Missed Charges Mess With Your Profits
Too many freebies or discounts can leave a clinic with shaky finances.
Jason Castner
For the first time in several years, bottom-line profits fell at veterinary practices nationwide in 2025. The pandemic-era spike in puppy and kitten appointments is in the rearview mirror. Clinics are seeing fewer new patients, higher operating costs, and reduced cash flow. Raising prices has been a necessary step for them to offset the decline in appointments. However, what’s needed is more than just fee adjustments. It’s time to confirm your practice is paid appropriately for the products sold and services rendered.
Paying Less Than Expected
Price discounting can lead to financial disaster for a practice owner. Here are the three considerations for appropriate discounting.
1. Quantify
Your practice may well have a problem if you don’t know the total value of the discounts provided in 2025. Tracking them can vary based on the practice management software system you use.
Discounting may seem insignificant when done at the individual invoice level. Twenty dollars here or there might not seem like a big deal. However, if multiple doctors give $20 discounts several times a day, the impact can be tremendous over a full year. I have seen too many practice owners shocked at what discounting did to their bottom line.
2. Be Intentional
If you offer a loyalty program and believe it is a valuable component of the client bond, that is being intentional. Once you have quantified your practice’s discounts, determine which ones are appropriate. Offering 20% off products and services to rescue groups and key clients might mean zero profit for you. What if you reduce the percentage? Could you restrict the discounts to services only?
Also, consider who has access to your software’s discount function. Limit it to the practice owner, key managers, and associate DVMs. Furthermore, do your associates understand what they may discount? Once you quantify the total discounts, you might identify DVM-specific issues.
3. Audit
Run your practice management software’s discount report quarterly. Confirm that the discount types and dollar amounts are appropriate. Address any issues with the doctor and manager teams and set clear expectations.
The Problem With Missed Charges
Nothing is a more insidious attack on profitability than missing charges. I am talking about products you think you sold, lab tests you performed, and services the team provided, but for which no money exchanged hands. I have had many clients struggling with a high cost of goods sold and elevated labor costs, only to discover a significant underlying reason was missing charges.
One of my clients implemented safeguards to more accurately capture charges. The next time we met, he proudly stated, “We did much better yesterday. We only missed a six-month heartworm preventive, one fecal test, and a senior blood panel.”
He considered it a good day to have forgone nearly $400 in revenue. However, multiply $400 by five days a week and 52 weeks, and the two-doctor practice was on pace to sacrifice more than $100,000 in revenue.
Avoiding Missed Charges
Empower your entire team to capture all charges. Many doctors place the responsibility on support staff, but it should involve everyone.
Using your computer system to create estimates is an effective way to ensure charges aren’t overlooked. Many PIMS will gray out items once someone enters those charges, and a quick review will highlight any outstanding items. In that case, charges might need to be entered.
You can also store treatment plans for common conditions within the PIMS to promote consistency among doctors and ensure captured charges. For example, when “Check ears” is entered as the chief complaint, a treatment plan can include an exam, biohazardous waste charge, ear cytology, and ear cleaning. Those fees can be easily posted to the invoice.
Another effective solution before client checkout is to use a code, such as DONE or RTG (ready to go), to indicate the charges are in, the medical record is complete, and someone has reviewed the chart.
Bundled charges or group codes can prevent missed charges, too. For example, a DOG code (annual dog visit) can automatically reveal an exam fee, biohazardous waste charge, and rabies, DHLPP, and Bordetella prices.
If your practice uses paper for quick notes, check-in, or in-clinic travel, attach any vaccine stickers to ensure the charges are captured.
For practices that minimize paper use, doctors and staff can use a laminated sheet showing standard services and codes, quickly circle what was done, and write in other items at the bottom.
If your practice is paperless, the team member who performs a service should immediately enter it in the computer. For example, a veterinary technician who obtains a patient history, performs a nail trim, and collects an ear cytology and fecal sample enters those charges as they occur. Doctors can then add anything they do. Having each team member initial the travel sheet to indicate everything was entered and reviewed ensures accountability.
Finally, a client service representative should review the charges with the client to confirm everything. Saying, “Today, Dr. A did an exam, Bordetella vaccine, senior lab profile, and nail trim,” allows the pet owner to respond, “I also got a refill of Simparica Trio” or “I also asked for an ear check.” Sometimes, front desk employees are scared to question a doctor or technician, but they should be able to ask, “Did you trim Sophie’s nails? I saw the request in the appointment, but I don’t see a charge.”
Auditing Records Is Vital
An audit is more than just checking for missed charges. It’s also an opportunity to ensure all aspects of the medical record are filled in: patient weight, vital signs, subjective history, physical exam, diagnostics, diagnoses, and recommendations. You will see whether a doctor offers overdue services, such as vaccines, blood tests, and fecal exams, even if the patient didn’t come in for that reason.
I recommend that someone other than the doctor and tech working on a case review the chart before checkout. If your hospital uses a travel sheet, a third party can compare the charges in the PIMS to those circled or highlighted on the travel sheet. That person can also review the reminder section in the computer system to see whether anything overdue has been overlooked.
Many hospitals don’t have the time to audit every record, but you can catch common issues by spot-checking 10 records per doctor and technician each week. Also, audits conducted on the same day as the visit allow the staff to make possible corrections and call the client.
FINDING MISTAKES
A 2025 Veterinary Hospital Managers Association survey asked about the top two issues identified during audits of medical records and invoices. The most common responses were incomplete documentation (54%) and inaccurate billing (51%).
Fonte: todaysveterinarybusiness.com
