BACK TALK SYSTEMS, INC. 14998 W. 6th Avenue, Suite E-500 Golden, CO 80904-5025 800/937-3113 800/696-1165 (fax) www.backtalksystems.com Team Tip #48 MONEY MATTERS (Part 4) by Susan Hoy Now that you have your collections mentality adjusted and you believe in the value of chiropractic, it is time to collect from the patient. Remember, during the initial phone call you advised him that payment is expected at the time of service and you accept cash, check or credit card. When the patient arrived at your office, one of the forms he or she signed was the office policy form agreeing to be responsible for payment of the services rendered by your office. You also verbally advised your patient of his or her insurance coverage and what you will be collecting from him today and on subsequent visits. Your patient now has the information he or she needs to commit to chiropractic care. At this point, I personally like to make suggestions for convenient payment options. For instance, for patients who have a co-payment, I suggest that they pay for several visits in advance and make advance appointments. The script for this arrangement is as follows: "Mr. Jones, Dr. has indicated that you need at least two visits per week for a period of time. Please allow me to make a suggestion. I recommend that you make all of your appointments now. That way you can get the appointments that are convenient for you. If you schedule the same days and times, your appointments will be easier to remember. Of course, our front desk assistant will be happy to work with you in case you need to rearrange your appointments. Also, many of our patients pay for several visits in advance, so that they can leave directly after their appointment and not stop at the front desk to make payment or to make another appointment." (As with any communication, let the patient feel that you are only thinking of their convenience. Of course, you are also getting what you want too. It's called a win/win solution.) About this time, some patients like to make deals such as, "How about if I pay at the end of the week?" Here's what I have noticed about patients who promise to pay at the end of the week. They just love to cancel their last appointment of the week. Then they come in on Monday and promise to pay at the end of the week again. Suddenly, the balance is high and before long your doctor is asking why that patient has dropped out of care. The solution is to either collect for every visit or in advance. Often, the patient will tell your doctor he can not afford treatment and asks if the doctor can discount his or her fees, or could he pay a little at a time. I suspect this is where I am going to get in trouble with some of you. In most cases, patients can actually afford care, they just choose not to. In other words, the upcoming vacation, the new car, the new stereo system or the new clothes are more of a priority. Don't you just love it when the patient to whom you are giving a discount cancels the next few visits because of his Hawaiian vacation? My doctor likes to tell patients who ask for discounts, " See that staff out there, they like to get their paychecks every week and they like to get raises. I try to keep my fees reasonable and I just can't afford to discount my services". The only discounts we routinely give are for students. If the patient does have a hardship, our doctor will document it and discounted fees are negotiated. However, the rule in our office is firm! Whatever fee is agreed upon, must be paid at the time of service. We do not allow our patients to get involved in a payment plan. Again, it has been my experience that if you allow a payment plan, the patient will pay at the onset, however, as the balance grows, the patient begins to miss appointments. Finally, the patient owes a large balance and will disappear. I don't think I'm exaggerating when I say this has happened to us 90% of the time. We then need to begin the collection process, which inevitably makes for a disgruntled patient who begins saying negative things about our practice. In part I of this collection series, I explained the law of equal exchange. Patients must perceive equality in services vs. payment. If they owe you money, they must justify the reason. The justification is that they did not get better under your care. Dissatisfied patients are more verbal than satisfied patients. Please make sure your patients pay what they agreed to pay not only for your sake but for their sakes as well. One thing our office wants to avoid is monthly billing, because it is costly. We get a lot of executives who want preferential treatment. We believe all of our patients deserve preferential treatment but not when it comes to monthly billing. So, when someone says, "Susan, could you just send me a bill at the end of the month?" My first response is that of surprise. I love to use body language to let the patient know how I feel. Then I just say, "We have no monthly billing procedure. It's a costly process, but I do have a solution. You may want to do as many of our patients, they keep their credit cards on file. Then, if you also make multiple appointments, you can just leave after your appointment without stopping at the front desk." They almost always agree and the way I presented it made it look like a favor to them. Of course, it was a favor to us too! Now that we've solved the problems with patient balances, let's solve some of the day to day dilemmas that happen at the front desk. First, the front desk CA must know the patient's payment responsibility, and if not, he or she must be advised! Sometimes, as small as our offices are, the right hand doesn't know what the left hand is doing. So, whatever was agreed upon with the patient must be communicated with the front desk! Additionally, all agreements must be written on the travel card or patient file. The front desk CAs must know what to collect or they tend to say, "We'll catch you on the next visit." That is the first collection sin. Catching you next time is not an option and it is the beginning of a collection problem. What if the patient forgot his or her checkbook? The patient then asks if it's OK that she pay next time for both visits. Not OK, thank you. Here is a solution for that problem. Always have self- addressed envelopes at the front desk. "Mrs. Smith, since it's our policy to pay at the time of the visit, I would appreciate your putting your check in this envelope as soon as you get home, and drop it in the mail." Here's an idea I got from a CA friend. In the morning she puts a couple of stamps in her purse from the office stamp supply (be sure to let your doctor know you are doing this.) When a patient forgets the checkbook and there is doubt as to whether he or she will follow through with her promise to mail the check, the CA walks over to her purse and announces, '"I'm going to give you one of my stamps." This extraordinary service always results in receiving a check by return mail! Patients don't forget such courtesies. Along those same lines, one of our patients came to us for an emergency visit. Not only did he not have enough money to pay his bill, he asked if we could loan him ten dollars in order to get home. Oh, yes, we could write a book, couldn't we. Since we don't want to encourage this particular type of situation, I quietly told the patient that I personally would lend him the money and gave it to him out of my wallet. He was extremely grateful and touched. And, the money was paid back by return mail. This was done with the knowledge of our doctor, of course, who would have replaced the money if the patient had not paid it back. Or, the patient announces he can not pay until payday. Since it is office policy to pay at time of service, this is not an automatic OK. In our office our front desk CA is supposed to say, "I'll just ask Susan if we can do it this time." In other words, the front desk CA must go to a higher authority. Our doctor is not the higher authority in this case. The less our doctor knows about particular patient collection problems, the better. He does not want the problem to compromise his care. Often there is only one CA in the office and it is difficult to blame someone else except the doctor. In this case, blame the accountant. The CA should ask the patient to stop by on payday to render payment. The CA should indicate that this is an unusual request and she is usually not authorized to make such decisions. If you let the patient know this is a problem and not a usual occurrence the patient will not make a practice of it. While it is good to have a friendly relationship with patients because we want our patients to connect with us, there should always be professional boundaries that should not be violated. When boundaries are violated, the patients will feel free to ask for favors and special privileges. So just be a friendly professional and don't get caught up in close relationships. The best thing to remember is to blame the "office policy" when there is no one else to blame. Patients certainly wouldn't want to get anyone in trouble for violating the policy. The most important piece of advice I can give is to let your communication to patients be from a "How can I serve you" mentality and conveying what is best and more convenient for them without violating office policy. You may order our new TEAM TRAINING AND PRACTICE MANAGEMENT MANUAL package, from which this article is taken, by calling 800/937-3113 today.