How much are your charts worth?; Sharing the cost of health insurance with your employees; Writing job descriptions for workers who wear many hats; The right number of payers will keep your practice afloat; Tough sanctions for doctors under Medicare's suspicious eye; How to make patients mind your schedule; Don't let preauthorizations get lost in the shuffle; How to find a billing service that's worth what it charges; When slow payers create cash-flow problems.
Q What is the value of an active patient's chart? I'm leaving practice and want to sell my records to another doctor.
A Many consultants suggest that you sell all of your charts for the equivalent of one year's income (practice revenue less overhead expenses).
Q My partner and I have only two employees in our small, rural practice. One is a medical assistant; the other acts as our receptionist, secretary, and transcriptionist. We want to be more organized and professional about our yearly reviews, and, to do that, we need to prepare job descriptions for these positions. Can you provide us with sample descriptions?
A It's impossible to generalize about job descriptions; they vary greatly from practice to practice. To help you get started, we've listed the fundamental tasks for each position. But you and your partner must customize the job descriptions to fit the needs of your small practice. Do this by writing down each employee's duties, then specifying which are primary ones and which are secondary. Allow your workers to review your list and add or delete tasks, as appropriate.
Medical assistant: Pull charts; assist physician with examination and treatment; take histories; perform routine lab procedures; administer certain medications or injections under a doctor's supervision; instruct patients on preparation for tests; collect and prepare specimens for transport to the lab; prepare and clean exam rooms; sterilize instruments; maintain diagnostic equipment; maintain inventory of clinical supplies; perform other tasks as requested.
Receptionist/secretary/ transcriptionist: Greet patients; answer telephones; make appointments; gather appropriate insurance information; file medical records and reports; collect payments; file claims; transcribe medical records; prepare bank deposits; type reports and correspondence; make reminder phone calls; follow up on patient no-shows; maintain inventory of office supplies and forms; perform other tasks as requested.
Our consultants question whether your office is adequately staffed. As you write these job descriptions, consider whether additional employees are warranted.
Q How many managed care plans must I contract with to support a solo specialty practice?
A Four to eight, on average, but it varies by community. In general, the more plans you contract with, the more accessible you'll be to patients. Also try to avoid having any one plan provide more than 30 percent of your patient base. Your practice would be devastated if you had to terminate your contract with that plan.
Q After HCFA fined a colleague for billing irregularities, the doctor's hospital yanked his admitting privileges. This, even though a hearing to appeal the fine is still under way. Is the hospital allowed to do this? Does the doctor have any recourse?
A The hospital can do anything it wants under whatever bylaws it has set for sanctioning physicians who run afoul of billing regulations. Just as your colleague has appealed HCFA's fines, he can appeal the hospital's decision to rescind his admitting privileges under whatever administrative rules the hospital has in place for doing that.
Q When patients want to reschedule appointments at the last minute, it wreaks havoc with my schedule. How can I discourage them from doing this?
A There's not much you can do. Charging patients for no-shows tends to sour relationships, the fees are hard to collect, and health plans frown on the policy. So focus your efforts on education. Your scheduler should remind patients every time they make an appointment that your office requires 24-hour notice for cancellations. In addition, a staffer should make reminder calls to patients the day before their scheduled appointments.
Keep a log of patients who tend to miss appointments. That way, your scheduler will know to focus extra attention on these people.
Q Is it better to keep pending preauthorizations in patients' charts or in a file specifically established to track them?
A Cover your bases by doing both. If your office maintains a tickler file at the front desk, employees will be less likely to lose track of patients needing specialty care. By also including a copy in a patient's medical record, you'll have all the necessary information in one place.
Don't forget to enter the preauthorization in your computer, too, so that it will be included on the patient's claim form.
Q For the last year, I've farmed out billing tasks to a third party that has proven useless. What should I look for in a billing service, and how do I find a good one?
A Choose a service that has been in business at least five years, belongs to a trade association, and has worked forand satisfiedcolleagues. Visit the offices of recommended companies, observe how they do business, make sure they have experience in your specialty, and ask for reports on their collection results. Find out how they follow up on delinquent accounts.
Restrict the contract to one year, and make sure you have the right to terminate the contract at any time if you're dissatisfied.
Q Some HMOs take so long to pay that I've had to borrow money simply to meet office expenses. What can I do about this?
A If your state requires insurers to pay claims within a certain amount of time, report the delinquent HMOs to the state department of insurance. And be sure to tell the plans you'll be doing so.
First, though, make sure that your office isn't the source of payment delays. Audit your claims submission process to confirm that you and your staff are using correct codes and providing the documentation necessary to support those codes.
Q Our 10-doctor multispecialty group is in the process of revamping benefits. So far, we've bucked the trend of requiring employees to pay a portion of their health insurance premiums. But now we're reconsidering. What would be an appropriate amount for staffers to contribute?
A The typical contribution is between 10 and 50 percent, with 25 percent being the norm. Another option is to continue to pay full coverage for employees, but require them to pay for dependent coverage.
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;7:274.