The importance of the front desk, and the experience that patients have there, can never be overestimated. Stacey Fitzsimmons of Account Matters, Inc. has witnessed this time and again through her work with PT clinics across the country. Considering that the patient's assessment of your clinic (and not the therapy you provide) could hinge on those interactions, you have to make sure that the person at the front desk fits the bill and gets properly trained. Having a natural people-person and problem-solver and someone who is positive, encouraging, and straightforward is essential. Far more than we give them credit for, they have a direct connection to the revenues of your company. Now the question remains, are they more important than the PT's in the back? It's worth considering. Follow today's episode as Stacey sits down with Nathan Shields to tell you.
I have Stacey Fitzsimmons of Account Matters. She's been in the physical therapy space for decades. Thanks for coming on and joining us. I appreciate it. We're going to talk about some important stuff.
You're welcome. Thank you for having me. It's a pleasure to be here.
Tell us a little bit about you and Account Matters, what you have done in the physical therapy space here in the last couple of decades and what you're working on. What's gotten you to this point as we're speaking?
Account Matters has been around for a few decades. The original founder of this company is my partner, Diane McCutcheon. She has been in this business for more than two decades. I came on board in 2003 in a consulting manner specific to the PT/OT world. That's what Diane's background was and me coming on board with her, I followed suit. The difference between some other owners out there of billing companies and me personally, is I went into a physical therapy clinic and got hired and I've done every one of the jobs at the front desk, the billing and collecting. The only thing I haven't done myself is the actual treatment because I'm not a physical therapist. Everything that I've learned when I was on the job and then everything I've listened to from people through the years of consulting was how I formed my billing company, Account Matters.
I tried to take all of the complaints of what people hated. I didn't want to do that in my billing company because I keep hearing people complain. That's how we formed ourselves. Going back to the 2003 time, we were forming ourselves of not just a consulting company, but let's open up and give this industry what they need and that's all admin support. Front desk right through your collections getting your money in. That's what we did in this business is we started the billing company. We started adding on, we started training programs and it was all geared towards the front desk and billing department. We offer all of those services here at our company that we can certainly do for people but we took it one step further where if you don't want to outsource your billing and front desk, you don't have to.
We do have trained professionals here that will teach the right person on your side in your practice. For some of those things is I've always tried to set myself a little bit different. There's certainly a ton of billing companies out there. There are a lot of good ones as well as bad. I like to be a little different. I like to try to capture things that I'm not your typical billing company that only knows how to bill, push your payments and collect. I do understand the entire private practice section for physical and occupational therapy.
You initially started off as business consultants and have worked your way over to the billing side a little bit more, from what I remember. When you talk about the billing cycle, you're talking not just about the billing department, but you included the front desk in that. That's a misunderstanding that some physical therapy owners have is not recognizing how much the front desk impacts your collections.
That's where my passion comes in. I was in a lot of pain and couldn't walk. I couldn't work because I was always in pain. I went to a physical therapist. For the reason you become a physical therapist, I didn't become a therapist, but I can appreciate the gift that therapists have to get people pain-free and live their lives. I also understand that you went to school to do that. That's your gift. I don't have that gift. I don't want to touch a human in pain. My gift is business and figuring out how to make sure that what you're doing is going to get reimbursed. A physical therapist by nature, you will do anything for anyone. You love helping people or you wouldn't be in this business.The only way you're going to continue seeing people is if your doors are open. Click To Tweet
If you have a private practice, it's hard for a therapist to remove the heart. It's hard for them to say, “I'm going to treat Stacey because I know she can't walk and I don't care if I get paid,” which I understand from a therapist. That's your heart. That's you saying, “I need to get Stacey better.” I look at it from you're valued and you won't be able to keep your doors open if you keep doing this for people. I understand it, not from you just have big hearts that you want to help. I'm taking it more like you do, but you should get paid for it because the only way you're going to continue seeing people is if your doors are open.
Is that how you train your front desk people and your billing people? Not to necessarily remove the heart, but training them from a perspective of, “We provide a valuable service and we deserve to get paid as much as possible for the service that we provide. That is your responsibility to ensure that the collections come through at 100% so that we can be reimbursed adequately, if not more so, for the services that we provide,” right?
Absolutely. The part where we're working with the front desk and why I keep bringing your front desk person is because, in my opinion, your front desk person is the most valuable person that you have working in private practice. The reason is they’re the first person to answer the first phone call from a patient. Nathan, you might be the best therapist on the planet. If I'm hurt and I'm calling your clinic, I'm not going to talk to you. I'm going to talk to your front desk person. If she or he is rude, they don't pick up the phone, they give me non-complete answers, I don’t know’s, I will most likely pick up the phone and go to the next person on my list. It makes good sense to bridge the gap between your therapists, therapy owners and the front desk that is typically, “We just need someone to sit in that seat.” It's a lot more than sitting someone in the seat.
If you have the right people, you, as the therapist, with your heart of gold, don't have to answer your patients about their bills and what's going on because you have people to take that hit for you. That’s where it's very important to get the right people at your front desk in your billing department. Those are the people that you, as the therapist, “I don't know what's going on with you. I don't do billing. Go see Stacey in the billing department. She can tell you what you need.” It takes you right out of the equation and it will help your practice to be viable and profitable versus I want to help someone because you are helping them but you should get paid for it.
A good front desk person is like gold. They can set the tone of the clinic. They are the customer service arm of your organization if you will. As you said, you could provide the best therapy on the planet but if they get a bad interaction with that front desk person, either coming in or going out, they're going to remember that more so than the care that you provided. They'll find somewhere else.
Back when we were doing the consulting, we used to travel around the country and we would assess a private practice. What our findings are. We would go through everything down to when I walked through your front door, is it clean? Some places are dirty and messy when you walk in and me as a patient coming in here, “This is dirty. I don't want to be laying on this equipment.” It's very important to think beyond, “I have the absolute best therapist in the world.” It's almost where I can appreciate it if you're going to open a practice, the first thing on your mind is getting therapists in there but it should be getting your admin staff and then adding the therapist. The therapist already knows what they're doing. They need a bench, a table and equipment. It's about your admin staff.
How do you find, recruit or hire the right person for the front desk? What are you looking for? How do you train owners to find the right person?
I like to find and ask people certain questions about where they came from. I don't care if someone came from the local coffee shop and they're coming in here applying for a job to be my biller. I want to know, at that coffee shop, give me one of your worst days where every time you turned around, there was a problem, and tell me what you did to fix the problems. I want to know what you did at your last job. What was the perfect job you had? Tell me the one thing that you did to make a difference in the company you worked for. I'm usually the one to ask not so much specific questions about the job you're trying to hire them for, but I want to know what you do in your jobs. If you’re a hard-working person, it doesn't matter what your job was. If you're a cashier, be the best cashier out there. If you're a therapist, be the best therapist. I'm always looking for the person to be the best of what they are. Not everybody has the education to be a therapist or a doctor. Some are truck drivers, and they're the best truck drivers out there.
What you're trying to key in on is to get the best front desk person. When they come into the interview unless it's COVID time and you have a mask on, are they smiling? Do they smile at you? If your patients are coming in, they're not coming in because they feel great. They're coming in because they don't feel good. Is someone going to greet them with a smile? “Hi, Stacey. It’s nice to see you. Hold on. We'll be right with you.” In the interview, how did they dress? They knew they were coming to an interview. Were they sloppy? Because they'll do that at your front desk. Again, we're not looking for models. We're looking for a clean-cut, for someone that can speak clearly, someone that can smile, make people feel happy, warm and welcomed. Typically, what I look for when I'm going for new candidates, it's not so much, “Do you have a degree and what's your experience?” It’s, “What can you bring to us? If we give you the right tools, will you learn and be able to do this job?”
It’s maybe more at the front desk than from physical therapists, but we often talk about soft skills. Skills that have to do with personal interaction, feeling other people out, and becoming a problem solver because we can teach the technical skills like how to call, verify insurance, how to collect the copay, here's the paperwork you need to fill out and here's how you do the EMR. Those are all hard technical skills. We can teach you that stuff, but you want someone who's inherently what we like to call high tone. Someone who is naturally happy and excitable. They don't have to rev themselves up to interact with individuals on a regular basis. They want to interact with people and get to know them.
They ask more questions. They’re involved. They know, just like the therapists know, all about the dog, the kid that's sick, and the husband that's hurting as well. They ask those questions. We like to look for people who are in a high tone. I liked the questions that you brought up about people's past experiences because it sounds like you're trying to figure out, number one, were they high producers in their previous jobs? Were they also problem solvers? There's so much that comes out of nowhere at the front desk that if those people are going to be productive, they've got to be able to solve their own problems with the best knowledge that they have without coming back to talk to the owner every day or every second about, “I've got this. What about that?”
In any private practice that I've been in, they are busy. You've got people coming, do they have a copay? We've got people leaving, do you want to schedule an appointment? We've got referrals and OCS we need to get because this one is coming in tomorrow. “We can't schedule an eval for the first visit because this therapist doesn't like that.” They are answering phones so you don't want to hire someone walking through the door, dragging the feet, and sloppy dressed. You’re like, “What's your five-year plan?” “I just want to have a good job.” You're not looking to better yourself. I always say, “I like the people that don't try to be better than anyone else. I like the people that try to be better than they were the day before.”
You want that energy, but again, you don't want someone coming and telling you their whole life story because that's what they're going to do when your patients come in. You don't like your patients listening to me saying, “I know. I felt awful and this is happening because.” They don't feel good. You want someone at your front desk, “How are you doing? It’s a great day. It's sunny out.” It's really important. You're looking for an ambassador of your company. You're looking for a professional person that you can train on the hard stuff like, “Here's a book. This is how you build. This is how you do that.” You're looking for more than that. You're looking for someone that's going to fit in and make your patients feel like, “I'm so glad I came here. Stacey was so nice when I walked in the door. She couldn't have made it any easier to do my paperwork.” That's what you're looking for.
Many people that are reading might be thinking, “I don't have that person,” or they're thinking, “I've had a lot of turnovers and I can't retain the people that I'm wanting.” What are your recommendations for such a position that can be a high turnover position?
We do have a turnover guide. It's a free download that everyone, if nothing else, get your free Turnover Guide. It's a Bit.ly/turnoverguide. Hopefully, you can read some things that will help you out right off the bat. It's not science. Sometimes, people leave for reasons we can't predict or out of the blue, your best person found the dream job down the street. That's always a tough one to swallow. If you don't give the right person the right tools to succeed, they're going to leave because if you find the right person and you stick them at the front desk to figure it out, they're looking for guidance, a leader, and they will leave you.
Once you do find the right person or if you're reading and you think, “I know that I have the right person. She just doesn't know what she's doing.” It's up to the owners. It's up to you to get out there and find the tools to give to them. We have all kinds of training programs here at Account Matters that we work with a lot of clients on basic data entry. How do you put a person complete into the software? What is it that you're looking for? How do you call and check on benefits? They should be done before you have the patient in for their email. If you hire the right person and they don't know any of this, you're going to lose a lot of money. They're set up to fail. If it's the right person, failure is not an option. They will leave and find a job with a leader that will give them the right tools.
The right people want to know their scorecard and what does a successful front desk person looks like. If you can't tell them, “Your job is to produce blank.” Most front desk it is, “Your job is to fill the schedules.” There might be some other iterations of that, but it’s essentially, “Keep the schedule full.” That's their job. If they can't tell you that, then you haven't trained them on their basic purpose and product. Their job is not necessarily to collect all the copays. That's a vital part of their job but their main job is to keep the schedule full. Number one, they need to know stuff like that. They need to know the statistics that you're going to judge them by. That's what I meant by the scorecard. Are they collecting 100% of the copays on the patients that are coming in? There should be benchmarks.Your front desk person is the most valuable person that you have working in private practice. Click To Tweet
Right off the bat, “You're coming with us. In your first week, you won't be very fast. The second week, we want you to go from 5 new patients in the system to 10 new patients.” You know your businesses. If no one has a benchmark, they're going to do whatever they want. I've certainly learned my lessons in business as the years go by, “I gave them an open-ended window, how come they didn't do more?” I gave them an open-ended window and they did what they wanted. It's all about setting benchmarks in what is best for the company, not the individual people.
Are there certain benchmarks that you think are more important than others?
I do, especially when it comes to scheduling. The number one benchmark is to make sure that every new patient gets in your schedule within 24 to 48 hours. If they call on a Friday, it will be Monday. Because people are usually leaving a doctor’s office with like, “Go see a PT.” It's top of mind, “I'm hurting. I'm in pain. I can't walk. I'm going to call now.” “I can't get you in for two weeks.” You all know PT places are everywhere. They're going to call someone else. I would say a benchmark is a 24 to 48-hour window for any new patients coming in. They need to make sure they learn the schedule enough to leave those spots open and get your patients in.
The other one that you brought up that I'm very big on is the copay and patient money. I'm huge on that because the minute your patient is discharged, it dropped 60% of you collecting that money. They are out of sight, out of mind, “I'm not going back there again. I don't have the money. I'm not paying it. I wanted to spend it on something else.” It's very important to train your front desk person right away, “These are the reports from your software that you should be running every morning because this will tell you what you should be collecting. At the end of the day, did you meet that? Did you collect all of the money or did you not?”
My goal is always 100%. I almost find no one that can do 100% but if you keep it 100%, you will get the most you can get out of your front desk for collecting. Why aren't they collecting? Is it because they're asking the patients, “Do you want to pay?” If that's what they're saying, you want to train them to say, “How would you like to make your copay? Cash, check, or charge?” Not do you because if you say do you and you have a 21-year-old and it's a Friday, he's going to say, “No, I'll pay next week because I'm going out tonight.”
Have you found a way for owners or front desk people to keep credit cards on file and make that transaction easier for copays?
I would say it's a 50/50 out there with people wanting to do it and people not wanting to. It's all above board and you can. There is a form that does need to be filled out from the patient because the patient needs to give you the okay. I do recommend trying to get the patients to leave a credit card on file. If they know it's on file and they've signed for it, then you should have no problem every time they come in saying, “Hold on, Stacey. Let me finish running your card and give you a receipt.” It's not a question and you're not asking. It's, “You agreed every time you came in, I was going to run your card. When I see you, I'm running the card.” It's little tips like, “Don't ask.” They already gave you their okay so run it when they come out, “I’m running your credit card. Your receipt is coming up in one minute.”
I came across a coaching client who used COVID as a nice excuse to minimize that hand-to-hand transaction contact and transmission or whatnot like, “We're going hands-free as much as possible especially here at the front desk. What we'd like to do is keep your credit card on file. That way, we minimize that hand-to-hand transmission.”
That's perfect because everybody is in the same boat. No matter where you live, you can use that as your excuse. Everybody is dealing with COVID so that’s a good one.
You could say an excuse. You could say, “According to our new COVID-19 guidelines, this is what we would like to do.” Make that part of simply how things go.
The other benchmark you may want to keep in mind is cancel and no-shows. If your front desk person doesn't know how to track them properly, you might think you have a lot more cancels and no-shows than you do. Make sure that your front desk person knows that if it's not a true cancel, they're deleting appointments rather canceling appointments because that's a benchmark you can set not only for your front desk, you can set that for your therapists. I like to go, “How many? Why are they canceling? What are the reasons?” If you have a cancel no-show policy that has a payment associated with it and if your front desk is collecting, less likely your person will keep canceling and no-show. Those are my top three benchmarks I always give to people.
The cancel and no-show rate seems to be a team attack. If you're below 90% arrival rate, the whole team has to be involved. One of my mentors has said in the past, “The patient will only take their therapy as seriously as the therapist takes it.” If someone cancels and on their follow up visit after that, no one says a thing at the front desk or the therapist about the cancellation, how important it was that missing that appointment sets back their care and the results they're going to get with physical therapy, then the patient is going to think, “I can cancel. It’s no big deal.”
Being a billing company, we've seen mostly every denial, especially in the work comp insurance companies. We've had a few companies come after us for certain clients because they're wondering why it's taking so long to get better. When we send all of the documentation, they know that they've canceled and no-showed so many times that they stopped paying. It’s not only you at the clinic that’s like, “Now I have a therapist that doesn't have an appointment.” You can tell the patient but sometimes, it comes to the insurance companies. If a twelve visit is the norm for whatever part of the body for this insurance company but you're more like the ‘80s going another month that you may get questioned. These insurance companies are going to be mad at you because you're not making it important enough to get the patient in there. You want the patients in there.
The front desk is so vital in that aspect because the therapists aren't answering the cancel call that comes in. They’re not on the phone. It's so important that the front desk understands exactly what we're talking about now and how not coming in for therapy is going to inhibit their progress in care and prolong their care. Also, it's imperative that the front desk also understands the purpose of the clinic and they buy into what physical therapy is all about. If they're casual and laissez-faire about physical therapy and patients coming to physical therapy, that's their attitude on the phone.
That's why people get away with it because they're calling your front desk. “Stacey, can you tell my therapist I can't make it.” “No problem. Goodbye.” If the therapist doesn't say anything, they're like, “I didn't have to talk to the therapist because I see him three days a week.” If you said, as therapists, “Stacey, you missed yesterday. That's the third no-show you've had or the third cancel. We're trying to get you better. I built this plan specifically for you. We want to get you better. If you need to cancel, maybe you could come in at a different time the same day.” If they're not saying anything and your front desk doesn't know, your front desk will keep taking the call, “I'll tell them.”
You need both of them to come together to say, “I took a call from Stacey. She canceled again. Do you want to talk to her? Do you want to say something on the next visit?” They should be working together. Typically in the PT private practice setting, there's always a wall built up in between the therapists and the front desk or your admin staff. I am one consultant that loves to go in with my big wrecking ball and break that wall because it's very important that they communicate for the scheduling and for the no-shows. I can't tell you how many therapists hate their front desk because they always schedule the new people for the last visit of the day. My answers are usually, “Have you told them?” “No, I didn't.”
If you don't talk to them, they don't know. You want to make sure in your practices that there's no wall being built and there's complete communication. That will help your cancel, no-shows and anything else that has to do with your patients because if your front desk doesn't feel that they are going to be undermined or not listen to, anything that comes up, they're going to run to the therapist and say, “I just saw Stacey in the hallway. She said XYZ or whatever.” If there's no bridge between the two sides, you're leaving each one open to not say anything and your patients are doing whatever they want.
For those owners out there that have a front desk person that they're questioning, “I don’t know if this is working out,” or they’re not fully satisfied, do you find that front desk personnel who has been there a long period of time, say a year or more, and then you try to implement this stuff, that it’s hard to teach an old dog new tricks? Is it hard to push in some of these benchmarks, products, and training into people who have been there for a while?Make sure in your practices that there's no wall being built and there's complete communication. Click To Tweet
Yes sometimes and no sometimes. What I will say is this is where the owner has to be a true leader. I know you've been with me for a year. We're making changes. They're non-negotiable. I am the owner. This is how I want it done. This is how it's going to be done. When you do that, it goes pretty well. Your worker might be a little upset for a few days getting to know the new process.
They can’t control how they're going to respond.
You can't. You have to stick with what you say. What happens sometimes is this is how we're going to do it. The next week you check-in, “It didn't work. I know how to do it this way. I've been doing it this way for years.” If the owner says, “Okay, fine,” and walks away, you've not bettered your company at all. You're staying the same and you're probably missing things. There was a reason why you wanted to change something in the first place. If you stick to your guns and they will not change, they're not the right person. If you stick to your guns and they're like, “This stinks but I'm getting the hang of it.” The next week, “It's a little better. I still don't like it, but it's better.” The third week, “It's not that bad. I’ve figured it out.” That's how you would approach your people that have been there. As an owner, when you make that decision, don't go back on your decision. It's this way. Once you do it correctly, prove to me that it won't work and we'll change it again but I'm not for changing until you prove me wrong.
I liked a couple of things that you said there. Number one, the leader comes in and says, “This is how things are happening. This is the structure that we're going to use. These are the checklists that you're going to follow. In the morning and the evening, you're going to turn them in.” What you said inherently in there without saying it was that you were also following up on a routine basis. It's not like, “This is how we do things. Good luck. Go do it and tell me how it goes.” No. It’s, “This is how we're going to do things.” Follow up on a routine basis and say, “How did that go? Can you show me what you did? Did you follow the process? What did that look like? Here are the checklists that I expected out of you.” If you draw the line in the sand but then don't follow up, then the front desk will go back to the same thing.
I can give you great examples because you're all probably saying, “She just talked about me.” What I see is a front desk person that has had that job for years and they've always done things manual. I'm talking mostly about copays and they're recorded on an Excel spreadsheet and/or a paper form that you have to fill out or a paper receipt. It’s then put into your new updated software that tracks everything for you. It happens to everyone. I'll say, stop the manual systems. You have three systems for a copay. You have software. It's 2021. It works. Use your software, “I don't trust it.” If you do that, you will have discrepancies because you're doing something three times.
If you have a patient asking you a question and you only did 2 of the 3, you'll forget the third one, “How come my three balances don't match up?” The perfect example would be, “Stacey, we're stopping the written process. We don't need the written receipts. They're all on the computer.” If you’ve never checked back in with me and this has happened. I've checked a month later, “How's your front desk doing after the training?” I'll start asking questions. “We still have the written one.” “Why?” It is follow-up. You want to make sure, as the owner, to be a leader. They're going to follow you. “This is how it's done. Do it this way successfully for three months. If you still hate it and it's not working, we'll change it again.” You've got to stick to your guns. If it fails, it fails. Not everything is going to be a winner but you can't let your employee tell you it's going to fail without proving it's going to fail. It's all about the follow-up.
They're not running the ship. They're trying to and they shouldn't be. You need to take the helm. You talked about it and while I have you, I also want to ask you about this. The communication and the relationship between the front desk and the billing department can sometimes have some animosity. How do you help that? Fortunately, we got to a point where the front desk love the billers and the billers love the front desk. They worked very cohesively and they share data. They shared their evening reconciliation forms on a regular basis. They were able to talk back and forth. The billing department could train the front desk on certain items and all that kind of stuff. For people who don't have that type of relationship, where do you start in healing that animosity between front and billing departments?
The first thing is you have to set the company culture as you're a team. I am passionate about communication and being a team. In my company, we all have hybrid schedules. The new people haven't even met half of the other people that work here. I'm big on team-building events. It's important to close your place down periodically to have your entire staff and forcing them to work together. There are a million things on the internet that you can get for, “What should I do for team-building exercises?” Pair people up with people they normally don't work with. They don't like each other because of their positions at their job. If you get that out of the equation, chances are they will like each other.
I also have an army background and anybody that's been in the military, it's one big team. You're not singled out. The goal of the company is to have 100% collections at your front desk and have your cancel and no-show rate at 0%, if possible. It's the company goal. You can set individual goals for people, but you should be bringing your entire company together at least once a month for some type of meeting. More than just lunch to say, “Stacey at the front desk, what are some of your issues you're having when it comes to scheduling with the therapist?” That's the opportunity to get someone to say, “I think this one gets mad at me every day because of the evals but there was nothing available. I'm not sure what to do.”
That's the opportunity for the therapist to say, “That's really easy. Whatever the answer is, this is what I would rather you do. Come to see me. I'll move another patient. Whatever the case is.” It's all about forcing them to talk to each other. What we've done in other practices through the years is we would help host that first real meeting and almost force them. I would be bringing up, “When you're scheduling, what do you have trouble with?” It gives the opportunity for everybody like, “Don't take this personally.” We have one company goal in mind and what is the company goal? Everyone should be working toward the company goal.
Your personal feelings are non-existent. This is work. After work, if you don't like someone, fine. If you want to go out with someone, fine, but during work, the company should be all the same vision. Where is the company going and what is the job? Have those meetings. Don't have a meeting just for your admin staff and the therapist. You should at least do one company meeting and make it almost mandatory. Who are your managers? They should be getting other people to talk, “Didn't you say last week you were mad about whatever?” Call people out on what they're saying to get them to talk. You'll find once the mouth starts opening, it all comes out. People are usually, “If you would have said this to me a week ago, I could have given you the answer. I would have told you don't book my schedule XYZ.”
It's all about communication. Communication is the number in any business. Communication is certainly key. To bridge the gap, I would strategically form meetings or events where you're forcing them to work together. As I said, chances are they're going to like each other. If you put them in an environment where they come in and they can see, “The wall is up. These are my people because the therapists are in the back.” That’s how they come on board. Your orientation for your new people whether it's therapists and/or admin staff, you should be taking your new person, “This is Joe. He's the new therapist.” “Hi, Joe. I do all the scheduling. If you don't like what I'm doing, come see me immediately.” That's when you set that. As your new people are coming on, make sure they meet. Everyone they are going to work with and open, “This is my job. If you see any problems, you come to talk to me. I'll help you out.” That will help tremendously to bridge the gap.
Going back and thinking about it, the billing person was a part of the front desk training process. It wasn't some office manager, the therapist training, or the front desk themselves. There was a portion of our onboarding and training where the billing person would get on the line or come in person and train the front desk person as well to know what was wanted and expected on the billing side. There was that clear communication and they understood, “She wants it this way and she likes it filled out that way because of this reason. That's what I'm going to make sure I do.”
It’s funny you say that because I have a billing company. We have billers that come in and that's all they do is billing. We have people that come in, they are payment posters and then we have collectors. They all know what each job is because what was happening early on in the billing company is you'd get complaints from one of them about, “The payment poster this and the biller this.” If you don't know what they're doing, you need to appreciate their position. It's the same thing in an office and this is where your big company meetings come in. The therapist might be like, “This is an easy job. You're sitting at the front desk.” They all think that.
If you said to Joe, the therapist out there, “Since you have a cancel, why don't you come to sit at the front desk for the next hour? Listen to me answer the phone. I'm taking a copay. I'm scheduling. I’m entering new data into the software. I got a call on a referral because this one just left.” If they don't appreciate or know what someone's job is, it's so much room for them to criticize about stuff they don't know. You're a front desk person. They're not going to be a therapist but they should go back and see what they're doing. What is it that Nathan does when he goes back there with the patient? Is he nice? How does he talk to the patient when he comes in?
It should be, “This is what the therapists do. Every time a patient leaves, this is what the documentation is. When they're complaining notes, ‘I hate doing notes,’ this is what they're doing.” Otherwise, a new front desk person can be like, “What's the big deal? Just write a note. Stacey came in and she feels better.” If you don't know what someone's job is, it's very easy to criticize and point the finger until you sit in their seat. Going back to what I first said, I've sat in every one of the admin seats in a PT private practice. I 100% appreciate whoever is at that front desk with ten arms trying to get the job done. I sat in the back and watched therapists. If we're going back decades, there was no documentation. It was all manual. “I can't read your writing. What are you doing? Why do you have to write so fast? You have to do the whole SOAP. There is a lot of notes.” It's all about trying to not teach someone, someone else's job but to let them know what the job is so they can appreciate what each other is doing.
As we're wrapping up here, is there anything else that you'd like to share that you might recommend owners consider as they're looking at their front desk personnel?
Going back on everything we've touched on is look at your benchmarks. Start coming up with what you want to do because when you make the decision to make your changes, stick to your guns. Even if it doesn't work out, prove that it doesn't work out. Don't give up on it. We did write a book and it happens to be all about the front desk to create your own front desk guide. Go to our website AccountMattersMA.com. We have a link on there. There's a book on Amazon and it is tailored specifically for PT and OT private practice front desk.Communication is the number in any business. Click To Tweet
This will help you write a workbook that you can say to every new person coming in, “This is how we answer the phone. Everybody answers the same way. This is how we schedule and do the cancel and no-shows.” Go to our website and check it out. My biggest thing with owners is appreciating every person that's in your business and getting them to appreciate everyone else's position in your business. It's a ship that needs to move together with nobody jumping off.
What's the name of the book?
The name of the book is The Administrative Power Center because that's what we developed. Under it, it's billing for rehab private practices. It's oddly enough hard to find on Amazon because if you type it in, it comes up with everything that does not say administrative power center. When you find it, we’re the only book called The Administrative Power Center. It's your revenue cycle that we've renamed, we'd beefed up, and we made it a little more fun for people to learn instead of looking at your typical revenue cycle.
I love that you hit on reminding the owners that if they're going to make changes, be certain and clear about it. Also, make sure you verbalize what your expectations are. Our arrival rate is 85%. Successful arrival rates are at 92%. Make sure that's the benchmark. That's what we're expecting. Our over-the-counter collections rate is 75%. I expect it to be 100%. This is what my expectation is. Be clear about those and put it in writing. That's part of the book that you're talking about is to create that workbook, put it in writing and that workbook ends up being, “This is how you get to 100% over-the-counter collections.”
It's your guide on how to run a front desk from A to Z. My partner, Diane, and I wrote it. We have close to 60 years of this particular business. Diane has only worked in PT/OT private practice as well as I. My final thought is to check the book out. It's a great tool for you that you can use for your entire company.
If people wanted to reach out to you or Account Matters, what would you recommend? How do they reach out to you?
There are two different ways. You can go to our website. You'll see a little Ask Dan A Question and you can click on there. There's an info box you can send anything to. If you want to email me, my email is Stacey@AccountMattersMA.com and I will get back to you personally.
Thank you so much for sharing your wisdom and your years of experience in this space. You shared a ton of great value. Thank you so much for taking the time to come on.
You're welcome. Thank you.
Have a great day.
Stacey Fitzsimmons is the President and COO of Account Matters Inc. Prior to Account Matters Stacey served in the US Army as a paratrooper and a mechanic in the 82nd Airborne Division and then owned and operated a sporting goods retail shop for several years. Stacey has 18 years of experience working with physical/occupational Therapy private practice owners across the country.
Stacey along with her business partner Diane McCutcheon, have recently written and published the book “The Administrative Power Center” to help educate the importance of the front desk position in a private practice setting. Stacey’s mission is to provide the tools and or services of outstanding administrative support to physical therapists nationwide, allowing them to get paid right the first time.
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Puff Daddy’s iconic song goes “It’s all about the Benjamins!” That is why if you're going to work hard, be sure that you're getting paid for it because you have value. Unfortunately, not all PTs realize this. They do not like dealing with the numbers and billing headaches. This is where Kevin Cappel of Jet PT Billing comes in. Moving from PT ownership to consulting to starting his own PT billing company, Kevin definitely knows his way around the ins and outs of PT. Sharing his knowledge and expertise, he talks about the best billing and financial policy practices for the small practice owner. He also shares some of the expectations he has of his billers and what PT owners need to do to maximize their reimbursements.
This episode is going to be more about billing and financial policies and procedures. In order to do that, I brought on Kevin Cappel, a physical therapist, who owns Jet PT Billing and have over 25 clients across the United States. He's been doing billing for several years now. I thought it would be a great time to talk to him about some of his expectations for billing KPIs, financial policies and procedures that are expected at the front desk because so much can happen between when a patient comes in the door and collecting that money. It's important that we review our financial policies and procedures and really groove those in so that the patient doesn't become disgruntled because of the financial part of it and can focus on the treatment that they receive. Allowing you to do the same. That puts a great onus on the front desk personnel and making sure they're clear on the financial policies, but also that they're explaining those same financial policies to the patients. Kevin shares a ton of great information in a short amount of time.
I've got Kevin Cappel of Jet PT Billing with me. I'm excited to bring him on because I haven't had someone who's experienced in billing yet on the show. First of all, thanks for coming on, Kevin. I appreciate it.
Nathan, thanks for having me. I'm glad to hear I'm the first talking about billing. This is awesome.
If you don't mind sharing with my audience a little bit about your professional story and what got you into PT billing?
I started as an athletic trainer. I ended up going back to physical therapy school. I worked for a large corporate entity. I ended up running a sports medicine office for them. I decided I was getting bored with that and wanted to go into private practice. I and a business partner have started our own practice in little old Winona, Minnesota. After about several years, we have been doing some work with a consulting group. I was asked to help a little bit with that consulting group and I started enjoying the consulting part. I ended up selling my interest in the business practice to my partner.
I went and joined their consulting group for about a year and a half. The biggest part that I was doing when I was helping our clients were dealing with their billing issues. I had been the go-to person in our private practice to handle the billing. It came naturally. Finally, after being in a bunch of offices, dealing with a lot of problems, seeing good things and seeing less than good things, I decided it was time to start up a billing service. I left the consulting world and said, "I'm going to start a billing service." That was in 2009. It's been several years of doing that and I'm enjoying it.
I don't know how many of them are out there, but you're a PT that started a billing company. You don't see a lot of that. You see PTs going into consulting or some other aspect of administration. Guys who start billing companies are pretty rare I'd assume, but that also it’s a strength for you.
It is probably rare. I'm not familiar with another situation like that. Compound that with the experience of having been in private practice. It's like, “I've been there and done that.” I know exactly what the owner is looking for and wants and that's what we're trying to provide.
I'm assuming that you haven't got that consulting blood out of you. You do a little bit of consulting with your clients as well as doing the billing services. Are there certain KPIs that you're focused on and looking at when you're bringing on a client or looking at an existing client?
There are and you're exactly right about the consulting. I enjoy being able to sit down with one of our clients one-on-one and help them grow their practice. That has not left my blood. Certainly, one of the largest KPIs that we look at is collection ratio. I like to get an idea of how well they are collecting. I also like to look at the average total days of AR to see how fast are they turning that over? If it’s 35, 40, 50 days or longer, it's like, “They need some help on that.” Those are a couple of big ones and then to look at the AR buckets and see what is current and what's sitting there 60 to 90, 90 and older. That tells a big picture about the practice and how well they're collecting.
I had a goal in my private practice to keep that 90-plus days AR below 10%. I think when you've got a good biller, that's possible. If you don't have one, someone that's settled into their groove as a biller and knows what they're doing, that might be difficult. What do you think about that number?
I agree with that totally. We used that as a benchmark. We break it down even a little bit further. We try to have 5% as the goal for insurance, AR. That leaves a little margin for a patient balances sitting there also on. As a billing service, you want to try to separate the insurance stuff versus the patient responsibility because we don't have as much control over the patient balances as the client does because they're sitting there facing them right up front. That's where having good policy and somebody that's a bulldog at the front desk to collect those copays makes a big difference. We send statements out and we try to follow up on that. As time has gone on, relying on statements to bring that money in is becoming less and less effective.
I like your idea of keeping the insurance AR at around 5% or below because not only do patient balances start getting out of whack, but when you start throwing in liens or worker's comp claims, then inevitably that number is going to get pushed up.
As per Puff Daddy, 'It's all about the Benjamins!', and he's not wrong. As a PT owner, you need to and deserve to, maximize payment for the value you provide. Kevin Cappel, PT of Jet PT Billing shares what it takes to do that @ptownersclub Click To Tweet
When you mentioned liens and the whole attorney thing, that throws a whole another wrench into it because you lose total control over those. There's nothing you can do when it starts getting into litigation. Those numbers need to be factored out because you can't control that. For those practices that have a high volume of litigation stuff, they’re a whole different breed and are going to have a different series of statistics that you may want to look at to make comparisons on.
When you say a percentage of collections, that number can be skewed quite a bit. I'm sure with your clients you have a pretty standard fee schedule, so you should know what your percentage of collections are?
You are 100% correct. That number can be all over the dartboard because there's a lot of variables. The different regions of the country have different allowable that they follow. Even Medicare varies depending on where you are geographical. The other big variable is that practices fee schedule. If somebody has a low fee schedule relative to another practice, it's going to throw that whole comparison out. When you're looking at collection ratios, you can't compare one practice to another if all you're going to use is that single index because there are too many variables.
If someone is going to throw out a fee schedule that's two times Medicare and another practice is going to throw out a three times Medicare or one and a half times Medicare, then there's no comparison to be made. In our practice for the sake of those who it might help, we tended to have our fee schedule around two times Medicare. We were always shooting for collections around 50%. That worked out pretty well for us. Once you have the standard from years past and it's easy to work off that standard going forward and gear your expectations accordingly.
That's a pretty safe standard to assume. That's fairly normal to look at two times Medicare or somewhere in that neighborhood.
Speaking of some of the consulting that you do, what are some of the things that you're coming up against your clients or other PTs that you talk with nowadays at this time of the year?
At this time of the year, it's deductible season. It's that crazy time of year one when there's an awful lot of stress put on the front desk to make sure that money is collected there because it's not going to be coming or at least not as much of it is going to be coming from the insurance companies. Hopefully now, we're getting on the back end of a lot of that. As time goes on, nearly everybody's deductible is going up. It takes longer to fulfill that, which means there has to be good policy in place and people that know how to enforce it to be able to collect that money.
Do you help and train some of your owners or the front desk personnel on how to collect up at the front desk for copays, co-insurance, and deductibles so that doesn't linger and sit out there?
We provide that to whatever degree our clients want assistance with that. We certainly have had some clients where we have met online with their front desk and talked about some strategies. The basis has to start with a strong financial policy that is presented to the patient when they come in for that initial visit. They sit down and read it over and agreed to it. If there are no teeth put into that policy, then it becomes difficult to back things up later on down the road and try to collect what they owe.
We're getting into a couple of things. One is that you need to have a strong financial policy. A lot of us, maybe we pull something off the internet or if LegalZoom has something like that, we'll pull something down and insert our company names into it, not knowing exactly what our financial policy is and what teeth it has. Another part of it is what instruction do you recommend we give or training do we give to the front desk as they hand over the financial policy? If I'm thinking in my practice, it was simply part of the paperwork and the front desk handed it over. They filled it out and turned it in without the front desk saying anything about the financial policy. Do you recommend that they do some training in verbalizing what the financial policy is?
Whenever there's an issue and we have a disgruntled patient, it's a disagreement. When you look at that word, it means there was a lack of agreement. It's a simple process. We've all been there. We've gone into a doctor's office and they give you the clipboard and all of the paper on it. Stick a pen in your face. Tell you to go sit down in the far corner, read it over, sign it and bring it back. They have no clue if you read it. They probably don't care. We've all been in that situation. It lends itself to not caring if that patient reads it or understands it and then we wonder why there are disagreements down the road. The best practices to take that patient into a back room that allows them the security of being able to ask questions, sitting there with them and making sure that they read it. That they don't go pass something they don't understand. They get it all in. Even initialing in different areas to make sure that they read that paragraph because that one might be more important to understand that some of the others. It's making sure they agreed to it. Not just that they sign up, but they understand it. That can go a long way because then they know what's expected.
As you train on this, do you recommend that person that takes them into the back room is the front desk person, an office manager or the PT themselves?
It's not the PT. Having been a PT, we all know that we want to separate the whole money part of it from the treatment. We want to put our attention on treating the patient and let somebody else deal with the whole money thing. I wouldn't recommend that. That's my personal take on it. It should be somebody that deals in the financial area. We can't afford to have our front desk person leave the front desk because we need them there. If there's a billing manager or if it is the biller, depending on the size of the practice, take fifteen minutes with each new patient and make sure that they get this so that we eliminate issues down the road.
I can see the value in this simply because if the patient understands what they're financially committing to, then it's going to resolve disagreements down the road. It allows them to simply focus on the treatment that they're receiving as well. There's a huge benefit in that. Also, it minimizes the discomfort at the front desk of collecting those copays, those coinsurances and the deductibles at the front desk. That person needs to have a mindset and a personality in which it's simply a matter of following the policy that the patient already signed and not be hesitant in asking for that money.
It's easy to ask for that money when that front desk person knows that patient has been told this is what's going to happen. You should expect that you're going to have to pay your $25 copay or whatever it is at each visit. It becomes easy then.
Do you find that the best front desk people that are able to collect the copays, insurances, deductibles at the front desk also have a little bit of salesmanship in them? I'm assuming some of the patient concerns are going to be more PT-related than financial-related.
Typically, you think of having somebody at the front desk as an entry person or an entry position into the practice and it needs to be a whole lot more than that. Being able to wear a sales hat and not understanding from the business end of it but having a little sense of understanding of what goes on back there behind the doors in the treatment area. Having a little empathy for what that patient is going through and has gone through and then we got to pull some money out of them at the same time. It is a pretty complex set of skills that one needs to have at that position to do it well.
That position is so strong. You get what you pay for. I know in our clinic we were typically paying them about $10 an hour and we're having some turnover and difficulty in training them. When we bumped that pay rate up to $13, $14 and above, you’ve got a different caliber of the person at the front desk. They stayed longer. They were more professional. They understood what was needed to keep the practice up and going and didn't need a significant amount of handholding and excessive training. I'm trying to say that as an aside simply because a lot of times you think you can pull somebody off of Craigslist, pay them a little bit over minimum wage and think your practice is going to run great. Those guys, they're handling your money, they're handling the number of patients that you see. That's a valuable position in the clinic that sometimes we overlook.
I couldn't agree with you more. The other component that you expect of them is that they make sure everybody arrives on time for every appointment. That's a whole another thing. When you factor the value of having every patient arrive on time and get to every appointment that they are scheduled plus collect the copays, deductibles and all that stuff over the counter, that's huge. Putting a couple of extra dollars an hour on top of that is awesome and will generate a higher skilled or higher qualified applicant. Another piece of it is certainly there are plenty of practices that bonus or incent their front desk based on the percentage of copays they collect and the percentage of patients that arrive on time for their visits. When you start dangling those carrots in front of personnel like that, it becomes a little bit easier to collect that money.
Maybe you remember a ratio but I remember a few years ago, someone talking about the amount of money you collect per dollar owed significantly goes down if you don't collect it up front. If you have to turn around and send out a bill, essentially you can expect you're going to collect $0.65 on $1 that's owed because you'll have to write off stuff. I might be throwing a number out there that I don't recall. Does that sound familiar?
It is. In fact, I would say it may even be less than $0.65 on the dollar at this point. It's getting more difficult to collect based on statements all the time. It's a decaying percentage.
If you can collect it up front at the time of service, you automatically get $0.50 on the dollar right there. Tell me a little bit then about the financial policies that you see and your clients have and people that come to you. As we're training, we want to make sure that our front desk knows these financial policies and can articulate them clearly. If the policies aren't strong enough, if they don't have the teeth and clarity to begin with, then they can be useless.
Probably the tendency is that most practice owners are afraid to put too much in it because it may scare people away. I'm going to tell you that's not the case. I have never heard of that being the case. In fact, we have some clients that have added policy footnotes and so forth that they require their new patients to provide them with a credit card. They've got that on the account so that if the patient isn't making their payments or when they're finished with therapy and hasn't made their payments, they run the card. One, in particular, joined us not too long ago with this policy. He was afraid to put that in because he thought he was going to lose a lot of patients. He had had two patients that decided not to seek treatment there because of that policy. His comment was "Those were probably patients that weren't going to pay me anyway."
You might think, “That's too bad, I lost two patients.” Two patients compared to the 100 or so that he might have gotten in that month, it's a small percentage. Considering the inability to collect, when you have to send out billing statements, then it's probably not worth the time and effort of the physical therapy involved to not collect on that.
I would say probably the one thing is that the more you can put into your financial policy, the better you are. It doesn't mean that you have to enforce everything that's in it. If it isn't there, you can't do anything about it. The more the merrier and put it out there so that at least that's in.
Is that something that you can help people with? You do billing for PT clinics. If someone wanted the one-off send, "Can I send you my financial policy for you to review and give you recommendations?" Is that something that you provide?
I would be happy to. I'm all about trying to improve the condition of private practice physical therapy. If we can make a small thing like a financial policy stronger for somebody that's going to better their clinic and improve their ability to help their staff and more patients, I'm more than happy to help with that.
If you can give us an anecdote, what are some policies that you see that aren't in there that should be in there or that are in there that shouldn't be in there? You shared with us a little bit about keeping their credit card on file and make that standard policy. Is there anything you've seen that’s a solid financial policy procedures that might be missing?
Certainly, the piece about that we are going to collect the copay. Just a simple little statement that we have a contract with the insurance companies as well and if we violate that contract, we will lose our right to be able to work with them. If you let the patient know that, you have to do this.
It's not negotiable.
This is part of our contract. We don't want to lose our ability to deal with these payers as well. We have to do this. A simple little sentence along that line can go up a long way. You typically don't think of this and in the medical world an awful lot but finance charges. If somebody isn't paying on time, why wouldn't we assess them a 12% or 1% a month finance charge that's going to incent them to pay that bill sooner? If that's not in your financial policy, if they haven't been made aware of that, you can't do that so include stuff like that in it.
For some reason, I was always under the impression that it was illegal to add in interest to a healthcare bill across the board, but that's not true. That's maybe a false idea I have.
It is not illegal to do that. Different states have different stipulations on how high that percentage rate can be. I certainly would advise anybody to check with their state's statutes on that. I can't imagine there's a state that would not allow it to go at least to 12%, which is way lower than most credit cards are.
We're essentially becoming a bank at that point. We covered a ton of stuff and thank you for sharing. Reimbursements are going to go lower. There are more value-based payments coming down the line. What's the direction you see in the PT market for reimbursement?
You're right that the insurance companies certainly are trying to decrease the reimbursement. We're tending to see a trend toward more practices trying to go out of network so they can try to capture more reimbursement with that. I ran across a situation where Aetna has now decided in a few states that they are going to require pre-certifications for all physical therapy, occupational therapy and in some cases some chiropractic for particular states that are out of network. They're again trying to strengthen their leverage to be able to better control those practices that are deciding that their in-network reimbursement is too low. Let's get out of network, but now we're going to further try to hamstring you even when you're out of network.
Do you see some of the practices that you're working with? You work with how many practices across the country?
We have 25 clients currently from all across the country.
Do you see a number of them starting to go out of network here and there with maybe some of the insurances that are a little harder to work with?
I don't know that I would say I'm seeing a trend of our clients going out of network. I'm seeing a trend of new startup practices that are not trying to get in-network because of that and are certainly trying to supplement the traditional private practice with as much cash-based reimbursement as possible.
Do you see a problem with that going down the road or is that something you might recommend people consider?
I don't see that a problem. It would be a problem for me as a billing service. I don't see that as a problem for practice. In fact, I would certainly encourage to try to open up as many different types of revenue sources as possible. Anything that you can do that is cash-based, it totally makes sense to do that.
I can see why guys are doing it that way to minimize the headache and maximize your profits.
The more cash basis your practice is, the fewer staff you have to hire. You don't need somebody to do the billing. You don't need to contract with a billing service to do that. I'm talking to kids in my own business. It totally makes sense because that whole process of playing the game of trying to get paid from a third party is what other business practice does that in the world other than healthcare.
Kevin, you shared a ton of great stuff with us in a short amount of time. Is there anything else you want to share?
As we've been talking about the whole frontend and financial policy and so forth, I would certainly encourage practice owners to sit down on an annual basis and look at your financial policy and see what w what ways can we strengthen it. Evaluate that compared to what problems you may be having with your reimbursement area of your practice. See if there's a way that you can leverage your financial policy to improve that especially at this time of year with deductibles and all of that stuff.
It's a good time to look at stuff on an annual basis for sure. You provide some help and support to your clients. I know if anyone out there hasn't heard my episode with Dee Bills. She does specific training for front desk personnel. That kind of training can go a long way. You can get a great return on your investment there. If you can get that front desk to manage the clinic from the helm, you can see the significant difference in your collections, in your arrival rates and the cancellation rates. You name it. I liked that you brought up that even those KPIs should be incentivized for that post.
We underemphasize the value that the front desk can bring to our practice all too frequently. We touched on that earlier certainly. The more attention that can be given to that area and helping them, shore them up with practice drilling on giving them scenarios of hard to deal with patients so that when it comes to that, they've got it. They've done it before. They know exactly what they're going to say and how to say it and able to get the product that they need and want.
Are you recommending roleplay?
We always hate it. That is some of the best training you can do.
We've all done something new. When you do it and don't do it as well as you wanted to and take a step back and reflect on what you did it, you always say, "I wish I would have said that or next time around I would do it this way." That's what roleplay does and that kind of drilling allows you to work the kinks out so that you know how you're going to do it the next time.
I'm a big proponent of that. If people wanted to reach out regarding the billing services that you provide or even some of the consulting on financial policies that they currently have in place, how would they get in touch with you, Kevin?
The best way to reach me is by email and that's Kevin@JetPTBilling.com.
You provided a ton of great information in a short amount of time. I appreciate you taking the time.
Thanks, Nathan. It was fun talking to you. I enjoyed it very much.
We might have you on again sometime to talk about something else billing-related.
I would welcome that opportunity anytime.
Thank you, Kevin.
Thank you, Nathan. Have a good one.
Kevin Cappel began his professional career as an ATC at a D2 university in MN. He went back to PT school and then worked for a large hospital-owned sports med center and became an office manager. In 2001 he opened a private practice with another partner and grew that. In 2007 he sold his interest to his partner and joined a consulting group and worked there for 1.5 years. During his time there he helped many practices, and in particular with the billing area of their practices. He realized that he was pretty good at sorting out those problems and so decided to create his own billing service and that is how Jet PT Billing came to be in 2009. Jet PT Billing currently has 25 clients from all across the US.
Dee Bills, PT, spent a year perfecting her clinic's front office procedures and now has it down to a science. Dee found Front Office Guru in 2016 and now specifically trains front offices to optimize the patient experience, the arrival rates, and, thus, the collections at the front desk. In doing so, she has been able to turn around clinics that were severely under-performing to eventually achieving more than 95% arrival rates week over week. Dee has systematized her processes and is willing to share some of them in today's episode.
We all know how important the role that the front desk plays in our clinics. In fact, we know that the front desk can have a significant positive and negative impact on our clinic’s efficiency, patient experience, revenues, and arrival rate percentages. No matter what kind of physical therapy we provide, good or bad, the front office can many times dictate the experience that the patients have and the revenues of our clinic. I decided to bring on Dee Bills, the Owner of Front Office GURU to talk about some of the things that she recommends that we do to make sure that we have a well-run front office team.
Dee has been a physical therapist for over twenty years. In 2004, her husband achieved his career-long dream of owning an outpatient physical therapy practice. In 2011, they recognized that significant changes were happening in healthcare in general, declining reimbursements being one of them. They decided to get a business consultant. I'll let her share the story as to what eventually led her to really focus on the front office, but over really perfecting and systematizing their front office procedures, she recognized that they got results of over 95% arrival rate, which is amazing. In 2016, Dee realized that she wanted to help others also obtain the same success and founded Front Office GURU. She offers front office training programs in practices across the United States and Canada. I for one am really excited to have her come on and share some of her secrets as to what it takes to have a well-run and efficient front office team.
One thing she mentioned was, “We get what we train.” That can be applied to every position that we have on our team. Specifically, I know Dee trains her front office staff for over twelve, fifteen weeks I believe. From past experiences, I think that's about eleven to fourteen weeks longer than I train my front office teams. If we really want to make a significant impact on our practice, we really have to focus on our front office teams because they can be the face of our clinic no matter what kind of physical therapy we provide. Let's see what Dee has to offer and what she recommends we do to improve our front office teams.
I have Dee Bills, a physical therapist out of Virginia, the Owner of Front Office GURU, who has made it her mission and focus on the front office and we are going to talk about that. Thanks for joining me, Dee.
Thank you, Nathan. I'm excited to be here.
Thanks for helping us focus a little bit more on the front office. We spent a lot of time focusing on management styles and owning your practice. One of the greatest effects that any of our team members can have is at the front office. Do you mind sharing a little bit of your story, where you came from and what got you to the point where you are now?
I was a physical therapist for under twenty years when my husband had recently purchased our PT practice and he was running it. One of the big things we noticed was that insurance was decreasing and declining reimbursement. We had a ton of decrease in referrals from doctors because they all had their own PT practices. We knew that if we didn't do something, we weren't going to really be there anymore. We weren't going to survive at the level we wanted to. I came away from treating patients and started working in the practice. We happened to get some consulting ourselves and the practice started to expand and we went to this financial course. The gentleman that ran the course was talking about finding areas of inefficiency in your practice. It was something that really hit me. As I started to evaluate things, I was watching us bleed money from our front desk.
I took over the front end of our practice. I worked side by side with my front desk staff. I started to learn what worked well with patients and what didn't get the result we were looking. The things that they were saying that really weren't getting good results. It was very evident that we were bleeding money with patient arrivals. We weren't capturing patients like we could. We weren't collecting what we should. I started to write policy in our practice and put in measures that worked. Lo and behold, our arrivals went to 95% every week. We are capturing 90% to 95% of the patients that we’re calling in for evals. We started to have a great machine on the frontend.
You said you were bleeding at the front desk. Was it simply that maybe they weren't collecting copays, they weren't following up with patients to make sure they were following their plan of care? Is it those types of things that you're talking about when you say bleeding at the front desk?
Yes, we were bleeding visits. A patient would call and say, “I'm not going to able to make it now.” My front office would say, “No problem. We'll see you on your next visit.” What ended up happening was, “We need to get them in. We need to handle them.” One of the big things I hear a lot is, “Can you tell me your hours?” The front office will immediately jump to tell somebody their hours. What ends up happening is there's this dead air and the front office says, “Is there anything else I can help you with?” The person will go, “No,” and then we've lost a new patient. That was a big thing for me. I was in another group online and there were a lot of people that were asking me, “How do you do that? How do you get 95% arrivals? How do you get your evals to show up?” I was helping a lot of people. I realized that my practice didn't need me as much anymore as it used to. It’s running really well. I missed helping people. I wasn't treating anymore. That's how Front Office GURU was born. I decided to start helping owners have the same success that we were having.
As you were doing this and with the successes that you had, did you find that simply implementing the processes made a major difference? Did find that you had to find different people and train them appropriately?
It's a little bit of all of that. It comes down to having the right person in place, having set processes and systems that work and get results. The third thing is training your staff and putting that effort into making sure your front office staff is as skilled as your clinical staff would be in their duties.
As you went through implementing some of these systems, processes and training people, that was probably a good way for you to filter out who was going to stay on the bus and who you need to kick off?
We still go through that now. That's really important to not be agreeable to someone who's not on board with you. It's being able to handle that employee well and setting parameters. We were just talking about that in our clinic about you set a parameter, they have to do this within two weeks. If they don't, it's time to go because you don't want to waste a month on somebody who isn't willing to do what you need them to do.
Is there a way that can filter out those people ahead of time? Are there certain personality types? Is there a part in your interview process that lets you know if that front office person is going to work with you or not?
One of my biggest pieces of advice is to have a system that works for you and not alter it. We are really big on testing from day one. The testing comes from us. We don't pay for online testing any longer. You have to know what you're looking for. If you don't know what you're looking for, it's hard to find them. You’ve got to lay that out. It's one of those things that we forget. If you don't write down what you're looking for, it's a lot harder to find it. You don't have the same certainty, but when you write it down, you now have the certainty of what you're looking for. What's your ideal employee look like? It’s just like we all know what our ideal patient looks like. What is our ideal front office employee look like? Do they have previous training or don't they? Are they good at sales? Are they friendly but at the same time can they manage people? Once you know that, then you have more certainty about what you're looking for when you're interviewing people. The biggest piece of advice is to test them. Put little challenges everywhere and if they can't follow challenges in writing, it's very likely that they're not going to be able to handle a verbal challenge.
I was a neuro PT for a long time and we talk about single-step and multiple-step commands. Your employee is the same thing. If your employees can't follow a single-step command, they're not going to be able to follow multiple-step commands. Our whole day is multiple-step commands, “I need you to do this and then I need you to do this.” If they can't do it in writing, they're definitely not going to verbally pick up what you want. We put challenges in everything we do in our hiring process, even our PTs but our front office especially. They don't have the same previous training and skillset. The PTs go through five, six years of schooling to get where they are. Your front office hasn't necessarily done that. A lot of them fall into the job that they ended up by happenstance. They don't go, “I'm going to do that forever.” It's a big thing to look for throughout your process.
Going back to looking for that ideal person, it hit me while I was at PPS. Brian Hart has mentioned how we oftentimes put out an ad and list the basic minimum requirements, “Can you breathe and answer a phone? Can you type at least fifteen words a minute? If you can meet these criteria, then you're qualified for our job.” Instead of saying, “We've got high standards and these are the standards. Number one, here are our values and our mission. This is our purpose. You're going to be expected to handle a ton of calls. You’re going to handle a ton of patient complaints. You're going to be asking for money when people don't want to give it to you.” Instead of really laying out what our ideal candidate would look like or ideal employee is, we instead list the basic minimum requirements and put it out on Craigslist and then we're disappointed with the replies that we get.
Years ago when I started helping Mike in that position, I went through eight employees in a year and I was like, “Enough, this is insanity.” It was the hiring process. I posted an ad, I get 150 resumes for the position and then I'd be upset when I was wasting all this time trying to hire the right person. We have a set of challenges that we put out there in the ad. If they don't follow those criteria, we don't even respond to them. We'll have lots of them call and be like, “I didn't hear from you.” Our front office is trained to say, “If you haven't heard from us, it means that you probably didn't follow some part of our process and we wish you the best in your job search.”
You'll put a challenge in the ad itself?
Yes. Why waste my time? I don't want to read 150 resumes. I want to look for, “Did you send me a cover letter? No, okay you're done.” There are just simple things you can do. I was just working with the young lady that's taken that over for me in the practice. The more discerning you are in what you're looking for, the more you challenge them, the more likely you're going to weed out all of the people that are just looking for a job versus, “I want to work somewhere and make a difference.” That's something really important.
Another thing because this really applies and it's important, they are not your front desk, they are not your front office, they are your patient care coordinator. It applies to what you were just saying about collecting money, managing the schedule. They are not a medical receptionist. You get what you title them. It's really important to give them the title of patient care coordinator so they understand that their job is to coordinate the patient's care. It's not your PT’s job. Your PT provides the care but your frontend, your patient care coordinators, they coordinate care. It makes a big difference. I've worked with PTs and vets and it makes a huge difference what you call them because they focus on the wrong thing. If you call them a front desk they think, “I'm just here to answer the phone.” Answering the phone is such a minute part of what they really do. That's a big part of it. That's something to look at if that's not what you're doing in your practice.
We were talking about it before that it's such a huge part of the business. If there's a disconnect between the physical therapist, the owner, whoever's working at the front desk and coordinating patient care, there's a ton of money that can be lost. That lends to a bad reputation, if patients aren't getting better or if they're not happy with the collections processes. “I wasn't told this is what I had to do beforehand.” A lot of that can look bad on your clinic in spite of how good your physical therapy is.
They’re first and last point of contact that any patient will ever have with your practice. The very first contact could be the very last contact if they don't handle that patient properly. Especially for smaller practices, for owners that are treating all of the time, they don't get the opportunity to hear what's being said, what's not being said, how it's going. Before they ever see that patient, they could lose that opportunity. That's where I focus the most on is lost opportunities and how to prevent them, how to script things the right way so that the front office has that ability to handle patients, to coordinate a patient's care so that the PT can provide it and not worry if the patient's showing up or not or if they're scheduled or not. That's not in their job duty, believe it or not.
What do you tell the owner practitioner, maybe he has a little bit of support staff and he's got a front desk person that he is not totally happy with? What's your first recommendation to them? Is it to focus on your processes and showing them up or go back and find a better person who has got a little bit more fire in the belly?
In one of my blogs, I talk about the willing and able employee. The ideal employee in your practice is somebody who's both willing and able to do the job that they're hired for. There are two parts to ability. I have the ability. I can do the math, I can handle people. There's the ability that we provide them. This is a big one and this I see a lot. We hire people who say, “I have experience.” We put them on the post and we don't train them in our expectations. We don't make sure that they can handle the objections and they're not scripted. We assumed that because they have experience from somewhere else that they can do that. We get what we train. The first thing I recommend for owners is to listen. First of all, you have to listen and hear what they're saying so you know where they're out, meaning they're not following what you would want them to do or able to do that. You want to train them.
Just like with a patient, if a patient cancels the first time, I assume that we did not handle them properly and train them on our policy. It’s the same for an employee. If an employee messes up or isn't doing things, you have to go back and look at your policy first, to make sure that you have sorted out your training processes, that you retrain them. We retrain once. If I retrain you on something once and you can't do it, then we sit down with them and we really have a conversation, “Do you see yourself lasting here? Are you invested in this? What are your goals?” My husband is amazing at being able to sit down with an employee and run this with them. They'll usually say, “I don’t want to be here,” or they'll say, “I'll do whatever it takes.”
The next thing I would say is after looking at your training, lay out your expectations for the position. A PT knows exactly what they need to do. See the patient, treat the patient, and help the patient. The front office has a very extensive list. One of the things I learned when I started working in my front office is, we as PTs really didn't learn what it takes to run our front office when we were in school. When we hire people, we have a tendency to hire people thinking that they're either going to know how to do it or their experience will help us. A big part of that is laying out what you expect of them. If you don't lay out your expectations, you end up getting what you get, which is somebody who isn't necessarily directed the way you want to go.
I hear that often from owners and managers that they're not doing it. I say, “Tell me what their job duties and expectations are.” A lot of times they're not very specific themselves and that breeds exactly what they're getting, which is an employee who's like, “I'm just doing what I got to do.” If you ask your front office what their job duties are, they will tell you that it's answering the phones, faxing, filing, scheduling patients. They won't say to you, “My duties are coordinating the patient's care to make sure they get in for care and that they understand that we're here to help them.” It's a huge eyeopener.
They'll usually list off a bunch of duties that they do in order to complete their tasks. That's how they'll define themselves instead of looking bigger picture and saying, “My job is to coordinate the patients care so that they achieve their physical goals and make sure our company has collected everything that is due financially on our end as well.” They don't look at a broader perspective like that. They go down their list of tasks that they needed to perform that day. Their job ends up becoming a checklist instead of really focused on getting the product that they're there for.
It's helping them understand their product. A lot of times if you go up to your front office, any of your staff and you ask them what their product is, they don't necessarily tell you or they get confused. A big thing that I work on with companies, owners and their front office is, “What is the product?” We shifted away from all the fancy words and everything because as an owner, we understand that. Even your clinical staff don't understand that. We started focusing solely on people helped as the product of the practice. If you look at all the stats that you measure, they actually in each department are a representation of how that department helps people.
When we shifted, we still have valuable final products of our practice. We teach our staff what their valuable final product is as these people helped. When we put our entire staff on it and we showed them how their stats or metrics are equivalent to people helped, they are much more focused on helping people than they are on a number. When they can equate 95% arrivals to, “95% of the patients that I worked with this week understood that they needed to get in for their care. They can't cancel at the last minute or affect somebody else.” What ends up happening is you see them winning. They look at their stats differently. They're more driven toward achieving higher. We've grown exponentially in 2018 just like we did it years ago. It really was because we hired people that wanted to focus on people helped.
We talked a little bit about and maybe you've done some of the research yourself at how that front office person or patient care coordinators, how much money they'll actually lose the clinic. You might think that the physical therapists aren't charging enough or maybe they're not seeing their patients more than two times a week, which has been shown to improve patient care. Have you found how much money can be lost at the front desk if they're not trained and working properly?
A lot of times too we focus on arrival rate. If your arrival rate is not running in the 90s, you're losing a lot of money every year. On top of arrival rate, if you look at new patients and you look at that new patient phone call, if you called in or had somebody call in, the average front office will get through that phone call. They think they have to get through it quickly but that's the most important phone call that will ever take place for your practice. Some of the things you'll hear is, “What are your hours?” The front office will say, “We're open from 7:00 to 7:00 every day.” There's this dead space and they say, “Is there anything else I can help you with?” The potential patient will say, “That's it.” Every now and then they'll say, “I'm ready to schedule.” Most of the time we're not handling that shopping around the patient or, “Do you take my insurance?” Instead of converting them right then and there. The thing to remember is anybody who calls your office that is not a current patient should be a patient. Nobody picks up the phone and calls your office to ask a question if they don't need your help. They may not be ready to confront the fact that they need your help but they need your help. That's a big part of it.
I started talking to PT owners and veterinary practice owners. They all agreed it was probably on the low side, that the average practice loses probably ten potential new patient visits a week. If you do the math, let's go with $100 reimbursement, which is a little bit high for the national average, unless you’re in Alaska. The potential loss to your practice for the full plan of care is close to $400,000 to $500,000 a year to a practice. When we started focusing on that, we were able to ramp up our ability to capture that. It's a big thing I focus on. A lot of times we focus solely on a rivalry, but we forget that we market.
For those of us that are doing a lot of internet marketing, which in our area, all of our doctors have PT practices. Our marketing is either to pass patients to the internet. One of the things that you will find is that they’re a little bit harder to convert. If a patient care coordinator does not know how important that call is and how to really convert patients on that call, you're losing them before you ever got them. It doesn't mean they're not going to try to call back again but usually by then, they are a lot worse. It's helping them handle that and training them how to handle that will be the most valuable thing to any practice.
You really do some training and even letting these candidates know that they're going to be essentially salespeople. There's got to be a part of that within them that says, “I know you're just asking about hours but you're not calling me because you really want to know our hours. What you're really calling me about is what we sound like on the phone. How do we treat people over the phone? What specialties can you sell me on that might help my particular condition?” The front desk can do a lot of that because the physical therapist can't. Do you do a lot of training on that then? You mentioned that the calls were too short. Do you tell them you need to be on the phone for a certain amount of time or these are the certain questions you should be asking to follow up?
The first thing I teach them is the importance of that call. That call is the number one most important thing. When you rush through that call, you just get my name, my phone number and you give me a time, you're not helping me to buy in. The most important thing the front office needs to understand is that these people are reaching but they're not reaching at the same level as somebody who says, “I have a script, I want to come in and I want you to fix my problem.” Those are your ideal patients. Every front office will tell you that's their dream patient, “Fix me.” They're easy, they're nice, they'll pay whatever, life is good. The average patient is reaching but they're not ready to reach in. I know you did an interview with Shaun Kirk and he's a mentor. One of the things he taught us a long time ago, and you've probably heard this too from him, is he used to do these evals with his patients. He'd say, “Do you believe you can get better?” If the patient said no, he’d be like, “I'm sorry to hear that.” He would escort them out because they were telling him they didn't believe you could help them. They don't even get to your PT if your front office doesn't handle them.
My new patient program really teaches the front office how to handle patients from day one all the way through a scheduled-out plan of care. It teaches them the right question to ask and how to ask it. I teach them that you don't answer that question until you've asked my questions, until you've run them through. I don't have any way of handling you. If I say, “We're open from 7:00 to 7:00,” and you're like, “Thank you so much.” I could say to you, “Would you like an eval at that point?” You could be like, “No.” I teach them how to handle a patient and establish a system that can be used over and over again as the practice expands. We've gone from one front office to now we're getting ready to hire our fifth in our clinic. Our patient care coordinators, they have different levels. That’s important to be able to expand and not have to remember all the things you have to teach them. Make sure that they can literally get on a call with a patient and recognize that this patient needs help. Recognize that, “The patient may not be reaching as hard as I want them to. It's my job as the patient care coordinator to get that patient reaching harder and acknowledge the fact that life is not going to be good if I don't fix my problem.”
Have you used a private shopper or someone who has called to assess the capabilities of your front desk in the past? Have you used one on your practice or have you done it for other clients as well?
Yes. It's actually part of our hiring process. We’ll teach somebody how to handle a patient and then we will either have them call a “patient” or it's usually one of our staff who's on a cell phone in another room. They don't know that though. We'll have a “patient” call in and have them handle it. We have secret shops. A long time ago when I was running my front office, my mother-in-law called me one day and said, “You need to call the office.” I'm like, “I'm on my way there now.” She goes, “You need to call the office.” I was like, “Okay.” I called the office and recognized that Eeyore was working at my front desk and was like, “Good morning.” I was like, “We’re in so much trouble if I don't handle this.” I find it's really good for the owner, “Why don’t we call our practice?” It's really good for the owners and managers to call your practice from time to time or have a family member do it.
I have called other practices before. Usually what I do is because I work one-on-one with most practices, we get on video conferences once a week. I will drill with them and I will be the patient care coordinator and let them be the patient first and then I will make them be the patient care coordinator and I'm the patient. We're really working off all the scripts that I've provided. It's a big part in your practice. If you don't drill with your staff, they won't ever get better. It doesn't matter what you hand them to do if you don't practice it. It's like PT school, you could not do an anterior move on a shoulder until you had drilled that with your professor 100 times and your partners are like, “That's a grade four stop.” We all laugh about it. It's the same for your front office.
Remember, they didn't go to school for this. They may come from somewhere else. Most of the time, staff come with bad habits they picked up somewhere else. They don't necessarily come with the experience that you really need in your practice. That's really important to remember if you want somebody to be successful. Remember a willing and able employee part of the ability is I make sure you're able. I'm back in my practice, training up a new team member. It's amazing to see how we drill. She is awkward because it's like, “I have to play act with you.” I walk out front and I listened to her on a call with a patient. I watched her reviewing policy with the patient or going through something with a new patient. It's just so much more on point because we took the time to drill it and really make sure she could do it before I said, “You're set free. Have a great day.”
Do you audio or video record and feedback to them to give them pointers?
Yes. Everything is video. They can record all of our calls so that they can take pieces or all of it and train future staff or current staff. I provide all of the drills. If I give you a script, I don't just give you a script, I provide the drill as well. A lot of times the owners are like, “Okay, great.” When I give a script, I'm very adamant that you shouldn't change it. I know for a fact it's tried, true and it's tried by me. It wasn't my front office to try this. I worked my front office for six months next to my Eeyore and Eeyore did not improve. He needed to leave and then I work for three more months with two women side by side. That's where a lot of these systems came from. When things didn't work or didn't go well, I went back and change them until they worked. I learned how patients speak. How to speak to somebody to get the result I'm looking for. I can tell you even in our practice when one of those stats goes down, it's always related to something not being done or said to the expectation that it was trained at.
My staff knows how to go back and fix it versus me having to, “Let's drill it again.” Usually, I will find them drilling. That's the goal. Every owner's goal is to put it in now but not have to keep putting it in over and over again. If you're constantly having to train and retrain, hire and rehire, give me a call. I don't want to see it. It's such a waste of time. I don't know about you, Nathan, I look at Mike and when he tested drop down into the organization, we all want him back out again. Go be an owner. We don't want you working down here because things don’t go very well when the owner drops down and gets involved. It's like, “Go back and be the owner. Dream for me.” That's a big thing as owners, I don't want you to keep dropping down into your organization to train and retrain staff.
You’ve reached an ideal scene there. It blows my mind to think that these patient care coordinators know what statistics they're supposed to provide and report. They also are self-correcting. That blows my mind. Every employer's dream is to have a team member that knows their stat. When that stat goes down, without talking to you about it or even before you mentioned anything about it, knows what they need to do to go back and train themselves to get their statistic back up. That's a different world.
It was my dream. It was something that I learned a long time ago and when we received our consulting. Also when I told you I went to that financial course, it was to build a machine that you can walk away from for a month and it runs itself and fixes itself. That hit home so hard for me. Mike and I at the time were working 60, 70 hours a week. That was not an ideal scene. Our kids were like, “You guys are at home and you're talking about work again.” Now our kids are like, “Did you go to work today?” We're like, “Yes, we did.” They're like, “Really?” It's a different scene for us. Don't get me wrong, when you have new staff, it is difficult to find quality front office staff. Everybody I've talked to is struggling with that and we can say, “The United States has a 3% unemployment rate.” When you look at that in reverse as a business owner, it also means, “I'm scraping the bottom of the barrel unless I get lucky and some amazing person is looking for a job.”
You want to be as discerning as possible who you hire. If your Spidey sense says no, listen to it. You have to have challenges in place and challenge them. If you don't know what to do, call me. I can help you with that too. Even larger practices go through that. I've worked with several larger practices and some of them I've known forever. We've laughed about certain things that might've fallen out or we could make better. We put our attention on it and we put some systems in place. The next thing you know, it gets better. It's when you are always coping that life doesn't get any better.
When you can finally organize and systematize, things just tend to improve. Dee, thanks for your time. If people do want to reach out to you, how can they get ahold of you?
If you go to my website, FrontOfficeGuru.com, there is a link where you can schedule a free call with me. You can sit down and talk about your front office. I do offer three different programs. One is the hiring and recruiting program for the front office. The other is front office training for both new patient program and patient arrivals, which patient-inpatient program handles everything in a new patient. You can really capture, manage, control that new patient situation. The arrivals program handles everything after that. How to build schedule efficiency? How to increase your arrivals and really manage your patients? This is for the front office, for the patient care coordinators. It's also for the owner because when you work one-on-one with me, I actually provide you a course pack which becomes your training manual. The purpose of you not having to work with me again, you take away the skills of everything they teach you in so that you could train up an employee in two to three weeks. It doesn't take us that long. It takes us much longer. It takes us roughly about fourteen or fifteen weeks because you get breaks in there to implement stuff. I give you all the implementation that you need to do. I provide all the training. I work one-on-one with the clinic so that the end result is your stats go up, and you and your team have such a better condition.
The patients are happier when they have a good front office.
Yes, they are.
Thank you much for your time and sharing some of your insight into making our front offices better. It can be such a huge boon to the clinics if they can really get a handle on what needs to happen at the front desk. I really appreciate you sharing.
Thank you so much for having me, Nathan. If you haven't figured out, I'm very passionate about what I do. I really enjoy working with a private practice, especially physical therapy because it's near and dear to my heart. The ultimate goal is the survival of private practice owners. I love working with my practices. You become part of the Front Office GURU family basically. It's important to me just like it was when I worked with patients.
Thanks for sharing. Hopefully, we'll see more of you in the future and bring you on again sometime.
Thank you so much, Nathan. I wish everybody the best and I hope to hear from some of you.
I started my career as a physical therapist and spent over 20 years working in patient care. In 2004, my husband Mike achieved his career-long dream of owning an outpatient PT practice. In 2011, we recognized that with the impending changes in healthcare, we wouldn't survive without making changes and improving our practice efficiency and expanding our reach. We began working with a business consultant and I took over the front end of our practice.
While at a financial course, the speaker talked about building a well-run machine and to look for any inefficiencies that were holding us back. I immediately realized that our front office was bleeding visits, and this was affecting expansion and revenue.
So, I took over management of the front office. Over the next year, I worked at our front desk as a Patient Care Coordinator and learned what it took to properly manage patients. I developed reproducible front office training and systems to increase efficiency, organization, and patient control. During that time, our patient arrivals rose to an average of 95%!
In 2016 I realized I missed helping others, so I founded Front Office GURU to help other practices have similar success to ours and recognized my true purpose. I now offer front office training programs to practices across the US and Canada.