Fees, fees, fees. Many veterinarians and practice managers lose sleep over whether their practices' fees are set correctly. Are they too high? Are they too low? Are some too high and others too low? Should we hire a mystery shopper? Raise every fee 10 percent? Throw some darts at our fee schedule and raise the items we hit?
Stop the insanity, says Denise Tumblin, CPA, president and owner of Wutchiett Tumblin Associates and a Veterinary Economics Editorial Advisory Board member. As she told a group assembled at the Veterinary Economics Progress In Practice seminars held in conjunction with CVC Central, there is less pressure to raise fees if you start charging for every service you have a fee for. Instead of worrying about your fees, start working to reduce the frequency of missed charges. Here's how:
1. Identify the holes in the bucket. Figure out what charges you miss most often. Tumblin says that in the practices she consults with, the top missed fees for outpatient services are medical progress exams, extended exams, blood draws, and clients? ?While you're at it? requests. For inpatient cases, practices most often miss examination charges, hospitalization fees, monitoring fees, and injection fees.
2. Communicate your expectations from day one. When a new doctor or team member begins work at your practice, go over each item on the fee schedule and give clear direction about how you expect the new hire to charge for services. Discuss your fee protocol regularly, especially if you make changes.
3. Convey the seriousness. If a doctor or team member knowingly refuses to charge for services or to charge the full amount, he or she is embezzling from the practice. If you characterize the problem in these terms, many people will see it in a different light.
4. Swap cases and discuss. Periodically, pull 10 recent outpatient cases and 10 recent inpatient cases for each doctor. Have doctors review each other's work and determine whether they would have worked up the cases differently. Compare the medical record to the invoice and identify any missed charges. Eventually, patterns may emerge—i.e., one doctor often forgets to charge for fecals; another charges for a level one exam when she really should charge an extended exam fee. Once you've identified bad habits, you can begin to correct them.
For more on reducing missed charges, check out Benchmarks 2007 and Benchmarks 2008.