Rick's Business of Audiology Blog

Past Due Accounts: What do do?

Often I find Audiologists lump all of their bad debits into one pot, and then either fret over it or ignore it.

I suggest they be divided and treated differently. Perhaps this counts as profiling, or prejudicing, but I suggest you call it sorting. Some of you will have third party payer agreements that will require specialized treatment different from what is suggested below.

Take the A/R and sort it by size.

Over some amount: say those over $500 or $1,000 for example get special attention. Amounts this large will most likely receive calls, letters, or special collection attention or action. Each gets a business owner decision and is given its own plan of action to be followed up by the office staff. Review progress and planned action monthly.

Middle amounts: say perhaps over $100 to the above get standard attention. A phone call following the bill or letter to identify why it isn't being paid and then act accordingly. Evaluate the appropriateness of the patient's position and the value of the amount owed. Monthly review of the process and if needed specific items to be questioned. Office staff recommends write off, note to file, or perhaps in rare cases collection.

Small amounts: say less than $50 get little attention. Send a couple of bills, perhaps a call to clarify, and then either write off immediately, or make a note to the file to have it paid prior to additional services being performed. Recognize these as small amounts not worth losing a future patient over.

Rick

Audiology and Collection Agencies

I know, the agency people call you: Persistently. They are sales people and that is what they do. They work for a collection agency and they say they are there to help.

They want you to hand over some of your patient information to them. Why? They say: So they can collect amounts owed to you. Amounts of money you deserve from these deadbeat people who haven't paid you. Money your patients have that is rightfully yours.

But what really happens? They annoy, badger, and otherwise irritate your patients. They send your patient's information to computers "out there somewhere" that connect with other computers to attempt to damage or destroy your patient's financial reputation. In reality, most of the time, they actually collect nothing.

In reality all of the time they irritate your patients and drive not just your patients, but their friends, family, and others they know, away from you.

You spend many dollars, and lots of time and effort, to improve your professional reputation. You go to a lot of effort to improve your relationship with your patients, referral sources, and others in your community.

Even if a collection agency badgers or harasses one of your patients into paying them, and they forward some of it on to you, do you think that patient will ever be back when they have money? Do you think any of their family or friends will receive a positive recommendation about your practice from them? Do you believe you have improved the professional image of Audiology?

If you found yourself turned over to a collection agency by someone you trusted for your health care would you feel better about them or worse? Would you be more or less likely to go back? Would you be more or less likely to recommend them to a friend?

This is one of those situations where you want to think about winning the war, even if you lose a few battles.

Medicaid Payments Delayed or Missing

Medicaid is a state by state issue so there is no national answer but here are three things to try:

First, check with your state Audiology Association or Speech Language Hearing Association.   Usually they have someone as a government contact.  They often know if it is a statewide problem, or just a problem in your office.  Sometimes there is some quirk that is missed in the billing process that prevents an office from being paid.  These people often know what it is and can help.

The Magic of Packaging!

The Value can be in the Presentation:

I can give my daughter a new dress by just hanging it in the closet. She will eventually find it and may or may not like it. She may not say thank you or even take much interest in how it got there. She may never know I bought it for her. Our relationship may not be strengthened by the effort expended.

Or I can give my daughter a new dress buy creating an experience; creating an event. I could wrap it up in a box with some colorful paper and a bow perhaps even a card with her name on it.   Then then I could put is somewhere where she will see it, perhaps under a tree in the living room, for a few days so she can wonder what it might be. In our home we call this seasoning. The presents are seasoning under the tree. Seasoning involves imagining what might be in there and realizing who put it there. Perhaps a few questions go back and forth, even a shake or a rattle.

Then when everyone is there she opens the box. Yes it is the dress she wanted! She says thanks and tells everyone how much she likes it. Perhaps even runs off to try it on displaying it for everyone.

It is the same dress; just presented differently. The Magic was in the packaging.

Packaging consists not just of wrapping, but timing and presentation.

This presentation can pay big dividends with your patients.

When someone makes an appointment to visit you in your office a present has been put under the tree. To the extent you allow them to enjoy the anticipation you are doing them a big favor. Give them a glimpse, and then wow them.

Rick

Missed appointments: Perhaps a bad first impression?

I wonder how many “missed” appointments weren’t really “missed” at all, but not really serious appointments in the first place.  Or appointments where the intention, wasn't realized because of some discouragement.

OK, the public assistance people have a reputation of not showing up, or showing up on time.   Perhaps their inability to show up on time is why they are on public assistance in the first place. 

What about the people who show up for other things on time.  Why do they become no-shows?  Perhaps it was easier for them to agree to an appointment, and then not show up, than to tell the person on the phone they didn’t like them. 

They made an appointment, but weren’t committed to it.   I think this happens more often than we like to admit.

Clarity Produces Efficiency & Effectiveness

The obvious isn't always obvious. Often professionals spend many hours and much money trying to improve the patient outcomes with little success. Yet overlook simple inexpensive places for improvement.

Ethics and “Free” Stuff

ASHA, AAA, and ADA, all have Code of Ethics that discourage, or prohibit depending upon how one reads them, participation in activities that constitute a conflict of interest.   Most third part payers have items in their contracts prohibiting kickbacks or other similar payments.   

If you take Medicaid or Medicare for testing you may find problems even if they don't pay for hearing aids.

Most people believe that the free trips and free marketing allowances and other free stuff offered by many of the companies selling you hearing aids most fall into this prohibited category.   When the buying group is taking you and your spouse to Mexico for a long weekend as a way to influence your choice of supplier I think it is a pretty obvious violation.  Remember the Starkey Cruises of years past, gone.  Just for this reason, it just hasn't caught up with the other guys yet.      

Government Limits Care Options

If the government controls our health care dollars then politicians will control the procedures that we have available to us.  Example: Medicare hasn't been good for hearing aid funding.  

I know Sarah Palin has been criticized for her "Death Squad" comment. It probably won't have that official title. In fact I expect the politicians will manage to make it difficult to determine who is making the decisions.  But the decisions will be being made.

CRM Systems: Scheduling and Billing

These are three that I believe are good choices for you:

(CRM = Customer Relationship Management System)

www.sycle.net  Perhaps the easiest to get started with.  They also offer a trial period which is useful for you even as a way to think about how you would use any of the systems.

www.hearform8.com

www.timsforaudiology.com

Each has their plusses and minuses for any particular office situation. I have experience with all and all are reasonable choices for dispensing Audiology offices.  

Siemens and Starkey have their own proprietary systems that may be OK if you are going to link yourself to one vendor, which those of you who know me know I discourage.

There are several other less used systems which are probably not worth researching unless you have unique circumstances.

The days of a paper appointment book are gone; and ought to be gone for you also.

Rick

Government vs. Managed Care

Today ADA sent out an alert by Kim Cavitt that is well worth actually reading; one of those things that makes your ADA dues worthwhile. Perhaps even worth printing off and keeping in your files for quick refresher guidance later.

Some managed care programs are requesting Audiologists provide "free" services to become a participating provider. This puts them in apparent direct conflict with any office that is a Medicaid or Medicare provider. ADA is warning Audiologists that take Medicare to avoid any of these arrangements.

Your ability to follow Medicare rules, or your professional ethics, isn't the managed care provider's problem. It is your problem. They will happily allow, or even encourage, you to violate the "other guy's" rules.