ome doctors struggle to keep a steady flow of new patients. One of the reasons we hear the most often for new-patient numbers that are lower than average is difficulty explaining initial finances when a patient calls and asks the question, “How much does it cost to see the doctor?” As many as 60 percent of the inbound calls to offices asking about fees can be lost if mishandled by the front desk. One of the most dangerous examples of mishandling occurs when new patients are offered free or ridiculously discounted initial exams or first visits. Giving away initial care, or any care, is considered an inducement. To help you avoid the risky pitfall of inducement, it is necessary to follow specific procedures and scripts. Having a set phone script for new-patient “shoppers” along with a “pre-acceptance interview” process is excellent for practices that wish to offer patients the chance to find out if they are a good candidate for chiropractic care without any financial risk.
Having a set fee for the initial visit that is legally discounted makes your new-patient scheduling so much easier than ever before.
Just about anyone who has answered a phone in a chiropractic office has fielded the question about how much the doctor charges. Each of us has also proceeded to do the “Texas Two-Step” dance around that question. The truth is that we really do not know what the fee would be for a particular patient’s required care, but we do have a general idea of how much an initial visit usually costs. Depending on the answer we give, it could be the difference between a scheduled visit and a dial tone in our ear.
Patty the Possible Patient: “Um, hello…can you tell me what it costs to see the doctor?”
Sally Sunshine at the Front Desk: “Well, that depends on what your insurance company allows.” (Scripts are meant to assist with screening those who are Uninsured or Partially Insured)
Patty the Possible Patient: “Oh, I don’t have insurance.”
Sally Sunshine at the Front Desk: “Well, that is not a problem. Our office is a member of ChiroHealthUSA, which entitles its members to a maximum initial visit fee of $150 . We can tell you about that and assist you with becoming a qualified member when you come into the office. Would morning or afternoon be better?”
And so it goes, and you will usually have no problem scheduling the appointment. Having a set fee for the initial visit that is legally discounted makes your new-patient scheduling so much easier than ever before. But when you have someone who has more questions, couple the procedure described above with an offer of a “Pre-Acceptance Interview” for maximum effectiveness.
An office can offer a pre-acceptance interview with a patient at no charge if this is a routine part of your initial visit procedure, if it is not advertised in public and if no evaluation or treatment is given. Often, a pre-acceptance interview is the best procedure for allowing patients to come in and find out if they are in the right place or are a good candidate for care, while avoiding any claim of financial inducement. In order to stay compliant, your office should have a written policy that declares the way you follow your policy as standard procedure for pre-acceptance interviews.
The pre-acceptance interview is an opportunity for the doctor to gather information about the patient’s condition and for the patient to learn more about the doctor, the doctor’s office and chiropractic care in general. During the pre-acceptance interview, it is vital that the patient has a clear and distinct opportunity to “opt in” and direct the doctor to move forward with any services before you move to CPT coded/charged services. After explaining the maximum initial-visit cap, if the patient is still not sure if they want to be treated by the doctor, there is a simple add-on to the previous script with Patty the Possible Patient.
Sally Sunshine at the Front Desk: “Well, Patty, I understand that you still have questions, but let me assure you, we offer an initial visit with the doctor called a Pre-Acceptance Interview, where you can fill out some healthcare information and discuss with the doctor the care in this office and whether you’re a good candidate for care. There is absolutely no charge for this interview, and rest assured, Dr. Jones won’t move forward with any billable services until you give your okay. Let’s get you scheduled, how does that sound?”
Once the patient comes in the office for the initial visit and fills out a history and intake form, the patient can be introduced to the doctor and the initial review can begin. Once the doctor gets a sense of what will be necessary for the patient, the doctor can say:
Dashing DC: “From what you’ve shared with me, I think you’re an excellent candidate for chiropractic care. In order to move forward from here, I’ll need to conduct a thorough history and evaluation, including an examination (and possible X-rays), to locate the underlying cause of your problem. Once that evaluation is complete, I can review the results and give you a report of my findings and what continued care would look like. As Sally discussed with you, these initial services are capped at $150 for our ChiroHealthUSA members. Are you ready to move forward?”
It is a responsible patient who takes into consideration their ability to pay and to follow through with care.
Do not attach too much meaning if a patient ultimately says “No.” It is a responsible patient who takes into consideration their ability to pay and to follow through with care. Being gracious and understanding in this scenario may pay in spades later. The patient has now met the doctor and knows more about their care. It is unlikely they will go any place else once they decide to opt-in for care. If they do go elsewhere, and it is because the doctor offers discounts illegally or does not charge copayments, let it go; let them go. Hold your head high and know that you may have to get 10 “no’s” to get a single “yes.”
Using this process of capped fees and initial interviews is an excellent way to get someone to walk through your door. Remember, be aware of the potential for an inducement offense if the opt-in moment is not clear and defined to the patient, take the time to flawlessly follow your procedures for pre-acceptance interviews, and you will see an increase in new patients and community awareness of your office.
Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P) and, since 1983, has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kathy is known as one of our profession’s foremost experts on Medicare and can be reached at (855) TEAMKMC or