Missed charges put clinic workflow and trust under scrutiny: full analysis

A new Veterinary Viewfinder episode is putting a spotlight on one of the most common and least comfortable business dilemmas in practice: missed charges. In “Missed Charges: Who Pays When the Clinic Gets It Wrong?,” released May 6, 2026, Dr. Ernie Ward and Beckie Mossor, RVT, examine what happens when a clinic fails to bill for care that was already delivered, and who should make the call on whether to pursue payment or write the charge off. (podchaser.com)

The topic lands at a moment when veterinary teams are paying closer attention to the link between documentation, workflow, and financial performance. AAHA reported in April 2026 that missed or incorrect charges are among the most common problems practices uncover during medical-record and invoice audits, alongside incomplete records, human error, inconsistent processes, and limited staffing. (aaha.org) In a separate AAHA financial standardization resource, the association describes missed charges as a KPI issue that can show up in falling average transaction fees and often traces back to breakdowns in how teams hand off cases from exam room to checkout. (aaha.org)

The financial stakes can be meaningful. dvm360 previously cited consultant Joy Fuhrman, DVM, MBA, saying practices miss about 10% of charges on average, equating to roughly $64,000 per doctor per year. (dvm360.com) While that figure is not new, more recent vendor and trade coverage suggests the core problem remains persistent, especially in high-volume hospitals where multiple team members touch the case and not every action makes it cleanly from the medical record to the invoice. (instinct.vet)

AAHA’s recent expert commentary points toward a systems-based response rather than a blame-based one. Heather Prendergast, BS, AS, RVT, CVPM, SPHR, told AAHA that if care is delivered, the invoice should reflect it, and that auditing is fundamentally a workflow, quality-control, and role-clarity issue. (aaha.org) Kellie G. Olah, SPHR, CVPM, SHRM-SCP, similarly argued that daily spot checks and layered review processes are more effective than infrequent audits done long after the visit, when habits are already entrenched. (aaha.org) AAHA’s financial workflow example also assigns invoice double-checking to front-desk staff while making charge entry and protocol communication a shared responsibility across reception, technicians, and veterinarians. (aaha.org)

That framing matters because the question in the podcast title — who pays? — is really two questions. One is external: should the clinic go back to the pet parent and request payment for a missed item? The other is internal: should the loss be treated as a training issue, a management issue, a software issue, or an individual performance issue? Industry guidance leans toward the latter categories first. AAHA’s experts explicitly caution against making auditing punitive, instead using it to improve consistency, defensibility, client education, and charge capture. (aaha.org) AVMA PLIT’s client-management guidance, while not specific to missed fees, also emphasizes compliance with state practice acts and recordkeeping requirements, reinforcing that billing disputes can quickly become documentation and risk-management issues. (avmaplit.com)

Why it matters: For veterinary professionals, missed charges are about more than recapturing revenue. They can expose weak SOPs, unclear role ownership, and communication gaps that affect both the medical record and the client experience. If a pet parent receives a follow-up bill after believing checkout was complete, the practice may recover some revenue, but it can also spend down trust. That makes prevention more valuable than collection. Stronger estimate communication, real-time charge entry, invoice review before discharge, and clear internal policies on post-visit corrections can reduce both financial leakage and friction with pet parents. This is also one reason charge-capture automation and tighter PIMS integration are getting renewed attention. (aaha.org)

What to watch: The next phase of this conversation will likely focus less on who to blame and more on operational safeguards — including AI scribes, automated charge capture, required invoice checkpoints, and written clinic policies for when a missed charge should be corrected, disclosed, or absorbed. AAHA’s recent reporting already points to software, templates, and workflow redesign as the direction many practices are taking. (aaha.org)