Running a chiropractic office is a business. Simply speaking, your office could go out of business if your fees aren’t collected. A good CA should be a good collector. Unfortunately, collecting fees is usually the weakest link in the CA’s office procedure. Your staff must learn and practice the techniques of collecting until they become second nature.
If you have a CA who isn’t a “born collector” or is initially uncomfortable collecting, don’t despair. He or she can develop into a great collector with the right attitude and training.
When your CAs collect from patients, they should not exhibit an angry attitude. However, they should maintain firmness. Patients respect this. Always make collecting a positive and natural routine procedure. Don’t lose patient control by allowing your CAs to be “wishy-washy,” or by letting the patient establish the collection procedure.
Remember, the principle behind collections is a simple one: “Money is a receipt for services rendered and a by-product of service.” Paying for services rendered is a part of the patient’s therapy. Anecdotally speaking, if patients don’t pay for their care, they will often complain of poor or no results. Conversely, if they do pay for their care, they tend to respond more quickly and get better results.
A Matter of Attitude
One of my CAs asked me on her first day of employment what my attitude was regarding collections from patients. My answer was, “I give the best chiropractic service possible to my patients. I pay a lot of money every year to attend post-graduate studies to provide that great service. So I expect to be paid for the services I render. Patients pay in this office.”
The CA said, “That’s all I need to know,” and she continued with the collection tradition of my office, which is a collection rate of 98% of all services rendered. You, too, can achieve that type of collection rate at your practice.
Back Up Your CAs
The doctor should always side with his or her CAs when patients try to play the “Mommy- Daddy” game, because that’s what some patients do when they don’t want to pay. Remember when your mom said you couldn’t use the car on Saturday night and you asked your dad? That’s exactly what some patients try to do. Don’t let that happen. The doctor should say, “I just work here. Ask the boss. She’s out in front.”
One of the biggest mistakes you can make as a doctor is to discuss past due payments with patients when they corner you in an adjusting room. The CAs should handle all collections. It’s their job.
Sometimes you have a patient who is creative at finding ways to avoid paying for chiropractic care. This type of patient always has lots of reasons to be given special privileges. The best defense is to tell your CAs to use your accountant (or “office policy”) as a shield. The CA can politely tell the patient, “Oh, Ms. Chance, I would love to give you 10 months to pay your bill, but I’m so sorry, our accountant (or our office policy) won’t let us.” Always put the blame on a set-in-sone policy or a third party who will never be seen by the patient.
When it comes to collections, a poorly timed phone call, an idle threat, or even a postcard can spell trouble and provoke a malpractice suit. I once heard about a doctor’s front-desk CA who, desperate to prove her worth, made collection calls at midnight. The patients complained to the doctor, and the CA was fired. Use common sense. Never allow your CAs to call collect, and make sure all calls are made after 9 a.m. but before 8 p.m. Even if your office is open, don’t phone outside these hours.
Not all collection tactics are awful, but some, including ones you and your staff may have used, may be just as illegal. “Unfair and deceptive acts and practices” are prohibited under Section 5 of the Federal Trade Commission (FTC) Act, and every state now has some form of this FTC statute.
While interpretations of the law vary, you’ll be much safer if you make sure your CAs stay within the following bounds during the collection process:
· Identify who’s calling. Without mentioning the overdue bill, CAs should immediately identify themselves and say they are calling on the doctor’s behalf. They should ask to speak directly with the patient and never make idle threats or use abusive language. If a message needs to be left, it should be simply, “Have Mr. Hughes call Mrs. Kemp at Dr. Smith’s office at 555-1212 before 5 p.m. today.” The debt is between your office and the patient, so don’t risk an invasion-of-privacy suit by making the fact public.
Can you call your patients at work? Yes, if other attempts to contact him or her have failed, and if neither the patient nor the employer has previously asked you not to call there. But keep the number of calls to the workplace to a minimum. If they interfere with the person’s duties and he or she is fired as a result, you could be held responsible.
- Don’t involve others. Only talk with the patient about his or her bill. Technically, you may not even be able to discuss a patient’s bill with his or her spouse. Never contact a third party, such as a boss or landlord, as a means of cajoling money out of a patient. If the disclosure got someone fired or evicted from his or her home, a court would not sympathize with you.
- Don’t misrepresent. A CA should never attempt to deceive a patient into thinking he or she represents a collection firm, an attorney or a government agency. Nor should the CA say the patient’s account has been turned over to a lawyer or collection agency when that’s not true. The CA should also never say you plan to turn the collection effort over to an attorney, collection agency or small-claims court unless you intend to do so.
Collection letters should always be accompanied by a copy of the original statement and should never be presented to a patient as a legal form, such as a summons or a threat to place a lien on the patient’s car, house, property or other assets. Stating to the slow payer that he or she has committed a crime is also illegal in many states.
- Don’t resort to extortion. Never ask for a post-dated check to halt legal proceedings that might otherwise take effect after a specified date. Also, it’s extortion in some states (New York, for example) to threaten to report a patient’s delinquent status to a credit-rating service.
- Don’t even hint that you might charge interest. Unless the patient was informed in writing at the time of service that he or she would have to pay a specific interest rate on an unpaid balance, you could be subject to civil penalties.
- Protect the patient’s privacy. Names of delinquent payers shouldn’t circulate outside the office or be discussed with other patients or non-employees. A group practice in the Northwest, for instance, tacked to its bulletin board a list that read: “The following people should please see the office manager immediately regarding overdue payments.” One patient sued, and although the fact that the information was true saved the doctors from paying libel damages, the courts found that the patient’s privacy had been invaded. The patient was awarded punitive damages. The jury ruled that the list subjected her to “public scorn, contempt and ridicule.”
When sending collection notices, don’t stamp envelopes “past due,” and don’t use postcards. The few extra dollars you might collect or the pennies you may save in postage aren’t worth the risk of inciting a patient to sue. You could be violating postal laws as well. Postcards advertising a debt or threatening legal action are considered “non-mailable” by the post office. Conviction for sending one carries a $l,000 fine, up to one year in jail, or both.
- Use common sense. If a collection practice seems unfair, deceptive or annoying, it’s far better to avoid it than to risk going to court.
- Don’t push too hard. The number-one underlying cause of malpractice suits is a “too-vigorous” collection effort, not mistakes on the part of the doctor. A vindictive patient and a dishonest lawyer will quickly try to turn the patient’s debt into a money-making opportunity. So remember not to push too hard.