Your Practice 5 ways to regain financial control
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Transcript of Your Practice 5 ways to regain financial control
Because your patients come first.Because your patients come first.Because your patients come first.
Your Practice Your Practice 5 ways to regain financial control5 ways to regain financial controlYour Practice Your Practice 5 ways to regain financial control5 ways to regain financial control
Steven A. Adams, CPC, CPC-H, CPC-I, PCS, FCS, COASteven A. Adams, CPC, CPC-H, CPC-I, PCS, FCS, COA
Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First
Five Ways to Increase Your Five Ways to Increase Your IncomeIncome
Five Ways to Increase Your Five Ways to Increase Your IncomeIncome
Step 1: Understand the Reimbursement Process
Step 2: Reduce denials
Step 3: Understand Revenue, Collections, and Overhead Step 4: Deal with Accounts Receivable
Step 5: Implement
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What’s Going On?
Goal 2001 Monthly 2002 Budget
GROSS CHARGES
ADJ USTMENTS
RECEI PTS 344,175.00 100% 100% 28,681.25 344,175.00
-
1 Total Salaries 132,642.00 38.5% 24.0% 11,053.50 82,602.00
2 Staff Fringe Benefi ts 3,037.00 0.9% 1.3% 253.08 4,474.28
3 Staff Retirement - 0.0% 1.0% - 3,441.75
Lab Supplies 1,768.00 0.5%
Clerical Supplies 3,517.00 1.0% 293.08
Clinical Supplies 18,603.00 5.4% 1,550.25
4 Total Supplies 23,888.00 6.9% 6.4% 1,990.67 22,027.20
Rent 37,777.00 11.0% 3,148.08
Utilities 0.0% -
J anitorial 0.0% -
Building I nterest 270.00 0.1% 22.50
Other Occupancy Costs 0.0% -
5 Total Occupancy Costs 38,047.00 11.1% 6.9% 3,170.58 23,748.08
6 Telephone 1,832.00 0.5% 1.8% 152.67 6,195.15
7 Advertising 802.00 0.2% 0.2% 66.83 688.35
8 Malpractice I nsurance 14,323.00 4.2% 1.7% 1,193.58 5,850.98
9 Business I nsurance 0.0% 0.6% - 2,065.05
Equipment Rental 3,556.00 1.0% 296.33
Computer Support 0.0% -
Computer Repair 0.0% -
Equipment I nterest 0.0% -
Computer Exepnse 12,562.00 3.6% 1,046.83
10 Equipment Total 16,118.00 4.7% 2.4% 1,343.17 8,260.20
11 Billing Service - 0.0% 0.8% - 2,753.40
Dues/ J ournals 3,794.00 1.1% 316.17
Conventions/ Seminars 3,162.00 0.9% 263.50
12 Total Dues and Education 6,956.00 2.0% 1.1% 579.67 3,785.93
13 Prof essional Promotion 0.0% 0.3% - 1,032.53
14 Automobile 0.0% 0.7% - 2,409.23
15 Business Prof essional Fees 3,054.00 0.9% 2.2% 254.50 7,571.85
Payroll Taxes 15,289.00 4.4% 1,274.08
Other Taxes 1,493.00 0.4% 124.42
16 Total Taxes 16,782.00 4.9% 3.6% 1,398.50 12,390.30
17 Miscellaneous Expense 9,278.00 2.7% 1.4% 773.17 4,818.45
18 OVERHEAD 266,759.00 77.5% 60.0% 22,229.92 206,505.00
19 PROFI T 77,416.00 22.5% 40.0% 6,451.33 137,670.00
Dr. Sample
1997 Entire Year
20
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1. Reimbursement 1. Reimbursement ProcessProcess
1. Reimbursement 1. Reimbursement ProcessProcess
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To Evaluate ReimbursementTo Evaluate ReimbursementTo Evaluate ReimbursementTo Evaluate Reimbursement• Find out what you are doing
• What you are getting paid
• If not or not enough why
• Either way, correct it
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Top 10 Services
Charges Percentage
1 99213 $170,610 32%2 99212 $82,192 15%3 99231 $50,967 10%4 Capitation $42,345 8%5 99222 $23,870 4%6 99211 $21,320 4%7 36415 $11,596 2%8 99283 $9,545 2%9 90659 $9,435 2%
10 85610 $9,144 2%$431,024 81%
9What Are You What Are You
Doing?Doing?
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What Are You What Are You Getting PaidGetting Paid
Top 10 Code Fees Analysis
Description Current Medicare BCBS PPO Aetna1 99213 Level 3 OV 55 50 $44.40 $652 99212 Level 2 OV 42 36 $25.00 $553 99231 Level 1 H F/U 63 33 $52.23 $704 Capitation Capitation Capitation Capitation Capitation Capitation5 99222 Level 2 Admit 155 108 $105.01 $1256 99211 Level 1 OV 26 20 $18.32 $307 36415 Venipuncture 13 3 $5.67 $208 99283 Level 3 ER 115 59 $60.12 $1109 90659 Flu 15 Internet $12.43 $20
10 85610 Protime 18 13 $7.83 $16
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Are You Doing Are You Doing EverythingEverything Right? Right?
Is Is AnythingAnything Missing From Your Missing From Your
List?List?
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Top 10 Services
Charges Percentage
1 99213 $170,610 32%2 99212 $82,192 15%3 99231 $50,967 10%4 Capitation $42,345 8%5 99222 $23,870 4%6 99211 $21,320 4%7 36415 $11,596 2%8 99283 $9,545 2%9 90659 $9,435 2%
10 85610 $9,144 2%$431,024 81%
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Comparative Profile Analysis ########
Physician: Dr. Sample - 1 YearSpecialty: Internal Medicine Locality: GA - Atlanta
CPT Code Qty Billed
Total Dollar
AllowanceRedistributed
Frequency
Redistributed Dollar
Allowance Net ChangePhysician
PercentagePeer
Percentage99211 823 $16,968 257.48 $5,309 $11,660 14.02% 4.39%99212 1,872 $65,642 662.08 $23,216 $42,426 31.90% 11.28%99213 3,104 $149,271 3,403.29 $163,664 ($14,393) 52.89% 57.99%99214 70 $5,186 1,259.02 $93,280 ($88,094) 1.19% 21.45%99215 0 $0 287.12 $31,702 ($31,702) 0.00% 4.89%
5,869 $237,067 5,869 $317,171 ($80,104) 100% 100%
HCCA Inc. Confidential Page 2
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0%20%40%60%80%
100%
99211 99212 99213 99214 99215
Established Patient Visits
Frequency Comparison
Dr. Sample - 1 Year Peer Average
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Comparative Profile Analysis ########
Physician: Dr. Sample - 1 YearSpecialty: Internal Medicine Locality: GA - Atlanta
CPT Code Qty Billed
Total Dollar
AllowanceRedistributed
Frequency
Redistributed Dollar
Allowance Net ChangePhysician
PercentagePeer
Percentage99231 809 $29,435 270.51 $9,842 $19,593 90.70% 30.33%99232 69 $3,913 459.63 $26,068 ($22,155) 7.74% 51.53%99233 14 $1,116 161.86 $12,900 ($11,784) 1.57% 18.15%
892 $34,464 892 $48,810 ($14,346) 100% 100%
HCCA Inc. Confidential Page 6
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0%
50%
100%
99231 99232 99233
Subsequent Hospital Care
Frequency Comparison
Dr. Sample - 1 Year Peer Average
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Comparative Profile Analysis ########
Physician: Dr. Sample - 1 YearSpecialty: Internal Medicine Locality: GA - Atlanta
CPT Code Qty Billed
Total Dollar
AllowanceRedistributed
Frequency
Redistributed Dollar
Allowance Net ChangePhysician
PercentagePeer
Percentage99221 25 $1,781 9.96 $709 $1,071 12.69% 5.05%99222 154 $18,048 68.55 $8,034 $10,015 78.17% 34.80%99223 18 $2,821 118.49 $18,573 ($15,752) 9.14% 60.15%
197 $22,650 197 $27,316 ($4,666) 100% 100%
HCCA Inc. Confidential Page 5
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0%
50%
100%
99221 99222 99223
Initial Hospital Care
Frequency Comparison
Dr. Sample - 1 Year Peer Average
Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First
Don’t overlook ANY POSSIBLE source of
legitimate revenue
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To Evaluate ReimbursementTo Evaluate ReimbursementTo Evaluate ReimbursementTo Evaluate Reimbursement• Find out what you are doing
• What you are getting paid
• If not or not enough why
• Either way, correct it
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2. Reducing Denials2. Reducing Denials2. Reducing Denials2. Reducing Denials
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Reducing DenialsReducing DenialsReducing DenialsReducing Denials• Your staff hates working denials
• Working denials costs you PROFIT
• Denial reports should be mandatory
• When you find something wrong, fix it
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NearlyNearly
Of all claims are returned Of all claims are returned because of missing information because of missing information
of CMS 1500 formof CMS 1500 form
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Usually a claim Usually a claim fails to fails to passpass a computer a computer
editedit
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Top 6 DenialsTop 6 DenialsTop 6 DenialsTop 6 Denials
Duplicate Charge - Processed / Processing Not Medically Necessary Patient not Identified Code No Longer Recognized Incomplete CLIA Number Information Does Not Support Number
of Services Provided
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Weekly Denial Report
Patient Code Denial Code Description Resolution 14 Joe 85610 C0-B7 Provider not certified W/O 6 Robert 80061 C0-50 Not medically necessary Correct ICD-9 Code 12 Helen 90772 C0-97 Bundled Re-file with –25 16 Will 81002 C0-50 Not medically necessary Correct ICD-9 Code 22 Pat G0101 PR-49 Routine screening Correct ICD-9 Code 28 George 99244 C0-16 Lacks information Re-file with UPIN 7 8 9 10
Total Number of Denials for Week – 15 Total Number of Services Received – 200 Total Denial Percentage for this week: - 15 / 200 = 8%
10
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Reducing DenialsReducing DenialsReducing DenialsReducing Denials• Your staff hates working denials
• Working denials costs you PROFIT
• Denial reports should be mandatory
• When you find something wrong, fix it
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3. Revenue, Collection, and 3. Revenue, Collection, and Overhead RatiosOverhead Ratios
3. Revenue, Collection, and 3. Revenue, Collection, and Overhead RatiosOverhead Ratios
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RatiosRatiosRatiosRatios• Establish Goals• Work to meet goals• Monthly physician meetings are to be
mandatory• When you find something is wrong, fix it
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Revenue, Collections & OverheadRevenue, Collections & OverheadRevenue, Collections & OverheadRevenue, Collections & Overhead
You Need 5 Pieces of Information Total Charges, Adjustments, Receipts,
Aged A/R, and a Financial Statement Collection Ratios - Gross & Net Office Overhead and Profit Percentage Months in A/R
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Establish Establish Practice Goals Practice Goals
to Measure to Measure SuccessSuccess
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ChargesCharges
ReceiptsReceipts
$575,831$575,831
$348,668$348,668
$348,668$348,668
$575,831$575,83112
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Charges - AdjustmentsCharges - Adjustments
ReceiptsReceipts
$575,831 - $205,421$575,831 - $205,421
$348,668$348,668
$348,668$348,668
$370,410=$370,410=12
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Be very careful about Be very careful about staff makingstaff making
Be very careful about Be very careful about staff makingstaff making
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Goal 2001 Monthly 2002 Budget
GROSS CHARGES
ADJ USTMENTS
RECEI PTS 344,175.00 100% 100% 28,681.25 344,175.00
-
1 Total Salaries 132,642.00 38.5% 24.0% 11,053.50 82,602.00
2 Staff Fringe Benefi ts 3,037.00 0.9% 1.3% 253.08 4,474.28
3 Staff Retirement - 0.0% 1.0% - 3,441.75
Lab Supplies 1,768.00 0.5%
Clerical Supplies 3,517.00 1.0% 293.08
Clinical Supplies 18,603.00 5.4% 1,550.25
4 Total Supplies 23,888.00 6.9% 6.4% 1,990.67 22,027.20
Rent 37,777.00 11.0% 3,148.08
Utilities 0.0% -
J anitorial 0.0% -
Building I nterest 270.00 0.1% 22.50
Other Occupancy Costs 0.0% -
5 Total Occupancy Costs 38,047.00 11.1% 6.9% 3,170.58 23,748.08
6 Telephone 1,832.00 0.5% 1.8% 152.67 6,195.15
7 Advertising 802.00 0.2% 0.2% 66.83 688.35
8 Malpractice I nsurance 14,323.00 4.2% 1.7% 1,193.58 5,850.98
9 Business I nsurance 0.0% 0.6% - 2,065.05
Equipment Rental 3,556.00 1.0% 296.33
Computer Support 0.0% -
Computer Repair 0.0% -
Equipment I nterest 0.0% -
Computer Exepnse 12,562.00 3.6% 1,046.83
10 Equipment Total 16,118.00 4.7% 2.4% 1,343.17 8,260.20
11 Billing Service - 0.0% 0.8% - 2,753.40
Dues/ J ournals 3,794.00 1.1% 316.17
Conventions/ Seminars 3,162.00 0.9% 263.50
12 Total Dues and Education 6,956.00 2.0% 1.1% 579.67 3,785.93
13 Prof essional Promotion 0.0% 0.3% - 1,032.53
14 Automobile 0.0% 0.7% - 2,409.23
15 Business Prof essional Fees 3,054.00 0.9% 2.2% 254.50 7,571.85
Payroll Taxes 15,289.00 4.4% 1,274.08
Other Taxes 1,493.00 0.4% 124.42
16 Total Taxes 16,782.00 4.9% 3.6% 1,398.50 12,390.30
17 Miscellaneous Expense 9,278.00 2.7% 1.4% 773.17 4,818.45
18 OVERHEAD 266,759.00 77.5% 60.0% 22,229.92 206,505.00
19 PROFI T 77,416.00 22.5% 40.0% 6,451.33 137,670.00
Dr. Sample
1997 Entire Year
Financial Information
20
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High OverheadHigh OverheadHigh OverheadHigh Overhead
Low Revenue Poor Management High Staff Salaries Poor Contracts Lack of Budgeting
20
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RatiosRatiosRatiosRatios• Establish Goals• Work to meet goals• Monthly physician meetings are to be
mandatory• When you find something is wrong, fix it
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4. Accounts Receivable4. Accounts Receivable4. Accounts Receivable4. Accounts Receivable
8
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““Every dollar you earn, but Every dollar you earn, but fail to collect, is a fail to collect, is a costcost to to
your practice.”your practice.”
““Every dollar you earn, but Every dollar you earn, but fail to collect, is a fail to collect, is a costcost to to
your practice.”your practice.”
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A/R BalanceA/R Balance
Average Monthly ChargesAverage Monthly Charges$91,101$91,101
$47,985$47,985
$91,101$91,101
$47,985 =$47,985 =12
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Days Totals Actual Goal0-30 42,636.00$ 47% 50%
30-60 6,541.00$ 7% 20%60-90 4,424.00$ 5% 12%90-120 5,510.00$ 6% 10%120+ 31,989.00$ 35% 8%
91,101.00$ 100% 100%
TOTAL A/R
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What’s a Dollar Worth?What’s a Dollar Worth?What’s a Dollar Worth?What’s a Dollar Worth?
$0.00$0.10$0.20$0.30$0.40
$0.50$0.60$0.70$0.80$0.90$1.00
0-30 31-60 61-90 91-120 121-150 >150
Worth
US Department of US Department of CommerceCommerce
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What is A/R Worth?What is A/R Worth?What is A/R Worth?What is A/R Worth?
0-30 days
31-60 days
61-90 days
91-120 days
120 + days
$42,636
$6,542
$4,424
$5,510
$31,989
$91,101$91,101
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What is A/R Worth?What is A/R Worth?What is A/R Worth?What is A/R Worth?
0-30 days
31-60 days
61-90 days
91-120 days
121 + days
$42,636
$5,887
$3,539
$3,857
$12,795
$15,987
$42,636
$6,542
$4,424
$5,510
$31,989
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5. Just Do It!!5. Just Do It!!5. Just Do It!!5. Just Do It!!
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Revenue Revenue -- Overhead Overhead ==
ProfitProfit
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Cuts Expenses & Codes & Collects
The Same
Goal 2001 Monthly 2002 Budget
GROSS CHARGES
ADJ USTMENTS
RECEI PTS 344,175.00 100% 100% 28,681.25 344,175.00
-
1 Total Salaries 132,642.00 38.5% 24.0% 11,053.50 82,602.00
2 Staff Fringe Benefi ts 3,037.00 0.9% 1.3% 253.08 4,474.28
3 Staff Retirement - 0.0% 1.0% - 3,441.75
Lab Supplies 1,768.00 0.5%
Clerical Supplies 3,517.00 1.0% 293.08
Clinical Supplies 18,603.00 5.4% 1,550.25
4 Total Supplies 23,888.00 6.9% 6.4% 1,990.67 22,027.20
Rent 37,777.00 11.0% 3,148.08
Utilities 0.0% -
J anitorial 0.0% -
Building I nterest 270.00 0.1% 22.50
Other Occupancy Costs 0.0% -
5 Total Occupancy Costs 38,047.00 11.1% 6.9% 3,170.58 23,748.08
6 Telephone 1,832.00 0.5% 1.8% 152.67 6,195.15
7 Advertising 802.00 0.2% 0.2% 66.83 688.35
8 Malpractice I nsurance 14,323.00 4.2% 1.7% 1,193.58 5,850.98
9 Business I nsurance 0.0% 0.6% - 2,065.05
Equipment Rental 3,556.00 1.0% 296.33
Computer Support 0.0% -
Computer Repair 0.0% -
Equipment I nterest 0.0% -
Computer Exepnse 12,562.00 3.6% 1,046.83
10 Equipment Total 16,118.00 4.7% 2.4% 1,343.17 8,260.20
11 Billing Service - 0.0% 0.8% - 2,753.40
Dues/ J ournals 3,794.00 1.1% 316.17
Conventions/ Seminars 3,162.00 0.9% 263.50
12 Total Dues and Education 6,956.00 2.0% 1.1% 579.67 3,785.93
13 Prof essional Promotion 0.0% 0.3% - 1,032.53
14 Automobile 0.0% 0.7% - 2,409.23
15 Business Prof essional Fees 3,054.00 0.9% 2.2% 254.50 7,571.85
Payroll Taxes 15,289.00 4.4% 1,274.08
Other Taxes 1,493.00 0.4% 124.42
16 Total Taxes 16,782.00 4.9% 3.6% 1,398.50 12,390.30
17 Miscellaneous Expense 9,278.00 2.7% 1.4% 773.17 4,818.45
18 OVERHEAD 266,759.00 77.5% 60.0% 22,229.92 206,505.00
19 PROFI T 77,416.00 22.5% 40.0% 6,451.33 137,670.00
Dr. Sample
1997 Entire Year
20
Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First
Goal 2001 Monthly 2002 Budget
GROSS CHARGES
ADJ USTMENTS
RECEI PTS 444,000.00 100% 100% 37,000.00 444,000.00
-
1 Total Salaries 132,642.00 29.9% 24.0% 11,053.50 106,560.00
2 Staff Fringe Benefi ts 3,037.00 0.7% 1.3% 253.08 5,772.00
3 Staff Retirement - 0.0% 1.0% - 4,440.00
Lab Supplies 1,768.00 0.4%
Clerical Supplies 3,517.00 0.8% 293.08
Clinical Supplies 18,603.00 4.2% 1,550.25
4 Total Supplies 23,888.00 5.4% 6.4% 1,990.67 28,416.00
Rent 37,777.00 8.5% 3,148.08
Utilities 0.0% -
J anitorial 0.0% -
Building I nterest 270.00 0.1% 22.50
Other Occupancy Costs 0.0% -
5 Total Occupancy Costs 38,047.00 8.6% 6.9% 3,170.58 30,636.00
6 Telephone 1,832.00 0.4% 1.8% 152.67 7,992.00
7 Advertising 802.00 0.2% 0.2% 66.83 888.00
8 Malpractice I nsurance 14,323.00 3.2% 1.7% 1,193.58 7,548.00
9 Business I nsurance 0.0% 0.6% - 2,664.00
Equipment Rental 3,556.00 0.8% 296.33
Computer Support 0.0% -
Computer Repair 0.0% -
Equipment I nterest 0.0% -
Computer Exepnse 12,562.00 2.8% 1,046.83
10 Equipment Total 16,118.00 3.6% 2.4% 1,343.17 10,656.00
11 Billing Service - 0.0% 0.8% - 3,552.00
Dues/ J ournals 3,794.00 0.9% 316.17
Conventions/ Seminars 3,162.00 0.7% 263.50
12 Total Dues and Education 6,956.00 1.6% 1.1% 579.67 4,884.00
13 Prof essional Promotion 0.0% 0.3% - 1,332.00
14 Automobile 0.0% 0.7% - 3,108.00
15 Business Prof essional Fees 3,054.00 0.7% 2.2% 254.50 9,768.00
Payroll Taxes 15,289.00 3.4% 1,274.08
Other Taxes 1,493.00 0.3% 124.42
16 Total Taxes 16,782.00 3.8% 3.6% 1,398.50 15,984.00
17 Miscellaneous Expense 9,278.00 2.1% 1.4% 773.17 6,216.00
18 OVERHEAD 266,759.00 60.1% 60.0% 22,229.92 266,400.00
19 PROFI T 177,241.00 39.9% 40.0% 14,770.08 177,600.00
Dr. Sample
1997 Entire Year
Doesn’t Cut Expenses But
Codes & Collects
Appropriately
21
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Think About ThisThink About ThisThink About ThisThink About ThisOn the financial statement, there are more
than 30 lines showing us how we spend our money. However, there is only one line that
focuses on how much we make. To me, that’s the most important number on the financial report, yet nobody acts like they
know how it is to be addressed.
Now You Do!
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Work Smarter, Not HarderWork Smarter, Not HarderWork Smarter, Not HarderWork Smarter, Not Harder
Because . . .
50% Overhead (average practice)With a
5% Increase in RevenueOr a
5% Reduction in ExpensesWill result in
10% Gain in Your Salary
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If All Else Fails, One Pill, That’s If All Else Fails, One Pill, That’s All…All…If All Else Fails, One Pill, That’s If All Else Fails, One Pill, That’s All…All…
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Any Questions
Office: 888.624.6474
Direct: 770.241.4344
E-Fax: 404-848-8661
E-mail: [email protected]
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