The conversation with the insurer should follow a simple script, says Keegan. “Did you receive this claim? If the answer is no, resubmit it. If the claim was received, ask when the check was cut. If a check wasn’t cut, find out what information the insurer needs to process the claim.”
If need be, remind mulish insurers of your state’s prompt-pay law and its penalties, and your readiness to file a complaint with insurance regulators. Practice-management consultant Elizabeth Woodcock (also a coauthor of “The Physician Billing Process”) has developed a state-by-state list of prompt-pay laws:
My overhead is high, and my efforts to control it haven’t worked. What can I do?
You can’t expect to control costs if you never ask for price breaks — or demand them. Consider office rent. In a soft real-estate market, you might be able to negotiate a dollar off your landlord’s rate per square foot by extending the lease for three years. If the landlord doesn’t budge, turn to “pass-through” expenses such as cleaning and lawn care that are divided up among tenants, says Mertz. “Sometimes there’s no limit on pass-through expenses. Why not ask the landlord to cap increases at 3 percent a year?”
The cost of supplies like exam-table paper and syringes often creeps up over time because an office manager gets chummy with an ingratiating salesperson and “doesn’t want to beat on her friend for a lower price,” says Mertz. Motivate her to haggle by offering her a bonus of 5 percent of whatever she saves, says Mertz. And haggle annually, comparing your vendors’ prices to what competitors advertise.
Yet another approach toward finding the best deals on supplies is group purchasing, sometimes available through your medical society or a local hospital, notes Mertz.
Operations
I’m so buried under the crush of work that I rarely get home for supper anymore. I miss my family.
Falling behind on appointments is one sure way to work late. Another is spending every night playing catch-up on tasks like clinical documentation and phone calls, says practice management consultant Gray Tuttle in Lansing, Mich.
To avoid facing a stack of charts at 5:30 p.m., he suggests documenting each visit as soon as it’s over while the information is fresh in your mind. That’s more efficient than batching charts at day’s end and trying to recall what the 9 a.m. patient said about her gallbladder. Other consultants advocate the “fourth exam room” concept — set aside every fourth appointment slot for charting.
And those sunset phone calls? Too many doctors are ringing patients about negative test results or prescription refills instead of letting a medical assistant do it, says Tuttle. Only make the calls that require a physician’s level of expertise.
Patients often complain about long waits. How can I stay on schedule?
You need to do some investigating to find out exactly what’s clogging up your patient flow, says Tuttle. One common culprit is too few exam rooms: “A primary-care doctor needs at least three.”
Or it may be too few (or poorly trained) medical assistants to room patients, take vital signs, and prep for procedures. A poorly supplied exam room means you’ll be interrupting visits to chase down tongue depressors. Make sure everything you need is in the same place in every exam room.
And schedulers can make you run behind by booking patients into unrealistic appointment slots. “They try to shoehorn a comprehensive new-patient visit that needs 30 minutes into a 20-minute slot,” Tuttle says. The solution? Define three or four standard slots and then give employees written guidelines on what kind of patient is appropriate for each.
Finally, the blame for a restless waiting room may lay with a doctor who doesn’t manage his time well, he adds. “The first patient is scheduled for 8 a.m. and the doctor rolls in at 8:30 a.m.” Not good.
I've thought about adding an associate to reduce my workload and increase my earnings, but I worry about losing money on the deal. Any advice?
Yes, you could experience financial pain by hiring another physician, especially if you’re a soloist. You’ll need to subsidize the associate while she ramps up her production. And what if she turns out to be a slowpoke?
An overworked soloist takes less of a risk by hiring a nurse practitioner or physician assistant. “They can do 80 percent of what a physician does, but at half the cost,” says Tuttle. Consequently, they yield a better return on investment, as borne out by data from the Medical Group Management Association. In 2007, physician assistants in primary care received a median $81,052 in compensation and generated $217,584 in collections, while those figures for family physicians who didn’t deliver babies were $173,812 and $363,214, respectively. Think about it this way — two physician assistants cost less than one FP, yet outproduce him.
