Practice Management

If a patient leaves your office in a huff

Q Occasionally, a patient storms out of my office for seemingly inexplicable reasons. Under such circumstances, who should follow up with a phone call: the office manager, receptionist, or doctor?

A The office manager. If she finds out that the patient is upset with you, then you should talk to the patient, too.

How to get paid for coordinating disease management services

QHow should I bill for counseling provided by my RN to patients who need ongoing supervision and education for things like cholesterol reduction, heart-healthy diets, and asthma management? She usually spends 20 minutes with a patient. I spend about five minutes reviewing her work and the patient's current condition.

A If, on that same day, you examined the patient or performed any other services, then bill for your time only. You can't bill separately for nursing services that occurred during the same visit. But if the patient saw only the nurse, then use CPT code 99211. When you use this code, you must be on the premises when the services are rendered. Instruct your RN to document her services in the patient's chart.

Can disability payments be deducted from your buyout share?

QDuring my 15-year tenure with our practice, I received six months' worth of disability payments. Now my group wants to dock that amount from my buyout. Is this fair?

A It depends on the details of your contract. Technically, if the contract makes no mention of this issue, the group shouldn't invent new rules at the 11th hour.

However, if you took six months of disability leave in the last year of your employment, fairness dictates that you forgo the amount paid out for that time.

Finding a first-rate office manager

QI recently joined the ranks of new physicians and am planning to open my own family practice. Since I have little business experience, I'll need to hire a topnotch office manager. What should I look for in a candidate?

A Look for a mature individual who is knowledgeable in all aspects of medical practice, is up to date on coding and billing, and preferably has worked for physicians in your specialty. An added bonus would be certification by the Professional Association of Health Care Office Managers.

What to ask patients in a satisfaction survey

QWhat questions should my partner and I include in our first patient survey? We'd like to get a sense of what people think of our service, image, and professionalism.

A Here's a basic set of questions:

• How would you describe your telephone contact with our office?

• Were you seen promptly? If not, how long did you have to wait?

• Was the office easy to find?

• Was parking convenient?

• Was the waiting room comfortable?

• Did you find educational materials helpful?

• Were you treated courteously by our staffers? Did our employees meet your needs?

• Were assistants' and doctors' instructions clear?

• Did you feel comfortable with the office's cleanliness and overall appearance?

• Did you get enough time and attention from the doctor?

• Were you satisfied with the treatment you received?

• Were home care instructions adequate?

• Were financial policies explained well? Were your questions answered?

• What improvements would you like to see?

• Would you recommend us to other family members, friends, or co-workers?

Negotiating a PA's salary

QI'd like to hire a new physician assistant who has been training in my office for the last few months, but we've been having problems agreeing on a salary. The going rate his school quoted seems too high for our rural Midwestern practice. Plus, the PA will only have a temporary license for his first five months of practice. What should I do?

A Check with your state's chapter of the American Academy of Physician Assistants (www.aapa.org) to see whether the salary your PA wants is higher than the going rate in your area. (You'll pay $90 for AAPA membership, plus $150 for the salary profile.) Set the PA's starting salary a bit lower than the going rate, but also give him a productivity bonus of 30 to 40 percent of his collections.

Remember that he already has a lot going for him: He has been working in your office and knows your practice, and presumably you have enough patients to keep him busy. He'll be profitable for your practice, because you can bill most payers for services "incident to" yours at your rate. His temporary license should be of no concern.

When you've been expelled from government health plans

QI've just been notified that I've been kicked out of Medicare and Medicaid for five years. May I continue to see patients covered by these plans if they agree to pay me out of pocket? If Yes, may I make referrals for specialty care and prescribe medications, lab tests, and diagnostic examinations?

A You may continue to see these patients, but it's unlikely that any of them would want to pay you out of pocket for services the government would cover if provided by another physician. And while you may make referrals and write prescriptions for these patients, Medicare and Medicaid won't cover those services, either.

How much should you pay a management company?

QOur eight-physician multispecialty clinic is negotiating a new management contract. Under our previous contract, the fee for those services equaled 3 percent of net collections—an amount our former management company assured us was the norm. The new company contends that 7 to 10 percent is the average fee, which seems exorbitant to us. What's the going rate for such services?

A Seven to 10 percent isn't unreasonable, if the company actually handles your billing and collections. In fact, it wouldn't be out of line to pay even more if the company also takes on accounts payable and other business functions. But if the firm merely oversees various office functions, 3 percent is about right.

When Medicare refuses a refund

QWhen my office manager notified Medicare that it had overpaid me, the carrier informed my practice that it would apply the overpayment as a deduction against future claims. This will mess up my bookkeeping, so I'd rather send the carrier a refund. Do I have any choice in the matter?

A It depends on your agreement with the carrier, so check the language in your contract. If your contract doesn't address the issue, ask the carrier which department should get the refund check. Make copies of all correspondence, and send communications via registered mail, return receipt requested.

Edited by Kristie Perry,
Contributing Writer

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 mepractice@medec.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.

Kristie Perry. Practice Management. Medical Economics 2002;1:109.