Practice Management Q&As

December 3, 2004

Late patients, Medicare audit

Handling chronically late patientsQ. A diabetic patient whom I see often demands my first appointment of the day. But he's always late, and that puts me behind schedule for the rest of the day. What's the best way to accommodate him and still stay on time?

A. Double-book his slot and leave a blank spot later in the morning. If this doesn't do the trick, have your receptionist politely tell him that your office makes a special effort to accommodate him and that you expect the same consideration in return. If, despite your polite efforts, he shows up late again, your receptionist should tell him he'll have to wait until you can work him in.

Paying staffers what they're worth Q. Should I increase wages for staffers who receive certification from a coding, billing, or managerial association? Do such credentials in a job applicant warrant a higher starting salary?

If you decide not to grant a raise, it's a good idea to give the employee a one-time bonus. This will recognize her initiative without locking you into a higher salary.

Ways to discourage freeloadingQ. I'm considering sending statements to patients I've given professional courtesy. That way, they'll know the value of the service, and they'll be less likely to abuse it. But I'm concerned this might appear rude. What's the right thing to do?

A. It's a waste of time and money to generate a statement. Plus, doing so could skew your accounting system. Instead, have your cashier give the patient a copy of the encounter form at the end of his visit. The form should reflect the procedure or level of service and the fee, along with a notation that you've written off the charge as a professional courtesy. The cashier should explain that you're providing the copy for the patient's records as an additional service.

If this gentle reminder doesn't work, consider revising your professional-courtesy policy. Many practices have done away with it.

When expense-sharers may share liability, tooQ. I share office space, expenses, call, and letterhead with one other sole proprietor. We're not a partnership or professional corporation, but we do business under the same name. What's my risk if that physician is sued? If there's none, what's the best way to tell patients that we don't share liability? Through signs in the waiting room or disclaimers on our stationery?

A. Since your arrangement looks like a single practice, it could be construed as an "ostensible partnership." The courts could hold you liable for the other doctor's actions. A sign in the waiting room or disclaimers on your stationery won't sufficiently clarify your relationship. Instead, you should incorporate separately and each use your own letterhead, telephone lines, and billing forms.

While you can still share office space and staff, it's a good idea to have a separate front-desk window for each doctor, if possible. Prepare a patient brochure, clearly spelling out that you're an independent practitioner who shares space with another independent practitioner. On your office's front door, make sure both doctors' names are visibly separated.

Why you need a professional appraiserQ. I'm putting my practice on the auction block. Is there any reason I can't do the appraisal myself?