Practice Management Q&As

When insurers are slow to pay

Q: At what point should my office resubmit a claim that appears to be delayed or lost? Thirty days? Sixty days? Should we call the carrier first or simply mail another copy?

A: Check each plan's provider manual before you do anything. Most contain information about how quickly to expect reimbursement and instructions for dealing with late payments.

If there are no instructions, call the insurer after about 30 days. The claims examiner may be able to process a delayed claim right away, allow you to fax a lost claim directly to her, or tell you why the claim hasn't been processed. Never remail a claim unless the carrier asks you to. It could lead to your being paid twice—and that could lead to an accusation of insurance fraud.

Do credit cards improve collections?

Q: Would allowing patients to pay mailed invoices by credit card improve collections or cheapen my services in the minds of patients?

A: It will improve collections by making it easier for patients to pay. It will also shift the burden of collections to the credit card company. You should allow credit card payments at the time of service, too.

Just be aware that banks typically charge a 2 to 3 percent administrative fee for each transaction, so shop around for the best deal. If your collection rate is already 95 percent or greater, the administrative fee could wipe out any benefits credit cards bring.

Drawing a restrictive covenant

Q: A young doctor will soon join me as a salaried associate with the expectation that she'll buy into the practice in two years. But in the event that things don't work out well between us, I'm including a restrictive covenant 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 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 markers such as roads, rivers, or railroad tracks, rather than on a simple mile radius.

Keep in mind that the distance will vary depending on your specialty and your community: A rural setting calls for a larger radius, while an urban setting needs a much smaller one. Attach a map to your contract highlighting the boundary.

Marketing to price-shoppers

Q: Occasionally, a prospective patient calls to ask how much I charge for an office visit. My receptionist explains that my fees vary depending on the nature of the visit. I suspect this answer is driving away patients who are comparing fees as they search for a new physician. Should my receptionist be more specific?

A: Yes. The patient has the right to know how much your services will cost before he "buys" them. Have your receptionist quote your fees for a 99202 and a 99204, telling callers, "New patient visits generally cost between $X and $Y, depending on the problems uncovered during the visit." Finally, instruct your receptionist to highlight practice pluses, such as convenient location, free parking, insurance participation, quick prescription refills, and prompt callbacks from the physician.

Staff evaluations in a one-doctor office

Q: Is it necessary for a small general practice to do performance reviews? I employ only a receptionist, nurse, and billing clerk. Evaluations seem too formal for our family atmosphere.

A: Even a small office will benefit from performance reviews. It's a chance for you to say, "Thanks for a job well done," which will ensure that your practice keeps that family atmosphere. Evaluations also give you a non-confrontational way to prod a poor performer into doing a better job, thereby avoiding bigger conflicts down the road. Plus, it's good to have a paper trail documenting an employee's problematic performance should you need to discipline or fire her.

Do evaluations once a year. They don't need to be time-consuming. Spend about 20 minutes thinking about each staffer's performance, put your thoughts in writing, and then take 15 to 20 minutes to discuss it with her. Encourage her to respond to your comments. Also, consider asking employees to evaluate your performance as a manager.

When you need a bigger office

Q: My partner and I have outgrown our office. What should we look for as we shop for a new one?

A: First, look for proximity to your hospital, ancillary facilities, and your homes. Make sure the space is accessible to patients via major roadways and public transportation. An office in or near a shopping mall can work well if access isn't impeded by heavy traffic, bridges, or railroad crossings.

Finally, check for construction quality, access to public-utility hook-ups, potential for remodeling or further expansion, sufficient parking, and appearance.

Scale back on professional dues?

Q: To save money, our practice is thinking about limiting reimbursement for membership dues to each physician's national specialty society. We'd coordinate our memberships to state, county, and subspecialty societies so that only one of us belongs to each. Is this a good idea?

A: No. It's shortsighted for the practice to give up tax-deductible business expenses that give each one of you valuable networking opportunities and access to CME.

Make it easy for patients to find you

Q: In addition to a Yellow Pages listing for our practice as a whole, should each partner maintain an individual listing?

A: Yes. Referrals are usually made to the doctor, not the practice. Individual listings are especially important if you belong to any managed care plans with provider lists that don't include your practice's name, address, or telephone number. But don't pay for large or bold text on individual names.

Covering all bases in your office manual

Q: I need a checklist of items to include in an office policy manual. I don't want to overlook anything when I update mine.

A: You should make sure you cover the following topics:

• Attendance and working hours (including work schedules, absenteeism and tardiness, breaks and lunch periods, compassionate leave, holidays, jury duty, military leave, personal leave, sick leave, vacation time, and overtime).

• Pay policies (including when pay is earned and when it's paid, overtime rules and which employees are exempt from overtime, performance evaluations and salary reviews).

• Benefits (including bonuses; profit-sharing; health, life, and disability insurance; and tuition reimbursement).

• Personal appearance and conduct (including dress code, substance abuse, and smoking).

• Patient confidentiality.

• Conflicts of interest and moonlighting.

• Employment law (including equal employment opportunity, and sexual harassment and how to report it).

• Using practice equipment (including telephones, vehicles, computers, and personalizing office space).

It's also important to include an at-will employment statement and a form for staffers to sign and return to you acknowledging receipt of the manual. Have a labor lawyer review the manual before you give it to employees: Poorly written policies can cause problems down the road.

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

Kristie Perry. Practice Management Q&As.

Medical Economics

Sep. 17, 2004;81:65.