The Truth About Collections

Accounts receivable and collection percentages are a subject that we hear about frequently. Every doctor has a different idea about what a good collection percentage is as well as how to collect money for services rendered.

For example, I have talked to many doctors who feel obligated to let patients/clients go without paying. They feel guilty about trying to collect from someone if they feel that the person is in a financial hardship.

While this is quite altruistic, it is very short-term thinking. These doctors must also understand that they can’t continue to provide help to their patients/clients if they can’t afford to keep the doors of their practice open. Another fact that is not commonly known is that failing to pursue a bill and persevere in asking for payment can actually have a negative effect on the patient/client’s self-respect. People expect to be billed, even when they complain. While it can be uncomfortable to deal with objections, realize you are making it possible to help many more patients over the years – and that is worth mentioning to them, as well.

Failing to insist on payment for services rendered can also lower your own esteem, making it harder to collect the next time. If you provide a service, you should be compensated for it. Period. Unless you go into a situation knowing in advance that it is going to be a charity case – and there is certainly room for that in any practice as long as it is planned for – you should always insist on being paid for rendering that service.

Of course, this is great in theory, but being able to actually collect all monies owed is another story and requires good group coordination and effort. If you and your staff are trained on how to do this from initial contact through patient discharge, including having the proper policies in place with your staff and patients/clients, your chances of collecting at the time of treatment go up exponentially. We believe that you should be collecting 98% or better of what you are producing, minus insurance adjustments. If you are collecting less than 98%, you are losing net income out of your own pocket.

Here are a few other tips that may help you when dealing with the uncomfortable situation of a patient/client who is saying they cannot make payment:

  1. Believe it or not, smiling is one of the strongest tools you have to deal with uncomfortable topics. Frowning or looking worried can have a subtle but negative effect on the conversation. Smiling naturally in a friendly manner when it is appropriate to do so is the best method.
  2. Speak confidently, concisely, and firmly. Never apologize for your prices.
  3. Listen carefully, but also use silence to control the conversation. One of the most powerful things you can do in a conversation is state your piece…and then shut it. The silence will become uncomfortable for the person, and they will often try to fill it by giving you reasons why they cannot pay. Acknowledge those, and continue to gently insist that a solution is found to make payment.
  4. Stay calm, even if the patient/client gets upset. Your emotions should not give the person any excuse to take offense or try to wiggle around the main topic of the conversation.
  5. Focus on one thing only – the patient/client – when making the calls to collect. Do not multi-task, but instead, concentrate on the person in front of you. This makes them feel important to your practice (which they are), and shows a level of care that can make paying easier to face.

By using these tips, you can gain better control of your collections percentages and thereby the level of care you can provide to future patients/clients. Any staff who deal with collections in your practice should be drilled on a regular basis in how to handle objections, present payment requests, and demonstrate a genuine, caring attitude. Whether you are asking in person before the person leaves, or trying to collect over phone, text or email, these same points apply.

Staff normally dislike roleplaying, and it is too easy to avoid in the busy week. But the reason for the distaste is often only a few simple (and very easy to correct) mistakes on the past of the executive doing the drilling:

  1. Only correct one thing at a time. Letting people have wins is one of the most overlooked, and therefore most important parts of drilling. When your staff first start out practicing objections-handling, they may make many errors all at once. THAT’S OKAY. It’s a drill, not a test. Simply pause the drill, correct just one thing, and have them continue drilling until that one thing is handled. Then take up the next error.

Failing to balance criticism with praise. When staff do something right during a drill, pause and let them know. This reinforces what you want, and in fact can often be more powerful than any negative criticism you might offer. In other words, push the hardest on the thing you want more of.

If you are a practice owner and would like free help regarding collections or any other management topic, we will help you if you help us by doing a 15 minute anonymous interview regarding practice management. Fill out the form to your right, and we will be more than happy to assist you. (highly recommended)

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If you are a practice owner and would like free help regarding collections or any other management topic, we will help you if you help us by doing a 15 minute anonymous interview regarding practice management. Fill out form below, and we will be more than happy to assist you. (highly recommended)









14 Steps to Safeguard Your Practice from Embezzlement

Our research staff continues to find that embezzlement is an issue that is still prevalent in practices nationwide. Consequently, we are revisiting this subject to provide additional advice.

 Minimize the Risk

More than likely, you’ve heard the horror story about a colleague whose trusted employee embezzled money from his/her practice. To preclude this from happening to you, there are steps that you could take to minimize the risk of embezzlement.

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We recommend that the following procedures become a part of your normal routine, as they will help to safeguard you from embezzlement. 

Handling Cash

  1. Make it your firm policy that you provide every patient/client with a receipt for cash payments.
  2. Cash handling and cash record keeping duties need to be segregated. Have one person collect patient/client portions over the counter and another person post balances. Have a third person make the bank deposits. As the owner, you must play an active role in monitoring sales and cash if you have too few employees to fully separate those three duties.
  3. Each month, compare the amount of cash deposited in the bank to the receipts and/or balances posted in your collections log. There could be some minor fluctuation, of course, but a significant difference for that month is a warning sign and should be investigated.
  4. Start a simple patient/client sign-in sheet listing patient names and the date signed in. Compare this on a daily basis to an over-the-counter-collections report (and day sheet or equivalent). Look for inconsistencies, such as patients/clients who are on the sign-in sheet but not listed on the day-sheet report. Spot-check by phone call to patients/clients who are reported to not have paid an amount due that day. This can be done as a “quality control” call to the patient/clients. Of the questions asked, one might be something like, “It’s our policy that all patients/clients who pay any cash on the day of service receive a receipt. Did you receive a receipt today for any cash you paid?” Put this policy in writing and IMPLEMENT IT. That will make it far more dangerous to attempt embezzlement.
  5. Make it a written policy that you conduct unannounced checks of petty cash and other cash accounts on a regular (bi-weekly or monthly) basis. Conduct those checks without fail.

Fill out the form on this page to read steps 6-14, they will provide you with the essential data regarding the proper management of your accounts receivable and other office records (highly recommended). Scroll to top

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Read steps 6-14, they will provide you with the essential data regarding the proper management of your accounts receivable and other office records (highly recommended).










Dealing with a Problem Employee

I received an email from a doctor having a staff problem. I replied to her and thought this might benefit some other people out there. Please see our discussion below:

Hi Ken,

As an employer, how can you tell your employee to stop his/her: gum smacking, not to laugh at the end of each sentence, to stop blowing her nose as everybody can hear it, to stop asserting herself on someone else’s conversation?

I have such a hard time saying something to my assistant about these issues. Everybody in the office is being affected, and I am not happy at all with her. I try my best to tell her what I would prefer from her as an employee, but it hasn’t worked.

Please help me.

Dr. S


My Reply

Dear Dr. S,

There are several things that can help you in this current situation and help prevent this from happening in the future. This is a bit of a lengthy reply due to the nature of your problem. Please take the time to read through this as I believe it will give you some insight into the problem and how to handle it.

The first, and probably the most important thing is to make sure that you have very detailed job descriptions and office policies in place. In your office policy manual, there needs to be written policies about acceptable and unacceptable employee behavior. When new employees are hired, they are given a copy of this policy manual, and they are to read and sign off on them. This lets them know what is and isn’t permitted in your office. They agree to this, and you now have legal recourse for disciplinary action and/or termination for non-compliance.

As new policies are written, a copy is handed out to all employees for them to read and sign off on. These signed agreements are added to their personnel files. These can then be referenced in regular employee evaluations, disciplinary actions, and if needed, termination situations.

If, however, you only deliver your requests verbally, you leave these requests open to interpretation. It is imperative to have everything in writing so that there is no room for interpretation.

The other underlying issue that I see here is hiring the right people to begin with. There are three steps here:

  • Attracting the right kind of employees,
  • Determining who to hire, and
  • Training them to do their job properly after you’ve hired them.

When you are looking to fill a new position, the wording of your ad/listing is key. Where you are advertising is also a big factor. Utilizing employment agencies that pre-screen applicants to your qualifications can greatly increase the quality of candidates that you see, weeding out the lower quality people ahead of time.Determining who to hire is a shot in the dark for most doctors. They read a resume, conduct an interview and take a shot. No one writes on their resume that they are chronically late, don’t take directions well and can’t get along with others. What you see on a resume is only what the applicant wants you to see. Similarly, all you hear in an interview is what they want you to hear. They say the right things or at the very least what they think that you want to hear in order to get the job.

After they are hired they stay on their best behavior until they get comfortable; then, they become themselves. Only then do you know who you’ve really hired.

You need a more objective way to screen and hire people so that you have a better idea of who they are, what kind of personality they have, their responsibility level, their aptitude and their work ethic. Corporations have been hiring people this way for years. Small businesses suffer through much higher turnover rates due to their lack of successful hiring techniques.

Personality tests, IQ tests, Aptitude tests are all implemented to get a feel for who a person really is and how they will fit into your practice and interact with the staff, more importantly your patients.

Once you have hired the right person, you need to make sure that you train them properly. This is where detailed and up-to-date job descriptions and office policies come into play. It is vital that you equip your new employee with the proper tools to do their job rather than throw them to the wolves and hoping they pick up the proper way to do things as they go.

Here is a policy regarding employee performance evaluations. Take a look at this as I think it will give you an idea of the kinds of policies that should have a place in your office policy manual.

To receive “an example policy regarding employee performance evaluations”, please fill out the form to the right. This example policy can help you better understand the exact types of policies that are most beneficial to have in your company’s office policy manual. (highly recommended). Scroll to top

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Fill out the form to receive a policy regarding employee performance evaluations (highly recommended).








Building a Successful Practice Through Efficient Hiring

To build the most productive and profitable practice, having stable staff who work together to accomplish the mission of the practice is vital. Knowing how and whom to hire is a key skill. To lose employees who may have seemed appropriate for your team when you hired them, yet were not actually a good fit once on the job, is an enormous hidden expense in a practice.

In fact, based on the typical costs of finding, interviewing, testing, training and getting a new employee fully functioning on the job, turnover costs can equal six to nine months of the position salary. If a job pays $3000 per month, your costs could be anywhere from $18,000 to $27,000 each time the position turns over. Therefore, it’s vital to know how to screen applicants properly in order to hire the best possible individuals for your practice and to avoid the stress and high cost of frequent turnover.

Checking References

Checking the references that a job applicant provides is an important—but often neglected—step in the hiring process. The quality of staff can make or break a practice; so, investigate carefully and hire only those whose backgrounds indicate competence and imply that they would be good employees.

Checking references is not always an easy process. In order to protect themselves from legal or privacy issues, many employers have become reluctant to voice opinions about a former employee. However, you should still do reference checks on any candidate whom you consider hiring, to gather any data available.

It’s best to check references prior to a one-on-one interview with the applicant, since you might uncover information that will eliminate that candidate beforehand and save you the interview time. If that’s not possible, check references after the interview, but before hiring.

Here are some questions you might ask references:

  • How long was _______ employed by you or your company?
  • Can you tell me his/her ending wage/salary?
  • Why is he/she no longer employed there?
  • Was he/she a loyal employee?
  • Was he/she dependable?
  • Do you feel he/she is honest?
  • Would you rehire this person?

Again, a past employer may not be willing to answer some of those questions. The key question is the last one, “Would you rehire this person?” This question is important to ask if the person providing the reference is very guarded or hesitant in giving answers.

Keep in mind that checking references is just one of several vital steps in the hiring process. Another important part is to determine the attributes your ideal applicant would possess.

Fill out the form on this page to read the rest of the article and receive our Hiring Interview Checklist (highly recommended). Scroll to top

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Read the rest of this article and receive our Hiring Interview Checklist that you can use to determine the characteristics of your ideal employee (highly recommended).








How to Deal with Canceled or Rescheduled Appointments

One of the most common problems doctors want help with is dealing with canceled or rescheduled appointments. If a doctor’s office has too much of this occurring it can wreak havoc on their daily production. Normally, when this is occurring it is a sign that the receptionist is not properly trained in scheduling appointments, managing the appointment book, or handling cancelations and rescheduling.

When you are getting a high volume of cancelations, you should ask yourself these questions:

  • Does your receptionist immediately reschedule a canceled patient/client?
  • Does your receptionist ask the patient/client to put the appointment in their calendar, phone, or day planner so they won’t forget?
  • Do you keep a record of the reasons behind cancelations for future reference and to implement any needed corrections?
  • Do you have any sort of policy regarding cancelations that is part of the “welcome to the practice” information given to patients/clients?
  • If you have such policy, do you enforce it?

Here are some other questions you should ask yourself as regards appointment no-shows:

  • What actions do you take when someone doesn’t show up for an appointment?
  • Do you call the patient/client after a certain length of time, e.g., 10-15 minutes?
  • Do you have any sort of policy regarding no-shows that is part of the “welcome to the practice” information given to patients/clients?
  • If you have such policy, do you show it to no-show patients/clients the next time they come into the practice?

The doctors we deal with are all asked these simple questions, and many more, when they are dealing with cancelations, no-shows, and reschedules. We recommend that you closely evaluate the management systems and training that you have in place with the staff members involved; then, fix or implement the proper procedures to reduce the number of patients/clients lost. This normally leads to increased production without any increase in marketing or staff expense, which, of course, leads to greater efficiency and net income in a practice.

If you would like more help dealing with canceled or rescheduled appointments or any other management topic, fill out the form to the right, and we will be more than happy to assist you.

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If you are a practice owner and would like to receive either:

  • A Practice Owners Job Description pack (valued at $129)
    OR
  • A free one-hour consultation on any practice management topic

In exchange for 15 minutes, anonymous phone survey (at the day and time of your choosing), to assist in our upcoming publication by The Practice Solution Magazine (highly recommended). Fill out the below form.










Screening Applicants

The Group Interview
Finding a new employee is a very time consuming process. To consolidate efforts and streamline the initial stage of the interview and selection process, have all of the applicants who meet the basic criteria come into the office for a group interview session. The purpose for this is that it consolidates the office manager’s efforts, giving you an opportunity to get a look at the applicants and screen out those whom you do not care to invest any more time in. The finalists from this segment will then be invited back for an in-depth individual interview.
Once you have collected all of the resumes from your advertising, go through them and screen out those that do not have the qualifications you are looking for. Take into consideration whether or not the applicant included a cover letter and whether that letter really communicates something about the applicant. Look at the experience, background and talents being conveyed in the resume and letter.
The First Interview
Phone those applicants that appear to be the very best and schedule them to come into your office to fill out an application. During this phone call you can rate their phone voice and composure and get a bit of a feel for their willingness. Make notations on the resume. Schedule all of the applicants for the same time, e.g., an evening after work or on a Saturday morning.
Make preparations ahead of time. Have packets of paperwork ready for each of your applicants. Their packets will contain an application, a questionnaire, a sheet that they will fill in with their employment goals and what their understanding of a practice is. They will also be asked to write a brief collections letter and sign an Authorization for Release of Information form.
When the applicants arrive, welcome them and deliver a brief statement (10 minutes or less) about the practice, its purpose/mission and the position. Then, direct them to the pre-printed packets handed out. Have them:
  1. Fill out their Job Application Essays.
  2. Fill out their Hiring Questionnaire. Asking them what your practice is about, its purpose, the position that they are applying for and a few negative and positive things about the position or practice.
  3. Write a brief letter to a client who has an overdue account (which gives you a good indication of how the person deals with others on sensitive matters).
  4. Sign and date the Authorization for Release of Information form.

As the applicants complete their forms, rate them on their appearance (1-5) and take them individually into a private office to conduct a brief interview (about 5 minutes for this first interview). This will give you a feel for the person.

Before your applicants leave, give them each a card for a complimentary exam at your office. (This is optional, but could garner a new patient even if not hired). Thank them all for coming in and let them know that they will be hearing from you within the next couple of days.

Fill out the form to the right and receive “Screening Applicants – Part II” (highly recommended). Scroll to top

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Fill out the form to continue reading this article Screening Applicants – Part II (highly recommended).








The Basics on Bonus Plans
Getting Staff to Produce the Quantity you Need and Want

It is very wise to have a bonus plan for staff in operation in your office. If you reward staff for increasing their production and the production of the practice, they will naturally want to continue to do that, and the whole staff will tend to operate much more as a team.

In structuring a bonus plan, the simpler you can make it for yourself and your staff, the better. Bear in mind that you want the staff working as a team and that there are several areas of concern. Consider the following:

The best bonus plans are ones that get the entire staff working together towards increased viability for the whole practice, while rewarding their own increased production. A plan that gives staff bonuses when the practice is not viable is a loser for the doctor/owner. At the same time, not providing bonuses to staff for their increased production when the practice is getting more and more viable provides no incentive or reward for the staff and will lead to a less cohesive and productive group. So, you have to put together a system that takes into account the major statistics of the practice, the viability of the practice, and the individual production of the staff members.

Certainly, you want higher production statistics, but if you pay bonuses only on increased production, you could be painting yourself into a corner if the collections do not keep up with the production. You could be paying bonuses out of your own pocket!

At the same time, generally, only one person is handling collections. But even so, a team effort can come into play in this area. Staff members who do not formally have anything to do with collections can still be of assistance by not overburdening the person in charge of collections with other matters. The staff can offer to help out with getting statements out. If appropriate, the staff can offer to perform other helpful functions (as time allows) so that the person in charge of collections can handle financial matters. All staff should be cognizant of relaying important financial related information to the accounts manager if they become aware of a situation that could affect the financial area. Additionally, the better service a patient/client receives, the easier it is to collect payment. All staff can contribute to collections by doing their own jobs well.

If the staff is focused only on production statistics, they may not focus an appropriate amount of attention on promoting new patients/clients in the practice. New patients/clients coming into the practice is one of the prime factors involved in your being able to generate more production and collections. The new patient/client area ties in closely with the growth and viability of the practice. All staff can be responsible for the inflow of new patients/clients into the practice by their own promotion from their job area, as well as outside of the practice.

The point becomes self-evident. The staff must be focused on all of the above and working as a team to keep all of those statistics going up. The practice will grow, and they will be rewarded for their contribution to that growth. At the same time, the practice’s viability must be looked at.

To read our “sample bonus plan”, please fill out the form to the right. (highly recommended). Scroll to top

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Fill out the form below to read our sample bonus plan (highly recommended).








Do You Know What Constitutes Great Service?

The Four Components of Great Service

Great service to your patients/clients is one of the most important factors required to build a successful and thriving practice. Under the heading of great service, you will find the following key components: convenience, communication, cost and quality, and the importance of your service as perceived by the patient/client.

Convenience: Consider the location of your practice. People generally select a service based on how convenient it will be for them to get to the location. Surveys and studies show that well over half of the public selects their healthcare services because of a conveniently located facility.

Are your hours structured to meet the needs of your patients/clients? Most people operate on a very hectic schedule and will actively seek out those practices that offer convenient or flexible hours. Practices that really work at ways to make it more convenient for their patients/clients to use their services will surely reap the rewards for their efforts.

Communication: Words are not the only way in which communication occurs. Appearances and actions weigh equally as important in conveying an idea or concept to your patients/clients. Look at your staff, building, reception area, signs, business cards, letters, etc. What do these communicate to the public?

Decide exactly what it is that you wish to communicate to your patients/clients and prospective patients/clients. Then convey that in not only verbal communication, but in all of the above categories as well. Teach your staff to do the same.

To receive the other two points that constitute great service, please fill out the form to the right. (highly recommended). Scroll to top

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Fill out the form below to receive the other two points that constitute great service (highly recommended).








Proper Case Presentation and Better Case Acceptance

We have found that doctors can lose thousands of dollars per month because they are unaware of some of the principles associated with proper case presentation and case acceptance. In addition, sometimes the best treatment planning and case presentation doesn’t result in patient acceptance because staff members are not trained in systems that will increase patient compliance with what the doctor is recommending. Lost revenue due to inefficiency and missed opportunities for growth cost a practice far more than most doctors realize.
One small but vitally important point to be aware of in presenting treatment plans is that the terminology used must be easily understood and at the understanding level of your patient. We see all too often doctors using technical terms that are not understood by the common patient. If the patient doesn’t understand the terms, they won’t fully understand the recommendation, and the acceptance rate will be lower than it should be. This is but one point of many key parts of proper case presentation and better case acceptance.

Another basic but vital point in treatment plan presentation is only presenting what you feel is the best course of treatment for that patient. We’ve seen far too often doctors assuming that patients/clients can’t afford a treatment, so instead of presenting what they feel is appropriate, they present an A, B and C option. Of course, the C option is the least expensive, and the A option is the most expensive. When you present multiple options up front, the likelihood of someone picking the A option (the best course of treatment) is greatly reduced. When you present cases in this manner, you will likely be performing a disservice to your patients, and your gross income will end up going down.

You should always present one course of treatment to the patient/client. Diagnose the condition – do not diagnose their pocket book. Do not fall into the trap of pre-judging what you think they can and cannot afford. They have come to you because you are the expert, and they want your expert opinion. Present it, and if they have concerns, objections or need more education on the matter, handle each issue one at a time. If it is a concern about being able to afford it, let them know that you accept credit cards and care credit (if applicable) to help them make payments and get the treatment. If you exhaust all other avenues, then give them a B and C option. But, never lead with anything other than the A option.

If you do this, your patients will start getting a better level of care, and the income of your practice will go up. If you would like more information on how to give a proper case presentation, increase case acceptance or any other management topic, fill out the form to the right, and we will be more than happy to assist you.

If you would like more help dealing with increasing your case acceptance or any other management topic, fill out the form to the right, and we will be more than happy to assist you.

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If you are a practice owner and you have any questions regarding this procedure or its implementation, fill out the form to schedule a free call and we would be happy to assist you.









How Do You Get Your Employees to Think Like You Do?

The Mission Statement

A primary responsibility of the owner of a practice or a business is to set the pace and direction for the practice or business by contemplating, defining and establishing exactly what the mission of the practice or business is. By doing so, the owner provides the guiding principle for the entire activity.A mission statement can be used to maintain the focus for the owner and staff. It can be used as a point of reference along the line. Oftentimes, a staff can simply get caught up in the day-to-day functions of their individual jobs, forgetting (or maybe never having really known) what the purpose of the activity is. A fully functional team can then never truly come to fruition.

It is up to the owner to determine why he/she is engaged in the activity to begin with, what the purpose and goal is and to form a team that is mutually in agreement with the purpose and the goal. It is that understanding and agreement that will allow people to evolve into a coordinated group, working together toward the long-term objectives of the owner.

The second part of this article contains a sample mission statement. Use it as a model for developing one that suits your practice or business. Once it has been developed, distribute it amongst your staff, go over it as a group at your staff meeting and have each staff member place their copy in the front of their respective staff binders.

Fill out the form to the right to receive your “sample mission statement” (highly recommended). Scroll to top

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Fill out the form to receive your sample mission statement (highly recommended).