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Skimming off the top?

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  • Skimming off the top?

    My current contract is set up so that I receive a percentage of my net collections

    I try to track my daily earnings by using the Medicare fee schedule to estimate what I'm bringing in.

    I know many insurances will pay less than the Medicare fee. I know plenty of our procedures / visits will get rejected as well.

    But I'm noticing my earnings spreadsheet is consistently higher than the company's version to the tune of anywhere from 2 to 5%

    Given how roughly I'm estimating, is that an acceptable range? Or do you think the company is skimming off the top with my earnings numbers?

    I don't want to storm into admin over 5% especially if I'm using such a rudimentary estimate system but at the same time, I'm not sure what kind if variance is normal when estimating revenue?

    Anyone have a more elegant solution to tracking revenue and making sure the company isn't giving me a low number?

  • #2
    Your pay is based on billing or based on collections?

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    • #3
      Based on collections

      Is that where I'm going wrong? We are collecting much less than what we are billing out?

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      • #4
        Brings back bad memories from not too long ago. Happened with my husband. He was on production (but wasn't on partnership track- he didn't want to go that route) with a group and they would never show him the books on his OWN finances. And what they said about his collections was widely divergent with his estimates. Don't know of a % though... if I had to hazard a guess, it would be about 30-40%. He was extremely patient with them but after a couple of years of getting nowhere, he quit and put up his own shingle. This case was fairly obvious though, that the group was cooking up the books in some form or fashion... 3 other non-partners who were unhappy too quit within a day of DH leaving and they all joined forces.

        Moral of the story... if you trust your instincts on this, ask to be shown your billing/collection. You should be able to sit down with someone from billing and go over things to your satisfaction. If there is resistance, there may be an underlying cause. Wish you luck!

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        • #5
          Thanks for the advice and for sharing your story

          I think I will sit down at the end of the financial year to discuss billing with them (and to see if the % gap widens or lessens)

          I can understand a 5% swing but would certainly get suspicious of someone cooking the books if it widened to 30 or 40%

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          • #6


            But I’m noticing my earnings spreadsheet is consistently higher than the company’s version to the tune of anywhere from 2 to 5%
            Click to expand...


            This could also be a sign of lack of internal controls at the office employee level. Sorry to say, but doctors' offices are well-known for lax procedures and for hiring employees who know (or learn) how to game the system. When they are fired, they are not usually prosecuted for various reasons, reputation of the doctors being one. The employers may simply be blind to it.
            Working to protect good doctors from bad advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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            • #7





              But I’m noticing my earnings spreadsheet is consistently higher than the company’s version to the tune of anywhere from 2 to 5% 
              Click to expand…


              This could also be a sign of lack of internal controls at the office employee level. Sorry to say, but doctors’ offices are well-known for lax procedures and for hiring employees who know (or learn) how to game the system. When they are fired, they are not usually prosecuted for various reasons, reputation of the doctors being one. The employers may simply be blind to it.
              Click to expand...


              Gaming the system as in front desk staff pocketing patient co-pays?

              Or mid-level managers redirecting collections into their own pockets?

              The health system I work for runs a fairly tight ship: cameras all over clinic, multiple front desk employees, on site office managers, monthly revenue reports, etc. I'd be more inclined to think that they're underreporting my collections rather than someone at the employee level pocketing my money. Or I'm just being paranoid over that 5%

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              • #8
                If you are paid on collections, it is normal for that to be less than the billing.  I have no idea what the percentage is on average as I work for a hospital.  But it can be significant.  In my case I do something somewhat similar with a spreadsheet to track rVUs as that is how I am paid.  However it never matches exactly the hospital's numbers given their billing cycle etc.

                I am sure someone else on here can tell you what the average collection percentage can be in a private practice..

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                • #9
                  You need to be aware that your write offs from the previous months will get taken out of your current pay. There is lag time. I'm a partner and know this for sure. It's a sad hard truth.

                   

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                  • #10




                    Given you are estimating based on billing and not collection I’d guess 5% is accurate. Keep in mind a few cases will have significant lag on payment. Might be able to get it down to 2% at best in my view but it varies depending on lots of factors.
                    Click to expand...


                    Just spoke with billing and I think this is what's going on.

                    The report that runs in February only reflects collections up through January. Through that prism, I think the number is much more accurate when compared to my personal numbers through January.

                    Will keep an eye on everything as the financial year progresses.

                    Thanks to everyone for their input!

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