“A lot of what we do in coding and reimbursement ties into that business component,” she notes. “A great part of it is making certain that the front office is running smoothly. An even bigger part is the whole reimbursement picture and making sure that [you] understand both compliance and charge capture. It’s kind of a thin line: You want to follow all the payers’ rules but also capture everything you can to get paid what you deserve.”

Others say the office manager should be the first hire if you’re starting small. Particularly in a single-physician practice, that person and the coder could be one and the same. In all but the most lavishly financed practices, staff (and physicians) will have to fill more than one role in the beginning — this person can manage billing and other tasks until revenues increase sufficiently to allow for more hires.

Even when you expand, you’ll want to be able to head off scenarios like, “Susie just quit with no notice, and she was the only person who really knew how to use the billing software!” Provided you’re able to keep accountability clear and the reporting structure transparent, cross-training of employees is often a good idea. The payoff of avoiding disruptions down the road is well worth the effort.

Make Your EMR Play Nice With Your Staff Consider hiring key staff members before making that EMR purchase, and involve them in the decision. As coding expert Sheri Poe Bernard says, “An EMR only takes you so far. And it can take you pretty far astray if it doesn’t have the right edit tools within it.” If you’ve enlisted experienced pros, they’ll contribute questions you might not have thought to ask, and you’ll improve their buy-in to your practice. In any case, remember that, “You have to have a human proofing” the EMR’s output, says Poe Bernard. “You always need a human to look at it, because a human — the physician — is going to be held accountable.”

Even though she had “zero patients,” Santmyire-Rosenberger started her practice with three experienced employees, including an office manager who handles billing and collections. At first, she says, she considered that position a luxury. Now she views her office manager as an absolute necessity, particularly with a staff that’s increased to five.

“I could do it with a lot less — I could run my office on a daily basis with two people,” she says. “But would people get their questions answered? Would patient waits be as short as I want?” By maintaining a sharp focus on what she considers the keys to good patient service, circling back to the mission and vision, Santmyire-Rosenberger is able to keep things running smoothly while turning a healthy profit.

‘New practice seeks dynamic professional… ’

The experts are unanimous: Do not skimp on staffing. You may find it necessary to pay a little more to hire the right staff, or to invest more in the long term to help with the professional development of someone less experienced but with the right attitude and intellect. The latter course may be your best bet in rural areas or those suffering acute staffing shortages.

Either way, “You get what you pay for,” notes Poe Bernard. You could bring in a family member to help you get along, but hiring people who lack key background knowledge, particularly when it comes to finances, usually results in one of two equally untenable scenarios: (1) putting yourself and the practice at risk (either through inappropriately low charge capture or fines/takebacks for incorrect charges), or (2) expending the invaluable resource of the physician’s time resolving matters that should be delegated elsewhere. “If you want to hit the floor running and start your practice with a full schedule and a robust patient load,” says Poe Bernard, “you’re going to have to have somebody competent in place.”

Finding such a person isn’t easy, and formal credentials are just a starting point. In fact, you’ll want to confirm with the issuing institution all credentials and degrees an applicant claims. Falsification of this sort happens astonishingly often, and practices could save themselves a heap of trouble by checking the facts before making an offer. Background and credit checks are a must as well.

Half of all practices will experience embezzlement, the highest rate of any service-sector business. This crime usually goes unreported (or unnoticed), but don’t risk missing a rap sheet. A credit report, likewise, may not turn up much. You’ll probably want to know, though, if your prospective billing manager carries a $50,000 balance on her Neiman Marcus card.

Formal references are falling out of favor as applicant-vetting tools, as the legal ramifications of giving a negative reference can make it difficult to get meaningful information out of former employers. Or, says Poe Bernard, “They doom you with faint praise.” It’s nevertheless worth asking for professional references and calling to follow up. What someone refuses to say about a colleague can tell you plenty.

A candidate’s attitude, work ethic, and maturity level should carry quite a bit of weight in hiring decisions, too. Just don’t get too chatty when seeking clues to this subjective info, as that’s often when interviewers run afoul of labor law by asking about personal matters such as age or marital status.

If you elect to outsource nonclinical work — and plenty of practices do so quite successfully — rules similar to those outlined above apply. Before farming out billing, IT, or even many human resources functions (through an entity known as a professional employer organization), ask plenty of detailed questions, follow up on references, and remember that cheaper is often not better.