I started out as a CA, so I know exactly how challenging it can be to run around doing the equivalent of putting out fires, spinning plates, and juggling chainsaws—and doing it all with a smile on your face. Balance, in this case, is not only about finding that sweet spot where everything's running smoothly and you're feeling happily productive, but also about literally balancing the books at the end of the night. When one of your biggest areas of responsibility is in balance, it's a huge step toward also finding your personal sanity and balance. Your doctor depends on you to keep him or her up to speed with consistent and complete reports from the front lines. Unless you and your doctor are clear on a daily basis, anything and everything could be going on behind the scenes, from missed charges and minor errors to gross embezzlement. Anyone can learn to manipulate the computer system and pocket cash, or even worse, pull something one of our clients experienced: a staffer made up charges for herself and her family and billed her personal insurance, then removed the services from the computer, told the carrier she had paid, and asked for payment to be made to her home. Organizing and balancing the charges and sign-ins at the end of the day not only protects you, it also helps you and the doctor have some semblance of order. One of the most important procedures for keeping your financial system running smoothly is to make sure that you balance your money, your charges, and your paperwork. I think it's most helpful to do this both at the end of the morning and again at the end of the day. This 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 organize all materials at the end of every day and file them by date. The items are compiled 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 also keep a cash till, so part of your procedures may include balancing the cash till. Remember these different procedures should be customized to your own office and documented in your SOP manual. Here is a simple process that is easy to implement for end-of-day balancing at the front desk: Start by balancingthe material you have in front of you. Make sure all charges and payments have been entered for the day, and print out your end-of-day sheet. First: Gather all routing/fee slips that have been entered into the computer, count the total number, and write it on the top copy. The total should equal the number of names on your sign-in sheet and the total of office visits entered into the computer. Review the sign-in sheet, count the total number of names, and write the number on the top. Total the charges from each routing/fee slip. You can either total them with the calculator tape, or you can create an Excel spreadsheet where you enter each slip in a column and set up a formula so that it will total at the end. Some practices like to do this kind of pro cedure because the bookkeeper can then confirm that all of their fee slips were added. The total of charges should equal the amount of the total services/charges in your computer and on your end-of-day sheet. Make sure that: a. The total number of signed-in patients equals the total number of routing/fee slips and the total number of office visits on the day sheet. b. The total amount of the services on the calculator tape equals the total amount of the services entered on the end-of- day sheet. Next: 5. Total all of the collections from the front desk, includ ing checks, cash, and credit cards. Usually, the insurance deposit is done separately, so you may not have to include that. If your procedure does include insurance, total all four types of collections. The total of these should equal the total of collections in your computer for the day. If any of these don't balance, you have to go back and find out why. This is when having a trial balance at the end of each shift is invaluable; you will have a way to know if the discrepancy occurred in the later part of the day, and you only have to go back through that section to find your error. Once you know that everything has balanced, com pare the sign-in sheet, schedule, routing/fee slips, and day sheet to be sure each patient appears in all places. Any patient who may have walked in could have slipped through the cracks. Have a place to keep money that needs to be depos ited. This should be a locked desk or safe. Your other items are now ready to be put into your end-of-day packet and stored wherever that is kept. 10. Review the procedure for making your end-of-day packet. Throughout the day, make sure that you keep deposit slips for front-desk collections versus insurance collections. Whoever enters the insurance checks should list each patient's name on the deposit slip, or list the insurance company for bulk payments, such as Medicare or Blue Cross Blue Shield. Keep a copy of each deposit slip, making sure it all balances with the end-of-day sheet for all collections. Then compile your packet in this order: Routing Slips EOBs entered today Copies of deposit slips Sign-in sheet(s) End-of-day sheet from computer Finally, put a rubber band around all of your materials and file them in date order. You could stack them in boxes categorized by the month, or scan all of the materials into the computer by date to reduce paper clutter. There you have it! The secret to being a balanced (and sane) CA is to have a balanced practice. And you didn't even have to pat your head and rub your tummy at the same time to do it. KatliyK lills Chang is a Certified Medical Compliance Specialist (\K^S-P) and, since 1983, has been providing chiropractors with reimbursement and compliance training, advice ami tools to improve the financial performance of their practices. Kathy is known as one of our profession sforvmost experts on A lexiicarv and can be rvached at (855) TEAK IKMC or mfddhncimivemty.com
