Giving away a Fortune
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Yes, it's easy to miss a charge here and there. But those $10 blood collections and $21 fecal exams add up. And over time
that total could be costing your practice team a coveted piece of equipment or the extra hands needed to smooth a crazy day.
That's what was happening at Starkville Veterinary Hospital, a two-doctor practice in Starkville, Miss. "We were missing charges because we weren't writing them down at the time of treatment," says owner Dr. Larry Anthony. "On
busy days, it's challenging to remember all the details, and often we were rushing to complete the bill because the client
was waiting."
After making some changes, Dr. Anthony and his team turned their fortune around. First, they reviewed missed charges to find
out what was happening and then clarified the teams' expectations about charging for all services rendered. "Now I think we're
more thorough and don't rely so much on memory," he says.
Dr. Anthony's far from alone in missing charges. I often see $10 to $15 of missed charges on 10 percent to 20 percent of outpatient
cases. Often-missed services include fecal exams, skin scraping, and blood collection.
On hospital cases, $40 to $60 of missed charges on 25 percent to 30 percent of cases is common. Items often missed include
in-patient exams, injection fees when multiple injections are provided, and the use of fluid pumps.
When you look at missed charges objectively, it seems some doctors go out of their way to provide care without billing the
client. Yet charging for the care you provide is critical. A healthy financial picture gives you the resources you need to
continue to elevate patient care, invest in new medical technology, and give doctors and staff members raises. The first step
to taking control: Get everyone on the same page—including you.
"You will find something you've missed" To correct the problem, you need to know how many charges you're actually missing and the reasons why. The first step: Pull
a random sample of 10 hospitalized cases and 10 outpatient visits completed by each doctor. Then compare the medical records
to the client's invoice.
Crediting doctor production
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Make a copy of the invoice, and at the bottom of it, list the services provided free of charge (either intentionally or unintentionally),
along with the usual service fee. Tally the results. For example, in 20 outpatient cases, you might see missed charges on
five (25 percent) with an average missed charge of $10. Discuss the results in your next staff meeting, and try to find out
why you're missing charges. Also compare the invoice to the original treatment plan estimate. Was it within the estimated cost range? If the total exceeded
the estimate, did you discount the care provided? If so, by how much?
Talk about the results in your next staff meeting. How accurate are your treatment plan estimates? Can you develop a bank
of standard treatment plan estimates so you're not re-creating the estimate each time?
Dr. Anthony and his staff members completed this exercise and found they missed very little on outpatient cases, but they
were shocked by the frequency and amount of missed charges on hospital cases. They missed an average of $50 per case on 85
percent of those sampled.
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