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 By Neil B. Gailmard, OD, MBA, FAAO, Editor October 27, 2004 - Tip #145 
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Do you want to put something down on that?


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Have you ever heard the sentence above uttered by a staff member in your office? That, and the much more common "how much did you want to put down on that today?" are a reality in eye care practices every day. I cringe when I hear it. When I do hear a question like that in my office, I know it's time for retraining on the topic of collections at the next staff meeting.

You may not like the answer

The questions above actually seem fairly innocent and even logical to the untrained. After all, it is what your staff member needs to know to print a receipt - so she asks it. The problem with either question is that you may not like the answer. The answer might be: "No, I don't want to put anything down." Or, "Let's see, I think I'll put $10 down (on this $600 order)." Like attorneys in court, our staff members shouldn't ask questions if they won't like the answer.

Of course, the error can be corrected so it seems like no big deal. The receptionist simply explains the office policy of requiring 50% down at the time of order. But having to invoke "the policy" is not a good thing because it's always used to say NO. I want our staff to say YES whenever possible. The patient is made to feel badly - like he's trying to be cheap and get away with something. But the office corrected him and won the issue at hand.

Get comfortable with money

I believe these undesirable collection phrases occur in our offices because people (staff in this case) are naturally somewhat intimidated and uncomfortable about asking for money. We need to be certain they get over that. There is nothing unnatural about asking to be paid for services rendered, and the patient is actually expecting to pay something. We just need to tell them how much and when. There is often a tendency to say too much when a person is nervous or hoping to avoid a confrontation.

What should they say?

The best way to handle the payment at checkout is for the staff member to simply state the total charges incurred at that visit. For example, if a patient in my office had an eye exam and then ordered new contacts and glasses, and the total fees were $730, the technician assisting on the case would have explained the fee breakdown for all services and materials as they were selected and written on the superbill. The patient is escorted to the business office counter, and introduced to a receptionist, who would say, "Mrs. Smith, your charges today are $730." Period. It takes some practice to just be silent after that, but it can be done.

The patient often takes out the checkbook or produces a credit card and pays the whole amount. We are happy to accept it. Cash flow is important, so the sooner we're paid, the better. In other cases the patient asks if they have to pay the whole total now, and we reply that only a 50% deposit is required (with the balance due upon dispensing). It sounds so much nicer than the mean office policy scenario mentioned earlier.

By the way, if there was some amount that our office would accept directly from an insurance plan (our list of accepted plans is pre-determined), that amount would have been deducted from the total and the patient's balance would have been stated.

Talking business with staff

We recently had a staff meeting about all this in my office. I explained the importance of cash flow to my staff by telling them that our practice is actually a business and we have many suppliers to pay and the sooner the patient pays us, the better. I find staff members like to be included in business aspects, and when they're told about them, they want to help. Instead of just caring about the patient's needs, which still should come first, they are also aware of our business needs. It's now not just printing the receipt, but it's collecting revenue, which pays her salary.

A fairly new receptionist came to me about one week after this staff meeting and said she was amazed at how well it worked when she just stated the total balance. Patients were paying their full fees up front and had no problem with it. I noticed a jump in the deposited receipts also.

Free enterprise

Sadly, I think optometric practices have always been poor at collecting fees, and many have become worse over the past twenty years as our profession has concentrated on "billing and coding" everything we do. We are seeing the free enterprise system fade away in optometry as it has in health care in general, and it's too bad because it was so good for us. I'm doing my part to keep it going as long as possible.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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