When an insurer overpays; Who keeps inactive charts? Do you need a triage nurse? Make on-call time less hassled; Guard against job-discrimination suits; Business cards that work; Why you need staff meetings; Use this free advertising; Learn why patients pick you
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Q: My partner and Iwho share income and expenses equallydisagree over who should reimburse an insurer if an audit turns up overpayments. Should we split this cost down the middle or should the doctor whose claim it is pay the whole thing?
A: View it as an expense, and share it equally. If overpayments or downcoding by third parties is a big problem, it's probably time for you and your staff to brush up on your CPT and ICD-9-CM codes.
Q: When I retire at year's end, who should assume responsibility for records of inactive patientsmy partners or me?
A: Your partners, since the charts belong to the practice. Also, your partners will be able to respond more quickly and easily to requests for copies from patients, other physicians, or the courts.
You should have a written agreement that says your partners will store the records for as long as required by state law or until the statute of limitations expires, whichever is longer. The agreement should also give you the right of access to the records and should spell out how the records will be destroyed.
Remind your partners that they'll be able to use the records as a marketing tool for luring back former patients.
Q: Too often, our nurse practitioner ends up with patients beyond her expertise, while the five FPs in our group get the kids with runny noses. We suspect this mix-up stems from our reception staff's lack of clinical knowledge. Should we hire a nurse to do triage? Could an LPN handle the job?
A: An RN or an LPN who has been specifically trained for clinical triage would solve your problem, but either would be more costly than necessary. A medical assistant or improved training for your reception staff would probably be a better choice. At the very least, provide written instructions to your appointment schedulers so that they know how to route patients to the appropriate provider.
Q: The six-doctor call group I'm in is proving too much of a hassle. Far too many patients call at night and on weekends for minor problems. I'm considering dropping out of the group, but if I do, how can I get someone to cover my solo practice?
A: Before you quit the group, call a meeting to see whether your colleagues are having similar problems, and try to come up with solutions.
For instance, you could create a patient-education pamphlet which explains which symptoms can wait for treatment during office hours and which call for a trip to the emergency room. But be careful not to create the impression that you're discouraging patients from calling you when they need care.
If you decide to quit the call group, a locum tenens can cover for you while you're taking vacation.
Q: A job seeker my practice rejected is threatening to sue for discrimination under the Americans with Disabilities Act. Her lawyer claims we turned her down because she's hearing-impaired. Neither our office manager nor I remember noticing any disability or asking about the candidate's physical ability to do the job. But we have no documentation besides cryptic notes jotted down during the interview. How can we defend ourselves, and how can we avoid similar accusations in the future?
A: For now, save those cryptic notes. Your attorney may be able to use them to defend against a lawsuit. Even if a case proceeds, a judge might rule that the candidate's hearing impairment is reason enough not to hire her, since oral communication is so important to patient care.
To prevent future problems, develop standardized interview questions to ask each applicant. Have a labor lawyer review your list to make sure all are permissible under the ADA: Under the law, you can't ask an applicant about her health status prior to making a job offer. You can, however, ask about her ability to perform certain functions. Make sure job descriptions are clear and that antidiscrimination statements appear on applications and related paperwork.
Write down candidates' answers as completely as possible. Save resumes, applications, and interview notes.
Q: Should my partners and I list our services and the insurers we contract with on the back of our business cards?
A: No, for three reasons: (1) your cards would look cluttered and unprofessional; (2) your managed care participation is subject to change; and (3) information about clinical services belongs in your practice's brochure, where there's space to explain them fully. Put the brochure and cards at your reception desk, and in the waiting and exam rooms.
Q: Our practice recently cut out weekly staff meetings. Instead, the office manager has been sending weekly memos to keep everyone up to date. Although this seems to work fairly well, I suspect we're overlooking things by skipping face-to-face gatherings.
The problem is making time. Our hours, which are staggered, already run from 8 a.m. to 6 p.m. with an hour for lunch. To reinstate the meetings, we'd have to ask employees to come in at 7 a.m., leave at 7 p.m., or give up their lunch hour once a week. Should we just forget about it?
A: No. Regular staff meetings are an important communication and training tool. If you can't meet weekly, go for once or twice a month, holding meetings before or after hours, with memos in between. And pay staff for the extra time in the office.
Another option: Buy lunch for the staff once a week and hold the meeting during the mid-day break. The extra expense will be worth it in the long run.
Q: A patient sent a card thanking me for my prompt and undivided attention and praising my staffers for their kindness and courtesy. I'd like to post it on the bulletin board in my waiting room. Assuming the patient gives permission, is there a reason not to do this?
A: No. The letter is free advertising and great public relations. If the patient balks at your request, offer to remove her name from the letter. (If she still says No, at least you can allow your staffers to read it. They'll appreciate the pat on the back.)
But don't leave the letter on your bulletin board for longer than a month, or patients will think you've received no praise in the interim. Include other promotional information, too.
Q: I'd like to find out why my managed care patients chose me from a list of nearly 100 doctors. Should I include this question on my new-patient intake form, or should I have my receptionist or nurse ask?
A: Include it on the form, but have your receptionist check that it's been answered. In fact, you should ask this question of all new patients, not just those covered by managed care plans.
You could phrase the question this way: "Please tell us why you've chosen our office. Check all that apply." Then provide check boxes for the following: (1) recommendation by friend, relative, or colleague; (2) convenient location; (3) convenient office hours; (4) other (with space for explanation).
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 Q&As.
Aug. 20, 2004;81:68.