Wednesday, May 18, 2011


For the record, I appreciated all the comments on the last two blogs. I want to address them. First, my recalls. We have been in communication with TeleVox, our voice appointment confirmation system. It turns out they do recalls too. It is integrated into your system and if the person is due this month they will call them and remind them to call the office. We are working out the kinks, so I will let you know.

About the comparing. I know it is wrong in so many ways to compare. I know that you never know what is going on with other people when you compare. It doesn't matter to me that the people building the 8000 sq. ft. mansion on the lake are two physicians. It doesn't matter to me that the dentist down the road can't afford the Mercedes payments. It is not about them (and a couple of you alluded to that). It is about me. It is me not loving the situation I am in right now.

I know I should "count it all as joy," as the book James says. I know this, but I think it is human nature to compare. I mean, God devoted a commandment to coveting others things. Comparing is not a new problem (it is at least a 2500-year-old problem). But it is a problem, at least for me. I will try to keep myself in check. And most of the time I do consider it all joy. I just think it would be more joyous with other people's stuff.

I haven't talked about TV in awhile. Modern Family is still my favorite show. We are still big fans of both NCIS shows. We started watching Hawaii Five-O and Blue Blood.
I have heard The Middle is very funny, but I forget to put it on the Queue. Anyone seen this? Is it worth it?

Today I want to talk to you about collecting money. Before I go on, I have to tell you that I know that collecting all the money at the time of the service is always the best and that is what we try to do at our office, BUT sometimes it doesn't work that seamlessly.

My accounts receivables have always - and I mean always - been about $75,000. That means when I first started they were $75,000 and today they are about $75,000. They spike to $90,000 and dip to $65,000 but 99% of the time they hover around $75k. I get a report once a month and it is 4 pages long and it has everyone that owes the practice money, from the $4 outstanding to the $1998. It reports how many days they are delinquent and also where they are. Are we waiting for insurance? Have arrangements been made? Have we sent them to collections?

Before I talk about this list, let's go back to the systems. Yes, it is our goal to make sure everyone pays on the day the service is rendered. They are instructed to say, "Your bill comes out to be $1,500 today Mr. Warbucks. How would you like to pay for that? We take cash, check, MasterCard, Visa, Discover, American Express. If none of that is acceptable to you, we can get you application for CareCredit." We give them every option.

But this is hard to do. For instance, if the patient has insurance and the insurance says it pays 80%, we all know they pay more like 50%. Unless you have gotten a pre-determination, you never know what the patient is responsible for. So we collect the 20% at the day the service is rendered and we tell them there is a good chance the insurance will pay about 30% less than you think and you will be responsible for it.
We found that if we ask them to pay 50% up front it kind of ticks them off (and we can't afford to tick off the patients that actually do come in). Then we have to collect the rest of the money.

Then there are people that have huge treatments done and they make arrangements with my front people. "Why don't you pay half up front, and half at the cementation?" But then at the cementation appointment, there is some issue and then that becomes a collection issue.

Then there are the people that come in expecting to get a tooth out at $175 and I tell them it is best to save their tooth. They want really bad to save their tooth but they only brought $175, so I tell them they can bring the rest of the money in next pay day (nI have to tell you, these people are better at paying than the people who get the huge treatment, make payment arrangements, and then can't pay at the cementation).

There are people that expected their insurance to pay 100% (and so did we), butthe procedure was denied for some reason or another. Or the case that I just plain got over-zealous about and finished the work before they could afford to pay. There's also the patient that has been a patient here for 10 years and never can get their head above water and can never get ahead of their dental issues. They come in with a problem and I tell them to pay when they can.

How about the college kid who tells you his dad is going to pay? You send a bill to the father and they go absolutely apes#@$%t. How about the physician patient that has been a patient for 18 years? He gets his treatment and never stops at the desk, just walks right out. You know he is good for it. He has never been a problem, but he gets on the list because we have to collect from him. But you get enough of the above and what you are left with is a 4 page audit report (about 250 people).

Now, about the list. Over 50% have a line through them, meaning it is taken care of. For 10 or so, their treatment is not finished, so they are a non-issue. Another 10 or so have financial arrangements and are currently sticking to the arrangements. So that leaves about 80 or so people that are delinquent in some form or another. In a practice this big, I don't think that is that bad. Twenty or so are 30 days past due. And a couple of them are like $5 or $7, and these people are probably thinking they will pay the next time they come in.

Which reminds me of a question I wanted to ask you, Are you sending people a bill for outstanding balances of $20 or less? I have told my staff not to send a statement for $5 or less. But they say that if we have 100 people that owe $5, that is $500 out there that is our money. 14 people are 60 days over due. 7 people are 90 days over due, and 7 people have been sent to collections.

And the funny thing is, usually it is the SAME people. They will finally pay their bill and then come and get their teeth cleaned or break a tooth and there they are again, on the list. I just shake my head. I can go up there and micro-manage, but I like just sitting back here and shaking my head.

I don't know how to do this. I am not saying that we do it the best because I don't know what everyone else is doing. How do these numbers sound to you? How are your collections? Are you really strict with patients? Are you more loosey-goosey and are you getting burned? I am looking forward to hearing from you.

Have a great Wednesday,

1 comment:

Anonymous said...

Hey John,

We do the same thing...anything less than $5 we just collect when they come in next time. I don't see it reasonable to put a stamp on anything less. This is a frustrating subject that I can't help but be early into. The stuff you do is big ticket stuff versus what I do (primary teeth). I can't help but think that if you had your staff on the phone calling these people, then your staff would all be busy with collections and the little $7 and $8 bills would get collected over the phone. Then you would save on postage. As this comes out of my head, it sounds pretty good to myself. See ya later.


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