Practice Profitability

Don’t Miss Great Medical Billing Tips & Events In May Newsletter

Kareo May 7th, 2013

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The May edition of the Getting Paid Newsletter is full of great practice management and medical billing advice on patient flow tracking, PQRS, and coding. Betsy Nicoletti, MS, CPC, starts a conversation about key strategies to avoid an audit in her article, Reduce Your Coding Audit Risk. Practice management expert and Senior Market Advisory at Kareo, Rico Lopez continues his review of patient flow tracking and how it impacts your practice. In addition, there is information about our upcoming free webinar and a chance to win $150. So, if you haven’t already read it, check it out now!

Kareo May 6th, 2013

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by Rico Lopez, Senior Market Advisor at Kareo

In my first blog post, Take Control of Your Patient Flow (Part 1), we looked at a host of reasons why patient flow is important and how it can impact your practice. We looked at scheduling in Part 2, and now we are going to talk about your staff schedule and the value of cross training.

To fully maximize your staff time, you must first completed the previous section on analyzing your Appointment Schedule Template. Even if you feel confident that your appointment templates are solid, you will still need to perform the previous exercise to fully understand the prospective bottlenecks of your patient flow and how to appropriately allocate resources to minimize delays. You might be surprised what you find. I have worked with clients who realized after performing this exercise that they could actually see more patients with just some minor scheduling tweaks while eliminating major bottlenecks with simple staffing adjustments.

Maximizing the Value of Your Staff

Create a table to identify your existing staff, their certification/training, experience within your practice, prior experience and roles they are currently trained and can competently perform today.
Analyze your current staffing strengths and identify cross training opportunities. In the sample in Figure 1 above, I noted which role(s) each employee can cover today and I then I shaded (in blue) the 29 cross training opportunities. I am not suggesting that each employee should be cross trained in all roles for the practice – but the more flexibility you create with your staff, the easier it becomes to overcome bottlenecks in the practice.
Develop a cross training strategy. While it is not realistic to cross train all your staff within a few weeks, it is a good idea to schedule cross training of your staff during ideal times for the practice. Depending on the amount of cross training needed in your practice, it could take weeks or even months to get everyone fully trained. Prioritize the cross training based on the biggest impact to your practice.
Manage your staff schedule. In Figure 1 above, is it necessary to bring multiple staff members at 7:30? When does the practice really need them to come in? Are they needed more in the early morning or late in the day? What I have found in many practices is that some employers will adjust their employees work schedule to accommodate the needs of their employees without understanding the impact to the practice. Knowing your staff’s abilities (by creating the staff table above) and implementing cross training will provide you the flexibility to accommodate scheduling requests.

Identifying Bottlenecks

The last post where we created your patient flow worksheet and analyzed the downstream impact of your appointment schedule, should have given you some idea of the possible bottlenecks in your patient flow. The adjustments you made to your appointment templates as a result of your analysis will eventually provide relief.

There are other causes of delays in your practice other than those created by your appointment scheduling (we will discuss this in a future session). The key for now is recognizing when the practice begins to back up and determining the starting point of the bottleneck. Let me give you some sample scenarios that you will probably recognize:

Staff are waiting for patients to be handed over from the front desk and the doctor is waiting for patients to be placed in exam rooms and lobby is full of patients.
Patients charts are stacking up waiting for someone to call the patient, take them to vitals or the exam room for patient prep, half the exam rooms are empty and need to be cleaned/prepped for the next patient, provider and medical assistants are all preoccupied with patients in the other exam rooms, and the lobby is full of patients.
Beginning of the day or right after the office lunch break, there is a line of patients at the front desk and there are already several patients sitting in the waiting room.
Patients lining up at the check-out desk likely very frustrated and just want to leave but they still need to make follow up appointments and pick up additional paperwork.
Lobby is full of patients, charts stacking up, all exam rooms are full and provider is jumping from room to room with no end in sight.

Now that you are more aware of bottlenecks and are able to quickly recognize the issue, its time to talk about what actions you can take to relieve these delays. The first four bottleneck scenarios above can all be quickly resolved by reassigning resources to the area causing the backup. In some cases, it would only take a few minutes to get the practice back on track. The fifth scenario might warrant hiring another provider, but we will talk about that in another post.

Anticipating & Planning for Challenges

There will always be events in your practice that will cause delays to your patient flow. For some practices, this is accepted as status quo and just the way the practice functions. I am here to tell you – NO IT IS NOT! There are three things you can do–Eliminate, Anticipate, and React.

Eliminate: If you already know about issues that causes delays in your practice, then what have you done to eliminate them? We will review this further in a future session and what you can do to identify and eliminate these issues.
Anticipate: No one knows your practice better than you and I am sure many of you can even predict when and where these delays will occur. The items that reoccur daily or on a very frequent basis are the ones you will need to address. Anticipating the problem will allow you to assign resources in the right location at the right time. Here is an example of one item that most practices experience. First thing in morning when multiple patients arrive at your office at the same time many practices find that they are already behind at the beginning of their day. If this happens in your practice, then anticipate the situation and assign an extra resource first thing in the morning just long enough (~30 minutes) to help overcome the initial wave of patients. Now think of other scenarios in your office where you can almost anticipate delays and implement a solution to avoid future recurrence.
React: Once you have addressed the anticipated delays, let us talk about the unpredictable. This is where recognition of the issue and full understanding of your staffs’ ability to cover other areas will come in handy. Don’t be afraid to move staff around throughout the day – making sure you that these adjustments will not cause a different delay for another area of the practice. Your staff will eventually begin to recognize these situations themselves and take the initiative to assist the other areas as soon as they occur without any instructions from you.

Changing the Culture

Just like any other business, one of your most important resources is your employees. Creating a working environment where their initiative and teamwork are recognized will promote an ideal scenario for any busy practice. Acknowledging employees who act on their own to back-up their struggling coworker will send a clear message to all of your employees.

Set goals and reward staff for meeting and/or exceeding them. One of the ones that my employees used to enjoy is the 5-Day Challenge. If the clinic finishes on time (you pre-define what “on time” means) for 5 days straight, then on the 6^th day we have lunch brought in for everyone. Lunch is an inexpensive payment for reducing labor (or even overtime) and increasing patient satisfaction and employee satisfaction.

Watch for my next post when we will talk about overbooking and address various practice policies including no shows and patients arriving late for their appointments.

Kareo April 23rd, 2013

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In her February webinar, 3 Innovative Ways to Improve Collections, practice management expert Rochelle Glassman discussed some strategies for getting your patient payments and collections under control. She suggested making it easier for patients to pay by offering online billpay, reminding patients about their balance due when they schedule an appointment and at registration, collecting copays, deductibles and self pay balances at the office, and getting authorization to charge credit cards for balances due or for patient payment plans. The webinar attendees had a lot of questions, which we answered. But we continue to get questions about credit authorizations. So here are some answers to help you make the most of this tactic.

Q: Can we get a copy of the generic credit card authorization form?
A: Yes. You can download a generic credit authorization form here.

Q: How long does the credit card agreement remain in effect? Does there need to be an expiration date?
A: A payment agreement stays in effect until the balance is paid in full. When an agreement is made, it spells out the length of the agreement and the patient signs that agreement with the understanding of the length of the agreement. Recurring payments can be set up using a payment processing service. If you already accept credit cards, your merchant services department may already have a service in place which you can add to your current plan. Many banks such as Chase and Wells Fargo offer this option to their merchants for a monthly fee. This service is also available through other vendors such as Paypal, Chargify and Authorize.net. You can also use a credit card authorization form and charge the card manually each time.

Q: What do I say to a patient who refuses to give credit card info for fear of fraud?
A: You can assure them that the practice is maintaining security standards and give them a copy of the practice’s credit card security policy.

Q: Are there any legal requirements with regard to keeping credit information on file?
A: Yes, the merchant must be PCI DSS (The Payment Card Industry Data Security Standard) compliant. When compliant, you can legally store credit card information, with the exception of the CVV code. You can never, store the CVV code. Your merchant services provider should meet these standards. Details on the requirements can be found at PCI Security Standards Council at www.pcisecuritystandards.org.

Q: If you charge a credit card payment using Kareo, does it post to the patient account automatically?
A: Yes, on the New Payment screen, indicate the method as “credit card” and hit the Process Credit Card Payment button. You will need to be signed up for Kareo’s Patient Payment Services and have a card swipe connected to your computer. Contact the support team for more info or review the online how to article – http://www.kareo.com/help/practice-management/howto/enter-payments-from-credit-card

Q: In Kareo, how can patients make online payments?
A: If you sign up for our patient payment services you will be able to direct your patients to an online account where they can make credit card payments online. Also, if you send patient statements through Kareo to your customers those statements it will provide your patients with a link that takes them directly to this online payment portal.

About the Author: Rochelle Glassman

Rochelle Glassman is a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. She is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

Kareo April 16th, 2013

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by Rico Lopez, Senior Market Advisor at Kareo

In my last post, Take Control of Your Patient Flow (Part 1), I reviewed the impact of poor patient flow and the signs that is a problem in your practice. So, now you are probably wondering what to do next. There are several possible root causes for problems with patient flow that in turn affect your bottom line. In this, and subsequent, posts, I will look at some of the bigger problems and offer solutions.

To have any hope for resolution of any condition, you have to make a commitment to change. There will be struggles and even the dreaded trial and error, but in the end, you can make it better. In this treatment plan, we will discuss designing your Appointment Scheduling Template based on your projected patient flow.

Was your schedule set up to maximize your provider times or was it established using the traditional business hours that start at 8 AM and end at 5 PM? Don’t feel bad if you said the latter – surprisingly, most practices still build their appointment schedules in the same manner today as it was done 10-15 years ago.

Schedules that are tailored to the traditional business hours do not account for the “true” available time of your provider(s) and your staff. If your provider arrives at the office at 8:00 AM and your first appointment is at 8:00 AM – how quickly will your staff prep the patient to see the provider?

Coincidentally, if your front desk staff also arrives at work at the same time, are they ready to jump in to work and get the patient’s chart ready for the nursing staff? They typically have to log in to their workstations and prepare their work area before they can even call up the first patient.

A lot of practices will also plug in new patients or physicals (appointment types that typically require a longer visit time) in what they think are logical places in the schedule without fully understanding the downstream effect to their staff and to their providers. Worse yet, they will overbook slots to ensure that the provider always has a patient ready to be seen – again without fully understanding the downstream effect.

Some practices, by experience, have adjusted their schedule to account for staff coming in earlier to ensure that patients are ready to be seen when the provider is ready. The question now is whether you accounted for the full patient flow from beginning to the end of the day. Before you can fine tune your Appointment Schedule Template you must first create a projected patient flow.

So how do you create your projected patient flow? 15+ years ago, we used colored notecards, color markers and pushpins on a large bulletin board. Later on we moved to colored post-it notes and then finally to Microsoft Excel, which allows you to easily adjust slots, labels, colors and maintain versions in separate worksheets by copying the previous sheet and then applying adjustments.

What do I need to create this worksheet?

The provider start and end times represent the time when the provider is ready to see the first patient and when the last patient of the day should be complete. This needs to be very specific since everything else will revolve around it. This is why the Provider Time column has a label “Start Here.”

The projected patient “stops” or staff interactions occur at Patient Check-in, Registration, Nursing, Provider Exam, Visit Wrap-up and Patient Check-out. In your practice, you may have more or less. This may sound very simple but be sure to account for all areas since it will impact the overall timing.

You’ll need to create a list of all Appointment Reason Types (New Patient, Physical Exam, Follow-up, Consult, Nurse Visit, etc.) and the average length of time to perform this type of visit. Also, estimate the number of patients by appointment types for a typical day.

Once you have all of the above, then it is time to assemble. Start with the Provider Time column. Based on the number of exam rooms in your practice, determine the timing between patients to keep your provider going from one room to the next.

Now go backwards to the previous stops and determine the average interaction time required and keep going back until you arrive at the Check-in time.

Note that the “Check-in” time is the time you want the patient to initiate the visit. For the majority of the appointment types, this is the same as the patient’s appointment time, but many practices want their new patients to arrive 30 minutes before their appointment time to complete paperwork or fill out forms. Be sure to factor this in to your scheduling template.

Do not rely on your staff to tell the patient to come in a few minutes early to “fill out forms” before they are seen. Your staff may not always remember to tell the patient or the patient may not remember by the time the appointment comes up.

If the patient does not show up early as instructed, you are now waiting for the patient to complete your forms and the practice will fall behind. These types of delays will cause gaps in your provider slots and push all appointments back. We will talk more about other unanticipated delays later, but for this one, why not just factor this in to the patient’s appointment time and allow you to maintain control of your schedule?

In my example, I scheduled the first new patient to arrive at 7:30 AM, even though my staff will not begin registering the patient in the system until 8 AM allowing the patient 25-30 minutes to complete the forms. You will need to adjust this “padding” based on your experience with your patients and the number of forms you require.

Additional Tips and Tricks

Do NOT book multiple patients with the same Appointment Reason Types on the same time slot. We will discuss overbooking in a future post and why this is not always the right solution.
Do NOT book extended Appointment Reason Types either on the same time slot or in back to back time slots (i.e. Back to back New Patient slots). Try to stagger these throughout the day and fill in the gaps with nursing appointments or other visit types that do not require face-to-face interaction with your provider.
It is ok to have a New Patient come in on your first time slot, but be sure to also schedule follow-up appointments at the same time and shortly thereafter. This will allow the patients to flow back to the provider to be seen while the New Patient is going through registration.
If you only have a couple of exam rooms, you may want to stagger your patients by 10 or 15 minute increments. If you have more than two then, you can space out by 5 or 10 minutes. The patient wait time in the exam room should never be more than 5 minutes and definitely less than 10 minutes. When sitting alone in a room, 5 minutes feels like an eternity. Remember, the exam rooms may still require cleaning/ restocking before you bring in the next patient, so be sure to account for this.
Make sure you build in time throughout the day for your provider to do charting, coding and returning phone calls.
Establish your policy on walk-in or triage patients. If this is a normal occurrence in your practice, then go ahead and designate time slots to accommodate these patients. Balance it out with your average no-shows – so if you have an average of two no-shows a day, then you can fill in with a couple of walk-in or triage patients.
For some practices, it may be ideal to factor in lunch breaks to the template to account for the availability of staff. Note: Not everyone goes to lunch from 12 to 1 PM when the typical practice is closed for lunch break. At 12 PM, the provider and nurses may still be finishing up the last few patients of the morning so they may not be able to go to lunch until 12:15 or 12:30. However, the front desk may be able to go to lunch at 11:30 or 11:45 when all the morning patients have been checked in and will be back at the front desk to greet the first afternoon patients.

Fine-tuning your Appointment Schedule Template will take weeks and sometimes longer. Be patient and do not be too quick to make adjustments. I always say, “Don’t second guess your decisions unless outcomes tell you to do so.” If you have spent the time to analyze and map out your patient flow, then the expected changes will eventually come. Remember, you are dealing with a lot of old habits from your patients, your employees and your providers. It will require a total effort and buy in to succeed.

Watch for my next post when I’ll look at fine tuning your staff’s work schedule and how cross training will improve bottlenecks in your patient flow.

Kareo April 8th, 2013

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By Thom Schildmeyer, President, Aesyntix Health, Inc.

Over the last three months, we have had a significant increase in providers asking about cash flow. Specifically, they want to know whether or not they should open up their practice to more payers and/or seek alternative revenues sources. The complaint is the same: “I am working hard, but my income continues to go down.”

Oftentimes, the “knee-jerk” reaction is to aggressively try to attract and treat more patients, thinking higher volume alone will result in more money. Yet, there are considerable expenses associated with this strategy that can reduce profitability, from marketing and advertising to the actual cost of service.

In fact, many providers who travel down this path find themselves working harder and longer hours, only to increase levels of stress with marginal benefit to their bottom line. I recommend something different.

Focus on Your Outstanding A/R
Fortunately, there’s a much easier way to increase your revenue without expending additional resources. And it’s right there in front of you: your outstanding accounts receivable (A/R).

For example, take a practice that on average posts $50,000 in clinical charges each month. It’s not uncommon for this practice to have an outstanding A/R balance of 1.5 times that amount, or roughly $75,000, carried over each month. An average contractual adjustment rate of 25 percent* results in approximately $56,250 that the practice has earned and is legally owed, but has not yet collected. (* this rate varies based on a number of factors)

Can they afford to walk away from this money, leaving well-deserved revenue on the table? For most practices, including this one, the answer is no. But where do they start? The first step is to assess whether their billing staff has the capacity and expertise to focus on A/R collections. If so, simply redirecting them with a sense of urgency to improve performance can yield significant results. This practice does have the resources and did look to redirect.

Work Your Unpaid Claims
When assessing your outstanding A/R, look first at your unpaid insurance claims. Collecting on a higher number of claims sooner than later will result in immediate revenue for your practice. Below are a few best practices I suggested to this practice to help facilitate smoother claims submission and, most important, faster payment:

Identify patterns with insurance carriers: When working to resolve unpaid claims, it’s important to find a pattern relative to each insurance carrier. If you are able to discover a common factor, you can modify your billing style to avoid future denials.
Review claims before resubmitting: Make the most of the information you have before spending time to gather more, by addressing the following items:
– Ensure that proper contractual adjustments are made to each line item.
– Verify that CPT and ICD-9 codes are for covered services.
– Check modifiers; remember global periods, unrelated procedures on the same date of service, and separately identifiable evaluation/management services.
– Review insurance authorization and physician referral requirements to determine if an authorization is (or needs to be) in place.
– Determine if the bill should be moved to a secondary insurance or the patient.
Create a strategy for easy “wins”: If all information appears correct and claims still require follow-up, prioritize your unpaid claim list to pursue the “low-hanging fruit” first. Considering the age of the claim and outstanding dollar amount to prioritize your list is a common way to increase your collections success rate.

A less applied, but perhaps even more valuable technique is to look closely at your payer mix, identifying those that are easiest to work with and have faster turnaround times. Are you required to complete an online form, mail a letter, or make a phone call? If “Carrier A” processes claims in 10 days and “Carrier B” processes in 28 days, where should you start?

Combining these principles with your existing A/R process can help resolve more claims in a shorter amount of time. Furthermore, receiving the outstanding funds quicker can make the average amount per claim less relevant to your overall strategy. And ultimately, this is one step towards working smarter, not harder, to increase your bottom line.

About the Author

Thom Schildmeyer is President of Aesyntix Health, Inc, a leading provider of billing and purchasing solutions for dermatologists and cosmetic surgeons. He has more than 20 years experience consulting with practices in the areas of financial analysis, practice valuation, human resources, training and development, sales management, marketing, and patient relations.

Kareo April 4th, 2013

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In the recent webinar, Marketing for Medical Practice Profitability, Laurie Morgan discussed a handful of simple, free strategies you should employ for your medical practice. Whether you are new to marketing or a little more seasoned, there is probably something in this list that you’ll find useful.

Check your payer directories—every year! You’d be surprised how often there are small mistakes or outdated information in the listings. Keeping them up to date ensures that when patients are looking for a provider they can find you.
Take advantage of free online listings. Find them, own them, and keep them up to date as well. The more complete your listings, the easier it is for people to find you. If your resources are slim, start with the big ones. Google Places (aka Google+ Local), Healthgrades and Vitals are usually the best three to start with; in some markets, Yelp often shows up prominently in search results as well. You might also do a Google search for your practice and see which sites come up on the first page. Do this a few times over a week or two. That can be your starting point. Add pictures and a link to your website.
Don’t shy away from feedback. Many of the sites today that provide listings also provide a way for patients to give reviews. This information can help you improve your practice even when it’s negative. Be proactive and respond to problems and concerns!
Sign up for Google Alerts (www.google.com/alerts) about your doctors, practice and specialty. These alerts can help you manage your reputation online but alerting you to new listings and reviews.

If you are ready to put a little money into your online marketing, consider these additional options.

Get a website! Every practice should have one. Should be CMS-based and regularly refreshed and updated. Make sure whoever designs it understands SEO and helps you optimize. Ideally, offer the ability to download forms, pay bills and access a patient portal.
Try a service like ZocDoc (if they target patients you serve) to reach out to more potential patients.
Extend your hours to include some evenings and weekends where you see a demand.

For more about effective ways to marketing you practice, check out the recorded webinar and the recent blog post Your Top 5 Medical Practice Marketing Questions Answered.

About the Speaker

Laurie Morgan is a practice management and healthcare industry consultant with Capko & Company. She managed both start-ups and large-scale operations in the media industry before turning her focus to medical practice management. Her consulting focus is on driving and capturing revenue and operating more efficiently. Laurie has an MBA from Stanford University.

Kareo March 27th, 2013

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By Rico Lopez, Senior Market Advisor at Kareo

During my consultant days, I gave my clients five tips for successful patient payment plans. Here they are:

Always have a signed agreement. Have the patient sign an agreement with clear expectations that defines all the components laid out below.
Choose a realistic payment amount and reasonable timeline. The patient can always pay more than the scheduled amount or pay earlier. Set the amount so the patient can realistically make the payment and it meets the practice’s minimum payment amount. The minimum payment amount is something the practice should set in advance for their staff to enforce. The timeline has to be acceptable to the practice as well. The payment plan cannot be $1 a month for the next 100 months to pay a $100 balance. Along with defining the minimum monthly payment amount, the practice should also set a minimum balance to qualify for payment plans. Exceptions to these rules should only be approved by the office manager or the provider. If you find that you are getting too many requests for exceptions, then maybe you should revisit your minimum balance and/or payment amounts.
Define consequences for failure to pay on schedule. There has to be a consequence if the patient doesn’t follow through with the agreement. For example, the total amount becomes due unless patient gets back on schedule or if you offered a discount, they lose the discount. The consequences should be clearly spelled out in the payment plan agreement in writing. This agreement is signed by the practice representative and the patient.
Offer incentives to pay off total balance early. Offering incentives and discounts to pay can help you collect outstanding balances earlier in the payment plan. Always check your payer contracts to be sure you are in compliance with any discounts you offer. Each practice has to decide how much they are comfortable discounting, but determining the costs to collect outstanding balances over time (or in some cases, the risk of never collecting the full amount) is a good basis for determining an appropriate discount amount. Consider this, a balance that you fail to collect that is later referred and recovered by a collection agency may cost you 30-40% of the collected amount. The amount could be more when you factor in your staff time and printing and mail costs over time as well. You could lose as much as 50% of the original amount by the time you get paid. So would you rather dictate your discounts early on or have them decided for you down the line?
Offer the discount at the end of the payment plan. If you do offer a discount, discount the last payment (not on total amount or first payment). If you discounted the whole balance up front and then they failed to comply, it is harder to add back the discounted amount. It is much easier to waive their last payment or give them 50% off the last payment. This also gives them more of an incentive to stay on schedule so they can get the discount at the end.

More and more patients are paying a larger amount out of pocket for their medical care. Being prepared with clear guidelines for patient payment plans, a template for an agreement, and strategies to motivate patients to pay their bills can help you collect those patient due amounts.

Kareo March 26th, 2013

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At the recent webinar, Medical Practice Marketing for Profitability, Laurie Morgan and Judy Capko of Capko and Company discussed many strategies for effectively marketing your medical practice. If you missed Medical Practice Marketing for Profitability, watch the recorded webinar to find out about Laurie and Judy’s great suggestions. They received many good questions and were unable to answer them all. Here are answers to five of the most common questions that were asked by attendees.

Q: I read in an article that Social Media use for medical patient communications is going to be the highest law suit for HIPAA Violations, since they are not well secure developed. What do you think?
A: HIPAA applies to social media in the same way it applies to all aspects of your business. You need to follow the same rules. If you use social media, it is important to remember this and be careful not to divulge any information that identifies a patient or provides information about a patient. If a patient says something to you on Facebook for example, you will need to be ready to reply in a way that redirects the conversation to a secure location. You can say something like, I would like to discuss this with you please call my office.

Q: Can the Google programs be set up without activating the “reviews” portion?
A: Unfortunately, no. A lot of people are concerned about this, but we really see it as an opportunity. First, it can give you a chance address legitimate concerns that will affect other patients’ perceptions of your practice—for example, if the scheduling process is causing complaints because it’s too difficult, or if wait times in your reception area are more of an annoyance than you realized. Studies also show that the majority of reviews posted about physicians are positive—and the negative ones are mostly related to fixable administrative issues—so, some of the fears that people have are misplaced. Finally, if there is a truly illegitimate review that has been posted maliciously, most sites provide a means to get those removed.

Q: What is the best way to connect with potential referring physicians? Lunch? Stopping by to drop off lunch? Phone calls?
A: This may depend on your practice (location, specialty, etc.) and who your referring providers are. Your goal is to build lasting relationships. Ideally, the communication should be between the providers (not staff). This could be a phone call or scheduling an in-person visit. If you are a new practice or you are adding new providers or services, you may want to host an open house lunch or other event to try to meet your potential referral network. Also, ongoing follow up through thank you cards, a small annual gift, birthday cards, communications about changes at the practice, etc. is important.

Q: How does your recommendation about gifts relate to Federal Anti-Kickback and Stark Laws which prohibits solicitation (including gifts) of referrals?
A: These regulations are designed to prevent you from “buying” referrals. They do allow you to provide nominal gifts. We generally say nothing valued at more than $50. We also suggest gifts that can be enjoyed by the entire practice staff and not just the provider. For example, a fruit or candy basket or a cheese cake from a great local bakery.

Q. When do we know we should cut off new patient intake?
A. This is a big decision. You need to be cautious because once you say you are not taking patients, this can backfire and cause your patient load to decrease. So be sure this is the right choice. Do a thorough evaluation of your schedule and make sure you can’t make changes to accommodate additional appointments. Be sure you are meeting all of your revenue and growth goals. And determine if this may be a time to consider building the practice by adding another provider as opposed to limiting additional patients. If after all this, you decide that in fact you are not taking more patients, then go forward.

If you found this information helpful, then you might also enjoy our next webinar, What You Need to Know about Meaningful Use Now.

Kareo March 21st, 2013

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By Rochelle Glassman

In my recent webinar, 3 Innovative Strategies to Improve Collections, an attendee asked, “Can a physician refuse to see a patient if they have an outstanding balance and won’t pay or make arrangements to pay?” This is a patient collections question that required a longer answer than I could provide on the webinar. So here are my detailed recommendations.

In all patient challenges, the most important goal is to avoid a claim of patient abandonment and assure that patient care is not neglected. [1]Regardless of the reason for your issues with a patient, whether it’s unpaid bills, failure to follow advice, or mistreatment of staff, the same advice applies:

Document any issues you are having with the patient. Make sure not to terminate a patient until there is evidence in the record of the problem(s). Patients should be provided with notice of such problem(s) and an opportunity to modify their behavior. If the particular patient’s issue is an unpaid balance, meet with the patient privately and discuss the issue. Can a payment plan be established? Can the patient demonstrate financial hardship that you are able to document? Document your meeting with the patient, the issues discussed, and the patient’s response.
If no agreement can be reached regarding payment of amounts due, follow up in writing and let the patient know that unless a payment plan is established by a certain date, the practice will provide notice of termination.
If efforts to establish a payment arrangement are still unsuccessful, you may need to terminate the patient. Always remember that the patient must be provided with sufficient time to find alternative care before termination from the practice. Reasonable notice can vary depending on the patient’s medical condition and the difficulty which a patient may have in finding alternate care. For example, I recommend that an oncologist not terminate a patient for nonpayment of medical bills until the patient has completed the current course of chemotherapy. Alternatively, a patient of an internist who simply comes in when he or she has a cold or other minor issue may require only 30 days notice. There may be state-specific laws regarding minimum notice periods and these must also be observed. It’s not your responsibility to make sure the patient has found a new physician, only to provide sufficient time for the
patient to do so. However, in certain circumstances, there may certainly be ethical obligations to provide additional assistance to extremely ill patients to secure continued care.
Termination of a patient from the practice should not interfere with your ability to turn over the patient’s bills for collection. However, at all times through the termination process and thereafter, it should be the goal of the practice to attempt to establish a payment arrangement with the patient and to determine if there is a documented financial hardship.
In any notice provided to patients, make sure you clearly note the date on which they will no longer receive care and how they can obtain copies of their medical records. You should also offer assistance in locating a new physician, such as providing contact information for a state medical association or similar organization. The patient should understand that in the event of an emergency or urgent situation (which may depend upon specialty), the practice should take the necessary steps to assure the patient is properly cared for.
Like any other business, physicians should not be required to continue to offer services without payment. However, in medicine it’s not all about the bottom line. Take the time to properly handle each patient and to assure their understanding and continued medical care in order to best protect your medical practice.

In my last blog post, I provided my 8 Best Practices for Patient Collections, which I also discussed in the webinar. For more great information about improving collections and shortening your revenue cycle, check out the recorded webinar.

About the Author:

Rochelle Glassman Our guest speaker is Rochelle Glassman, a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

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