Checks and Balances

There are occasions when honest mistakes and oversights are made that can lead to financial losses for the office. Money that is coming in from patients or insurance payments throughout the day may get misplaced during busy patient hours. You may also have a small amount of petty cash available or a cash till—used to make change—that needs to be safeguarded. Some offices sell products like supplements or cold packs that are on display, those also need to be tracked. Without checks and balances in place, a practice is at risk for mistakes, missing money, and out of balance accounts. Here are several procedures you can put into effect to protect your office:

End-of-Day Balancing: One of the most important procedures you can use to keep your financial system running smoothly is to balance your money, your charges, and your paperwork each night or at the end of each shift. It might be helpful to complete a trial balance during your midday break to see if everything matches. Your procedure might look something like this:

1. Gather all routing/fee slips that have been entered in the computer, count the total number, and write it on the top copy. Next, review the sign-in sheet, count the total number of names, and write the number on the top sheet. The totals of each should match.
2. Total the charges from each routing/fee slip. You can either total them with the calculator tape, or you can create an Excel spreadsheet, enter each slip in a column, and set up a formula that will total the figures automatically. Some practices use this type of procedure because the bookkeeper can then confirm that all fee slips were added. The total charges should equal the amount of the total services/charges in your computer and on your end-of-day sheet.
3. Next, total all collections from the front desk, including checks, cash, and credit cards. Usually, the insurance deposit is done separately so you may not have that to include. If your procedure does include insurance, total all four types of collections. The total of these should equal the total collections for the day that are shown in your computer.

If any of these do not balance, you must go back and find out why. 

1. Once you know that everything has balanced, compare the sign-in sheet, schedule, routing/fee slips, and day sheet to be sure each patient appears in all places (a walk-in patient may have slipped through the cracks).
2. Keep a secure place for any money to be deposited. This should be a locked desk or safe. Your other items are now ready to be put into your end-of-day packet and stored if needed for future reference.

Create an End-of-Day Packet: All of the items that were used to perform the daily balance are then put together in a packet and archived, by date, in case there are any future questions. Some offices prefer to scan the following items and store the information electronically rather than accumulate stacks of paper. Consider HIPAA-compliant online storage or store them on a HIPAA secure server in the practice. File by year and month and use the date the information is stored for the name of the file (e.g., 2021-05-12). That file is then stored in May 2021, and that file within 2021.  

Some items that may be retained in the end-of-day packet include:

• Routing Slips
• EOBs entered today
• Charge slips signed by patients and end-of-day charge card reconciliations
• Copies of deposit slips
• Sign-in sheet(s)
• End-of-day sheets from computer

Use the Buddy System: Chiropractic offices come in all sizes, and it is sometimes hard to assign two people to the same task. However, no matter how busy the office is, two people should always count money and inventory to ensure that the totals are accurate. Create a policy for employees who can use the company credit card or write checks and set a limit on each transaction. If a refund needs to be issued to a patient, make sure that a second person reviews the account and authorizes the payment to the patient. If something seems irregular, report it to the person in your office (e.g., a manager or compliance officer) who can help take steps to correct the problem.

These checks and balances are used in industries worldwide, including everything from finance to fast food. Creating these policies is about preventing errors in the first place so you don’t have to consider that any of your staff may have taken improper actions. Risk management issues arise when the provider doesn’t know what’s going on. Financial errors can be devastating to an office if they go unnoticed for months or years. Being proactive helps the office run more effectively and efficiently.  

Rebecca Scott is a Certified Professional Coder who began her chiropractic career in 1989. She graduated in 2008 with an Associate Degree in Accounting and is a Licensed Clinical Chiropractic Assistant in the state of Maine. She’s a member of the Lewiston Chapter of the American Association of Professional Coders (AAPC) and is both a certified specialist working in curriculum development and an individual client consultant for KMC University. She or any of her teammates can be reached at kmcuniversity.com, info@kmcuniversity.com or by calling 855-832-6562.