SkinCare Physicians (SCP) is a private academic practice in Chestnut Hill, MA that was established in 2000. Today there are almost 100 employees, including nine partners, three fellows, three mid-level providers, two part-time dermatologists, and three aestheticians. The facility encompasses more than 20,000 square feet with 31 examination rooms, three procedure rooms, and two aesthetic rooms, and there is a separate clinical research suite where a multitude of studies are taking place at any given time.

With this much going on, a fail-safe collections process is needed to ensure the business side of SCP continues to run smoothly. Here, Chief Operating Officer Chrstine Foley shares her top 10 collection tips.

1. Keep it in House

We don't outsource any of the billing process (except a very small collection piece). That way we retain complete control over the entire revenue cycle. We also have a stake in how effective our collections are, versus an outsourced model where the billing company may have a stake, but much less.

2. Train Staff on Best Practices

We have caring and highly trained, long-term staff that interact well with the patients, understand our financial policies and procedures, and are confident in their financial discussions with patients.

3. Be Proactive

We allocate resources, such as a four-person referral department, to help educate patients on their financial responsibility based on the rules of their insurance carrier and to make sure that all insurances/referrals are reviewed and verified before the patient comes for their appointment.


A fail-safe collections process is needed to ensure the business side of a practice continues to run smoothly. Allocate resources, document well, and review outstanding balances on a consistent basis. Consider refusing new appointments for any patient with an outstanding balance due to the practice.

4. Collect Co-pays at Time of Service

Our staff always collect co-pays at time of service. This seems straightforward, but many practices still don't seem to do this.

5. Collect Deposits at Time of Booking

We collect pre-payments or large deposits for consults and expensive procedures at time of booking. We find that charging a deposit (usually partial, rarely the full price of the procedure) confirms that the patient is serious enough about the visit or procedure to financially commit to it. They have 24 hours to cancel, but then we are often able to re-fill the opening with another patient.

6. Develop a System for Collecting Outstanding Balances 

 Patients who have outstanding balances receive two statements, one letter, one phone call, and one email. Correspondence is reviewed by the physician before being sent to outside collections. A detailed spreadsheet is created documenting all interactions regarding the patient's outstanding balance.

7. Be firm

Our policy is that patients with outstanding balances cannot schedule additional appointments until the balance is paid, and we stand by it.

8. Allocate Resources for Collections

The billing department dedicates two full days to the collection process. An extensive check is made on each and every outstanding balance to ensure the patient and SCP staff are educated as to the reason why the total is due. This process requires a lot of patience, accuracy, and attention to detail, and we are confident all accounts are reviewed and addressed accordingly.

9. Make Sure Patients Know the Deal

We use an automated phone/email/text system to remind patients of their upcoming appointments, and at the same time utilize this communication to be proactive and remind patients that we collect payments at time of service.

10. Make it Easy for Patients to Pay

We have an online bill payment service that can be accessed via our website so patients can conveniently pay any outstanding balances.

A Grand Slam

This is not to say that there is nothing the practice should do better, Ms. Foley says. “We could strongly adhere to our cancellation/no show policy. It seems patients always have a unique reason why they did not come and we tend to be lenient,” she notes. “We adhere more to a three strikes and you are out mindset.”