Defusing a patient's ire over his insurer's mistake, What if a landlord won't renew your lease? How far to extend a noncompete clause, Why a billing service doesn't guard against theft, Who should pay employees' professional dues? When callers spend too much time on hold, Tracking where your payroll dollars are going, How to retain workers who hit the wage ceiling, When an associate doesn't keep up with paperwork
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QMy practice sometimes loses patients over payment disputes that result when a health plan stops covering a specific service but doesn't notify its subscribers. How can we prevent insurance changes from ruining our patient relations?
A When your office receives notice of an insurer's benefits change, send a letter to patients in that plan explaining the change. If your budget doesn't permit such a mailing, have your receptionist remind patients of the change as they call or come in for visits.
If it's patient satisfaction you're worried about, survey ex-patients about their reasons for leaving the practice. Include questions about the way your practice handles insurance disputes.
QMy building's new owner won't renew my lease, so I'm scrambling to find a new practice space. What should I do to avoid this problem in the future?
A Make sure your next lease includes a renewal option that carries over to a subsequent owner.
QThe contract with my new associate will allow her to buy into my practice after two years if things have worked out between us. In the event that they don't, I'd like to include a noncompete clause in her employment agreement. How specific should I be when drawing the boundary? How far should the restriction extend?
A Establish a boundary that accounts for approximately 80 percent of your patient census. If you try to cover every patient, the boundary will become too large and, possibly, unenforceable.
Base your geographical restrictions on ZIP codes or obvious geographic markers such as roads, rivers, or railroad tracks, rather than on a simple mileage radius. Keep in mind that the distance will vary depending on the type of community. A rural setting, for instance, calls for a larger radius than an urban one.
Attach a map highlighting the boundary to your contract.
QI monitor my practice's billing service by doing a monthly check on random accounts. I compare balances in our records with those the service has reported. I also verify that the reimbursements the service reports match its deposits to my account. Are these measures enough to safeguard us against embezzlement?
A No. Although you're doing a good job of keeping the service honest, you need to take the same precautions with your office staff.
Any payments made in cash are vulnerable to pilfering. An employee could destroy a patient's routing slip and pocket the money.
To guard against that, periodically check your day's appointments against the day's charges to make sure every patient has a corresponding charge slip. The slips should be sequentially numbered so you can easily see if any are missing. Ask an employee to put the slips in order at the end of the day and compare the day's total charges with total payments. You should also check your writeoff report to make sure employees aren't pocketing cash payments and listing them as writeoffs. Verify that the information you have is the same as that reported to your billing service.
As an additional precaution, both your staff and the billing service's employees should be bonded.
QMy office manager wants to join a professional association and has asked if I'd pay the annual dues. Should I? Should I do the same for other employees? Are the dues deductible as a practice expense?
A They are deductible, so your practice should pay them if it can afford to. By doing so, you'll build morale and earn loyalty. Besides, your practice will benefit from the education staffers receive.
QOccasionally, a patient complains that it took too long for our receptionist to answer the phone. How many rings are too many? What should we do if we exceed that number? (Please don't tell us to use voice mail: We don't like those systems.)
A Four rings are too many. The best way for your receptionist to handle two calls at once is to ask for the second caller's name and phone number, put him on hold, finish the first call, then return to the second. And your phone system should allow your office manager and billing clerk to monitor and pick up the overflow so that your receptionist rarely has to put a patient on hold.
If your phone lines jam up during specific time blocks, consider hiring a part-timer to help answer calls during those hours. But make sure you have other work for this employee so you're not wasting money on a staffer who'd end up sitting idle between calls.
QShould our group practice list employees' overtime as its own expense category, distinct from staff salaries? Do we need separate categories for tracking clinical and administrative pay?
A Dividing staff salaries into clinical and administrative categories on your expense report will give you a good idea of where your money goes and can help you evaluate staffing needs. You should definitely list overtime separately. A run-up in that category may be a sign that your staff isn't working efficiently or that it's time to add an employee.
QLast month, our office manager, a valued employee who'd been with us for 10 years, left when we told her she'd reached the top of her salary range. She'd be eligible only for cost-of-living increases. Should we have given our manager more headroom?
A Yes. The continual changes in the field of medical office administration require office managers to absorb new information and learn new skills. This deserves more than just raises to cover inflation. As one consultant puts it, "A good worker is never overpaid." It sounds as though another practice saw fit to pay her more than you did.
QOur new associate is having trouble producing operative reports and discharge summaries in a timely manner. Our patients love this doctor, so we don't want to lose him. Yet we're worried about malpractice risks. How can we prod him into completing dictation more promptly?
A Tell him that meeting certain deadlines is a condition of continued employment. You don't need to increase your liability by indulging his bad habits.
Establish an acceptable time period for completing dictation, and dock his pay if he's late.
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 2002;2:92.