Tag Archives: dental practice

Best Practices For Billing and Collections

16 Nov

Collections should not be thought of as something that only happens on the back end of the billing process. It should start by properly conveying your policies and expectations in advance to both patients and staff. Here are some tips you can implement in your practice to improve your patient collections at little or no cost.

Office Visits – Front Desk Responsibilities

1) Patients need to understand and acknowledge in writing that they are personally responsible for any charges not covered by insurance. They should be required to sign your financial policy at every visit, not just the first visit in order to remind them of their obligations. This should reduce the number of patients who have the attitude that their insurance made a mistake and it’s therefore not their problem.

2) Of course you always want to collect co-pays at the time of visit, but what does your staff do when a patient says they didn’t bring any form of payment? Turning the patient away is costly both in terms of a wasted appointment slot as well as the potential loss of that patient’s future revenue. Instead, train your staff to introduce themselves by first name to make a connection and then hand the patient a pre-addressed envelope to remit funds when they get home. For example, “My name is Karen and I’ve written my name on this envelope along with our address. As soon as you get home today, please put your check in this envelope and mail it back to my attention as I will be keeping an eye out for it.”

What to include and not include on your billing statements

3) Is your phone # on your bills? This may seem obvious, but some bills do not show a phone # and that delays payment by making it more difficult for a patient to call if they want to set up a payment plan or ask a question about their bill. Now they have to take the time to look up your phone # and they may put that off until later.

4) Is there a due date on your bill or do you just show the date the bill was generated? Many bills do not show a specific due date which implies that payment is due whenever the patient feels like paying.

5) Are penalties specified for violating terms? Is there any consequence to paying late? Why not include a late charge in order to give your bill priority over other bills which don’t incur penalties? A flat late fee is much easier to manage than a percentage of balance.

6) Do you show aging boxes on your statements? The use of aging boxes on statements which show 30, 60, 90, etc balances conveys exactly the opposite of what you want. It shows that you expect your patients’ balances to age and you’ve even made a provision for that right on your statements when you really want to convey an expectation of getting paid as soon as the bill is received. Aging boxes also train patients to only pay the portion of the balance that is the oldest rather than paying off the balance in full.

7) The use of colored paper for late reminders is helpful in getting patients’ attention as they stand out among the pile of white paper in a patient’s stack of bills.

Establishing Internal Collections Policies

8) Just like other aspects of your employee handbook, your collections policies should be in writing. This makes it easier when training new employees and demonstrates the importance placed on collections. Include performance benchmarks ($ collected or # calls made during a specific time period or establish a maximum % of AR over 60 days). Review and update your collections policy as needed while keeping it clear and simple. Determine how returned mail should be handled.

9) Define “past-due” and include the next steps for handling a past-due account. How many written contacts will be sent? How many phone calls will be made? When will this follow up occur and at what intervals? Evidence shows it is best to vary the form of follow up at regular intervals of 7-14 days.

A recommended process would be 2 mailed bills + 1 phone call + 1 warning letter and this should all occur within 90 days or less. If a patient has been asked to pay 4x in 90 days and you’ve gotten no response, they’re sending you a message and need to be in the hands of a third party agency because continued first party efforts at that point will not generate a good ROI.

Making Collections calls

10) Be careful when leaving voice messages so as not to “advertise” a debt owed to your practice when your message might be heard by others in the household.  Ensure that your staff is fully compliant with all Federal, State and Local Regulations regarding first party collections and telephone calls, or utilize a service to make these calls for you who is compliant.

11) Try to make a connection with the debtor by speaking clearly and enthusiastically. And stay firm by using phrases such as “It’s my policy that….”

12) Make the call with the mental attitude that you will get payment in full on one call, not that you’re going through a list and making calls just to get it over with. Your mental attitude affects what comes out of your mouth, so expect success!

13) If a patient says they don’t have enough money to pay their balance, ask, “How much are you short?” rather than, “How much can you pay?” This small change in language conveys an expectation that the majority of the funds are available and that you’ll be working out a payment plan for the smaller remaining balance.

14) Never make “idle threats”. It is a violation of collections laws to threaten to send a patient to collections unless using a collection agency is a normal practice for you.

15) Train your collector to take good notes so that if they have subsequent conversations with the patient, you can refer back to their notes and if that staff member leaves, it will be a good starting point for someone else to pick up their work.

Avoid Costly Violations

Use only an employee or a licensed 3rd party agency/attorney to collect for you, never an unlicensed 3rd party.  Only use 3rd parties who are committed to full compliance to all Federal, State and Local regulations regarding both first and third party collections.  Only use a 3rd party who provides you with a “hold harmless”” agreement as a matter of course.

Do not share information about a balance due with parties other than the debtor or their spouse. For example, if you call the debtor’s office and someone else answers the phone, do not leave a message about a balance due, only a message to return your call. 



Prior to discussing any patient A/R information with anyone outside your practice, make sure that you have a HIPAA Business Associate Agreement signed and on file with the individual or agency.

Collection Myths

All of these items are things to consider when establishing your practice’s individual collection policy, but they are not legal requirements.

  • There is no law that says you have to warn a patient that you’re going to send them to collections before you do.
  • There is no law that says you have to wait a certain number of days before sending a patient to collections.
  • There is no law that says that if a patient is paying $5/month that you can’t send them to collections.

Contact Me Directly

Please subscribe to this blog , or contact me with any questions.

Call me directly at 770-224-8504 or 888-780-1333
Schedule a phone call with me by clicking here
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Email me at David.wiener@cashflowstrategies.us

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10.5 Ways To Improve Your Collections

6 Nov

It’s a problem faced by virtually every business – how to deal with customers who pay their bills late, or not at all. While customers expect prompt and professional service, they don’t always meet the same standard when it comes to paying their bills.

Not like this…

Accounts not paid within terms can severely impact the cash flow of a business. A clearly defined and carefully communicated, yet diplomatic payment policy may help avoid difficult collection situations.

1. Have a Defined Credit Collection Policy:

One of the major causes of an overdue receivable is that the business

has not defined to its customers and staff when accounts are to be paid. If customers are not educated that accounts are to be paid on time – then chances are they’ll pay late or sometimes not at all. Make sure that your customer’s terms of payment are clearly stated in writing to each customer at the time of sale or services rendered.

2. Invoice Promptly and Bill Regularly:

If you don’t have a systematic invoicing and billing system – get one.

Many times the customer hasn’t paid simply because he hasn’t been billed or reminded to pay in a timely manner. This situation regularly occurs in smaller or newer businesses where there isn’t enough staff to invoice and bill on a timely basis.

3. Use “Address Correction Requested”:

One of the most difficult collection problems is tracking down a customer who has “skipped”. All businesses should be aware of a special service offered by the U.S. Post Office. Any statement or correspondence sent out from a practice should have the words “Address Service Requested” printed or stamped on the envelope. When a statement is sent to a customer who has moved without informing you of his/her new address and the words “Address Service Requested” appeared on the envelope, the Post Office will research this information. If the Post Office can locate a change of address on that customer, they will send you form #3547 with the customer’s correct address.

4. Contact Overdue Accounts More Frequently:

No law says you can contact a customer only once a month. The old adage, “A squeaky door gets oiled” has a great deal of merit when it comes to collecting past due accounts. It’s an excellent idea to contact late payers every 10 – 14 days. Doing so will enable you to diplomatically remind the customer of your terms of payment.

5. Develop a Systematic Plan to Follow up Past Due Accounts:

Determine ahead of time what action you will take and at what time frame you will take it. For example, at 15 days past due make a phone call. Your staff can start with a “courtesy” call to make sure that the statement was received. At 30 days past due send another statement with the message, “This is 30 days past due, please remit.” Having this plan and adhering to it makes both you and your customers aware of the fact you expect to be paid.

6. Use Your Aging Sheet – Not Your “Feelings”:

Many businesses (or well-meaning people on their staff) have let an account age beyond the point of ever being collected because he or she “felt” the customer would eventually pay. While there certainly are a few isolated cases of unusual customer situations, the truth is that if you are not being paid, someone else is. So stick to your systematic plan of follow up. You will soon know who intends to really pay and who does not. You can then take appropriate measures once you know where you stand.

7. Make Sure Your Staff is Trained:

Even “experienced” staff members can sometimes become jaded when dealing with customers. This usually occurs when customers have made and broken promises for payment. Make sure the staff is firm yet courteous when dealing with customers. Your collection staff could benefit from customer service training because, in effect, they must “sell” your customers on the idea that you expect to be paid. Make sure that your collection staff is trained to not only bring the account current, but to also maintain good will with your customers.

8. Admit and Correct any Mistakes on Your Part:

Sometimes customers do not pay because they feel you have made a mistake. If you have, quickly admit it and correct it. Your customer realizes that mistakes can happen in business. Unfortunately, many customers believe that “the doctor doesn’t need the money”. Denying an obvious error only fans the fire of resentment your customer may already feel.

9. Follow the Collection Laws in Your State:

In many states, businesses are governed by the same collection laws as are collection agencies. For example: Calling a customer at odd hours or disclosing to a third party that a person owes your business money are a few of the numerous collection practices that can cause serious repercussions. When in doubt, call your state’s department of finance for any clarification on the law.

10. Use a Third Party Sooner:

If you’ve systematically pursued your past due accounts for 60 to 90 days from the due date, (and they still haven’t paid) you’re being delivered a message by your customer. More than likely, you’ve requested payment four to six times in the form of phone calls, statements, and letters. Statistics show that after 90 days, the effect of in-house collection efforts wear off 80%. That means that the time and financial resources budgeted for collection efforts should be focused within the first 90 days where the bulk of your accounts can and should be collected. From that point on, a third party can motivate a customer to pay in ways you cannot, simply because the demand for payment is coming from someone other than you. Avoid paying a percentage to a contingency collection agency, using small claims court or hiring an attorney by utilizing a flat fee collection service such as TSI. It will save your business time and money.

10.5. Remember that Nobody Collects Every Account:

Even by setting up and adhering to a specific collection plan, there are a few accounts that will never be collected. By identifying these accounts early you will save yourself and your business a great deal of time and money. At the same time, your business will benefit from improved cash flow from the vast majority of accounts that do pay.

Developing and implementing a sound collections policy is a vital part of running a successful business. Follow these steps, and watch your business thrive while retaining a good professional relationship with your customers.

Don’t forget to subscribe to this blog for more Tips and Tricks to make your business or practice more profitable.

Contact Me Directly

Please subscribe to this blog , or contact me with any questions.

Call me directly at 770-224-8504 or 888-780-1333
Schedule a phone call with me by clicking here
Visit my website by clicking here
Visit my YouTube channel by clicking here
Email me at David.wiener@cashflowstrategies.us

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The Dentistry Uncensored Podcast with Dr. Howard Farran

5 Mar

I recently had the opportunity to join Dr. Howard Farran for a recording of the “Dentistry Uncensored” podcast at his studio in Phoenix, AZ. We spoke of all things concerning cash flow in the dental and oral surgery practice.

Howard Farran, DDS, MBA, the founder and owner of Dentaltown.com and Dentaltown magazine, has practiced dentistry at Today’s Dental in the Phoenix metro area for more than 30 years. In 2017, Incisal Edge magazine ranked him among the 32 most influential people in dentistry.

You can watch the podcast video by clicking here

Or listen to the audio podcast by clicking here

If you are have difficulties or questions about your practice’s cash flow, or would be interested in learning how your cash flow can be improved, contact me for a no-cost, no-obligation Cash Flow Checkup.

Contact Me Directly

Call me at 770-224-8504 or 888-780-1333
Email me by clicking here
Visit my website by clicking here
Visit my Youtube channel by clicking here

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DIY Collections – Don’t Risk It!

11 Sep

There are very clear rules about what can and can’t be said during debt collections.

The debt collection industry is governed by so many rules and regulations it could make your head spin. That’s why do-it-yourself debt collections can quickly get a company into hot water with state and federal regulators.

What are the rules that govern debt collections? What are debt collection agents never allowed to say and do? This article explores common mistakes businesses make when attempting DIY debt collections.

Bill Collector

Debt Collections No No’s

Three things you can never say when attempting debt collection:

  • Threaten to tell a boss, coworkers, or family about a past due balance. While you can contact work to try to find the customer, never share details about the debt to any third party.
  • Threaten to arrest the past due customer.
  • Don’t say, “I’ll just keep calling you.” Legally, you can’t call the person before 8:00 am or after 9:00 pm. If you call the customer at work and they ask you to stop calling there, you have to comply, however, the request must be in writing.

Understanding the rules means following federal legislation called the Fair Debt Collection Practices Act and the guidelines set by the Consumer Financial Protection Bureau.

Understanding debt collection rules is important for avoiding federal and state penalties.

If all this seems like a lot of rules for you to keep track of, you would be right. Debt collections are a highly regulated activity that makes it risky to take a DIY approach.

The good news is that there are services like TSI to help ensure debt recovery that complies with all rules and regulations. Our proven system is compliant, effective, and guaranteed.

Bonus Tip:

Various government agencies provide guidelines that help ensure that consumer rights are protected. There are specific practices that collectors must always avoid.  

Debt collectors cannot use unfair practices to collect a debt. This means debt collection practice can never include the following [Do not]:

  • Attempt to collect charges in addition to the debt. That is, unless they are allowed by contract or specific state law.
  • Deposit a post-dated check early.
  • Communicate by postcard.
  • Use language or a symbol on the envelope of a letter that indicates the correspondence is from a debt collector.

Consumers have rights that must be honored, which is why strict guidelines and regulations govern debt recovery practices. Not only is it essential that debt collectors treat consumers with respect, in addition, there are specific practices that collectors must always avoid. For instance, did you know that an individual can send a “cease and desist” correspondence to a debt collector – which means the debt collector is required to stop contacting the customer. The problem stems from an overly aggressive debt collector that goes after the customer over and over again in a short amount of time. Under federal law, this is considered harassment and if the activity continues after the cease and desist letter is received, the customer can report the debt collector to governing agencies.

Want higher recovery of past due accounts? Don’t put your business at risk by using a DIY approach; instead, put TSI’s simple system to work for your business. It’s convenient and designed with small- and mid-sized businesses in mind, AND interfaces directly with most accounting and practice management software.

Contact me for more information on how to:
  • Collect more of your A/R
  • Collect your A/R faster
  • Stay 100% compliant while collecting your A/R
  • Save both staff time and money

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How Debt Collection Affects Revenue Cycle in Healthcare

2 Apr

medical-debt

Debt collection is a hot topic in healthcare revenue cycle circles. That’s because hospitals are facing higher costs, declining reimbursement, along with high-deductible insurance policies and patients that simply cannot afford to pay.

This article looks at how debt collection best practices could improve the revenue cycle in healthcare. What are the issues affecting debt in healthcare?

Debt Collection and Medical Billing 

Medical billing serves at the core of healthcare revenue cycle. But Rev Cycle Intelligence points out the elephant in the room: Medical billing is often riddled with errors.

Simple mistakes in the patient billing record are a challenge in the revenue cycle. Collecting patient information at the front desk lays the reimbursement framework that every revenue cycle is built upon.

When you cull out simple human mistakes, providers are still left with the complexities inherent in billing practices that are unique to every payer. That alone creates glitches in clinical cash flow when reimbursements are submitted and rejected by the payer.

Another problem with medical billing is tied to the healthcare paradigm itself. It is a patchwork of disparate providers – even within a single health system. If the steps to getting paid hinge upon a previous interaction, but documentation are peppered with missing pieces, the likelihood of that provider being reimbursed by a payer drops with every missed checkbox.

A frequent issue that occurs well before the bill is generated is the issue of collecting a patient’s co-pay. Even when the co-pay is $20, the medical practitioner at the front desk may fail to collect it. For clinical administrators, it can be difficult to ask for payment from a sick patient. Now imagine the struggles when a patient has a $2,000 deductible. But failing to collect this revenue up front does nothing to alleviate patient responsibility for their bill. In fact, it almost certainly guarantees the need for debt collection later. Rev Cycle Intelligence states that 90% of the 12.7 million Americans participating in 2016’s open enrollment had high deductible insurance.

InsideARM has been waving a red flag around this issue, citing statistics that say, “The percentage of consumers not paying their total hospital bills will increase to 95 percent by 2020.” Even worse news for hospital revenue cycle, the volume of patients who are only paying a part of their overall hospital bill has declined from around 90 percent in 2015 to 77 percent in 2016.

As bad debt rises, healthcare providers are turning to debt collection agencies to help save their revenue cycle.

Debt Collection Improves Healthcare Revenue Cycle

TSI specializes in debt collection in the healthcare space. With over 45+ years of healthcare collection experience, we use an empathetic approach to collections to protect the patient relationships you’ve worked hard to cultivate. We understand the delicacy inherent in keeping patient satisfaction scores high while still collecting on an unpaid medical debt. That’s why we’ve invested in technology that can help us collect on all bad debt in ways that acknowledge and respond to patient payment preferences across multiple digital venues as well as through more traditional formats.

In addition, our proprietary data analytics platform, CollectX boosts your results by identifying the most liquid accounts and ensuring they receive the appropriate collections activity. Since implementation of CollectX, our clients have seen on average a 22% lift to their liquidation rates. Maintain your patient relationships, while improving your revenue cycle, with TSI.

To learn more about how to optimize your revenue, contact me today at 888-780-1333 or at david.wiener@cashflowstrategies.us.

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Not all Debtors are created equal!

27 Feb
After being in the ARM (accounts receivable management) industry now for many years, I can honestly say I’ve heard almost every story in the book from CEOs, CFOs, healthcare administrators, doctors, dentists, lawyers, accountants, billing managers to janitors as the reasoning or excuses from clients as to why their outstanding balance had not been paid.
Here are some common excuses:
  • They have been traveling.
  • They just lost their job.
  • They just moved and were not getting the invoices.
  • They came across financial hardships and needed some extra time.
  • They just had surgery and have been in the hospital so needed some time to get their things organized.
  • They weren’t satisfied with the service or product so didn’t feel the need to pay for it.
  • They were used to paying all their vendors after 60 or 90 days.
Here are some off-the-wall responses:
  • They said they were going to get their checkbook from their car and never returned.
  • They didn’t remember ever ordering that product or service.
  • They’re going through a divorce and to call the soon to be ex-spouse who is responsible for the balance, not them.
  • They were wondering if their creditor would be willing to barter instead.
It might seem odd to hear even the common excuses listed above if you aren’t in a business that extends credit or if you are in general a good paying consumer.
It may even seem like an episode from a spin off series of the Twilight Zone where customers walk into Costco, load their shopping carts full of items, walk past the cash registers, give the friendly greeters their mailing address to send them a bill and walk right out.  Luckily for Costco, it isn’t the case as they don’t extend credit (only through a 3rd party financing credit card partner).  Unfortunately for millions of other businesses around the world that essentially happens every day.
In my opinion the most vital thing to understand if you are in a business that extends credit or carries an accounts receivable is:
NOT ALL DEBTORS ARE CREATED EQUAL
I explain to my clients that they’re only going to have to deal with 4 types of payers.  I laughed the other day when a client told me that 4 payers is 3 more than he’d care to deal with.  Can you blame him?
Here are the 4 Payer Types:
  1. Dutiful  (Always pays their bills on time, probably has an 800 or higher credit score.)
  2. Distracted (That busy working professional who is good for the money but hasn’t yet gotten to all 10-12 monthly bills on their kitchen table.  They simply need a reminder text, email, phone call, letter and they’ll pay up.)
  3. Disrespectful (Has disregarded and ignored at least 2 billing cycles from the same creditor and hasn’t called to explain or apologize about non-payment.  Are paying some bills more timely, but they have chosen which bills to put off that don’t seem so urgent.)
  4. Deliberate (Have expressed to their creditor verbally that they will not pay the balance owed or expressed through non verbal cues of long periods of silence, mail returns and disconnected phone lines.  These are the most high risk debtors.)
Now be honest with yourself, which category do you fall under?
I want to note that, in my experience, these 4 payers types are found in all socio-economic income levels, meaning some wealthy people fall into the category of Deliberate high risk debtors while people from low income levels can be in the category of Dutiful payers.
I won’t get to into details about the psychology of why these 4 types of payers/debtors respond, react or do nothing in this article.  What I can tell you is by simply understanding that there are 4 payer types and that not all debtors are created equal puts you FAR ahead of the game and your competition.
The BILLION DOLLAR question is how do I efficiently and professionally address each of the 4 payer types to recover my past due balances? (That is if you’re in a business that extends credit, if you don’t have to worry about this then lucky you!!)
I would love to hear your comments, create some dialogue around the 4 payer types and hear your ideas on how your business effectively maximizes your accounts receivable in-house.

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INSURANCE MONEY WON’T PAY YOUR BILLS ANYMORE, DOC!

16 Jun

I was told today by a doctor that he refrains from pushing too hard to collect from a patient who owes him money, because of all the money he makes on the patient from insurance companies.  He is willing to write off patient balances, to keep making insurance money from the patient visits, and doesn’t want to offend the patient into leaving the practice by insisting he pay his bill.

This is the general attitude many doctors had 25-30 years ago.  It may have had some validity back them but times have changed!  Insurance money alone will not keep your doors open and your lights on any more doc.  You are putting your practice in jeopardy by not seeing what is happening around you!

High deductible health plans are the norm these days, and co-insurance is rising all the time.  Despite what the government tells us, there are more and more patients who do not have insurance, or have adequate insurance.  Self pay is now the highest payer in the medical world behind Medicare and Medicaid, and it is catching up fast.  According to recent statistics, patient balances now represent over 35% of a doctors income and soon, if major changes aren’t made, will be over 50%.

You can’t wish it away, or ignore it away.  You MUST find a way to motivate patients to pay you, and pay you faster than before.

Medicine, whether you like or not, or understand it or not, is a business.  You are trading a service for money, and the patient knows it.  They also know when you are leaving them alone about their bill so that you can continue to collect insurance money. Not only do they know, but guess who they tell?  EVERYBODY!!!  And guess what happens?  You get all the patients who don’t want to pay their bills.  Great!  Until, that is, until you watch your patient A/R go through the roof.  By the time you see this happen, you are already in trouble.

Don’t waste time.  There are automated tools to help your practice both maintain your good relationships with your patients, AND get them to pay you their portion of the bill sooner.  Call me today at 888-780-1333 and I will tell you about them.  Isn’t it worth 20-30 minutes of your time to keep the lights on in your practice over the long haul?

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Top 10 Tips To Improve Collections (Part 1)

6 May

It’s a problem faced by virtually every business and medical practice – how to deal with customers / patients who pay their bill late, or not at all.  While customers and patients expect prompt and professional service, they don’t always meet the same standard when it comes to paying their bill.

Accounts not paid promptly can severely impact the cash flow of a business or practice.  A clearly defined and carefully communicated, yet diplomatic payment policy, may help avoid difficult collections situations.

TIP #!

HAVE A DEFINED CREDIT POLICY

The first step is to clearly define when accounts are to be paid.  If customers/patients are not informed that accounts are to be paid on time, chances are they will pay them late, or sometimes not at all.  Make sure that your payment terms and expectations are clearly stated in writing to each person.

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