Disclaimer: Since this information may be of a generalized nature, no final decisions should be based on this information without first seeking professional advice for your specific circumstances.

1.

4.

• Raw talent. The best managers have high intellect.
• They are self-developers.  Added skills can't be forced on someone unwilling to learn.
• They lead with tact, grace and authority.
• They are not only efficient but also effective.
• They have technical skills and know how each job is done within the organization.
• They understand who the employer is and identify with the physician.

5.

• Do not tolerate staff members being unprofessional with patients.
• I recommend not charging a no-show fee. However, if you elect to
  charge a fee, you must charge all patients the same amount including Medicare patients.
• Investigate and try to determine the reason behind no-shows.
• Stay positive when dealing with missed appointments.
• Call forty-eight hours in advance with appointment reminders.

6.

• A "personal touch" is easier to establish and retain in a small practice.
• Overhead is easier to control and therefore remains lower.
• A small practice normally can function effectively with fewer employees.  This in turn makes managing easier.
• Actual office space can be more inviting rather than appearing as an institution.  A more welcome feel draws new patients.

• Yes it is legal to have multiple fee schedules, as long as no fee is lower than the amount you bill Medicare.
• The majority of practices are best advised to maintain only one standard fee schedule; however there are exceptions depending on payer mix.

• Submit all claims electronically.
• Submit clean claims by understanding the rules of coding.

• It is recommended that follow up is performed on unpaid claims within 45 days of the original date of submission
• Handle denials immediately.  All denials should be worked within 5 business days of receiving them.
• Get the patient involved in the process.  Whenever possible, let the patient know when payment has not been received.

• Many times offices simply hire people and put them to work with either improper or no instruction.
  Follow the "Hersey Way", referring to the well known management technique leader.

1. Telling-Train in the tasks necessary to do the job.
2. Selling-Explain the importance of the job and say it is important to do it a certain way.
3. Participating-Ask employee for input on better ways to do the job once they fully understand it.
4. Delegating-After the first three have been accomplished, leave the employee alone to do their job with limited supervision.

In the clinic office setting, the answer is :

• Yes, if the patient is an established patient and an established problem in which the plan of care has been determined.
• No, it the patient is a new patient or an established patient with a new problem
• For Medicare patients as long as all incident-to rules are followed.
• For other insurance plans, consult your individual contracts for their rules pertaining to NPPs.

In the hospital setting, the answer is:

• For Medicare patients as long as all shared/split Evaluation and Management rules are followed. CMS incident-to rules do not apply in the hospital setting.
• For other insurance plans, consult your individual contracts for their rules pertaining to NPPs.

• Perform daily and weekly audits.  Keep a pulse on the practice.
• Perform a daily reconciliation of the schedule against the encounter forms. This checks for failure to capture all charges.
• Perform a weekly reconciliation of patient encounter forms against the computer to identify charge entry errors.  Continue the process by performing a review of payments received and the final posting to the computer.
• Review the aged accounts receivable to determine neglect for follow up collection efforts.

• It is vital to understand where the practice is and where it should be.  The practice should be benchmarked against the Medical Group Management Association data by specialty.
• After you have the data, monitor your 90+ past due A/R gross and net collection rate, and A/R multiple.  By monitoring these indicators, you will be able to identify "red flags".

• It is not a bad thing to trust employees but it may be shortsighted for complete trust.
• All employees need to be aware there are checks and balances built into the system.  This protects them as well as the practice.
• Make certain the money collected both from the patient and insurance companies are handled in a complete and thorough manner.

• You will not be violating HIPAA privacy rules since disclosure of personal health care information to perform treatment, receive payment, or perform health care operations is acceptable.

• The 1997 E&M guidelines are going no where.  It appears that CMS and the AMA have stopped revamping the E&M documentation guidelines.  We may never get rid of the 1997 E&M guideline requirements.
• But don't forget you are allowed to bill E&M levels based on the 1995 E&M documentation guidelines.

• Very little of what is taught in MBA school help prepare a potential employee to effectively run a physician office.  An MBA graduate will still need to learn, on the job.  For example: Medicare rules and regulations, physician scheduling, and clinical staff productivity.  Without these basic skills, it is hard for any manager to gain the trust of the very employees they manage.

• Yes-When a manager bluffs a physician or an employee, it is the beginning of the end.  Both a physician and employee will lose respect and trust in the manager.