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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).










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 Do You Hold Employees Accountable for Their Positions?

Surveys show that workers are happiest when they are productive and are contributing to the success of the group in which they work. To boost morale, efficiency and longevity of workers, one must:

  1. understand the importance of one’s production,
  2. know exactly what one is supposed to produce and have a clearly defined final product,
  3. be properly trained to get that product, and
  4. be specific. Generalized statements leave too much room for interpretations and argument.

Whether you have a staff of 2 or 30, each position in the practice needs to have a clearly defined final product. Both the manager and the employee need to know exactly what the person on the post is expected to produce. For instance, a receptionist’s product is “communications handled swiftly, accurately and in a friendly manner.” A receptionist who consistently obtains this final product will keep the flow lines and the communication lines of the practice functioning and will be a valuable group member. How many new patients have been lost because a receptionist has failed to answer a phone call swiftly, answer questions correctly and/or set an appointment?

Determining the final product for each position is a starting point. A statistic needs to be developed, so the final product can be monitored accurately. For example, one of an office manager’s final products is “staff members who are fully trained for their positions.” Using a statistic such as “percentage of employees fully trained for their jobs” would show the OM’s performance.

How do you hold employees accountable? The answer is:

  1. name a final product for each position,
  2. figure out a way to quantify that product as a statistic,
  3. monitor the statistic,
  4. evaluate statistical trends, and

apply the correct formula to remedy any downward statistic or improve an upward statistic.

If you are a practice owner and would like free help with a particular employment concern or any other management topic, fill out the form to your right, and we will be more than happy to assist you. Scroll to top

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If you are a practice owner and would like free help with a particular employment concern or any other management topic, fill out the form below, and we will be more than happy to assist you.









Generating New Patients by Using Surveys

How do you market for new patients in a cost efficient and effective manner? Starting with internal marketing is always the best approach­, as it produces the most cost effective return, which is of utmost importance in managing a practice. Surveys are one method of internal marketing. But how do you go about generating new patients by using surveys?

Here’s the first tip that you can use to more effectively market: do a simple survey with all new patients who come in, in order to find out what brought them to your practice. This can be done as part of their new-patient intake forms, or the receptionist or any other designated staff member can ask the questions verbally.

We have a variety of prepared surveys for our clients to use. Here are examples of some questions you can use to create your own survey:

  • If you were referred, who referred you and what did that person say to interest you in our office?
  • If you responded to an ad, which one did you see? What about it attracted you?
  • If you responded to our website, how did you locate it and what about it interested you?

A second tip is to use surveys on your existing patient base. Start by going through your existing patient records and find about 50 of your “A-list” patients/clients. Do a demographic search of where your best patients/clients are from. Then write a survey for those patients/clients to find out:

  • what attracted them to your practice,
  • what keeps them coming back to your practice,
  • what they like the most about your practice and
  • which services, if any, they would like to receive from you that you don’t currently offer.

You can then use this information to target the greatest demographic area of your A-list patients/clients and use their survey answers as “hot buttons” in a marketing campaign targeted to generate more patients/clients who are similar to those A-list patients/clients.

This is called targeted marketing. It’s all about generating quality patients and clients, not just getting people to walk through the door. Quality patients keep their appointments, follow your treatment programs, pay their bills, spend more than their insurance allotment, etc. These are the kinds of patients/clients you want to generate for your practice.

If you can determine in which area your best patients/clients reside and what brought them to you in the first place, you can then design a marketing campaign to generate more of those types of patients and clients.

Don’t just guess at what you think will bring new patients/clients in the door. Find out what got your best patients/clients there and use that information to your advantage. “Know before you go” is the motto of all good marketing. You find out the “know” by surveying.

If you are an owner and would like free help on collecting past due accounts or any other management topic, fill out the form to your right, and we will be more than happy to assist you. Scroll to top

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If you are an owner and would like free help on collecting past due accounts or any other management topic, fill out the form below, and we will be more than happy to assist you.










12 Steps to Collect Past Due Accounts

Collecting on past due accounts is a function that the Accounts Manager will find herself/himself having to do. Any contact with a patient/client, even under these circumstances, should be kept on a friendly, professional and dignified basis. This will promote respect for the office and its business practices.

Always remember the following points with regard to your patients/clients:

  • Most people have good intentions and want to cooperate with agreements that they have made.
  • Although a person’s account may be overdue, most people still have a good intention to take care of it.
  • Most people prioritize their bills and will first pay those that they feel are most pressing.
  • Most people with past due accounts will pay those bills where someone is actively requesting them to pay.

Bearing in mind the above, your role is to arrange to be one of the creditors that your patients/clients will not delay paying. The following points may be helpful in this regard:

  1. Bill promptly every month.
  2. Ensure that your bills are accurate.
  3. Ensure that you have the original signed financial agreement from your patient/client.
  4. Contact the patient/client as soon as you realize the account has become delinquent.
  5. When you speak with the patient/client, let them know that you believe that they are able to make payment.
  6. Let the patient/client know that you expect to be paid, and refresh their memory on the signed agreement.
  7. Allow the patient/client their self-respect; never back them into a corner, insult or badger the patient/client.
  8. Explain to the patient/client that you want to help him/her work it out so that they can maintain the agreement that they made with your office.
  9. Be prepared to offer some options to the patient/client that they may not have considered.
  10. Be willing to really communicate with the patient/client so that a true understanding and agreement can be reached.
  11. If absolutely necessary, utilize the credit reporting associations. Let the patient/client know that you are planning to do so and that this will go on their credit rating.
  12. As a last resort, utilize the services of a collection agency, and let the patient/client know that you plan to do so.

If you are an owner and would like free help on collecting past due accounts or any other management topic, fill out the form to your right, and we will be more than happy to assist you. Scroll to top

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If you are an owner and would like free help on collecting past due accounts or any other management topic, fill out the form below, and we will be more than happy to assist you.










The First Step to a Successful Marketing Campaign: Research

To craft a successful marketing campaign for your practice, you must first conduct some basic research that will start to identify what your marketing plan and promotional pieces will look like and the message they should deliver. The first step in your research is to work out the general mindset and styles that dominate your particular geographic area. Every state, city, town or area has its own mindset and styles that are unique to that place. If you have lived in the area where you practice, chances are you know them well. Additionally, it is smart to check with others from the area to ensure that your opinion agrees with the general consensus. If you are new to the area, ask locals, as they generally have a good idea.

Some examples are provided below to give you an idea of what one might list as the mindset and styles for his/her area.

Example #1:

Mindset: “Slow and steady pace”, “Friendly”, “Easy going”

Style: Earthy. Lots of greens and whites used in colors.

Old fashioned.

Example #2:

Mindset: “Efficient and Professional”, “Friendly”, “Straight to the point”

Style: Modern and Edgy. Lots of blues used in colors.

High-tech.

Next, identify the top three practices in your area and find out how they market themselves. Doing this will enable you to see which marketing approaches have been successful for your area. Looking at your three competitors’ websites is a good start, as well as looking in the Yellow Pages, local newspapers, Valpak/ADVO, etc., to see how they are marketing. Look for which words they are using to sell their services to people, which offers they are advancing and what their designs look like.

The next step is to identify the successful campaigns or promotional pieces you have created and used thus far. You need to look for any promotional pieces, slogans, brochures, ads, internal marketing campaigns, discounts and word-of-mouth success that resulted in notable increases in delivery. Again, pay attention to the words that were used, the offers that were put forward and the visual impact of the design. It is also good to consider the general demographics of your area. A good website that provides this information for free is: http://www.city-data.com. Gathering this data should enable you to get a good idea of both what worked for you and what works for other similar professionals in your area. It also provides you with a general impression of what people in your area like and will respond to.

This basic homework will provide you with a foundation of information that can be used as you work out new marketing campaigns, whether internal or external.

Fill out the form on this page to read the rest of this article and find out the second step in crafting a successful marketing campaign. (highly recommended). Click to scroll to the top of the page.

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Your Responsibility to Your Staff

Just as your staff has responsibilities to you and your practice, you likewise have several responsibilities to your practice and staff.

The complexity of active leadership can be best understood by breaking it down into its essential and integral parts:

1. Communication: It is vital for the owner of a practice to maintain excellent communication with his/her staff and to provide active and visible leadership. The following are key elements involving communication that you, as an executive, should implement:

a. Communication of Goals.
Determine the purpose of your practice (most often presented in the form of a mission statement) and communicate that to your staff. Impart the goals of the practice to the staff and keep them informed of the projects that you intend to implement to achieve those goals. The better informed your staff is and the greater understanding they have of such matters, the more likely they will be working in tandem with you.
b. Communication Tools.
There are some fundamental communication tools to implement in the practice; see to it that your staff uses them. These tools can be established and maintained by your office manager; but, as the senior executive and leader of the practice, you must reinforce them. Examples of those tools are: written requests or proposals, written office communications, written office policies and the use of an effective communication relay system.
c. Responding to Communication.
It is vital that you and your staff respond swiftly to written communication. When people do not receive a reply to their memos or emails within an appropriate and reasonable period of time, thereafter they become less willing to communicate. As a result, the business can have more problems on its hands. (Keep that in mind when reading the second part of this article.

2. Staff Meetings: It is also vital that you ensure that the practice holds staff meetings once per week. This is one of the most valuable opportunities available to you for educating staff, setting goals and targets, and handling problem areas that should be addressed by the staff as a whole. The communication lines within the business will strengthen considerably too.

You, as the owner and leader, in addition to your office manager, should continually strive to establish strong coordination and leadership for your staff. Any problems or disagreements between the owner and office manager should always be sorted out OUTSIDE of the staff meeting and should never be addressed in the presence of any staff.

Staff meetings run most effectively if the owner and office manager meet prior to the staff meeting to plan and coordinate those matters to be addressed with the staff.

Fill out the form on this page to read the rest of this article and find out why writing and implementing Policy in your practice, as well as setting Goals and Targets successfully, is so vital to achieving expansion. (highly recommended). Click to scroll to the top of the page.

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Critical Practice Foundations

Critical Practice Foundations

The Basics

Most doctors, when starting their practices, miss some of the basic actions that should be established prior to opening.

An owner of a healthcare practice should always, as a first step, work out the following basics: their purpose as a practice owner, the actual product of the practice, and the statistics that will measure the success of the practice.

Below are examples that you can modify and use for your own practice.

Purpose of the Practice Owner

The owner’s purpose is to establish an efficient health care practice that delivers quality service to its patients and/or clients and to have a very solvent and viable practice that provides an enjoyable place for the staff to work and a high quality-of-life for the doctor/owner.

Once the purpose has been established, it is the owner’s responsibility to set the direction and the pace for the business and to demand that the valuable final products of the organization be achieved. To do that, she/he must work out what the product of the practices are. Here are some examples of products:

  • A solvent, viable, expanding practice that delivers high quality care and service
  • Satisfied patients and clients who have received high quality care and service
  • Statistics
  • Number of active patients/clients
  • Production
  • Collections
  • Net Income
  • Solvency (the amount of cash versus the amount of bills owed)

Putting the purpose, product and statistics in place will help create a strong foundation for the expansion of your practice.

Getting your staff on board with you is another part of this process.

Instantly receive the second part of this article, Getting Your Staff on the Same Page. Simply fill out the form to the right. Go to the form. Scroll to top

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The Truth About Collections

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 that feel obligated to let patients/clients go without paying. They feel guilty about trying to collect from a patient/client if they feel that that person is in a financial hardship.

While this is quite altruistic, what these doctors must also understand is 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. 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 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.

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Guest column: Coping With Conflict – Part Two

A Layperson’s guide to resolving conflict in the office

By Daniel A. Bobrow, MBA

President, American Dental Company

Part two in a series of two articles

In last issue’s article, we discussed models and tenets used to resolve conflict. In this part, I’ll go over the skills necessary that, once mastered, can greatly assist you in managing and resolving conflict in your office.

Active Listening

Truly listening and showing with your body language a sincere desire to know what the person is saying is vital. A person must feel that they are being heard for any resolution of any conflict or problem to occur. This can be further demonstrated by some of the points below.

Mirroring

Restating conceptually what is said to you to confirm your understanding. Care should be taken to “neutralize” statements by eliminating or changing words that are emotionally charged or are accusatory.

Pacing

Another method has to do with understanding and matching the tone and pacing of a person’s speech pattern, and, if needed slowing it down. The goal being to calm the person so a more productive conversation may take place.

BATNA

This is an abbreviation for Best Alternative To a Negotiated Agreement. It involves asking the person to consider what the best possible outcome will be if a mutually agreeable settlement can not be reached. An example of the use of BATNA is: “Joseph, I know you don’t like making reactivation calls in the evening. But you’re the only one on our staff who is capable of doing so. And you remember the mess we were in before we brought you on. What do you think will happen if we just stop doing this?” Embedded in this sentence is another technique called stroking (see below).

Reality Test

Similar to BATNA, reality testing attempts to get the person to see that his or her proposed solution is unrealistic, or at least, not optimum.

Blame Yourself, Not Others

A great way to neutralize tension during the mediation session is for the mediator to take responsibility for any misunderstandings or uncomfortable situations that might arise. For example, if a party grows impatient while the other party is speaking, you might say “I’m sorry for not giving you an opportunity to speak, Sam. Just as soon as Bill finishes, you’ll have your chance.”

Ask “Harmless” Questions

Ask “leading” questions: especially when the parties seem to have reached an impasse, ask “safe” questions that get the parties talking again. For instance, you might say “Whose turn is it to get lunch today? I’m starving!” or “By the way, did I remember to thank you both for helping me juggle those four patients this morning? I owe you for that one!”

Stroking

Let the parties know that they’re doing a great job in the mediation, and you really appreciate their willingness to sit down and talk things over. It’s too bad more people are not willing to talk and listen.

The goal of all the above techniques is to get people to see for themselves why resolution of the conflict is in everyone’s interest, including theirs. If someone feels that they are being manipulated, or that a solution is being forced upon them, the parties to the conflict will be less likely to adhere to the proposed agreement. Remember that agreement is not the sole criterion of success. In fact, if either party feels the agreement is “forced on them,” it may do more harm than good.

An Ounce of Prevention

One way to deal with conflict is to create an environment where it is less likely to arise. One way to do this are to anticipate the kinds of conflict between staff members, doctors, and patients, then implement systems and training to prevent these situations from arising. Examples include:

“Personality Conflicts” between staff

Implement some form of compatibility assessment into your employee screening procedure, as well as for current employees. Doing so can help you understand who is most suited for working with whom. Employ active listening and caucus tools (see part 1, last issue).

“Trust is an essential ingredient of a productive and profitable environment,” says Dr. Ira S. Wolfe, DDS, president of Success Performance Solutions. “The willingness of people to exchange ideas and collaborate is thwarted when people are selected and promoted on the basis of skills and experience alone. ” People have to be able to get along with their co-workers in order to have a winning team environment. Wolfe’s SMARRT management process encourages and facilitates matching people who are compatible with the job, the team, and the practice culture. There are also testing procedures that help choose the right person for the right job and assesses their potential compatibility with other staff. Find some technique, test, or company who has experience and proven results in this area to help you with this. Doing this properly will result in less conflict and stress, and higher practice productivity.

Patient Complaints about being kept waiting

Implement a policy of notifying patients in advance if the doctor is running late. Promote a “no waiting policy” as part of your mission statement or declaration of principles. When the occasional complaint does occur, be prepared to use disarming verbiage such as “The doctor asked me to apologize to you for not being able to see you. He is busy with a procedure that has proven more involved than we anticipated. He assures me he will do everything he can to see you as soon as possible. Is that acceptable to you Mr. Jones?” Doing so before the complaint arises in the first place is a great way to show your sincere concern for your patient and respect for their time.

Staff Member refusing to implement changes or “grow with the practice.”

Caucus with that person employing the techniques covered above. Through good communication and active listening you can get to the source of this team member’s unwillingness to work with the team. In many cases, you may discovering something more fundamental going on that has farther reaching implications for the practice.

Another way of preventing conflict is to hire, then educate and motivate staff members to recognize the value of the work they do, and the value of the practice to its patients and the community. Involvement in charitable groups, for instance, can give the practice team a sense of shared pride, and serve to put in perspective the disagreements as self-indulgent exercises that neither the practice nor staff members can afford.

As I am writing this, I am experiencing a poignant example of potential for conflict. I am working on my laptop on a return flight from a conference I’d attended. A rather ample gentleman was seated in front of me. As he reclines his seat, my laptop is thrust into my abdomen. I struggle in vain to position the laptop in a way that will not restrict my breathing. Out of desperation, I at last say, “excuse me sir, I’m sorry to distrub you, but I wonder if it would be possible for you to bring your seat back up just a little bit and still remain comfortable. I realize these seats were not designed with the use of a laptop in mind, but it would be a great help if I could continue working on this article as I am under somewhat of a deadline.” He was immediately accommodating.

In addition to my choice of words, the fact that I had earlier helped this same gentleman avoid a bump to his head by pointing out the open overhead cargo bay no doubt set the stage for his cooperation. As to what I said, I was careful not to use accusatory or demanding language that suggested blame or that I was entitled to anything. I also showed a respect for his comfort, and directed the cause for the situation to the design of the seats. Finally, I offered a reason why I needed to continue my work.

Final Thoughts

Remember, an agreement needs to last, especially if between staff members.

A number of resources are at your disposal if you would like to learn more about how alternative dispute resolution (ADR) can help you achieve more harmonious relations in your practice. Which are appropriate depends on factors such as the number of staff members and the types of conflict you experience. I invite interested readers to contact me if they would like to learn more about these powerful techniques.

Daniel A. Bobrow, MBA is president of the American Dental Company, a Chicago-Based Consultancy serving the dental profession. He has mediated and arbitrated various cases. He is also Executive Director of Climb For A Cause, a non-profit Foundation whose mission is to provide health care treatment and education to people in need worldwide. He may be reached at 312-455-9488 and

Dbobrow@AmericanDentalCo.com or

Director@ClimbForACause.org.