How Do You Know If Your Practice Is On Target?

Many physicians are overwhelmed with their day-to-day activities and are not aware if their practice is doing well or is in need of some fine tuning.  Below are five key areas of concern that should be looked into and followed up on to see how the practice is flowing.

1. Overhead

Calculate your overhead rate which includes staff and general operating costs by the total revenue the practice is bringing in.  Do some research on other practices similar to yours and see if they are comparable.  If your overhead rate is higher than the average for your specialty, consider reviewing all the cost that are involved within your practice and see if there are areas where you can reduce expenses.

2.  How productive is your practice

It’s a good idea from time to time to check the amount of referrals you are getting every month.  Make a spreadsheet of all referring doctors and see where possibly there is a drop in referrals or you are seeing an increase in referrals for a specific doctor.  By a physician taking 10 minutes out of their day to call a physician to remind them of your practice and also thank them for referring patients in the past, this could generate future referrals for the practice.

3.  Access the practices financial situation

Start by calculating a net collection rate.  When you enter into a contract with an insurance company, you agree to take a contractual adjustment from your submitted charges.  The net collection rate tells you whether you are collecting the remainder of your submitted charges once the adjustment has been made.  Calculate your net collection rate.  It should be 97% or greater to ensure a healthy bottom line.

4.  Avoid unnecessary hospital admissions or ER Visits

Evaluate a one month period and calculate the number of ER visits and admissions that were avoidable or potentially avoidable.  If your practice has a high level of preventable visits and admissions, create a quality plan to expand continuity of care, transition management, and care outreach.  Track this over time by checking it on a quarterly basis, with the goal of reducing your practice’s rate to zero.

5.  Survey referring physicians and patients

Many offices now use a patient survey or referring physician survey to evaluate their practice better.  This could be something that could be e-mailed or mailed with a return postage envelope to patients and referring doctors.  It can be done unanimously to protect their privacy as well.  This is an excellent tool to use to find out what’s really going on with the practice.  This data can be analyzed and put into good use to further make changes within the practice to help it run better.

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

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Billing Practices That Can Be Costly Part II

In part II of this article we will further discuss costly medical billing practices. In some cases, these have led to the loss of medical licenses for false reports include billing unnecessary services, double billing, upcoding or altering CPT codes, unbundling and false diagnoses. 

Unbundling is when you charge separately for a visit or a procedure that is normally part of another procedure or visit.  Double billing is when you bill for the same procedure multiple times on different dates. 

Upcoding refers to using a higher procedural code than what was performed.This includes billing for services that the patient did not receive or using codes that are at a higher level of what really took place during the visit or procedure.  Some examples of that are where a practice submitted bills for office visits for established patients on days where the office was closed, where the physician was not in the office or on vacation and on holidays and weekends when the office is closed. 

Another example is when a physician billed for office visits for parents and siblings when one child was brought into the office for a visit.  The parent had never been seen before but the physician used all the information provided for the insurance where the parent was the subscriber of the health plan, so it was easy to gain access to bill under the parent as well as the child.

Some health care providers advertise “free” services.  When the patient arrives it appears to be a “free” service but ends up being charged for the office visit and other procedural codes.

Other costly practices include failure to produce or complete medical records, which are required to back up billing codes, delegating treatment to individuals that are not qualified or it is not in their scope of practice, and performing procedures and tests that are not with valid consent from the patient.

Billing fraud leads to higher premium assessments by the insurance companies.  HIPAA prohibits billing for medical services “that a person knows or should know are not medically necessary.”  Also violating HIPAA laws and guidelines can result in monetary penalties up to $10,000 and an additional cost of 3 times the dollar amount for each claim.  These crimes are also punishable by up to 10 years in prison or even life in prison if a patient dies as a result of fraudulent activity.

Billing fraud is costly for all those involved, the practice, the doctor and their license and more importantly the patient.  Fortunately, most health care providers are honest and dedicated to helping and providing the best care for their patients and only want what’s best for them and their medical practice.

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

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Tips For Running A Productive Medical Private Practice That Thrives

Running a thriving private medical practice can have its every day challenges.  There are quite a few aspects of running a practice that contribute to keeping your staff and yourself productive.  One of the first issues is your staff.  Having a good staff can mean everything to an efficient practice.  It’s important to hire friendly, reliable and resourceful people to help run your office.  Understanding your staffs strengths and weaknesses is important in order to optimize the work flow. 

Having an office manager can help to relieve the physician from every day office issues and endless paperwork.  It’s also an advantage to “cross train” your employees so that each staff member is interchangeable in most aspects of the office if it gets really busy or if a staff member is out of the office for a period of time.

Another important issue is having an onsite biller or an offsite billing service to handle all the insurance claims and patient accounts.  A good and qualified biller is key to a productive office.  A good relationship with your biller is crucial.  A physician who is running a private practice needs to know how to bill.  Physicians didn’t realize when they were in medical school that they would become a small business owner.  In reality, that’s what physicians become whether they like it or not.  So it’s important that this is a priority when starting a private practice.

Have quarterly promotional events at your office.  Become involved with your local community, for example with the local chamber of commerce.  Get to know other physicians in your area.  A strong relationship is more fruitful and beneficial for your patients.

Another area to concentrate on is the cleanliness of your office.  Nothing is worse than walking in as a patient to a dirty and messy physician’s office.  Patients want to feel welcomed and comforted by the environment they are in before they see the physician.  A professional cleaning company is a good idea to have in order to keep the office looking clean and welcoming.  Their also should be staff members assigned periodically to check the restrooms to refill the soap dispenser, toilet paper and any other paper products.  A sign should also be posted in the restroom the importance of washing your hands after using the facilities.  Most office’s close at lunch time and that would be a good time to straighten up the waiting room from the mornings patients.  This area should also be checked throughout the day. 

Doing small things such as these can make a world of difference to your practice and more importantly the patients will feel that they are in good hands and are valued.  Happy patients mean more referrals; here’s to your thriving business!

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

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Medical Practice Disaster Plan

Over the last couple of years there has been so many natural disaster that most people were not prepared for.  There are also man-made disasters that happen as well, such as a possible gas leak, electricity pole down and fires.  Having a disaster plan doesn’t have to cost a lot of money but without one it could be severely costly to a medical practice.

One area of concern could be if you were to lose power or phone service was lost.  It’s also a good idea to have a staff phone book where you have each and every staff member list their emergency contacts such as name and phone numbers of several people in case of an emergency.  If employees have health issues they could also list those issues and also medication that they take.  Also the make and model of their car is also a helpful piece of information.

Keeping track of what patients have checked in the office and what patients have checked out is also a good way in an emergency to be able to determine who is in the building.  Having a supply of emergency supplies should be in a couple of areas of the office in case one area cannot be reached.  An emergency supply kit should not only contain first aid supplies but also a supply of food and water.  These items should be checked regularly to make sure it has not spoiled and items should be clearly marked with an expiration date for easy replacement.  Waiting for a disaster to strike and then try and figure out what is needed is way too late.

If the power is out it would be good to have plenty of batteries and flashlights.  In an emergency you really don’t know how long before help arrives.  Having blankets and pillows should also be included in the emergency kit.  Staff and physicians should have a disaster plan set in place.  It even would be a good idea to have a practice run of what to do during an emergency. 

There are many discount stores and warehouse stores that offer emergency kits that include many items mentioned above.  Army surplus stores are also a good place to purchase supplies.  All staff members along with the physician should be aware of where all the supplies are and what actions should be taken when or if an emergency happens.  At least once or twice a year these procedures should be examined.  New employees should also be trained and made aware of the disaster plan.

Things happen at a split second and it’s such an advantage to physicians, staff member and patients to have a well prepared office in case of an emergency.

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

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