Practice Management Q&As

March 17, 2006

How to document a staffer's misconduct

Q. I asked my office manager to keep a detailed record of my receptionist's rudeness with patients as evidence of her poor performance. But my office manager fears that this may give the receptionist ammunition to claim discrimination if we fire her, since she's in a protected class (age) and we don't keep records of other employees' patient interactions. What's the correct thing to do?

A. Start your documentation of her conduct by explaining that it's not normally your policy to keep such a record but her unusual behavior demands this special response to resolve the problem.

Q. Our practice gets about two no-shows a day, even though we always call our patients the day before to remind them about their appointments. How can we reduce the number of missed appointments?

A. First make sure your practice isn't contributing to the problem. For example, when patients routinely endure long waits in the waiting room, they'll have fewer qualms about inconveniencing you by skipping an appointment. Address these issues first.

Then set policies that encourage patients to keep their appointments. Preregister new patients on the phone. After they've given you personal and insurance information, they're more likely to feel they've made a serious commitment. Remind all patients to call at least 24 hours in advance if they need to cancel.

After you have your own house in order, you can get a little tough with no-show patients. First, call to reschedule the appointment. Then follow up with a letter saying: "We're sorry you missed your appointment. Keeping your appointment is not only important to your health, it also allows us to avoid inconveniencing other patients who are waiting for a time slot. We look forward to seeing you. Please call us 24 hours in advance if you must cancel." Then, if the patient misses his rescheduled appointment, you may want to consider dismissing him from your practice. Or let him know that you have no choice but to schedule his subsequent appointments in the least-desirable appointment slots-midday-so that a failure to show up would inconvenience the fewest people.

When an insurance card has the wrong name

Q. What's the best way to avoid confusion when a patient changes her name (usually because of marriage), and it no longer matches the name on her insurance card? If we change the patient's name in our records, but submit a claim under the name on the card, the insurance company will process the paperwork under her old name, and we may have trouble posting the payment to the right account. If we submit the claim under the new name, the insurance carrier might not pay.

A. Temporarily set up files under both names in your system, and have them cross-reference each other. To avoid a mix-up, file all medical and billing records under the new name. You can eliminate the old account in about six to 12 months-after the patient has received her new insurance card, and has had time to inform any other providers you may need to confer with that she's changed her name.

In this issue, the answers to our readers' questions were provided by: Kirk Brandon, Metropolitan Gastroenterology Group, Washington, DC; Ruth Levy, JD, Saratoga, CA; Michael J. Wiley, Healthcare Management and Consulting Services, Bay Shore, NY.

Do you have a practice management question that may be stumping other doctors, too? Write PMQA Editor, Medical Economics, 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.