In this Chiropractic Deep Dive, we uncover one of the most painful (and costly) issues in practice management: getting paid for the care you deliver. Based on Dr. Noel Lloyd’s Dirty Dozen system, this episode breaks down exactly how to clean up your collections process, eliminate bad debt, and recover tens of thousands in lost revenue. You’ll learn the three red flags that instantly identify “dirty accounts,” the weekly system that prevents cash flow chaos, and the financial scripts and tools top chiropractors use to consistently collect 96% of what they earn. If you’ve ever struggled with unpaid balances, chaotic insurance follow-ups, or inconsistent team accountability — this episode is your roadmap to Zero Dirty Accounts and full financial control.
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This Chiropractic Deep Dive episode was created using AI-generated voices to deliver the teachings and systems of Dr. Noel Lloyd and Five Star Management in a clear and accessible format.
Welcome to the chiropractic deep dive. We cut through the noise to get you the most powerful, actionable business intelligence out there. I'm your host and we're really proud that this Deep Dive is part of the Successful Chiro Podcast. And uh, it's brought to you by Five Star Management, a dedicated chiropractic consulting company.
Today we're tackling, I think. Probably the single most painful issue in practice management. Oh, absolutely. Getting paid for the amazing care you provide. It's huge. Yeah. So we're dissecting the system, uh, detailed by Dr. Noel Lloyd in a recent workshop he led. It's basically the playbook for getting to well.
Zero Dirty accounts. That's right. The dirty dozen. That's what he calls it. Okay. Let's start with the math, because it's pretty devastating actually. This isn't just, you know, small admin errors we're talking about. No, not at all. Dr. Lloyd really highlighted this brutal truth. If your practice collects, say just.
20% less growth revenue than it really should. And honestly, that happens way too often. Yeah. It typically costs you a crushing 40% less profit, assuming, you know, standard 50% overhead. Wow. 40% less profit off a 20% collection drop. That's, that can sink a practice. It does. It limits growth. It bankrupts practices, it creates this, um.
This vicious cycle that hits everyone on staff. Right. And there were specific examples from the workshop, weren't there? Like um, an associate. Yeah, exactly. Yeah. This young associate producing high volume, hitting all her visit goals, I mean, doing great work clinically, but her collections were stuck like only 40%.
So she couldn't hit her bonus metrics, not because she wasn't good at her job? No, it was because the office had a systemic failure. In collections. It wasn't her fault. Okay. So the mission here is massive. Then it's about reversing that leakage, stopping that financial bleed. What's the, uh, the ultimate goal?
Dr. Lloyd sets the quantifiable one. The goal is, well, absolute systematic excellence. We're aiming for 96% of collectible money. 96%? Yeah. And that's 96% after your MCO write offs, your managed care organization write off. Got it. And the big mission statement, the system has to function with or without the owner being there.
That's key. Okay. That sounds almost like military grade efficiency. So when you talk about a system, especially for credit extension, not just cash repays, where does Dr. Lloyd say you have to start? It all starts with discipline and data. Yeah. A system fundamentally is a written policy and procedure. You just can't manage what you don't measure.
Right. Makes sense. So this requires one very specific kind of nerdy report. Polled every single week. No, no excuses every week. And this report, it's non-negotiable, how it's laid out. Totally non-negotiable. You need all accounts. Don't segment them by PI or work comp or insurance. Everything together, okay?
All accounts alphabetical order, and it absolutely must include patient name, the date the account was established, current money owed, right then the aging buckets. 30 day money, 60 day money, 90 day money, uhhuh. And uh, if you can possibly get it, 120 day money too. Okay, so all the aging details. What else?
You also need the total money owed, obviously the last payment made amount and critically the date of that last payment. Gotcha. That comprehensive report, that's your foundation for triage, I guess? Exactly, yeah. That's the foundation. Once you have that data, then you run what Dr. Lloyd calls the red flag check.
Okay. Red flags. These are the criteria that basically scream danger! This account needs attention. Precisely. So what are those three non-negotiables? The red flags. Number one is size. The account balance hits a certain threshold. Dr. Lloyd uses a thousand dollars. $1,000. Hmm. Why that specific number though?
Did participants talk about why $1,000 and not say $500 or maybe $2,000 is the tipping point? Yeah, that's a great question. And it came up, the consensus really was psychological. Oh, under a thousand bucks. Most patients kind of feel like, okay, I can clear this up in a few payments. But once you cross that a thousand dollar mark, it feels different.
Totally. The patient shifts from I could handle this to, whoa, this is a major debt I need to figure out. And often that's when they might start avoiding calls, avoiding contact. Right. The relationship gets financially strained. Exactly. Above that a thousand dollars mark. It changes. Okay. That makes a lot of sense.
It shifts the psychology. What's the second critical red flag? Security. This one's crucial, especially for pi, personal injury cases, right? If that debt isn't protected by a lien or you don't have a letter of protection on file, you're basically running high risk unsecured credits, which means that account is automatically flagged as dirty until you get that security established period.
Okay? Size, security, and the third flag payment, history or age, any money that hits 90 days or older. Automatic flag. 90 days. Yep. Participants confirmed, you know, money owed that long just gets significantly harder to collect. It's a fact. So those three filters, size, security, age, they define your dirty dozen.
Yeah, the ones you focus on. That's it. You pull the report, you flag maybe a dozen or so accounts hitting those criteria and then. The meeting, the mandatory weekly meeting. Exactly. It's gotta be weekly, non-negotiable Check-in, preferably Dr. Lloyd says, with a trusted team member, like your co-pilot, shoulder to shoulder.
Yeah. Shoulder to shoulder, reviewing those top problem accounts, and the key is immediately assigning action items so nothing falls through the cracks. Right. The discipline of doing it weekly prevents the debt from just piling up and ensures no task gets forgotten. Okay, but these problems, these dirty accounts, they don't just appear magically.
Right? What did the workshop find were the biggest big fat account mistakes that lead to this mess in the first place? Oh yeah. There were definitely common themes. The number one sort of tactical failure is. Not tracking treatment against benefits. Ah, okay. Explain that. Well, you run the risk of, uh, what Dr.
Lloyd called mowing down somebody's benefits. You keep treating, maybe the patient feels great, but nobody's checking the insurance coverage limits. And then, and then boom, coverage ends. The patient gets hit with this massive, unexpected bill, and honestly, that debt is often almost impossible to collect.
Surprise debt is bad debt. Yeah, I can see that. And PI cases seem like another big blind spot. You mentioned security, but it sounds like they're easy to sort of sneak by. They really are. Until suddenly the patient owes maybe $5,000 because they started care. But key things were missing. Like maybe there wasn't an open claim yet, or they didn't actually have a lawyer confirmed, or you didn't get solid claim information upfront.
So what's the fix there? It's non-negotiable. You need a simple PI tracker form. Could be digital, could be paper, it doesn't matter, but you use it to actively follow that patient's claim status through their entire care plan. Such a small administrative step, tiny step saves literally thousands down the road.
Huge ROI on just being organized there. What other basic tools or policies were often missing? Things that could prevent problems? All simple stuff. Really, like not having a credit card on file for auto debiting, copays or balances, right? That seems basic now. It does. But you'd be surprised also not having a defined debt threshold.
You know, that specific dollar amount that triggers a necessary financial chat with the patient before it gets outta hand. So you catch it before it hits that a thousand dollars red flag maybe. Ideally. Yeah. And another big one, neglecting prior authorization. Not getting that PA upfront leads to delays.
Claim rejections, yeah. Just slows everything down and lets balance this build and internally. Communication breakdowns. Oh, huge. The mistake of having poor or no collection notes. If you've got multiple people working accounts receivable, which is common, very common, and there are no clear notes, people miss follow-ups.
They might duplicate effort calling the same insurer, and worse, the practice has zero accountability trail for what collection attempts were actually made. It's chaos. Okay, so if the system is designed to prevent all these mistakes, let's flip it. Let's talk about the strategies that do work. The ones that get practices to those really high collection weights, like 96%, 97%. Right,
the solutions, a big theme was automation and just crystal clear, upfront clarity. One participant, really stressed providing a financial report on day two. Day two, so right after the initial consult. Exactly, lay out the costs, the expected insurance coverage, the patient's responsibility, manage expectations from the get go and crucially get that credit card authorization on file right then and there.
Protection for the practice. Clarity for the patient. Win-win. Another participant, mentioned something, modernizing the payment process. Yeah, pay links. This was cool. So say a patient leaves. Mm-hmm. And maybe the card on file declines for their copay or something Happens all the time. Right. Instead of chasing them later, you immediately text or email them a direct payment link straight to their phone.
Click pay. Done. And that works. Several chiropractors confirmed it super quick, super easy, really boosts immediate collection success, especially for smaller amounts. Nice. What about the philosophy behind payments offering options? Yeah. One participant Shared a strategy focusing on like. Humane financial options, setting up insurance combo care plans right from the start.
How did that work? Offering patients, basically three clear choices, maybe. Option one is a straightforward monthly payment plan. Option two could be, say a 5% discount if they prepay for a chunk of care. Okay. And option three might be a bigger discount, like 10%, maybe plus a free re-exam if they prepay for the whole recommended plan.
Like annually. So it gives the patient agency, lets them choose. Sounds fair. Promotes commitment, but does managing three different options create an administrative headache, cracking discounts and stuff that came up too. And the conclusion was because the patient commits to one path right there on day two, it actually reduces friction and admin time later on.
Ah, because you're not chasing debt down the road. Exactly. The upfront work pays off by minimizing the backend scramble. Smart. Any, uh, administrative hacks? Shared internal stuff? Yeah. Two really clever ones. First, using an FC financial consult visit type. Right on the appointment schedule fc. Yeah, so if the front desk sees an accountant getting close to that practice's defined debt threshold, they flag the next appointment as an fc.
What does that trigger? It triggers a mandatory quick chat with the patient about their balance before they go back for treatment. That day stops the debt from escalating further. Proactive, I like it. What was the second hack? This one tackled a major friction point. Getting doctors to complete their diagnosis and new patient paperwork quickly.
Oh yeah. If the docs are late, you can't bill. Exactly. Billing gets held hostage. So participants love this idea. They called it the tie pulling authority, tie pulling authority. It's kind of a metaphor. Yeah. Empowering the billing team or the CA to gently, but firmly enforce those administrative deadlines on the clinical staff.
Basically saying, doc, we can't submit these claims until your notes are done. Huh, that's necessary. Sometimes it connects the clinical work directly to the cash flow. What about incentivizing prepayment? Was there a standout strategy? Definitely. One participant Strategy was pretty powerful. He offered a significant discount, maybe around 20%, to really incentivize patients to choose the prepaid option.
20%. That's substantial. It is, but he builds up the price from his desired prepaid rate, so the discount makes the pay per visit option seem less attractive. And the result, he said up to 70% of his patients were choosing to prepay 70%. Wow. Yeah, I mean, if you can get that kind of prepayment rate, your dirty accounts problem basically evaporates.
Okay. So prepayment is ideal, but if that's not possible, or for the balances that still occur, that weekly review remains the critical practical application. Absolutely. That weekly AR meeting. Just like Dr. Lloyd demonstrated, the doctor or owner sits down, looks at that report and makes direct clear assignments to the copilot.
Like what kind of assignments? Things like, okay, this claim needs to be rebuilt and resubmitted, or, call the insurance company on this one, or, we need to secure the lien for this PI case today. Clear action items, and there has to be follow up, right? Crucial. It relies on a consistent feedback loop. The copilot needs to report back, ideally even in a quick daily check-in.
Reporting what? Confirming, which accounts got fixed. Hey, I got the Carlson money, or good news, they agreed to drop a check by Friday for the Smith balance. That immediate accountability and maybe a little celebration. Totally. It keeps the momentum going, keeps the system running smoothly. It shows progress and the proof this works.
Did Dr. Lloyd share any results? Yeah, he shared a really powerful case study. A chiropractor, implemented this Dirty Dozen process, and just by doing that, he found an additional $70,000 in revenue in one year, $70,000 that was just sitting there uncollected, basically, yeah. Money he had previously left on the table because the system wasn't tight enough.
The ultimate goal, of course, is to get those accounts down so far that eventually you look at the report and there are no dirty accounts left, zero dirty accounts, that's the dream! It really boils down to this. Running a successful, truly impactful practice means we have to be meticulous business people too.
Yeah. We need to know these collection numbers inside and out, and we need to implement a strict system, strict but humane. Okay. That brings up a really important question for you, the listener to think about this week. Yeah. If we agree that the best collection practices involve things like prepaid plans and crystal clear financial options before treatment even starts.
What's the one change? Just one you could make to your day two financial process this week to start moving your practice closer to that ideal collection model. That's a great challenge. And look, if you're ready to stop leaving potentially tens of thousands of dollars in profit on the table, and you want help implementing systems like these.
What should they do? We really encourage you to book a free absolutely no obligation strategy call with our team here at Five Star Management. You could even specifically book time with Dr. George Birnbach to discuss getting these systems installed in your practice right away. And where can they do that?
The link to book that call is right there in the show notes for you. Easy to find. Perfect. We also wanna invite you to join us live. We've got a big event coming up in Orlando, Florida, November 15th through 16th. Oh yeah. It's gonna be fantastic. Two powerful events happening at the same time. That's right.
First, we have the new Patient Edge event that's laser focused on how to get more new patients fast, essential for growth. And running concurrently is the Win-Win Associates event. This one dives deep into our proven system for maximizing associate success, which means more growth, more freedom, and ultimately more success for the whole practice.
You can find the registration links for both of those Orlando events right in the show notes as well. Don't miss out. Absolutely. These are game changing strategies, so make sure you subscribe to the Successful Chiro Podcast for more deep dives and essential tips just like this one. Keep tuning in. We'll see you next time.