balance your money, your charges, and your paperwork. I think it's most helpful to do this at the end of the morning and again at the end of the day. That way. you have a trial balance at midday, so that if you find an error in your math or your count at closing, you won't have to rifle through an entire day's work. The most efficient practices get all materials organized at the end of every day and filed by date. Each of the items are compiled daily and sorted by date order using your chosen fil­ing system. If you need to find something relative to that day "s work, it's found in date order. Some offices keep a cash till, for example, so part of your procedures may include balancing the cash till. Remember these different procedures should be customi/cd to your own office and documented in your SOP manual. In this particular case, our doctor's story had a happy end­ing. Within three months of installing these new procedures, collections grew from under $50 a day to over $500 a day—all by instituting simple, casy-to-follow systems and procedures for doctor, staff, and patients. So. What's under your rug? Kathy Mills Chang is a Certified Medical Compli­ance Specialist (MCS-P) and, since 1983, has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kathy is known as one of our profession 'sforemost experts on A ledicare and can be reached at (855) TEAKlKKiC or [email protected]