Practice Management Q&A

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Installment payments; subleasing space; foreign accent modification

When patients miss payments

When a patient on an installment schedule misses a payment, how soon should we call to remind him the money is overdue? These are generally folks who are trying to be responsible about their medical debts, so I hate the thought of badgering them.

You have to insist on prompt payment. Call with a friendly reminder when payment is 48 hours past due-the very longest you should wait is a week.


My partner will be retiring soon, leaving me with his share of office space and expenses-which I can't afford. Instead of finding a new partner, I'd like to sublet the excess space to another physician. Can I simply charge him a percentage of his collections to cover his overhead?

Yes, as long as you don't refer patients to him. Referrals will violate Stark rules which prohibit you from referring Medicare or Medicaid patients to anyone that you-or an immediate family member-have a financial relationship with. These rules can be complicated. To be totally on the safe side, structure an arrangement where rent and other shared expenses are split on a fixed basis or according to a utilization formula.

If an accent gets in the way

We employ a nurse who speaks with a heavy accent, and some patients have complained that they can't understand her. She's pleasant and a good worker, so we don't want to let her go; on the other hand, she has to be able to communicate with our patients. What can we do?

Discuss the problem with her and explain how important it is for all patients to be able to understand her. Offer to pay for a tutor to help her with English speech patterns and pronunciation. Document her progress and set goals for improvement as a condition of continued employment. In the meantime, try to limit the amount of time she spends communicating with patients-especially on the phone. And when hiring in the future, pay more attention to a candidate's communication skills.

In this issue, the answers to our readers' questions were provided by: Kenneth Bowden, CHBC, Berkshire Professional Management, Pittsfield, MA; Judy Capko, Capko & Company, Thousand Oaks, CA; David Carpenter, CHBC, Healthcare Management Consultants, Southern Pines, NC.

Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics, 123 Tice Blvd., Suite 300, Woodcliff Lake, NJ 07677-7664, or send an e-mail to (please include your regular postal address). Sorry, but we're not able to answer readers individually.