Internal controls: Plugging the hole in your bucket (Proceedings)

How Many Services Rendered In Your Practice Are Not Accounted For?

A. Outpatient Services

Fecal Exam

Heartworm check

Injections

Nail Trim

Other

B. In-Patient Services

Surgical cases

      Suture material

      Anesthesia time

      Hospitalization

      Extra materials used

Medical cases

      Injections

      Fluid therapy

      I.V. catheters

      Radiographs

      Laboratory procedures

      Outpatient procedures

Vaccinations

Heartworm check

The Cost To Your Practice In Lost Revenue

A. Outpatient services - $ ________

B. In-patient services - $ ________

      Surgical cases - $ ________

      Medical cases - $ ________

Effect On Your Bottom Line

A. Represents "true profits"

B. High Gross – Low Net

Causes Of Ineffective Charging And Lack Of Effective Internal Controls

A. Practitioners are too busy

B. Receptionist-oriented problems

      Lack of concern

      Lack of motivation

      Lack of training

4. Responsibility "thrown upon them"

      C. Ineffective management

      D. Inefficient or confusing fee schedule and receipting system

      E. Intentionally not rendering services

      F. Intentional "give-aways"

How To Implement Effective Internal Controls And Prevent Client Give-Aways

A. Out-patient services

1. Itemized client statement

2. Have receptionist circle services requested by client

3. Receptionist should be required to review medical record

      Update preventative procedures

      Simple and efficient method of record keeping

4. Exam room check-off form

      Use of exam room technician

5. Practitioner to check through circled procedures and check-off any additional services rendered

Receptionist to post charges for ALL services rendered

B. In-patient procedures

1. Surgical procedures

a. Operating room usage form

      To be completed by surgical technician

b. Common sense (ie. If there is an operating room charge, there has to be an anesthesia charge)

c. One person in charge of posting all surgical fees

d. Charge for surgeon's time

e. Charge for anesthesia time

2. Medical procedures

a. In-hospital tracking form

1. Must have accurate medical record system

2. One person in charge of reviewing chart and posting all charges

3. Common sense (ie. I.V. catheters for heartworm treatments; "bandages," etc.)

Small Animal Treatment Sheet

Date: Client ID: Client Name:

Doctor: Patient ID: Patient Name:

Vaccinations

      Canine

145 Bordetella Booster

153 Corona First Vacc.

155 Corona Booster

100 DHLP-P Temporary

101 DHLP-P #1Adult

102 DHLP-P Booster

138 Parvo Booster

140 Rabies Canine 1 yr.

141 Rabies Canine 3 yr.

      Feline

113 FDRC Temporary

114 FDRC#1 Adult

115 FDRC Booster

130 Fe-Leuk First Vacc.

133 Fe-Leuk Booster

125 FIP Vacc.

150 Rabies Feline 1 yr.

151 County Registration

      Professional Services

200 Anal Sac Expression

234 Anal Sac Infusion

213 Analepetic Injection

235 Antibiotic Injection

239 Antispasmodic Injection

226 Ear Cleaning and Medicate

225 Ear Crop Retaping

204 Emergency Fee

206 Examination

202 Examination Re-Check

209 Examination Multi-Patient

228 Health Certificate

236 Steroid Injection

      Hospitalization

605 Hospitalization

601 Day-Patient Hospitalization

602 Intensive Care

674 Infusion Set

524 IV Cath.

611 Fluids Intravenous

612 Fluids IV Additional

610 Fluids Subcutaneous

613 Fluids Su Q-Additional

      Laboratory

455 Acth Stimulation w/Inj.

456 Amylase/Lipase

450 Basic Profile

452 Basic Profile/Total T-4

453 Basic Profile/Total T-4/PQ

361 Biopsy

438 Blood Glucose

402 SMAC

414 SMAC-Amylase-Lipase

415 Brucellosis Test

433 BUN Test

454 BUN/Creatinine

457 Cat Scan/Feluek

458 Cat Scan/Feluek/T-4

459 Cat Scan/Prot. Electrophoresis

401 CBC-Differencial

460 Collection/Interpretation

434 Culture and Sensitivity

417 Cytology

428 ECG

424 Flourescein Eye Stain

404 Fecal Exam-Direct

403 Fecal Exam-Flotation

416 Fine Needle Aspirate

405 Fungal Culture

406 Heartworm Exam

407 Heartworm Test-Occult

435 Paracentesis

408 PCV

436 Post Mortem

437 Schiotz Eye Pressure

440 Semen Evaluation

232 Shirmer Tear Test

411 Skin Scraping

413 T-4 Total/SW Lab

420 Thyroid Profile

449 Thyroid Stimulating s/Inj

412 Urinalysis

423 Urinalysis w/Sedimentation

448 Urine Collection-Paracentesis

421 Vaginal Smear

      Grooming

866 Nail Trim

860 Bath and Dip

      Anesthesia

500 Anesthesia-Inhalant

501 Anesthesia-Intramuscular

502 Anesthesia-Local

503 Anesthesia-Intravenous

506 Anesthesia-Additional

505 Pre-Operation Sedation

504 Sedative

MSCAN

      Surgery

311 Abscess Surgery

300 Anal Gland Removal/Bilateral

341 Anal Gland Removal/Abscess

342 Aural Hematoma Canine

343 Cruciate Ligament Repair

344 Cyst Removal

363 Cystotomy Canine Female

335 Cystotomy Canine Male

364 Cystotomy Feline

319 Declaw and Castration

320 Declaw and OVH-Feline

345 Tumor Removal

MSCSU

      Radiology

551 Barium X-ray (2 views)

555 OFA Certification Fee

556 Pneumocystogram/Contrast

558 X-ray 10x12 (2 views)

559 X-ray 10x12 Additional views

560 X-ray 14x17 (2 views)

561 X-ray 14x17 Additional views

562 X-ray 8x10 (2 views)

563 X-ray 8x10 Additional views

552 IVP Injection

MSCRA

      Dental

755 Extract Deciduous Teeth

757 Extract Teeth-Molar

751 Extract Teeth/Simple

756 Extract Teeth/Major

MSCDE

      Group Services

1 Castration Canine

2 Castration Feline

3 OVH Feline

4 OVH Canine 20 lb. or less

5 OVH Canine 21-50 lbs.

6 OVH Canine 50 lbs. Over

7 Dentistry

8 Declaw

9 ________________________

10 ________________________

11 ________________________

Cash

Check Charge Credit

      Tabs - Caps

061 Ace-Promazine 5 mg

069 Ace-Promazine 10 mg

043 Aminophyline 100 mg

100 Amoxicillin 50 mg

103 Amoxicillin 250 mg

145 Ampicillin 250 mg

196 Baytril #20

10 Benadryl 25 mg

852 Butazolidin 100 mg

150 Cefa-Tabs 50 mg

160 Cefa-Tabs 100 mg

162 Cefa-Tabs 200 mg

116 Chloramphenicol 100 mg

148 Chloramphenicol 250 mg

117 Chloramphenicol 500 mg

113 Clavamox 62.5 mg

114 Clavamox 125 mg

115 Clavamox 250 mg

988 DL Methionine 500 mg

871 DMC

854 Dexamethasome .25 mg

701 Droncit Canine

700 Droncit Feline

227 Enteromycin

051 Hydralizine 25 mg

12 Hydraxyzine 25 mg

11 Hydroxyzine 50 mg

866 Ibuprofen 200 mg

842 L-Thyroxine 0.1 mg

874 L-Thyroxine 0.2 mg

841 L-Thyroxine 0.3 mg

047 Lasix 12.5 mg

049 Lasix 50 mg

228 Lipo-Plus

245 Lomotil

719 Metronidazole 250 mg

870 Ovaban 5 mg

066 Oxazepam 10 mg

99 Phenobarbitol 1/4 gr

98 Phenobarbitol 1/2 gr

868 Prednisone 5 mg

867 Prednisone 20 mg

135 Tetracycline 250 mg

140 Tribrissen 120 mg

141 Tribrissen 480 mg

161 Triple-Sulfa

989 Urisal

242 Viokasse Tabs

      Liquid - Ointments - Misc.

702 Albon 2 oz

235 Amforal Suspension 2 oz

106 Amoxidrops 15 ml

753 Atropine OO

146 Bactoderm

755 Chloramphenicol OO Generic

754 Chloramphenicol OO Parke-Dav

163 Clavamox Drops

803 Derma-Clens

811 GDDL Otic

758 Gentocin Durafilm

757 Gentocin OO

759 Gentocin Opth Drops

805 Gentocin Otic 15 ml

799 Gentocin Top Spray

810 Liquichlor

814 Oti-Clens

782 PGA Otic

703 Panacur Granules

819 Panalog Ointment 7.5 ml

708 Strongid T

824 Tresaderm 7.5 ml

823 Tresaderm 15 ml

761 Triple Antibiotic OO

762 Triple Antibiotic OO HC

889 Triple Antibiotic 1 oz

828 Veltrim

240 Viokasse Powder 8 oz

Flea and Tick - Shampoos

955T DFT Flea Spray

956T DFT Refill

937T Dursban Flea Collar/small

938T Dursban Flea Collar/large

780T Lytar Shampoo

921T Mycodex Shampoo XXX

919T Mycodex Shampoo Allerthrin

920T Mycodex Shampoo Carbaryl

910T Oxydex Shampoo

924T Paramite Dip

941T Vet Kem Flea Tick Spray

939T Vet Kem Powder

942T Siphotrol Fogger 12 oz

974T Siphotrol Fogger 6 oz

      Heartworm Preventatives

277 Heartgard 68 (up to 25)

275 Heartgard 136 (26-50)

276 Heartgard 272 (51-100)

286 Filaribits 60 mg -100

287 Filaribits 60 mg -200

304 Filaribits 180 mg -50

302 Filaribits 180 mg -100

313 Nemacide 50 mg -100

278 Nemacide 100 mg -100

312 Nemacide 200 mg -100

279 Nemacide 300 mg -100

310 Nemacide 400 mg -100

297 Nemacide Liquid 8 oz

Food - Prescription Diets

      Canine

5650 CD Canine Can

5874 CD Canine Dry 10 lbs

5876 CD Canine Dry 20 lbs

5640 HD Canine Can

5360 ID Canine Can

5040 KD Canine Can

5802 KD Canine Dry 20 lbs

5540 UD Canine Can

5300 WD Canine Can

5790 WD Canine 10 lbs

5792 WD Canine Dry 20 lbs

      Feline

5440 CD Feline Can

5844 CD Feline Dry 4 lbs

5842 CD Feline Dry 10 lbs

5400 KD Feline Can

5460 RD Feline Can

5794 WD Feline Can

5793 WD Feline Dry 4 lbs

      Vitamins

366T Pet Tab FA Granules

367T Pet Tab 60

387T Visorbits 50

388T Visorbits 200

246T Laxatone

359T Nutfical

Miscellaneous

Medical History Input

Comments

Diagnosis/Future Plans

Patient No. Client's Name Phone No. Animal Name Reason For Admitting Date Entered Dr.

Dates

Laboratory - In House Professional Services Medication - Injections

Blood Screen 247 Brief Examination 3 Acepromazine Inj. 1018

Major Blood Profile 209 Emergency Care 8 Amoxicillin Inj. 901

Preanesthetic 210 Examination 2 Caparsolate Inj. 1411

Cbc 240 Recheck Examination 5 Centrine Inj. 1227

Cytology 227 New Patient Record 1 Chloroamphenicol Inj. 935

Ear Swab - Mite Check 236 Dexamethasone Inj. 1001

Fecal Examination 200 Droncit Inj. 1237

Fungal Culture 225 Immunizations Flocillin Inj. 932

Heartworm Elisa 207 Dhlp - Annual Booster 154 Gentocin Inj. 920

Heartworm Test 205 Parvovirus - Annual Booster 164 Lasix Inj. 1211

Leukemia Elisa Test 243 Bordetella 190 Penicillin G K Inj. 934

Leukemia - Fiv/Elisa 249 Rabies - Canine 1 Year 172 Prednisolone Inj. 1009

Parvovirus Test 252 Rabies - Canine 3 Year 171 Vetalog Inj. 1002

Skin Scraping 226 Fvrcp - Annual Booster 178

Urine Collection 50 Fel Leukemia - Annual Booster 178 Boarding

Vaginal Smear 241 Rabies - Feline 1 Year 173 Board - Canine 395

Urinalysis 218 Rabies - Feline 3 Year 174 Board - Feline 398

Medication 394

Laboratory - Sent Out Special Diet 396

Antibiotic Sensitivity 223 Medical Services

Bacterial Culture 222 Bandage - Light 27 Bathing

Fel Leukemia Antibody Test 216 Bandage - Heavy Padded 28 Bath 24

Histopathology (Biopsy) 228 Clean Ears Major 23 Clip Hair 21

Thyroid Profile 230 Clean Ears Minor 12 Comb Out Mats 20

Clean Wound 25 Medicated Bath 22

Radiology Corneal Stain 17 Medicated Dip 23

1 Radiograph / Interpretation 331 Electrocardiogram 350

2 Radiographs / Interpretation 332 Enema 39 Hospitalization

3 Radiographs / Interpretation 333 Express Anal Glands 16 Hospitalization - Full 375

4 Radiographs / Interpretation 334 Infuse Anal Glands 18 Hospitalization - Partial 385

Flea Treatment 15 Convenience Stay 381

Barium Administration 320 Medical Restraining Collar 58 In Patient Medication 387

Barium Series 321 Nail Trim 14 Special Cleaning 397

Double Contrast Cystogram 323 Catheter / Empty Bladder 48 Special Diet 396

Iv Urography Injection 318 Indwelling Urinary Catheter 49 Intensive Care 386

Ivp Series 325 Relieve Urinary Obstruction 47 Blood Transfusion 389

Pneumocystogram 316 Splint Application 29 In Patient Evaluation - Dvm 376

Positive Contrast Cysto 317 Tap Abdomen 43 In Patient Evaluation - Tech 377

Radiographic Consultation 324 Tap Thorax 45

Euthanasia 1896 Surgery - Elective

Fluids Cremation 1897 Ovariohysterectomy - Canine 750

Iv Catheter 53 Ovariohysterectomy - Lg K9 751

Jugular Catheter 54 Anesthesia Ovariohysterectomy - Feline 752

In Patient Fluids 388 Inhalation Gas Anesthesia 400 Orchiectomy - Canine 753

Flush Catheter 105 Routine Gas Anesthesia 404 Orchiectomy - Feline 754

Replacement Iv Catheter 101 Injectable Anesthesia 401 Declaw - Under 1 Year 755

Replacement Iv Line 102 Sedation 403 Declas - Over 1 Year 780

Preanesthetic Injection 406 Spay / Declaw 838

Operating Room Electronic Monitoring 407 Neuter / Declaw 839

Instruments & Supples 451 Extended Anesthetic 408

Special Instrumentation 452 Surgery - Non Elective

Standard Operation Rm Setup 450 Dentistry Abdominal Surgery 765

Clean & Polish Teeth 725 Hematoma Repair 836

Medication Dispensed Extraction _________ Min 727 Laceration Repair 759

Minor Teeth Scaling 726 Lance And/Or Drain Abscess 761

Food Dispensed Root Canal 728 Tumor Removal 791

Courtesy

Dates Dates

Surgical Usage Sheet

      Client's Name: Pet's Name:

      Item Quantity Item Quantity

      Packs: Monitors:

Small Spay Electrocardiogram

Medium Spay Pulse Oximeter

Large Spay Blood Pressure

Orthopedic

Other: (list packs used) FLUIDS:

L.R.S. L/500 ml

D – 5% L/500 ml

      Suture Material: D – 21/2 % L/500 Ml

Gut, chromic/taper needle Normal Saline 250 ml.

(0, 1-0, 2-0, 3-0) Blood Transfusion Set

Gut, chromic/cutting needle Blood

(0, 1-0, 2-0, 3-0) Hetastarch _________

Vicryl (0,1-0, 2-0, 3-0)

PDS (0,1-0, 2-0, 3-0) CATHETERS:

Ethilon (0, 1-0, 2-0, 3-0) Butterfly ga: ______________

Wire ga: ____________ Tom Cat Catheter

Hemoclips S M L Jugular

Needles (not in packs) Urinary Catheter

Red Rubber

PINS, PLATES, SCREWS: IV SETS:

Specify type, size & quantity Venoset ________________

1. ______________________________________ Travenol ________________

2. ______________________________________

3. ______________________________________ BANDAGE MATERIAL:

Specify Material, Size & Quantity

SUCTION EQUIPMENT: 1.

Set Up 2.

Tubes 3.

Catheters, Attachments 4.

Chest Tubes

3-Way Stopcocks MISCELLANEOUS:

Other: Gauze Packs

Abdominal Sponges

ANESTHESIA: Electrocautery

Atropine cc Drains

Promace cc Scalpel blades

Propofol cc Scope (broncho, procto)

Ket/Valium cc Gel Foam

Dormitor cc Nexaband

Phenobarbital cc Lap Sponges

Gas: Flow: Time: Biopsy Jars

O2

Sev DRUGS: Injectable/Topical

Iso Penn-Strep cc

Ampicillin cc

Solu-Delta Cortef cc

Report by: Epinephrine cc

Dopram cc

Date: Clindamycin cc

Cefalozin cc

Polyflex cc

PenG cc

IN-HOSPITAL FEES

      Calculate Your Fees Based On:

      Overhead Costs Per Minute

      Direct Costs At Percent (%) Mark-Up

      Return On Time To The Doctor

      Monitor Your Pharmacy

      Set % Mark-Up

      Minimum Per Pill Charge

      Pharmacy Preparation Charge

      Minimum Rx Charge