Medical Practice Management Tips Part I

Many medical practices have been suffering due to the high cost of malpractice insurance, rising supply cost, increasing changes with reimbursement rates and overhead costs, so physicians are constantly looking for ways to increase their revenue and lower their costs.  There are many tactics and tips that could help physicians to find other ways to increase their revenue to balance out other costs.

 1.  What to do when patients do not show up for their appointments

 One way to handle this is to have a no show policy that charges the patient.  This charge could be put in effect if the patient no shows for the first or second time.  It is at times somewhat difficult to collect, but if most patients want to continue to visit the physicians office in the future they will understand the policy and pay the charge.  One step further would be to have a credit card on file for this purpose, with the understanding that if the appointment is missed without notice, the patient’s credit card will be charged.  This should be relayed to the patient when making an appointment and it also should be posted somewhere near the check in area.  Also confirm appointments 36 hours prior to the visit so that if they cancel there will be time to fill in that appointment with someone else.  Start a cancellation list which you could refer to when an appointment slot has been made available. 

 2.  Offer your patients more services

 Patients are busy people too and how convenient would it be for them to be able to get additional services at the physician’s office rather than have to travel to another location either that day or later to receive the necessary testing to further evaluate them.  Some services that could be done in-house:  draw blood, conduct urinalyses and stool guaiac tests for example.  You should be able to bill for these items.  Also if the patient must go to another facility to receive additional services, help them to arrange the details, such as schedule the appointment for them.  Patients really appreciate that extra mile in their care and that results in them being loyal to the physician as a patient.

 3. Providing a niche could create more new patients

 There are so many physicians to choose from for a patient to seek care from.  Physicians should consider doing wellness medicine.  This could open up the range of patients that the physician normally sees.  Why not try developing a subspecialty such as diabetes, geriatrics, dermatology or thyroid disorders.  Or occupational health by doing pre-employment physicals, worker’s compensation, drug screening, drivers’ physicals and advertise that you offer these services whether it be in the yellow pages, online, or the practices own website.

 Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service


How To Keep Up With So Many Changes in Medical Billing

There are so many changes happening in the medical industry that has physicians and medical insurance billers stressed out and frustrated.  It’s getting more and more difficult to maintain a steady revenue due to changes in HIPAA laws, coding changes, government mandates and payer rules.  Here are some practical ways to improve your practices revenue flow.



Using Modifier 33 (Preventive Services)

What this modifier does is designates that the code you are using is a preventive service which means that the patients receiving these services are receiving them at no cost, (no cost sharing happens when this modifier is used). 

 These services must be identified before billing so patients are not billed inappropriately which could prompt many phone calls to the office. 

 New Patients Versus Established Patients

The definition of a new patient is one that has not received any professional services within the past 3 years from the physician or another physician of the same exact specialty.  If you have a subspecialty in your practice, make sure you correctly identify when a patient can be billed as a “new” patient; In order to maximize your reimbursement.  By doing this you will see a difference in reimbursement of up to 15% to 20%. 

 Prolonged Evaluation and Management Services

Time that must be spent related to a patients visit is often times separate from the one-on-one or face to face codes that are often used.  For code 99358 (prolonged E/M service before/or after direct patient care for the first hour) the wording of “face to face” is not in the description, which can effect code 99359 (each additional 30 minutes).

 At one time, these two codes were once limited and could only be used by physicians, they are now available to use by other qualified healthcare professionals.  If your practice employs other qualified healthcare professionals, make sure that these codes are being used when it is necessary and appropriate. 

 Medicare Physician Fee Schedule

Medicare payment rate for the physician’s fee schedule was threatened to change for the year 2012.  There could have been a possible decrease in the physician’s fee schedule of 27.4% this year.  This would have really hurt doctors who treat Medicare patients, and would have made it harder for seniors to find physicians.

 However on Friday, February 17, 2012 Congress passed an extension of the payroll tax for the rest of 2012.

 Many physicians are very busy and don’t have the time to evaluate every single change made but it is very important to be proactive in their practice and keep up to date with the ever-changing rules and regulations set forth by different entities.  Time that is set aside to research such things will only make the physicians practice more efficient.

If you are using a Medical Billing Service, they should be keeping you up-to-date with the changes of 2012, so that you can just focus on your patients.

Ways to Collect Deductibles at the Beginning of a New Calendar Year

It’s that time of year again when patients deductibles are needed to be met.  EOB’s are being received with no check and a large portion or all of the amount billed is going towards a patients deductible.  Then from that point, a patient invoice is sent out and it’s up to the patient and it’s their responsibility to pay the physician.  With that in mind, how can practices keep the cash flow going during the first few months of a new calendar year?  Most offices have taken a proactive approach with patients that have deductibles.

 Here are a few tips on ways to keep a steady cash flow during this time.

 (1)  Take the appointment schedule for the week or even each day and go through all returning patients and call the insurance company to verify how much of the deductible has been met. 

 (2) Start a separate list with the patients name and insurance and how much of the deductible has been met and what the deductible amount is.

 (3)  When making appointments, ask the patient if they have a deductible and if they say they do, then it would be wise to inform them that a portion will be collected at the time of service.

 (4)  Decide up front how much your office is going to collect, some offices collect between 20% to 30% of the total bill. 

 (5)  Make sure to indicate on the superbill for the insurance biller that the amount collected is for that days visit.  Otherwise the patient may have an outstanding account and you don’t want to confuse what date of service it should be applied to.

 (6)  Patients with Medicare may also have a deductible but if they have a secondary insurance, that insurance will usually pick up the secondary balance such as Medi-cal.

 Most patients know that they have a deductible and should not be surprised that they are responsible for that portion before their insurance starts to pay.  It’s best to be as tactful as possible when asking the patient that they are expected to pay up front when a lot of times the patient is ill and it may seem uncomfortable asking for payment under those circumstances but it is not unreasonable. 

 Even though this may be very time consuming for the office to handle, it really makes a difference during this time of year when you would normally be receiving payment from the insurance company but many offices have implemented this policy and have seen a big difference in their cash flow.  The office will truly benefit and it’s also a way to keep your patient portion accounts receivable lower. 



A “Welcome Letter” to New Employees

Nowadays it has become harder and harder to find good and honest employees.  A lot of medical practices have several staff members to manage at one time.  Some practices are under staffed as well and that adds to the stress.  When hiring new employees it’s especially important to set the ground rules from the beginning.


 Physicians are usually the “office manager” or they have designated someone in their office who fills that role.  Regardless of who it is many complain about several aspects of staff work ethic.  Here are a few:


*  Consistently late to work


*  Does not speak to patients with respect


*  Does not perform his or her duties in a timely manner


*  Calls in sick or takes days off consistently


*  Does not take direction well


*  Constantly having to remind them of policies and procedures of the office


There are several tips to work with these employees, if they applied themselves, could be an excellent asset to the practice.  When an employee is hired they should at that time be told of all their expected of.  Some physicians or office managers have even put this in a “Welcome Letter” that is given and gone over with after the hiring process.  This letter consists of a general listing of all the duties of the employee.  An example could look like this.


“Welcome to Dr. Jones Staff”


We are so pleased to have you join our staff and want to make your employment here  an enjoyable and a great working experience!  As our front office receptionist below is your duties in this position.


Answering phones                                                                  Be on time to work

Greeting patients                                                                     Treat patients with respect

Collecting co-pays                                                                  Be a team player

Making appointments

Fielding phone calls

Checking in patients

Checking out patients

Also helping in other areas of the office that is needed


Thank you for joining our staff and look forward to providing the best care we can to our patients which is our practices number one priority.


It also would be good to have the employee sign the bottom as well as the physician and also for the office manager.  This shows what’s all expected of that person.  So even though physicians may already have long time employees, it’s good to go over this with them and have them sign this form and keep it on file for the future.  Employers that are upfront with their staff and getting everyone on the same page is what has been known to work.  There’s no guessing game and it’s all in writing. A good employee that is going to be loyal and work well will respect and understand that. 


Importance of Correctly Training New Employees

When it comes time to hire a new employee what are some steps to take to ensure that he or she is properly trained?  Usually in a physicians office it is customary that the new employee may have various duties.  So this would no doubt require more than one person to help out in the training process.  A good way to handle this is to outline all the aspects of the office and if the new employees duties would require them to be involved. 


Some physicians have streamlined this process by having each individual of each duty have a half day or full day of training with them.  For example, if you have hired a new front office receptionist no doubt they would be involved in quite a few aspects of the office. 


First you would have an employee familiar with the front office procedures train them.  If the physicians office is busy like most offices are, this may require a full week of training or more.  When the office has hired a new receptionist or other type of employee it is very important that the new employee knows that first impressions mean everything. 


Secondly the receptionist will no doubt encounter phone calls from pharmacies or receive refill requests via fax or email.  This would be where the nurse or back office assistant could train them as to how to handle these requests.


Next, the office may encounter from time to time or for some offices Drug Company Representatives visit the office frequently.  Some physicians want to see them right away and do not want them to wait, some don’t mind them waiting for a bit while they finish up with a patient.  The physician may need to sit down and explain this to the new employee how important these visits are to them, or they can wait, or they may need to make an appointment to see the physician. 


Another aspect could be if the physician is a surgeon which requires someone to schedule dates and times for this.  The new employee would need to know the policies and procedures and who has the authority to make those scheduling decisions.


So there are many areas not mentioned that could come into play when hiring and training a new employee that should be gone over with them thoroughly and easily.  It’s very important to try not to go over every single aspect all at once but to go over things gradually so the person can comprehend things and grasp the direction so as not to overwhelm them.  One physicians office made a two week training schedule for the employee so they to knew what to expect to learn and go over each day.

Privacy Pitfalls of E-Mail

Unlike major hospitals and large physician’s groups, small primary care practices or clinics run a lower risk of stolen laptops, missing USB ports or database breaches jeopardizing protected health information and also personal information regarding patients.  E-mail is a very convenient way to communicate with patients but one error can easily be a breach of confidence and a HIPAA violation.

 Privacy breaches can occur when medical e-mail is:

 *  sent to the wrong address

 *  accessed illegally by unauthorized individuals

 *  forwarded inappropriately

 *  left unattended on a computer screen

 Also, it’s important to keep in mind that there could be medical licensing issues if an e-mail crosses state lines and violates the state laws.

 It’s better to be safe than sorry

 These are some tips to help your medical practice avoid any potential problems and any HIPAA violations.

 *  Make sure that the patient’s know that e-mail should not be used in lieu of calling 911 in case of an emergency or if the problem they are having is urgent or a sensitive problem

 *  Unless your office is using an encrypted system, you should make sure you include a disclaimer telling the patient’s the message isn’t secure

 *  Inform all patients including adolescents, that when they send an e-mail to the office this will automatically become part of their medical records, either filed on the computer or the e-mail will be printed as a hard copy and be filed into their chart

 *  Include in another disclaimer letting patient’s know that e-mails aren’t read every day, or the physician is out of town for an extended period of time or if the office will be closed for the holidays or other occasion

 *  Use a  neutral subject line like “message from your doctor” to avoid revealing any sensitive content that you may be sending such as “your AIDS test results”

 *  Have one or more staff members be in charge of accessing e-mails and relaying the information to the appropriate person, whether it be a billing question, nurse question, front desk or the physician himself.

 *  E-mails should be checked at least every other day but preferably every day if possible

 * Take time to re-read your message before sending it, and never copy a third party without consent.

 *  Erase hard drives storing medical e-mails prior to disposal

 *  Patient’s should also be made aware that if the practice is closed on Saturdays and Sundays that e-mails will not be read until the next scheduled business day

 E-mail is such a convenient tool to communicate with patient’s and that’s why it is imperative to make sure these guidelines are in place to protect your practice from any violations or any problems.