Logan Lutton

With all the useful information available on Physicians Practice, it is easy to become overwhelmed.

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site. In a December 2021 article on “webside manner”, Mark Allara, MD, writes the following:

For those unaccustomed to telehealth visits, establishing your virtual bedside manner or “webside manner” can be a challenging. Here are my top five telehealth tips to cultivating a pleasing webside manner, improving patient satisfaction and increasing loyalty:

Remember that most patients are unfamiliar with telehealth and could benefit from some upfront explanation, both operationally and financially. Take a few minutes to explain the technology, such as mute control, and ask if they can see and hear well.

Consider the visual aspects needed for a successful appointment and pleasing webside manner. For example, your office should be well-lit and organized to indicate professionalism.

Eye contact is crucial, but tricky to achieve online. Adjust your web camera so the patient’s video window is positioned to give the appearance of a face-to-face conversation while enabling you to also review their chart on your screen.

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Practice tip of the week: Webside Manner 101

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site. In a January 2021 article on creating a successful YouTube channel for your practice, C. Noel Henley, MD writes the following:

 - Whether you use your practice’s website or a personal site, each video you produce should link back to that location.

 - A professional-looking profile image is reassuring to visitors that the channel is maintained and created by a real person. Most people are suspicious of a doctor who claims to be an expert but doesn’t show what he or she looks like.

 - YouTube offers free tracking and analytics features built right into your account. Statistics like viewers per month, number of subscribers to your channel, and where viewers looked at your videos (desktop versus mobile), are calculated for you.

Practice tip of the week: Creating a successful YouTube channel for your practice

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site. In a January 2021 article on why physicians need more sleep, Colin Zhu, DO writes the following:

“This year, you need more sleep. With the coronavirus dominating headlines and physicians always encouraging us to be physically active and eat healthy, it’s easy to forget the benefits of getting a good night’s sleep. Here are some best practices:

Keep the bedroom your sanctuary, reserving it for sleep and sex.

Prioritize your sleep and make a bedtime routine prior to midnight and stick to it.

Keep the room pitch dark and relatively cool.

Avoid eating and heavy exercise right before bed.

Limit coffee and other stimulants to the morning as opposed to later in the day.

Power down screen time before bedtime preferably one to two hours before bedtime.

If you need a nap, limit it to no more than 30 minutes.”

Practice tip of the week: Why physicians need more sleep 

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site. In a January 2021 article on physician side businesses, Chris Panebianco writes the following:

“When it comes to pursuing entrepreneurial aspirations, a common path many physicians take is practice ownership. Today’s environment, however, presents even more opportunities for physicians interested in starting their own venture—and they’re not alone.

There are numerous ways a side business can benefit physicians, including:

The income from a second business is especially useful in uncertain times, during slow periods of regular business, or due to an unexpected event. By supplementing what you earn as a physician, you can gain more financial security to pay down debt, grow your wealth, invest in new opportunities, or set aside money in an emergency fund.

Another benefit of a “side hustle” is the freedom that comes with owning a business. You control the operations, and you get to decide the investments you make and the risks you’re willing to take. As the owner, you choose how much time to put toward it and you alone can reap the financial benefits.

In a challenging economy, it’s important to ensure control of your finances and career; exploring additional revenue streams is one way to do that. By pursuing a side business, and working with the right partner, you can feel more confident about your financial security.”

Practice tip of the week: Physician side businesses

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site. In a January 2021 story on eliminating practice gossip, 

“Creating a winning team culture in an office is a key to success that cannot be overlooked. Most team builders come in with a lot of buzzwords, flashing lights, and games in order to engage staff members; often times their solutions dwindle and fade as fast as they arrived. There are simple solutions that create a unified team environment that can become permanent. One of the easiest ways to build team unity is a no gossip policy.

The policy is simple- gossip once and you will be warned, gossip again and you will be released. You could implement a few different versions, and with a problematic and bickering staff, you may have to add a few additional steps prior to releasing an employee.

Gossip is dishonest, contagious, and breeds disloyalty for your medical practice and within your team. All of the standard bullet points about building a great culture within your company are affected by gossip. Typically, team members that gossip about each other, gossip about everybody: staff, physicians, patients, and business. It is not “healthy” for your office to allow gossip and having an office full of gossip is a quick way to experience legal and professional ramifications.

When you bring a policy like this into an existing office dynamic, it is imperative that you don’t hand this out in a memo or e-mail. It is imperative to hold a team meeting, with a detailed explanation, and an opportunity for your team to ask questions.

This policy may not be well-received by all of your staff or team members at first. Your biggest culprits will be the most vocal and try to win over the others. Quality people do not gossip, and after the initial implementation phase of this policy, you will be left with quality people, who monitor and remind each other to remain gossip free.”

Practice tip of the week: Eliminating staff gossip at your practice

Editor’s note: In celebration of another successful year, Physicians Practice is re-running the five most-read stories in 2022. We wish you a happy holiday season, and we’ll see you in 2023.

Employing non-physician practitioners (physician assistants, nurse practitioners, clinical nurse specialists, etc.) is an effective way to increase productivity in a physician office. However, under Medicare rules, covered services provided by non-physician practitioners (NPPs) are reimbursed at a reduced rate (85 percent of the fee schedule amount).

The “incident-to” billing rules provide an exception, allowing 100 percent reimbursement for non-physician services that meet the requirements detailed in the Medicare Benefit Policy Manual, Chapter 15, Section 60 (Services and Supplies Furnished Incident To a Physician’s/NPP’s Professional Service).

There are six basic requirements to meet the incident-to guidelines for Medicare payment:

The Basics of Incident-To billing

Services meeting all of the above requirements may be billed under the supervising physician’s NPI, as if the physician personally performed the service. Documentation should detail who performed the service, and that a supervising physician was in the office suite (although not necessarily the same room), at the time of the service.

Remember: Incident to applies only to Medicare. Further, the requirements do not apply to services with their own benefit category. Diagnostic tests, for example, are subject to their own coverage requirements. “Depending on the particular tests,” the Benefit Policy Manual explains, “the supervision requirement for diagnostic tests or other services may be more or less stringent than supervision requirements for services and supplies furnished incident to physician’s or other practitioner’s services.”

Similarly, pneumococcal, influenza, and hepatitis B vaccines do not need to meet incident to requirements. MLN Matters Number: SE0441 elaborates:

Must a supervising physician be physically present when flu shots, EKGs, Laboratory tests, or X-rays are performed in an office setting in order to be billed as “incident to” services?

These services have their own statutory benefit categories and are subject to the rules applicable to their specific category. They are not “incident to” services and the “incident to” rules do not apply.

Additional rules apply for incident to physician’s services in clinic, and services incident to a physician’s service to homebound patients under general physician supervision. These can be found in the 

Medicare Benefit Policy Manual, Chapter 15, Section 60

Slideshows

Here are six basic requirements to meet incident-to guidelines and get properly reimbursed for your care.