Daily Balancing – the Right Way

David Harris

Everyone knows that daily balancing is a key safeguard for your practice’s finances, but there is very little information available to a dentist on how to do it properly. So here’s a recipe:

  1. Which reports should be looked at? Most software can produce a lot of different reports. Most software has a report specifically designed for day-end review. It may be called a “daily summary”, “day-end report” or “daysheet”, or it may have a different name in your software. For purposes of this discussion, I will refer to it as the “daysheet”. The daysheet will normally show procedures performed, fees associated with the procedures, payments received and adjustments made, as well as any deletions or corrections that were made. Normally at the bottom of the report are totals for each of these activities, plus a breakdown of the payments received by type (cash, check, credit card payment, third party deposit, etc). Most daysheets also show your accounts receivable balance at the beginning of the day, and the balance at the end of the day. If the daysheet from your practice management software is missing some of this information, you will need to print additional reports to ensure that you have everything listed in this paragraph.
  2. There are reports that will isolate any one of these items in a single report. For example, most software will generate an adjustments report that only lists adjustments, or a production report that isolates procedures performed and fees billed. These reports have their uses, and allow you to review a specific type of transaction. However, for the day-end review that you are performing, I recommend that you to look at the daysheet, which allows you to see all of the activities undertaken for each patient today in a single report. So for a patient who visited the practice for treatment, you can see what was billed, what was paid, and any adjustments or modifications that were made. This is preferable to, for example, looking at today’s adjustments on a separate report, which means that you will not have the context for the adjustments made. Put another way, a $200 adjustment on $1,600 of treatment means something quite different from the same $200 adjustment applied to a $250 treatment, and looking at an adjustments report simply will not give you that context, without cross referencing to other reports. The daysheet, if generated with the proper settings, will allow you to have all of the information needed for your daily review in a single report.
  3. The daysheet and other reports from your practice management software used in this process need to be printed by you, your spouse, or an external person like a bookkeeper or accountant. You should never rely on a staff member to generate the reports used for reconciliation, because doing so opens the possibility of “selective reporting” where certain activities are excluded from the report. If this is done, you will think that report you are using summarizes the entire practice, when it does not.
  4. I love the approach taken by a friend of mine, Sandy Baird, who is a practice management consultant based in Tennessee. Sandy says that the day-end routine needs to be a team concept, and that team members other than the practice owner also have roles. For example, Sandy suggests that each associated dentist, assistant and hygienist needs to print a production report for their own activities, compare it with their schedule and ensure that correct fees and procedures were applied, and that work performed was coded to the correct provider. This is not a substitute for the owner’s review of the practice, but increases the chances of finding inaccuracies.
  5. You need to review day-end reports personally. This review should not be delegated to anyone, although as mentioned in the previous paragraph, your review should be supplemented by the reviews carried on by individual billers of their own activities. You are the only person who has a chance of spotting a discrepancy between what was done and what was billed for work that you performed, plus you, as practice owner must use this chance to look at the overall activities of the practice. Month-end reviews are also important, but there is no substitute for reviewing a day while what took place is still fresh in your mind.
  6. A delayed review of a day is close to useless. Your ability to find an error or unusual transaction degrades considerably with even a 24 hour delay in performing the review, and looking at last Thursday’s report on Monday afternoon represents a lost opportunity to find inaccuracies.
  7. When reviewing the day-end report, there are several things you should scrutinize:
    a. Review all fees that were billed for accuracy. Embezzlement is not the only threat to your practice’s revenue; simple clerical mistakes can also be costly. A one-digit error in a procedure code can cost you hundreds of dollars.
    b. Review payments received. One thing to check is to look payments made by patients during the day to ensure that your policies for collecting co-pays are being followed. In other words, if your policy is to collect co-payments (or at least estimates thereof) on walk-out, your daysheet will tell you if team members are following this policy.
    c. Ensure that there was a fee charged for every patient you saw today unless you know that a specific patient was booked for a “no-charge” appointment (an example of a no-charge appointment is a visit within a multi-visit procedure that had a single fee, such as an ortho check if your practice does orthodontic treatment).
    d. Review all adjustments (both debit and credit adjustments) and ensure that you understand the reason for them, and that the adjustments make sense in the context. Substituting an adjustment code for a payment code is one of the most basic methods of concealing theft.
    e. Check the “continuity” of accounts receivable. The “closing” balance of receivables from the last day that your practice was open should be exactly the same as the “opening” receivables balance for today. If these two receivables balances are not identical, it means that there was some activity in your practice management software between the end of your last workday and the beginning of the current one.
    f. An excellent idea is to print “roll-up” reports instead of current day ones from your software. Even though it is commonly called a “daysheet,” this report can cover any period you wish. So if today is Monday, and your office’s last working day was last Thursday, rather than review a Monday daysheet, you should be looking at one that spans the period from the last cutoff on Thursday until the end of today. This will show you any transactions that took place in the three days when the office was closed. Since you are printing the reports yourself, this is not hard to do.
  8. Ensure that all patients are “checked out” in your practice management software. Checking out is the process of closing an appointment in practice management software. Checking out a patient forces the front desk staff to either apply a charge or to record a patient as having had a no-charge appointment. When any patient who had chargeable work done is not checked out, you have lost money.
  9. Many practices do not use adjustment codes properly. Each “reason” for making an adjustment needs to have its own specific code. So each PPO, and every category of other discount (e.g., senior citizen discount, professional courtesy for referral sources, etc.), and every marketing initiative that you undertake, needs its own unique adjustment code. There should be very few “miscellaneous adjustments”, and whenever one is made, staff need to make a detailed explanation in the patient notes. Give some extra attention to any miscellaneous adjustments on your report, and check the notes made to ensure that you agree with the basis for the adjustment, and that it does not fit within one of the defined adjustment categories. And if there are a fair number of miscellaneous adjustments made for more or less the same reason, this is a good time to place a label on that type of situation and create a tailored adjustment code for it.
    Not having (and using!) specific adjustment codes deprives you of information needed to make key decisions about your practice, such as whether you should drop a specific PPO plan, or whether a specific marketing initiative is working. Having only a few adjustment categories (or one generic category that is used for all adjustments, and yes, I have seen this on occasion) also makes it easier to “bury” fraudulent adjustments. Forcing specificity makes inappropriate adjustments much more conspicuous.
    Whatever the cause of an adjustment, it represents money out of your pocket, and for that reason it requires scrutiny comparable to if you were writing a check for the same amount.
  10. There is no particular benefit to having an external party review the daysheet or daily balancing. You should personally verify agreement between practice management software and today’s deposit. It is permissible to outsource the monthly reconciliation that compares a month at once. Reconciling the entire month at once drastically reduces the workload involved for the person performing the reconciliation, because most of the timing differences that have occurred within the month will have worked themselves out, and it is only the ones that straddle the beginning or end of the month that need to be addressed. This monthly reconciliation provides a “double-check” on the daily work that you are doing.
  11. The “timing differences” discussed earlier in this chapter create challenges in balancing and reconciliation. Situations where collections are recorded earlier or later in your practice management software than when they are received by your bank mean that it is often impossible to know by closing time today whether today is properly balanced. When a patient pays today by credit card, it will be several days before that payment can be confirmed
    Conversely, payments deposited by insurance companies directly in your bank account normally appear in your account a couple of days before you receive the Explanation of Benefits from that insurance company.
    Timing differences complicated the balancing (done by staff) and reconciliation (done by you, your spouse, or an outside party) processes, because they require keeping track of “held over” items for a few days until the other part of the transaction can be verified.
    For timing differences, online banking is a must to allow you to confirm that the correct amounts were deposited. This adjustment is easy for amounts that appear in the bank before they are recorded in your practice management software. However, for amounts with the deferred receipt, confirmation that these amounts were correctly received needs to wait a few days.
    The result of this timing difference is that “real-time” end-of-day reconciliation is no longer possible, and you need to review balancing a few days after the fact to be able to verify time-lagged credit card deposits. Prosperident has developed a spreadsheet that makes monitoring of deferred and advanced amounts easier. If you are comfortable using spreadsheets, please email us at requests@dentalembezzlement.com, and we will be happy to send you a copy.
  12. In addition to dealing with timing differences, online banking access for the dentist is virtually a necessity for other reasons. Online access allows you to compare your practice management software against what actually appeared in your bank account. Relying on pieces of paper like a bank deposit book (which can be adulterated), and waiting for the bank to send a month-end statement to provide ultimate confirmation of deposits, are not good ideas.

California dental office worker arrested for allegedly obtaining fraudulent prescriptions

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Kristina Vargas

Thousand Oaks Patrol deputies were dispatched to a report of fraudulent prescription activity in Newbury Park. The investigating deputy learned that Kristina Vargas worked in a dental office and had fraudulently used a dentist’s information to obtain Carisoprodol (also known as Soma) for herself on 11 separate occasions dating back to September of 2018. Once the initial information was obtained, the investigating deputy contacted the Pharmaceutical Crimes Unit for assistance. Detectives gathered evidence and conducted multiple interviews confirmed the fraudulent prescriptions.

On December 31, 2019, Vargas was located and arrested in Newbury Park for 11173(a) HS – obtaining a controlled substance by fraud, 470(b) PC –forgery and 459 PC – commercial burglary.    Vargas was interviewed and then booked into custody at the Pre-Trial Detention Facility in Ventura. Vargas bailed out of custody and her next court date is set for January 17, 2020 for her arraignment.


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Content retrieved from https://www.citizensjournal.us/dental-office-worker-arrested-for-allegedly-obtaining-fraudulent-prescriptions/

Police: Ohio Dental Office Employee Swapped Painkillers for Saltwater

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Brittany Roehm

HAMILTON COUNTY, Ohio —

A Clermont County woman is facing felony charges in Hamilton County after investigators say she stole drugs from the oral surgery center that employed her.

Madeira Police responded to the Oral Maxillofacial & Dental Implant Surgery on Miami Avenue late October. The practice manager told police several doses of fentanyl were missing from their inventory.

Investigators said Brittany Roehm, 30, who also goes by Brittany Byland, is behind the thefts.

Court records said Roehm was employed with the practice when she allegedly began emptying vials of fentanyl and refilling the vials with saline.

Fentanyl is a powerful synthetic opioid pain reliever. It is comparable to morphine but considered 50 to 100 times more potent.

Investigators said she stole 10 portions of the drug, totaling to 470 mL.

Court documents said the narcotics disappeared between Sept. 6 and Oct. 18 2019.

A grand jury indicted Roehm on two felony charges, theft of drugs and tampering with drugs.

Roehm pleaded not guilty at her arraignment Friday. She is due back in court Jan. 22.


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Content retrieved from: https://kadn.com/police-dental-office-employee-swapped-painkillers-for-saltwater/

Florida’s Camille Garza has Embezzlement Convictions

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To watch a webinar on how to prevent people with “baggage” from getting jobs in your practice, click on the button below.

Forensic Hiring Webinar

While Camille Martinez Garza (born October 25, 1983) of Sunshine, FL, looks like she is having fun in this photo, she was probably having less fun when she was convicted of Grand Theft, Fraud, Organized Fraud of between $20,000 and $50,000 and a probation violation. She was sentenced to a year in prison plus ten years of probation.

These charges originated from her work in two Florida dental offices, and she is reported to still be working in the dental field.

She also has a long list of traffic violations, and your overall impression is that this is someone without much respect for society’s rules.

Ms. Garza personifies the need to conduct criminal records checks before hiring.

Here is one of her mug shots:

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Prosperident Pulse #90 — January 2020

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Dental Prosperident Pulse from Prosperident
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Issue #90 — January 2020
Podcast
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David Harris was honored to be a guest on his friend Dr. Len Tau’s podcast. Check it out HERE.
Tired of the same old stuff at meetings?
Did you know that there are some topics that we will ONLY discuss at closed-door, live events?
linda-gregg
Caren Irsuto pled guilty to embezzling over $600k from her dentist.
We would love to speak at your meeting or study club!
Here are some places where we will be speaking soon:
Jan 31 The Ohio State University, Columbus OH
Feb 19 Kamloops and District Dental Society, Kamloops BC
Feb 20 Dr. Wilson Kwong study club, Vancouver BC
Feb 27 Ortho2 User Group Meeting, San Diego CA
Mar 9 Cloud9 User Group Meeting, Atlanta GA
Mar 11 Schulman Group, Laguna Beach CA
April 1 Greater Long Island Dental Meeting, Melville NY
Apr 24 East Texas Study Club, Bullard TX
May 9 Smile Source Exchange, Atlanta GA
Jul 3 University of the West Indies, Jamaica
2021
Feb 25 Chicago Dental Society Mid-Winter Meeting, Chicago IL
For more information, click HERE or call us at 888-398-2327.
Did you miss a previous newsletter? We archive them HERE.

Software Can Lie
It’s something that we read over and over. A dentist in a Facebook forum states that embezzlement cannot be happening in his or her practice because they “check their daysheet every single day.”

Broadly, there are two types of embezzlement. The first takes place when the balancing process (in other words the daily and monthly comparison between practice management software and financial accounts) is unsupervised or incomplete. In this situation, stealing is easy because a thief can enter all payments into the practice management software and then simply “short” the deposit. This leaves patient accounts balances accurate. This is important to prevent patients from complaining about their balances, repeated occurrences of which might get an embezzler caught.
But what if the balancing process is done with integrity, which means that it is complete and supervised? Does this mean that it is impossible to steal? Not by a long shot. It takes a bit more planning than pilfering from the deposit, but it is something that most would-be embezzlers can master.

Something to Talk About…
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Welcome to 2020!
With decorations put away and offices open again after the holiday shutdown, today is the day when many of us turn our minds back to business.
2019 was a good year for embezzlers; a booming economy and lots of “how to” information on the internet created plenty of opportunity for them to ply their craft.
While many were caught (and you can read about these people in our Hall of Shame), plenty are still getting away with it.
Everybody knows that Prosperident can (stealthily) audit practices for embezzlement, but did you know that we also can help you improve your systems to protect you against being a victim?
Let’s make 2020 the year to stop these thieves in their tracks!
Sincerely,
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David Harris

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We are Prosperident, Dentistry’s Embezzlement Experts