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Practice Management Q&As


Dismissing patients for nonpayment

Q. Can I legally dismiss patients who can't afford to pay even a small part of their balance due?

A. As long as you don't violate state of federal antidiscrimination laws, you're free to reject anyone-unless you have a contract with a third party payer or hospital that requires you to accept their patients. Make sure you give the patient 30 days' notice, in writing, by certified mail, return receipt requested.

Q. To help my staff improve their computer skills, I'd like to pick up the cost of classes, but I'm afraid someone might leave my practice after completing training, and I won't get a return on my investment. Should I take the risk?

A. Yes. There's always a chance an employee will take his new skills and run. But if you've hired good people and treated them well, they'll want to stay, and odds are you'll more than get your investment back in increased staff efficiency. However, be a little careful about what courses you agree to pay for. Training in applications like your EHR system, for example, will almost always pay off. But before offering to reimburse tuition for word processing or spreadsheet management courses, make sure they're necessary, because the skills your employees gain will be broadly marketable.

Getting from paper charts to an EHR

Q. I'm sold on the idea of EHRs, but I really don't understand how the old paper records get incorporated into the system. Can you explain?

A. Many practices use a "hybrid" approach-both manual data entry and scanning-to convert paper medical charts to an EHR. At the onset of the transition, most physicians don't try to convert everything from a paper chart into the EHR. Instead, they identify the key information they need for a patient's next visit-medication lists, allergies, and latest lab values, for example-and have a staffer type that data into the specific places the EHR program provides for such information. Then they scan in the latest office visit notes and any other documents they may need in the near future.

Then, over time-several months to a couple of years later-they scan the rest of the chart into the EHR.

How to comply with CLIA

Q. When I open my solo family practice, I'll be performing simple tests like blood glucose, urinalysis, and rapid strep. What federal regulations cover such testing, and how do I comply with them? Is there anything else I need to know?

A. The federal CLIA rules (Clinical Laboratory Improvement Amendments of 1998) govern all laboratory testing in most states. You'll need a CLIA Certificate of Waiver to perform common tests like those you've mentioned (there's a complete list at To obtain your certificate, complete application form CMS-116 (available at Send it to the applicable agency in your state (for a list, see Once your application has been processed, you'll receive a CLIA identification number and be assessed a fee of $150 every two years.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health