Working as a Team to Get the Bill Paid

I like to think of the space between the exam room door and the reception desk as a Bermuda Triangle of sorts. All too often, agreements about follow-up, expectations of payment and even the clients themselves “disappear without a trace” the moment the exam room empties.

Clients might become distracted by a cute puppy in the waiting area or run into someone they know — or they might just want to leave the practice before someone asks them to pay.

The mnemonic EIEIO — as in the song “Old MacDonald Had a Farm” — summarizes how to deal with the Bermuda Triangle problem:

E — Estimate if appointment cost will exceed $100.

I — Inform client if bill is more than $100.

E — Escort client back to reception area (navigate Bermuda Triangle).

I — Inform receptionist of key information (e.g., scheduling, follow-up).

O — Obtain form for insurance claim.

The Old MacDonald Method

Estimate If Appointment Cost Will Exceed $100

People are generally satisfied with veterinary bills if the fees meet their expectations. The best way to meet expectations is to set them in the first place. Many veterinarians avoid discussing money with clients because it makes them uncomfortable. I call this fear “econophobia.” Failing to give an accurate estimate is a failure to set expectations, thus risking client dissatisfaction, unpaid bills and damage to the practice’s reputation.

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We have a rule in our practice: “If you billed it, you explain it.” This is partly to help everyone take responsibility for informing clients of costs and partly because receptionists should not have to to resolve disputes about invoices they did not create. I recommend giving an estimate for any appointment that will cost the client more than $100, which in many practices is most appointments. Having worked with hundreds of practices over the years, I’ve noticed that some make estimating cumbersome and complicated. I often see underestimated surgery fees and low charges for general anesthesia.

I recommend using five grades of surgery to categorize estimates, assigning all standard procedures to one of the five categories.

Inform Client If Bill Is More Than $100

I call this the $100 rule: No client should arrive at reception, either after an appointment or to collect an inpatient, not knowing that his or her bill exceeds $100. The receptionist should not be the first person to give this news to a client.

I always price the exam before the client leaves the room. Often this is integral to dispensing medications and demonstrating how to administer them. Exam fees are added when the medications are selected. The $100 rule means that if a bill totals more than $100, the client knows that before leaving the room. (I chose $100 because it seems to be the amount that most clients will pay without commenting. The number may be higher or lower at your practice.) Failing to advise clients when the exam bill is higher than $100 may lead to exclamations of “How much?!” at reception, setting off cascade of time-consuming, emotionally uncomfortable distractions, as well as the potential for an unpaid account or, worse, a lost client. Escort Client Back to Reception Area

The aims of escorting clients to reception — navigating the Bermuda Triangle — are twofold: to lead the client toward the payment area and to ensure that any follow-up appointments are booked. This is particularly important after recheck consultations, for which many clients assume there is no charge.

One way to avoid this misunderstanding is to walk the client to the receptionist and state whether and when the patient needs to be seen again. If no follow-up is needed, instead of allowing the client to leave the exam room alone and head for the exit, the veterinarian should casually but deliberately steer the client toward the front desk. If the receptionist is occupied on the telephone or with another client, when saying goodbye, add, “The receptionist will be with you in a moment.” Most clients realize this is code for “There is a bill to pay.”

Inform Receptionist of Key Information

Every business requires repeat customers to be sustainable. We can be proactive or reactive when it comes to follow-up business. The reactive mindset merely hopes that clients will return when their pets need veterinary services. By contrast, the more proactive mindset thinks, When will I see you again?

In an ideal world, every patient would be seen at least once year for a wellness check and vaccinations. Therefore, when a patient is “signed off” after a short-term illness, it is advisable to check the vaccination status to make sure that the pet’s annual booster is scheduled. In fact, it is most useful to determine status before the appointment. If vaccinations are not up-to-date, the best time to bring this up is at the final recheck. The topic can be broached by saying “I look forward to seeing you again at Maggie’s annual checkup” and asking when that is. Clients are often more amenable to paying for a vaccination when they realize that this can be done in lieu of paying a final recheck fee.

Clients tend to be more compliant with follow-up and vaccinations if the veterinarian instigates the process. As frustrating as it is, clients tend to be less compliant when a receptionist or nurse asks about follow-up than when the veterinarian either books the recheck or, in front of the client, requests it at the front desk. This handoff not only gives the veterinarian a reason to navigate the Bermuda Triangle but also is a way to provide the receptionist with key information to ensure the payment and follow-up process happens effectively and efficiently.

The following phrase imparts a lot of useful information: “Sarah, can you please give Mrs. Smith Scooby’s tablets and book Scooby for a recheck with me in 10 days?” I now know that Sarah knows exactly who we are dealing with, so she doesn’t have to ask the client her name, possibly for the second time. I can also give my receptionist a heads-up on any areas of tension, such as payment concerns or the need for extra compassion if bad news was given during the visit. This can be done via tone of voice or gestures agreed upon beforehand.

Obtain Form for Insurance Claim

The final component of getting paid relates to insurance claims that will be paid directly to the practice. Sometimes clients are less motivated to submit paperwork if their cash flow isn’t affected (i.e., the direct insurance claim). It is important that the veterinarian liaise with the receptionist to explain the account’s plan; again, articulating this in front of both the client and the receptionist seems to make a difference.

The Bottom Line

There is no point in doing great work but not getting paid for it! Everyone working in a veterinary practice must take responsibility for the financial resolution of each appointment. Veterinarians cannot assume that receptionists will make sure bills are paid. And, while receptionists may give estimates for standard procedures and request payment afterward, they have no control over what actually happens during procedures and, therefore, the costs. Ultimately, working as a team to get bills paid improves client satisfaction, colleague morale and the practice’s bottom line.

Dr. Faulkner divides his time between working in his own small animal practice in Suffolk, England, and coaching practice owners and managers. Through the Colourful Consultation, he helps veterinarians proactively pursue the four essential outcomes of veterinary practice: clinical resolution, client satisfaction, financial resolution and colleague satisfaction. For more information, visit colourfulconsultation.com.