[Music] Good morning health care leaders and welcome back to this season of practice management insights. I cannot believe that we are launching season 4 already of our podcast, and I am so glad that you have joined us. You know, when we launched this podcast last year, we had no clue where it would go, but did know that it would continue to grow and evolve as we tackle some of the topics affecting health care leaders today. Although I specialize in ophthalmology, the topics we cover in this podcast apply across all of health care. It includes areas such as human resources, financial management, customer service, marketing. We love your input and feedback as well. So as always, please feel free to reach out to us at Ashley, which is ASH LIE at pmlclaw.com. If you have a quick question, you would like us to tackle a specific topic in a future episode, or you just want to leave a comment. For this week's episode, we are going to dig right in to one of the highest financial risk areas of the practice. For theft and the misuse of practice funds, and talk about the wonderful world of financial controls. Even if you do not have direct authority over your practices finances, the systems and protocols placed in daily operations are critical to safeguarding practice profitability and limiting opportunities for theft. We tackled embezzlement in a previous episode, which is a really challenging and complex topic to cover in general, but especially in such a short period of time, because there are so many layers and each layer leads to more questions. Financial controls are equally complex, especially since this broad topic covers everything from the collection of patient payments, which can include something as small as a $3 copay, or as large as a $4,000 surgical procedure. To the way credit cards are captured or stored, the paying of bills and invoices, the storing and depositing of cash, and the posting of payments in the practice management system. Although in our practice, our main focus is always providing great patient care. The fact is that the money generated through that patient care becomes a foundation for many of our internal systems and workflow. We already agree that it would be impossible to cover every financial protocol, since there are literally hundreds in place at any given time. For purposes of this podcast episode, however, we will touch on the first two that I like to tackle when working with a new client, since it is through these first two that the foundation for all others tend to flow. The first is our front desk financial controls, and the second is patient payment protocols. First of all, let me say that there is no wrong way of doing anything. Each of our practices has a rhythm, a personality, a workflow that has been developed over time, and there are many ways to run a practice. So if what you are doing is working for you and your team, and there are no issues with theft, profitability or cost containment, then most likely you are doing great. It would be a lot easier if we all had one rulebook to success to follow without the thousand variations that naturally occur within our practice walls. But the fact is that we are all different and unique. So each practice is also different and unique. In my experience, however, when financial controls is discussed, there is typically either a risk or weakness in the practice's current workflow or an issue brewing, perhaps, that needs to be addressed. At the most basic level, when we talk about front desk financial controls, we are talking about the collecting of cash, checks, and credit cards from patients at the time of service. Most of us think of this as the time where we pay our insurance copay, or our share of the cost in seeing the provider on the day of our appointment. Some practices use a do not pass-go method and collect that copayment at the check-in desk when they tag a patient in as arrived for their appointment. Other practices will collect this payment at the end of the patient's visit at the checkout counter. Still, others prefer not to collect payments in the office at all, or to reduce the collecting of payments within the office so that they choose instead to build the patient for their copay or their share of cost of services. And then they cycle those payments instead through their payment processor. Now again, there are different ways to tackle each topic within a healthcare setting and none of them are right or wrong. I can share, however, that anytime we can estimate a patient's out of pocket cost prior to their visit and then collect that payment at the time of service, the higher amounts of revenue will be achieved and a reduction in overhead related to the billing cycle will naturally occur. Regardless of when or how you accept patient payments, whether it be at check-in, checkout, or billing the patient afterwards, one thing is across the board, hands down, super important. And that is what we truly mean by financial controls, which is the separation of responsibilities between staff members who are touching the money to really reduce the amount of opportunity for theft, for misplacement of funds, for errors, all of the things that can get us in trouble within the practice walls. A lot of it can happen right there in front of everybody at the front desk. So it's simplistic as this seems. The number one thing that we recommend that any office doesn't matter your specialty, actually any business should follow similar protocol, but especially in healthcare because there is such a large amount of payments coming through the building. And large amount of payments does not mean there's a large amount of profitability within the practice. It just means that there's a lot of activity going on in relation to patient payments. Number one rule, I like to advise, again this is all just my opinion. It's from working with different practices. It's from seeing what works best in my own practice. There are certainly things that we change, that we tweak. There's ways to make improvements, but at a minimum, these are the things that I have found that work really well. So number one is, you know, your new staff, in my opinion, in our office at least, we have about a four month learning curve. And that seems crazy to me, but it takes consistently in the 150 employees that I've onboarded over in this practice. You know, it is pretty darn consistent, even if you have healthcare experience. You take about four months to be fully onboarded. And that means learning our nuances, learning the types of care that our providers provide to patients, learning our schedules, our clinic times, and the flow, and how we accept referrals, and how we handle emergencies, how we triage patients, how we collect for copays. What are the copays? How do we verify insurance beforehand? I don't think that the average person actually understands the complexity of what your front desk is doing. Say thank you to them. Oh my goodness, even just making mistakes on how much a copay is, those kinds of things could rack a practice's finances, whether it be just having to clean it up on the back end or losing that revenue or not being in compliance with your insurance contracts. So say thank you. If this is not a big disaster in your practice, that means that they're doing a lot of good things and that they are actually doing a really good job with that. So collecting it up front, I actually recommend that for new employees, first of all, don't have them touch money for their first 90 days. That introduction period is so important that they're just training. We train, train, train, we tweak, we address confusion, we answer questions. We don't even let them touch money. A little closer, there's a whole variation of people's skill set. So some of them are really fast learners and they're confident and they're producing at a very low error. For those, we might start introducing them to money a little quicker, but you have to kind of read it a little bit, you have to kind of see how you're feeling. But for the most of our employees, especially the ones that you're investing in, who may not have experience, we really love it.
like to keep them away from money for 90 days. That is we trust them, we trust them completely. But you know, it's one thing to correct like a misspelling of a patient's name. It's a whole other process. If you have to trace back payments that were posted to the wrong account or that weren't posted at all and ended up missing or you know, the wrong copay being billed to the pay, there's just so much there. So kind of recommendation number one, keep them out of it for 90 days. Number two, top priority. I just, this seems so simple when I'm saying it out loud, but I've seen so many practices that don't use these really, really kind of straightforward policies. So you know, number two, non-negotiable. If you touch money in our practice, you have got to post it immediately in the patient's demographic screen in the payment window, whatever you use in your PM, your practice management system. If they pay you the wrong amount, it doesn't matter. You post it. You always tell the truth, always tell the truth. You don't tell the version of how you're going to fix the mistake later and jump ahead. So if they paid you $50, but the only owed you $40, you don't post $40 and put $10 aside. You actually post the $50, which will then generate a credit on the account that can be then dealt with through your credit process and protocol. So always tell the truth and always, always, always post money immediately into the system. For you managers, that means you also have to have a system of auditing, following up on this, but you've got to address that immediately. There are so many ways that employees can can steal from you, but also there's just mistakes that can happen that it really is our job to protect our employees and to protect maybe what they don't know and to reduce those mistakes as much as possible. So wait the 90 days, have a policy where you post the money immediately, but then the other part is a separation of responsibilities. All of you are probably already doing this. The our listeners tend to be higher level managers who have kind of been around for a while and understand that. But you know, I say that and then I actually see it quite a bit where it's the opposite. So healthcare, I don't know if it's just the nature of working with people, but we tend to be a very trusting industry, especially with kind of the people inside of our building who have been there for a long time or who have certain responsibilities that are really critical to supporting the practice such as, you know, everyone knows that the doctors have a scribe preference and that just becomes their kind of work bestie. There's also just these trusted leaders through the front desk and through different departments and sometimes those people are the ones that kind of put us at the highest risk and sometimes not. I'm just pointing out that we all have our preferences, we all have that person that we would trust with our own children, but the fact is that as we talked about in the embezzlement episode, you know, the number one person to embezzle is the administrator, the accountant, and a partner. So, you know, trust is important, but it's also really important that we have workflow and protocols that are supported and consistent and reinforced because it is through those protocols and workflow that we reduce those types of opportunities, but also mistakes. And we support those around us just to make sure that, you know, we all have this healthy environment and that we're just not at risk of that. That doesn't feel good to be the one making those mistakes. So helping out our staff also is really important. So, separation of responsibilities is the third kind of high level point in that topic. All that means, guys, is, you know, if someone is collecting a payment, they shouldn't also then be the one that's making the bank deposit or the one that's putting that payment, recording it in quickbooks. The reason why those positions who do embezzle or steal from practices, it's because they have too much control. There's not enough transparency and they can fudge things. So, you want to reduce that. It also helps with mistakes. This isn't all about theft. It's just, you know, having a transparent office in all areas, you're just going to be better for it. All of us make mistakes. So, if someone's looking over your shoulder and in your stuff, they're going to catch a mistake. They're going to help us fix those mistakes and they're going to help us do better. So, if you're front desk person is collecting a copay, they would then balance out their daily envelope or bag or whatever that looks like in your office. They would turn it over maybe to a team leader, an office manager. They would turn over to someone else. Maybe they reconcile each other. If you have a big team, whatever that looks like, you just want to make sure they're not pairing up, of course, in helping each other. But there should be, you know, several steps to it. So, then the team lead would reconcile everybody and then that person would hand over the cash to another person. Usually at that point is the administrator or the person responsible for making the bank deposit. And then they would also go through it. They would count everything up, make sure that it's accurate, make sure that it's been entered into QuickBooks correctly. Maybe that person is the one that enters in QuickBooks. And then there's a step of getting it to the bank. So, you know, at that point, it may be that someone else is making a bank deposit. In our office, we actually have a courier service. Don't be afraid to ask for things from your bank or the people you have, you know, kind of these long term trusted relationships with. Our bank provides that service free of charge. And all I have to do is send an email to a point of contact whenever we have a cash deposit. They send a courier out. It's completely secure. They take it. They deposit it to the bank. And so, I'm not even touching that again. So, it's just another separation. It's just another financial control that's in the mix. So, the second part of this is the other area where we collect a lot of payments within the practice. And that is through the surgery or procedures process. It may be if you're a practice like dermatology or maybe a retina practice, it could be for things like laser treatments or maybe a drug injection. For our office, we do interior segments. So, it could be things like lacic. For all of us, though, it would be examples would be going to the OR, taking a patient to the OR, such as for a surgery, a scheduled procedure in advance. So, large amount of money being collected. So, you know, some of this will be common sense. It'll be routine. Some of it will be new ideas for others. And, you know, that's why we're doing this podcast. It's just a way to learn and to kind of trigger ideas maybe that could be little pearls that maybe you do differently, or ways to just reaffirm that what we're doing, you know, resonates with other practices as well. So, in our office, you know, the number one piece of advice that I have for surgery payments is to collect those payments unless you do emergency work, okay, because emergencies can't be planned for. And there are situations, I think, that it is situational, that you evaluate kind of the needs of the patient, their ability to pay, and the how emergent the procedure might be. But for most of us, on a day-to-day basis, you know, we're booking out patients two, three, four months. A lot of those types of procedures can wait a little bit. So, if you have patients who are struggling a little bit with the financial aspect, and you have a policy in place where the payment is expected before the procedure, then of course you make a judgment call on those as far as, you know, maybe allowing the patient to enter into a payment plan or postponing the procedure or just going ahead and doing it, and then knowing that the patient will have to pay later or that you could actually even lose that revenue altogether. But in general, the number one recommendation is that you are collecting for surgery payments, which would be copays, deductibles, co-insurance amounts. For your office, I know that there's some ways to kind of get around regulations and collect certain things. Maybe on behalf of the OR or the ASC, it gets really delicate though. So, you know, I just never recommend that you do that. They are capable of collecting their own payments. But, you know, that's a whole other topic. But, you know, having a practice requirement that you collect those payments upfront.
Number one recommendation, just do it. It just do it. If you haven't been doing it and your patients are not trained and expecting this, they will absolutely fight with you. They will act like they can't pay it. They will just, they will not like it. However, that lasts like a week. Your staff gets really good at their verbiage and the way that they deliver that message. And I promise you, you will get through it. I remember when we used to not charge for refractions. And it was like, like we were just the worst place on the planet when we started collecting for refractions from patients. They just, they were so shocked. And it's, you know, it's like $40 or $50. So, you know, I get it. But I don't know if it was just us because you think, well, the patient who had a problem last week and then the following week, that patient didn't have a problem. They're different patients. So I have to actually think that it's the confidence of your staff that when you start communicating these certain points, your staff actually gets better at it. And there's a way of delivering it. You kind of roleplay that. I always talk about roleplaying because I think it's important to say things out loud and kind of critique each other. We do it in our team meetings. Well, tell me how you, you know, you explained that need of whatever service to that patient or tell me why they had a problem with paying it. Have you thought about saying it this way? So I think that that can be really helpful as well. But once you start collecting these payments, patients get it. You really can't go anywhere. I mean, you can't go the dentist now without prepaying some of these cost upfront. That alone is going to help a lot. And then, of course, you implement the same financial control. So our surgery schedulers have the same protocol that our front desk does. They all have their envelope or their bag. They collect their payments. They reconcile their payments. They post it to the system immediately. And it's a little trickier with the schedulers because they're also collecting for upgrades or advanced technology items. And we created a dummy code for those. You've got to post those immediately. Even if the patient ends up, you know, cancelling surgery or even if they're not quite sure, I don't know. Even if the doctor's not sure, well, what are we, what do you, I don't know what lens I'm going to use or what procedure I'm going to do until we get in there. If there is a cash component to it, my advice is to make your best estimation, collect from the patient. We can always refund them when we do that. And, you know, you don't want to hold their money. You need to show them that they can trust you. If we have to do a refund, we do it immediately. We try to do it at their one day post-op even so that that money is exchanged immediately back to them if indeed they paid for something that they didn't need to. So you follow the same protocol. You batch out. All the payments are posted. The money is turned in. And then again, you have the separation of responsibilities. The scheduler would never be the one that also then goes to the bank that makes those payments and, you know, has kind of that large amount of cash, you know, sitting around the office for multiple days. So I know this sounded simple. I can't tell you how many times I've worked with practices that just by making these small tweaks, especially collecting the surgery payments before surgery, it has had such a big effect on the cash flow of the practice and the reducing the cost of the billing on the backend. You know, every statement is like 75 cents just to send a statement out. So you're really doing everyone a service by doing this protocol up front on both sides. But then following those financial controls and making sure there's a separation of responsibilities and that the money is posted immediately, immediately. Even if it's wrong, it's immediately posted. I don't mean you post it wrong. I mean, even if the amount collected is not what was ultimately owed, you got to get it in the system. Well, that's it for today. Thank you so much again for joining us. I'm so excited about this month, this season, season four. We have a couple of interviews that are very interesting. I have so many friends in the industry that are just, they fascinate me because they're so knowledgeable and they're just the top of what they do. And thankfully, a lot of them are starting to talk to me and get interviewed for the podcast. So anything that we can share with you will continue doing so. And I hope that everyone has had a good spring so far, a good Easter. We're gearing up for a fruitful and successful year. So until next time, I hope everyone's doing well and we'll talk to you in the next episode. Practice Management Insights is a podcast produced by practice management and legal consulting. For more information, visit us at pmlclaw.com or to submit a topic for future consideration, email Ashley,
[email protected].
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