(Editor’s note — the concepts for this article were first presented in a webinar presented by the authors in May 2020.
When someone wants to embezzle from you, their approach is predictable. Thieves begin by asking themselves whether the reconciliation process used in your practice is thorough and complete.
By “reconciliation,” we are referring to the oversight by practice owners of the daily and monthly balancing done by staff. In its simplest form, reconciliation is the process of ensuring that the money that your practice management software says you received got deposited to your bank intact.
If a thief realizes that your reconciliation process is flawed, which is probably the case in 75% of practices, this bestows a particular blessing on that thief. He or she can steal by simply “shorting” the deposit; in other words, they can steal without needing to tamper with individual patient accounts to conceal it. Stealing in this way does not require high intellect or any -n-depth understanding of your practice management software.
On the other hand, if a would-be thief believes that a deficient deposit would be noticed (in other words, that the reconciliation process has integrity), now to steal he or she is faced with a much greater challenge. While it is possible to pocket payments from patients and insurance companies and conceal the theft by not recording the payments in practice management software, this will result in “phantom” patient receivable balances. For this reason, this approach tends to be a self-limiting method of stealing. If this “snatch and grab” approach is employed, sooner or later, patients may realize that amounts that they owe to the practice are overstated, and the act of these patients complaining may get the thief caught.
Therefore, a “tight” reconciliation process usually forces a would-be embezzler into a riskier and far more complicated embezzlement scheme where it is necessary to tamper with individual patient accounts to keep the amounts owing pristine while still stealing. This manipulation is certainly possible, but success requires a much smarter embezzler with a good knowledge of your software.
So what does this elusive reconciliation process entail?
First, we will mention that it consists of some daily activities and some month-end ones. Performing only one of these and omitting the other is problematic. Looking at day-end information and ignoring month-end reporting leaves the practice owner vulnerable to “day-off” transactions performed on days when the practice is closed and creates challenges with credit card payments and bulk receipts when there is often a timing difference between when these funds are deposited and when receipt is recognized by practice management software.
On the other hand, ignoring daily reports and focusing on a month-end review degrades your ability to spot entries in your software that are inconsistent with what actually took place. There is no substitute for a timely day-end review for this.
There are a few basic rules for reconciliation:
Print your own reports. Delegating this function means that you abdicate control over the choice of information for the reports. This approach leaves you vulnerable to selective reporting.
Timeliness is important. Review the day-end report from your practice management software before you go home for the day. Postponing that review, even by a single day, diminishes your ability to spot inaccuracies
Articulation is mandatory. If you have 18 working days in a month, the month-end report should equal the sum of the 18 day-end reports that you have. Prosperident has developed a spreadsheet that does the math for you (if you want it, please ask for it at firstname.lastname@example.org, and we will be happy to oblige).
Your receivables at the end of a period (whether a day, month or year) should always equal the following calculation: Starting receivables + fees – payments – adjustments. If you can’t “prove” receivables using this formula, something improper happened.
What should a practice owner scrutinize?
Daily, the most important report is the practice summary from your practice management software. This report has various names depending on the software you are using but will summarize the fees charged today, the adjustments applied, and the payments received.
Your review should include the following:
Review of the procedures billed for accuracy (and if you have other providers in your practice such as hygienists, partners or associate dentists, each of them should review their own summary and sign it to attest to accuracy).
Review the payments received. In particular, you are looking at whether your policies on the collection of co-payments at the time of the patient’s visit are being followed.
Review every adjustment made. Ensure that the amount, timing, and categorization all make sense. Force staff members making adjustments to be specific — there should be a separate category in your practice management software for each different PPO in which you participate and different codes for each type of marketing discount that you offer (senior discount, coupon discount, etc.) Anything categorized as a “miscellaneous adjustment” needs a detailed explanation attached.
Review the deposit amount, and compare it against the report. Rather than checking the amount leaving the practice, it is far better to use online banking to verify the amount actually deposited and to “lag” this part of your review by a few days to allow payments with a timing difference, like when patients pay by credit card, to catch up.
However, there are some things that require your personal attention. Here are the things for you to look at:
On a monthly basis, the good news is that the more tedious part of this review can be outsourced. Reconciling your bank account, merchant account (this is the account attached to the credit card terminal in your practice), and any third-party patient financing, payment management, or collection agency that you use is important but mundane. For this reason, it is completely understandable if you choose to outsource these tasks. A dental bookkeeper or your CPA firm are good candidates for this work.
This monthly review is the time to ensure that the daily practice summaries you have reviewed total to the same numbers as the month-end practice summary.
Review your receivables report. Focus on the overdue amounts and on the collection efforts being taken by your practice to collect them.
Practice management software normally has an “outstanding insurance claims” report. Review this and check on the actions taken to finalize outstanding claims (is a resubmission needed, or has the insurance company asked for additional information that has not been provided?)
Review the following reports:
Deleted transactions report
Modified transactions report
Review the “entry log” from your alarm company to see if a staff member is visiting the practice at unexpected times. A staff member logging extra (often uncompensated) hours is almost always a symptom of embezzlement.
Ensure that the month that you are reviewing has been “closed” in your practice management software. Do this by checking the software directly; don’t complete this task by asking a staff member. If you aren’t sure how to do this, your software has trainers and a help desk to teach you how to check.
Performing day-end and month-end reconciliation properly will not catch all embezzlement. However, it will eliminate the easiest ways to steal and the wanna-be thieves without the software knowledge and intellect needed to progress to more advanced stealing.
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