Don't let surgial patients disrupt your schedule; Keeping copies of your prescriptions; Tips for working with building contractors; When do colletion efforts become harassment?; Staffers who forgo health insurance.
Q After my resignation became public, my medical assistant said that she'd like to go with me to my new employer. Should I ask that group to try to accommodate her? If I make such a request, could it be considered "stealing" from my former employer?
A There's no reason why you shouldn't ask your new employer to consider hiring your assistant. Since you didn't solicit the employee, her departure wouldn't be considered stealing. In fact, with you gone, your old group may not need her. Just be sure the staffer knows that the final hiring decision at the new practice will be made by someone other than you.
Q The claims I submit to my Medicare carrier clearly contain my patients' signed authorizations to pay benefits to me. But the carrier says it doesn't have to pay me directly, because I'm not a participating provider. What should I do to rectify this situation?
A Assuming you're completing the claims forms properly (Medicare won't pay you directly unless you've indicated that you're accepting assignment), get on the phone and start the appeals process. The carrier is wrong. A patient may assign benefits to you, even if you're not a Medicare participating physician. Keep calling up the ladder, until you get someone who will resolve the issue.
Keep in mind, however, that once you accept assignment, you agree to take the Medicare-approved fee (including coinsurance) as payment in full.
Q During the past several years, I've been socking away money so I can leave the hospital where I work and open my own internal medicine practice. Would it be better to finance the start-up with a bank loan? If so, how much will I have to borrow, and how long does it typically take to repay a start-up loan?
A Don't finance a practice start-up with your personal savings! Take out a bank loan instead. Get a standard business plan worksheet from your bank, and use that to list the estimated costs for office space, equipment, supplies, and staff. This will help you determine how much you'll need to borrow. Ideally, you'll be able to repay the loan in three to five years.
Q My partner and I employ only two staffers in our rural clinic. We're struggling to decide what sort of paid leave package to offer. What do other small practices provide to employees for holidays, vacation, and sick time?
A Your benefits need to be competitive, regardless of your practice size and location. Offer the following holidays at a minimum: New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas. Give your employees five days of vacation time after six months of service, 10 days after one year, and 15 days after five years.
You should encourage workers to take time off at the same time the physicians do. After a staffer has been with the practice six months, most practices allow for six sick days per year.
Q How much should I spend on rent for my satellite office?
A Generally, 6 to 8 percent of the gross revenue derived from that office.
Q When a managed care patient cancels and later reschedules a surgical appointment, my office must get another referral from the patient's primary care doctor and a reauthorization from the plan. In addition, we must redo preadmission testing and reserve the operating room again. May we charge a fee to patients who cause this hassle and expense? What can I do to prevent patients from wreaking havoc with my schedule?
A Most managed care contracts prohibit charging these types of fees. A better strategy is to have each patient sign a written statement before the surgery is scheduled. The statement should spell out all the steps involved in scheduling surgery, and should clarify that it's the patient's responsibility to secure another referral from his primary care doctor if he cancels his original appointment.
Q Should I keep copies of every prescription I write?
A You could keep a carbon copy from your Rx pad, but it really isn't necessary. A note in the patient's chart is sufficient.
Q After my architect completed the designs for my new office, I began talking to contractors. In informal discussions, most contractors said construction costs would run from $60 to $90 per square foot. But bids came in considerably higherat $117 to $125 per square foot. Where can I turn for reliable information on building costs so that I may be in a better negotiating position with these contractors?
A You could visit medical offices you like and ask their builders how much it cost to construct them. A more practical recourse, though, is to ask your architect to suggest design changes that will bring the price down. Let the architect deal with the contractors; his experience gives him a negotiating advantage.
Q Instead of paying me directly, an insurer sent payment to the mother of a child I treated in the emergency room. The parent claims she "can't remember" whether she forwarded the $700 check to my office. We certainly have not received it.
It's been several weeks since I sent the initial bill to the mother. How often can my office contact this woman about payment without leaving ourselves vulnerable to charges of harassment?
A If the mother assigned benefits to you at the time of treatment, try to collect from the insurer, since it erred in paying the patient. If the insurer was correct in reimbursing the patient, and you've obtained confirmation that the check was sent, you're not likely to be charged with harassment if you follow the lead of most practices. The typical practice sends payment reminders every two to four weeks, and follows up those notices with phone calls. Allow the patient the option of setting up a payment plan, if necessary. If the patient's account becomes 90 days overdue, turn it over to a collection agency.
Q If an employee waives the right to employer-sponsored health care coverage, must we pay the worker what we'd ordinarily contribute for insurance?
Do you have a practice management question that may be stumping other doctors, too? Write PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to firstname.lastname@example.org (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management. Medical Economics 2000;8:159.