Practice Management Q&As

"But my last doctor waived copays!"Q: After several Medicare HMO patients of a recently retired physician transferred their records to me, I received complaints about charging the required copays. Apparently, their previous physician never collected the fee. Some of these new patients even threatened to seek care elsewhere. Should I waive the copays to keep them? I thought that was a violation of Medicare rules.

A: Generally speaking, it is. Waiving copays could also violate your contract with the HMO. So check the plan's rules. If a copay is required, tell patients that you're legally bound to charge it. But keep in mind that Medicare rules do allow you to waive copays under certain circumstances, including financial hardship. If any patients qualify, ask them to sign a statement saying they can't pay.

When office computers cause eyestrainQ: Occasionally, an employee complains about computer-related eyestrain. Any tips for preventing it?

Does this employee deserve a raise?Q: I'm new to solo practice and not yet very busy. I have one employee, a certified medical assistant, whom I pay $9.50 an hour. The CMA is responsible for answering phones, checking in patients, handling prescriptions, billing, and seeking approval for referrals. She's well liked by patients, and has been a tremendous help to me.

Citing an increase in the cost of living, she recently requested a raise of $1 per hour. Should I give it to her?

A: It might be a good idea if you want to hold onto a valuable employee with such a wide range of skills. But not all our experts agree, pointing out that the cost of living rose only 3.3 percent last year. Raising her salary by $1 amounts to a 10.5 percent increase. Instead, they recommend that you find out what the market rate is for CMAs in your area, and make sure she's earning in the upper range of that figure.

Dealing with petty cashQ: How much money should I keep in my petty cash box? Should I replenish the fund monthly with a set amount so the practice is never caught short? What expenses should be paid out of petty cash?

A: Most doctors keep $50 to $200 in their cash box, depending on the size of their practice. Use the money to cover small, unanticipated office expenses, such as delivery fees, cleaning supplies, and coffee.

Limit access to the petty cash box to a single employee. Whenever she withdraws money, she should place a receipt in the cash box listing the expense and how much she withdrew. Each month, check receipts against the fund's total. When it dips to 25 percent of its full value, write a check for the exact amount of receipts in the box. List the items paid for in the check register so you'll have a record and can deduct the expenses on the practice's tax return.

When an employee is terminatedQ: Must a fired employee be escorted from the building? Who should do that-our practice administrator or a managing partner? Should somebody supervise the terminated worker as he cleans out his desk?