Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 179
I have been getting too many calls from doctors nationally who are having trouble financially. Most of these doctors have the volume to maintain a very healthy cash flow and “CASH FLOW” is the #1 reason for survival or business death. I want you to pay careful attention to the noun I used, “business.” I am not talking about your practice; I am talking about your business.
One of my mentors used to say, “You have two hands, a service hand and a business hand, and each should not know what the other is doing.” You do not set your practice based on the business or the payment. It should be set on clinical necessity. Conversely, no matter what the diagnosis, prognosis and treatment plan of the patient, your business protocols should not change.
Many of you are so desperate for business or come from a position of abject fear in which you are so afraid of losing the patient that you will do anything to get the patient in the office and “HOPE” you will get paid. Remember, we hope for Santa Claus or the Easter Bunny and taking patients into your office regardless of their circumstances can yield the same results; what you expect will never come. Only in this case, it’s not the Easter egg or Christmas present (Sorry my fellow Jews...We don’t have any of those; all we get is the Adam Sandler songs.) that doesn’t come. It’s your fees!
The adage, “If you fail to plan, you plan to fail,” plays strongly on this issue and you have to stop practicing from a place of fear. In fact, if you are stuck in your failure technology, call me and I will do WHATEVER it takes to get you to take the first step. Just a warning, it won’t be pleasant because I will be putting a mirror in front of your face and you will not like what you see; no different than the ghost of Christmas future.
Here is the problem with taking a patient that has no benefits or insurance or money. You may not figure it out until the 2nd, 5th or 10th visit, but you don’t get paid. However, that is the least of your concerns. You had to pay for your staff, charts, headrest paper, toilet paper, air conditioning, heat, insurance, cleaning, malpractice, etc., and you are still liable for touching that patient. In essence, you paid that patient to come into your office to receive care. In addition, you are taking away time and focus from those paying patients who value your service enough to figure out how to pay you.
Here is the hard rule and it is NON-negotiable: When the new patient calls, your staff says, “In order to expedite your first visit and save you time, I will take some information now over the phone so we can get your paperwork pre-completed.” Your staff then proceeds to take all of the demographic information along with the insurance information.
As soon as they hang up, your insurance staff calls the insurance company or goes online to the insurance company’s Web site and qualifies the insurance to verify benefits. Should the benefits be confirmed, then there are no problems. However, if there are no benefits, then a phone call has to be rendered back to the patient to inform them that they have no benefits and let them know your cash fee for the first visit. If it is a cash patient or there is a co-payment required, upon entry into the office, after they complete the paperwork, payment should be asked for and received. No payment, no service...SIMPLE.
You already know what is going to be done on the first visit, so collect your fees up front. This is what was requested of me in my cardiologist, radiologist and primary care’s offices. I paid up front and then received the service. If there are extra services, then you can let the patient know after the service and collect it then or arrange to collect it on the second visit. At that point in time, you do not want to appear money hungry because you already collected a fee on the visit.
The patient will be highly motivated to return for the second visit as you should have taken or ordered x-rays and he/she will want the results. On the second visit, a staff member must sit with the patient and discuss all finances and payment issues. The patient must know what he/she is expected to pay and when. It is fair to him/her and no one likes a surprise...That is the shortest way to lose a patient.
Remember, if you fail to plan, you plan to fail.