Elizabeth Woodcock

Elizabeth Woodcock outlines her best practices for setting up telemedicine services from an administrative perspective, while emphasizing that it is never too late to get in the game.

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How to get started with telemedicine quickly


I heard it again just the other day: a physician complaining about the “lazy” new doctor he had hired to work in his practice. “Goodness gracious,” he said. “Who does he think he is? This physician actually wants to go home at 5 p.m.!” 

As you may have guessed, the new physician referenced above is young - a member of “Generation X,” those of us between age 30 and 45. A Gen X-er myself, I can relate to the new guy. It’s not lazy to want to leave the office at 5 o’clock; it’s part of our generational mindset. Sure, different people have different priorities, but they don’t always have to be in conflict with running a busy practice. 

So what does this mean for you? Can you work with your younger peers and their desire for a higher “quality of life”? 

Yes you can. Before you throw up your hands, understand the general characteristics of Gen X-ers: 

They work to live; not the other way around.

 Quality of life is a priority for Gen-X physicians. Although their older peers often interpret this attitude as laziness, Gen X-ers are actually very ambitious in their professional lives. They are, however, equally ambitious about pursuing satisfying personal lives away from the office. 

They work to have a life outside of work.

 Gen X-ers don’t want to be dictating patient notes at 8 p.m.; they want to be tucking their kids into bed. 

 Gen X-ers seek out relationships. Being loyal to their employer is not enough. They want to know how they can contribute to the organization in their own unique ways, and they will ask for what may seem to you like constant feedback about their performance. 

They’re skeptical of institutions and rules.

 Gen X-ers value individuality. They are skeptical of authority figures and the rules those figures lay down. Your fancy title won’t make them respect you; you’ll have to earn their respect by building relationships with these colleagues. They flourish under mentors, but they don’t respond as well to managers. 

Skepticism also makes Gen X-ers wary of consenting to long-term professional arrangements. Take the time to work with them on commitments such as practice partnerships. It may be a lengthy process to accommodate their concerns and desires, but your willingness to respect their needs will foster a relationship between you - and earn their respect. 

 Growing up in the Information Age, and, for many of this generation, having been surrounded by a tremendous amount of racial, gender, and ethnic diversity, Gen X-ers are more accustomed to dealing with differing viewpoints and new ideas. In general, they dislike routine and desire change. 

Gen X-ers needn’t be a thorn in your side. Know who they are, and embrace them for what they can bring to your practice. 

is a professional speaker and consultant specializing in practice management. Elizabeth is a fellow in the American College of Medical Practice Executives and a certified professional coder. She can be reached at 

This article originally appeared in the April 2007 issue of

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Younger physicians aren’t “lazy,” as many old-schoolers believe. But they do have different priorities.

Physicians Practice Pearls: Talkin’ ’Bout My Gen X-eration


You probably have at least one patient whom you know can pay you, but doesn’t. The patient continues to visit your office, saying “Just bill me.” 

Now suppose you recently discovered that BlueCross BlueShield sent this patient a $10,000 check for a surgery you performed on him last month. Nevertheless, the patient refuses calls from your office staff. Your medical-legal risk may prevent you from dismissing this person. But even if you could terminate your relationship, he would still owe you money. What can you do? 

 - Practices have historically used collections agencies only sporadically, but they can effectively “up the ante” on a deadbeat patient. Most agencies take their cues from you regarding how much pressure to exert on your clients. When negotiating with a collections agency, make sure you outline directives that preclude harassment. Most practice managers report that the recovery rate of medical accounts through collections agencies is less than 15 percent; so don’t expect the majority of your accounts to be settled this way. The key? Submit accounts sooner rather than later. 

 - Small claims court is regulated at the state level and often administered at the local level, so you’ll need to learn the rules for filing small claims litigation in your locale. Most such courts charge a small processing fee and require you to complete paperwork and present documentation of the debt. Many states have a maximum amount for a small claim - $5,000, give or take - but that typically covers most medical debts. The bad news? The court does not provide the means for actual collection. 

 - When patients refuse to turn over an insurance check they’ve received to cover services you’ve performed, you must first understand the assignment of payment. Most patients assign you the right to receive payment for services you provide to them. Explore such assignment rights with the insurance company involved to determine whether it will pay you directly and then go after the patients itself to retrieve its money. Failing that, call your state insurance commissioner to ask whether your state’s laws support your right to the assignment. If neither of these options works, report the misdirected payment to the IRS as income to the patient by submitting a 1099 Miscellaneous Income form. Some practices have tried this as a last-ditch effort to compel patients to submit payment. 

When it comes to the inveterate deadbeat patient, these strategies may prove an effective method of demonstrating that although you’re a compassionate and flexible physician, you’re also serious about collecting for your services. So pay up, please. 

This article originally appeared in the March 2007 issue of

Another selection from our weekly e-mail newsletter. This issue: dealing with deadbeat patients.

Physicians Practice Pearls: Deadbeat Serious


CMS has established an appeals process that allows you to present your side of the story and promises a comparatively fast review of your case. It has streamlined the appeals process (from the time you submit your initial appeal to when a federal district court hands down a binding decision) from 18 months to just over one year, maximum. Understanding the process can better help you get your side of the story heard. 

If you disagree with Medicare’s decision to deny payment for a given claim, first submit a written redetermination request to your Medicare carrier. There is no dollar minimum, but you must submit the request within 120 days of receiving the denial. Ask your carrier for the redetermination form. 

Denied again? You can then ask for reconsideration by a qualified independent contractor (QIC). If the denial in question covers a physician service, the QIC must be a physician. You cannot choose which physician; a QIC is an independent reviewer. Get your paperwork in order, as Medicare will not grant a QIC review if you fail to supply sufficient supporting documentation. Furthermore, you will not be able to introduce additional evidence to support your case at later stages in the appeal process. 

The QIC reconsideration stipulates no minimum dollar amount, but you must file your appeal within 180 days of receiving the redetermination decision. If you disagree with a denial but have no paperwork to support your case, Medicare won’t grant a QIC review. 

If you find yourself denied again, you can appeal the QIC’s decision within 60 days. This means bringing your case to an administrative law judge for a hearing. 

If you are again denied and you still want to pursue the matter, request a Medicare Appeals Council (MAC) review. Within 60 days, you must submit a written declaration stating why you object to the decision. The MAC, which falls under the jurisdiction of the Department of Health and Human Services Departmental Appeals Board, may agree to hear oral arguments from both parties - you and the carrier - especially if the decision hinges on a question of law, policy, or fact. 

 denied at this point, you may request a federal district court review. You must make this final appeal within 60 days of your MAC review. The findings of the federal district court are final. 

Many physicians and their staff members assume they have no recourse when Medicare denies a claim. They’re wrong: If you disagree with your carrier’s decision and submit substantial evidence to support your case, the decision can be overturned and you can collect for your services. 

This article originally appeared in the February 2007 issue of

Another selection from our weekly e-mail newsletter. This issue: how to handle Medicare denials.

Author | Elizabeth Woodcock

Articles

How to get started with telemedicine quickly

Physicians Practice Pearls: Talkin’ ’Bout My Gen X-eration

Physicians Practice Pearls: Deadbeat Serious

Physicians Practice Pearls: Appealing Medicare Denials