3 Must-Haves for Credit Card Processing | Q&A from the Webinar
If your practice currently accepts credit cards, or if you are considering incorporating them into your payment options, you likely have questions regarding the policies surrounding their use. To help you get the answers you need, we have compiled all the questions that were asked during our recent webinar, “3 Must-Haves for Client Credit Card Processing,” along with the presenter’s responses. Feel free to add any new questions in the comment section below. Q: What is PCI? A: PCI compliance stands for Payment Card Industry compliance. This is the regulation that the federal government puts on the credit card industry as well as merchants who accept credit cards. Similar to HIPAA in terms of documentation and patient record-keeping, PCI is the regulatory board that oversees all aspects of credit card payments. Q: What sort of fines do practices face for non-compliance? A: Most people don’t realize that they can be fined up to $2,500 per card that they’re not handling properly. So if you see 400 patients over the life of your practice, and you handle those cards improperly, you would face $1 million in fines. A big company like Target can handle that, but for most medical practices, that would put them out of business. Q: What percentage of medical offices are PCI compliant? A: An estimated 95 percent of practices are not PCI compliant, in one way or another. Q: How do I know if my office is PCI compliant? A: The first year you set up with a merchant services company, you have to take a PCI compliance survey. Then there’s a yearly survey after that. If you haven’t taken some sort of survey, or don’t remember taking one, chances are, you’re not compliant… and there’s a 100 percent chance that you’re being charged a monthly fee. That fee can range from $20 to $100 a month. Learn more about how CredEdge simplifies credentialing and protects your revenue: Schedule a Free Credentialing Consultation Book a Consultation
3 Must-Haves for Credit Card Processing | Q&A from the Webinar
The Safest & Quickest Way to Become Debt-Free
by Garrett B. Gunderson with Dale Clarke The Counter-intuitive Formula Your Financial Adviser Doesn’t Know Hint: It’s not about your loan interest rates, nor is it just about socking away more money by cutting back or even just about saving money on interest. As a financial advocate to professionals, I deal with this issue frequently with the business owners we work with. You want to get out of debt so you can reduce your risk, increase your cash flow, and have greater peace of mind, right? Unfortunately, in a zealous effort to get out of debt, too many people make critical mistakes that increase their risk and make the process much slower than it has to be. It’s not just a matter of prioritizing which loans should be paid off first. It’s also a matter of minimizing your risk throughout the process. Here’s the fastest, safest, and most sustainable way to do it: 1. Build Savings First. It doesn’t make any sense to start paying extra on loans until you have at least three months of income, and ideally six months, in a liquid savings account. If you have no cash reserves, what happens when you pay down your loans but then experience an unexpected cash flow crunch? You simply increase your loan balances again or even worse, miss payments and hurt your credit score, therefore getting charged more for future loans and you can miss opportunities to lower your interest rates. So before you even get started with paying down debt, build your cash reserves first. This puts you in a much safer and more sustainable situation. Don’t worry if you are wondering where that money might come from, details to follow, read on. 2. Raise Your Insurance Deductibles. Once you have cash reserves you can raise your insurance deductibles and extend elimination periods, which decreases your premiums, an extra benefit of having money in savings. This increased cash flow can then be used to strategically pay down debt. I recommend using your home, auto, and liability insurance to primarily cover catastrophic losses. With higher deductibles (again, assuming you have cash reserves to cover small losses) you’re less likely to make claims, which prevents increased premiums. The larger principle here is that when you approach debt elimination the right way it affects almost every other aspect of your finances. This is a more comprehensive approach that takes every factor into consideration, rather than looking at your debt in a vacuum. 3. Restructure Your Non-Deductible Debt by Rolling Short-Term, High-Interest Loans into Long-Term Tax Deductible, Low-Interest Loans. Again, the goal is to minimize your interest payments and maximize your cash flow. Then you can attack your remaining debt strategically, using your increased cash flow to eliminate one loan at a time. Another benefit of this strategy is that it improves your debt-to-income ratio, which then improves your credit score, which can then be used to negotiate lower interest rates and will result in increased cash flow. Having a better credit score also gives you more negotiating leverage. You can look into a streamline refinance on your existing mortgage. You can call your credit card companies, for example, and tell them you’re considering canceling and switching. They may be inclined to make their interest and terms more favorable for you, especially if you have a higher credit score. Assuming you have enough home equity and after improving your credit, refinance your mortgage and roll as much of your non-deductible loans (credit cards, auto loans, etc.) into it as possible. The tax deduction will also increase your cash flow. CAUTION: Do NOT do any of this if you’re undisciplined and your spending is out of control. If you’re just going to charge your credit cards back up again, you’ll just sink deeper into debt. 4. The Secret Sauce: Cash Flow Index. Here’s where the rubber hits the road. After minimizing your payments and maximizing your cash flow, you’re now prepared to focus on one loan at a time, thus creating the “snowball effect” until you’re completely debt-free. Most financial advisers and pundits will tell you to pay off your loans with the highest interest rates first. My advice is to ignore the interest rate and use my proprietary Cash Flow Index to determine which debt to pay off first. To determine your Cash Flow Index, take all your various loan balances and divide each of them by their respective payments. Whichever one has the lowest number is the one you should pay off first. For example: Home Loan Balance: $228,000 Interest Rate: 7% Monthly Payment: $1,665 Cash Flow Index: 137 ($228,000 ÷ $1,665) Auto Loan Balance: $16,500 Interest Rate: 8% Monthly Payment: $450 Cash Flow Index: 37 Credit Card Balance: $13,000 Interest Rate: 12% Monthly Payment: $260 Cash Flow Index: 50 Student Loan: $107,000 Interest Rate: 3.9% Monthly Payment: $650 Cash Flow Index: 165 In this example, it seems to make sense to pay of the credit card first because it has the highest interest rate. But the Cash Flow Index reveals that the auto loan should be paid off first. The trick is to pay off debt that gives you the greatest cash flow with the least investment. A high Cash Flow Index means your loan balance is high relative to the payment, while a low Cash Flow Index means your balance is low but with a high payment. Knock out those high payments first and you free up cash to work on other debts. In this case, by paying off the auto loan first, you free up more monthly cash, which can then be applied toward the credit card balance. Paying off the auto loan first means you can pay off both faster than if you started with the credit card. 5. Address the Risk Factor. Again, this strategy isn’t just about paying off debt faster and saving money on interest—it’s also about reducing your risk. Banks and other financial institutions tell you to pay off debts that lessen their risk
How to get out of debt without giving up your life
Strategies on paying off debt faster, paying banks less interest, and having some fun along the way. by Garrett Gunderson The key to getting out of and then staying our of debt isn’t just about working harder and limiting your spending; it starts with the proper mindset. To dig a bit deeper, the root of debt comes from consuming more than you produce. It is critical to be clear about purpose and how to produce in order to stay out of debt. One must always produce more than they consume. Without discovering where there may be a scarcity mentality or limiting beliefs, debt will be a constant companion. Once you have recognized and have begun to conquer the scarcity mentality around money, then you’re ready for the tools that can help you with being efficient on paying off and understanding your debt. One of the most effective ways to approach debt is to use the Cash Flow Index. The CFI is a scoring system to help you identify the efficiency of each of your debts. This scoring system will allow you to pay off the most inefficient debts first and then allow you to prioritize the order to maximize paying off your debt. Here’s how it works. Take the balance of the loan and divide it by the payment of each debt. The resulting number is the CFI rating. The lower the number, the less efficient the debt is and the sooner you should pay it off. To pay off debt as quickly as possible, pay the minimum on all debts except the one with the lowest score. Then take all other available ‘pay down money’ and pay it toward the least efficient debt. Once it’s paid off move to the next lowest score and pay it off. Rinse and repeat. Each time a loan is paid off your debt-to-income is improved. This is the percentage of each dollar you earn that is required to be paid towards required loan payments. When this is improved, your credit score can be improved as well. With less debt load, lower debt-to-income, and a better cash flow scenario, it is time to get better interest rates. Talk to your financial institutions after paying off a loan. Refinance, replace, or restructure. Now with your interest savings, the same payment will go further with paying down principal. Create small rewards and celebrate the victories along the way. You will feel the progress, live better, and have more fun. This isn’t just about sacrifice and delay, it is about living! This is one small piece of our greatest area of expertise and result. Cash Flow! To learn the very strategies we have taught our members and saved an average of $2,484 per MONTH, check out the Curriculum for Wealth by going to www.freedomfasttrack.com/cfw.
Finding a Standard of Success
“How are you doing? How are your KPIs?” On a personal level, that question seems easy enough to answer. But when it comes to your practice, it’s not so simple. With so many factors in play — from patient visits to billing, from revenue to workflow — it can be a challenge to have everything go smoothly at the same time. Not only that, but it’s difficult to determine a proper standard by which to judge your practice performance. Ultimately, your bottom line depends on multiple Key Performance Indicators (KPIs) that together paint a picture of your business. A quick comparison of your KPIs to industry standards may also point to potential opportunities to increase cash flow, identify areas for potential growth, and even improve employee morale. One of the first KPIs to consider is Average Visit Duration. This is not merely the amount of time you spend with a patient, but also includes the time that you spend on billing, documentation, scheduling and other “overhead” related to that patient’s visit. For chiropractors, who tend to see many patients for brief visits, the Average Visit Duration highlights — once you subtract the time that’s actually spent on patient care — how much is wasted on the “busywork” of running a practice. Another KPI that’s a key concern is Annual Patient Visits (APV). This figure is derived by dividing the number of patient visits in a given year by the total number of patients seen during that year. An APV that is substantially lower than the industry average suggests that too many patients may be terminating their treatment before they complete it — and that could be seen as a compliance risk. On the subject of revenue, it’s a good idea to look at your Pay Per Visit (PPV). The PPV is the average pay for all of your services that you receive for one visit — including both the patient’s copay and the insurance reimbursement. In order to calculate your average PPV, just count all the payments you received over the course of one month, and divide it by the number of patient visits you had in that month. When comparing your PPV to the industry average, a lower number indicates that you are likely not getting fair reimbursement from insurance companies. And finally, if you take your APV and multiply it by your PPV, you get the PV, or Patient Value. This amount reflects the total payment for a single patient over the course of a year. In and of itself, a low PV doesn’t present an audit risk, but it does pose a different kind of problem: When your PV dips below a certain level, it’s your bottom line that suffers, and it becomes more difficult to stay in business.
Ripe for Success
Software solution promises to be the “secret ingredient” By Kathleen Casbarro Will Ben’s new tech solution lead to the perfect outcome? “So…?” Carmen asked with an upward lilt that made it into a question, “how’s the documentation going?” “Thanks for asking,” Ben said, dropping a kiss on her nose. “I think it’s going to be good. You know I’ve been going back and forth a bit on how to approach the need for greater specificity in our documentation.” Carmen rolled her eyes. “I’d noticed. But I can see why, too. It’s hard to know exactly what you need to do and what the consequences are likely to be.” “Turns out the new software we’ve been looking at has an internal auditing process. Basically, I think we can work with the coaches to find out just how we can use our documentation to build the right ICD-10 codes, and actually try it out and see how far we are from perfection.” “And if you’re not quite perfect, you’ve got some time to work on it.” “Exactly. We’ll be able to see what practices we don’t yet have in place. We won’t be taking a shot in the dark and hoping we’re on the right track.” Mike sniffed. “Is that sauteed mushrooms I’m smelling?” “Yes. Mushroom ravioli tonight, with a fresh marinara sauce and garlic bread. Just a little good home cooking.” “Very good home cooking. Can I help?” “Come keep me company while I add a little squeeze of lemon.” Ben followed Carmen into the kitchen, where their son was already sitting at the table coloring. “I really feel like things are coming together,” he told his wife as he ruffled his son’s hair. “Just having a clear plan and a clear goal makes all the difference.” Carmen beamed.Ben held up his hands in mock protest. “Are you about to tell me some special way in which this reminds you of pizza?” “Not at all.” Carmen busied herself plating the ravioli and ladling on sauce. “I could however say that it’s like having a great recipe and setting out all the ingredients, measured and ready, before you begin to cook.” She added a slice of toasted garlic bread on each plate. “That’s the way you get a perfect outcome. It’s not that you don’t have work to do, but you have it all laid out clearly, so success is easier.” “I’ll take that,” Ben smiled. Will Dr. Ben’s new tech solution lead to the perfect outcome? Everything that we have published about ICD-10 can be found on our ICD-10 page.
Seeking Direction
By Kathleen Casbarro For ICD-10 transition, It’s Essential to Choose the Right Path Should Ben start practicing the new style of documentation long, or wait until he has to do it? “It’s great that you’re not experiencing pain any longer,” Ben told his last patient of the day, “but remember to come in for regular adjustments and keep it that way.” The young woman hefted her tote bag and stepped through the door. “I know I should, but somehow if I’m not having any pain I don’t make the time.” Ben commiserated. “Let’s go ahead and make your appointment now,” he suggested. “That way you’ll have that part done. Pam, can you help Sheila?” “Of course!” Pam took over with a warm smile.Ben understood what his patient meant. He had been trying all day to get used to the new clinical documentation he’d have to be using once the shift to ICD-10 codes took place. He had tried to note which side of the body each issue involved and to write notes with the level of specificity the new system would demand. It hadn’t been hard at first, but it had been a busy day. As patients mounted up and he and Pam skillfully navigated through a day filled with surprises as well as scheduled events, it got harder to take the time for the new style of documentation — and easier to fall back on the old system he found so comfortable. After all, it really wasn’t a problem right now if he skipped the notes on laterality or wrote something with less detail. The pain wouldn’t come up till later, so it was tempting to just wait till later to make the changes. In fact, Ben mused as he moved through his end-of-day routine, making the changes now was actually causing some pain. It was slowing him down a bit, distracting him from his key priorities, and probably irritating Pam and the rest of the team. Was it better to get a head start on it now, possibly lessening the pain of the transition in October but also perhaps lengthening the amount of time there’d be pain in the office? Or should he wait till closer to the time? In fact, maybe the best solution would be to do his documentation in the usual way and pass those on to Pam and the team, but then also to produce a second set of notes that would provide enough detail for the new set of codes? But then, Pam and the rest of the team wouldn’t benefit from the head start he would be getting. Ben suddenly realized he had been standing frozen in thought, one hand holding his car keys out in front of him and the other reaching for the door, for — well, an embarrassingly long time if anyone had happened to be looking. He shook his head and got back in motion. It was hard to know the right thing to do, that was all there was to it. Should Ben start practicing the new style of documentation, or wait until he has to do it? Visit our ICD-10 page to learn how ICD-10 diagnosis codes have been built into Genesis Chiropractic Software.
Hanging In
By Reuven Lirov Office unease leaves practice owners dangling Are the problems in his practice Ben’s fault? Ben sighed contentedly and rested his chin on his wife’s head. Their son was sitting on her lap and she leaned against him on the sofa so that he could hug her and their little boy at the same time. They had a cartoon movie on the TV, but Ben wasn’t paying attention to it. At times like these, their family seemed like a perfect unit, and his life seemed as though it was completely under control. So why didn’t it feel that way at the office more frequently? Carmen had problems at the pizzeria sometimes, but it always seemed as though she could just tackle the problem and solve it, and it was over. At his practice, it felt like they no sooner solved one problem than another came up. They had high turnover in the front office, and he knew that was part of the reason things slipped through the cracks, but maybe the high turnover was a symptom of the problem. Absenteeism, too — of course that led to turnover when people had to be let go, but it also seemed as though any time one person was missing it created a bottleneck in the office. Then when absent workers returned, it took three days to recover from every one day they’d been gone. Maybe they just weren’t getting the kind of training they needed, Ben reflected. Jonathan was laughing and squealing as the cartoon characters slid down a mountainside. It was funny in the cartoon, Ben thought, but sometimes that’s how it felt at work, and then it wasn’t so funny. The cartoon characters were bouncing from one branch and outcropping to another, their eyes comically huge, and his son couldn’t stop laughing. Ben couldn’t stop thinking that this was just what his workdays were like sometimes, bouncing from one problem to another and barely having time to get one issue cleaned up before another smacked into him. Forget about building and growing the practice — he was always in crisis mode. Ben didn’t really think it was a case of having bad workers. They made every effort to hire smart, competent people. And yet those smart people made mistakes and let things slide. He knew they didn’t provide intensive training to their staff, but where would he find the time to do that? He had always figured that if he hired good people, they could pick most things up on their own. Ben shook his head and Carmen smiled up at him questioningly. He returned her smile and willed himself to get his mind back into the present. He could think about his work problems later — in fact, he’d have to. He sighed again, but this time not with contentment. Maybe it was his fault. Are the problems in his practice Ben’s fault?
Mistakes
Office errors can spill over into patient care What are the consequences of mistakes in Ben’s office? “Honey, I’m home!” Ben sang out as he stepped through the front door. His small son ran and tackled his knees, and he was relieved to see that his wife was smiling. Ben swung Jonathan up onto his shoulder and hugged Carmen. “How’d things go at work today?” he asked her. “You were right,” she said. “Once I talked honestly and respectfully with the girls about how much time there were spending on… umm… personal things…” “By which you mean the super-cute delivery guy,” Ben cut in. “Exactly,” Carmen laughed. “Anyway, they saw my point and I think it’ll be okay. It’s just hard to get a conversation like that started.” Ben thought about his own staffing issues. High staff turnover, absenteeism and errors seemed to be a constant problem, and he didn’t feel that he had time to spare to deal with the issues — even if he’d had a good plan for approaching them. Jonathan’s attempts to get down got Ben’s attention away from work, and he set the boy gently on the floor. Jonathan scampered off and Carmen said gently, “Are you worrying about work again?” Ben agreed that he was. “Maybe it’s the upcoming changes in reporting regulations that are making me notice it more,” he said, “but I feel like we make a lot of mistakes.” “Any mistakes in a medical office feel like a lot,” Carmen observed. “Oh, it’s not mistakes in treatment. It’s things like incorrect diagnosis codes, forgetting to collect copayments, incomplete documentation, delayed payments — even overpayments.” “Not things that affect the patients, then?” Carmen asked. “Actually, that kind of mistake can affect the patients,” Ben admitted. “Whether it’s a billing issue that gets uncomfortable and the patient just doesn’t come back, or a feeling that things are falling through the cracks that makes a patient feel less confident about us, we can lose patients because of office problems.” “Plus,” he went on, following his wife into the kitchen as she raced to turn off the oven timer, “Every hour I spend dealing with office SNAFUs is an hour that I’m not seeing patients.” Carmen cocked her head, a steaming pan of baked sausage and eggplant in her hands. “I think it’s always easier to change the circumstances than to change people,” she said, setting the pan onto the table. She began to gather the ingredients for a salad. Ben grabbed a tomato and began to slice it. “The circumstances are pretty settled,” he objected. “We have things we have to do, sometimes by law. There aren’t any points for originality when you’re talking about medical billing.” “I get that, but there must be things that make it easier to make mistakes, or harder. Like lines in the parking lot make it easier to park a lot of cars than it would be if everyone just did their own thing.” Jonathan raced in at that moment with a picture he had drawn, and Ben pushed thoughts of work from his mind, but Carmen’s words came back to him later. It seemed like lots of little mistakes added up to big problems. If his staff couldn’t change, how could he get past the problems? What are the consequences of mistakes in Ben’s office?
Into the Fire
Poor Communication Turns Up the Heat in the Office How do staff problems affect Ben’s chiropractic practice? “Ben? Can I talk to you about something serious?” Ben turned to his wife in surprise. Carmen was usually easygoing, taking a relaxed attitude even in serious situations. “Of course. What’s up?” “It’s the girls at the pizzeria.” Like many pizza places, Ben knew, Carmen’s had lots of part-time help, including students and musicians who needed a day job. The work tended to be fun and casual, even though Carmen ran a tight ship. She had a lot of turnover — what restaurant didn’t? — but she rarely had staffing problems. “I’m usually the one complaining about my staff,” Ben said. “You go with the flow.” “I know,” Carmen agreed. “I think we’re a happy workplace, and the systems are organized enough that the people can relax. But we have this new delivery guy…” Carmen hesitated. “Spit it out!” joked Ben. “Well, okay, he’s really cute. Whenever he’s in the shop, the girls hang out near him, flirting, instead of doing their work.” Ben couldn’t help laughing. “That’s your employee problem? Listen, I have staff absences, paperwork backing up, information silos that mean we constantly have questions that can’t be answered because the only person who knows the answer is off –” “You aren’t even listening!” Carmen objected. “I can’t bring this up with the girls without insulting them, and I can’t bring it up with the new guy at all. I can’t fire him for being too cute –” “Sorry, Carmen,” Ben insisted, “you don’t know what staff problems are if your idea of a staff problem is how to avoid hurting somebody’s feelings. My people are competent, but there doesn’t seem to be enough communication among them to keep the paperwork and billing going smoothly. We end up looking bad to the clients because their files can’t be found, or missing out on billings because the paperwork has errors. Those are staff problems.” “Maybe you’re right,” Carmen said. “Those do sound like more serious problems. Are you paying enough attention to your workers?” “That’s part of the problem, I’m sure,” Ben admitted. “I’m in with patients all day. I don’t have time to oversee the staff, and I guess they all have a lot of freedom to set up their own systems…” Carmen laughed. “If everyone just does what he or she wants, you can’t call it a system.” “Well at least I’ve got you laughing,” Ben said. “Listen, just tell your people to get back to work. You’re letting your embarrassment over the situation make it seem more difficult than it is.” As they got ready for bed, though, Ben was wondering. If that was the biggest staff problem Carmen faced in her business, why was he constantly troubled by staff problems in his? How do staff problems affect Ben’s chiropractic practice?
