A typical practice buy-out

If you wait until it is time to retire to negotiate something with your partners, it becomes very difficult and could lead to costly litigation.

Recruiting the millennial workforce

During a time of shortage and changing demographics, hospitals, health systems and medical groups are competing to recruit and retain physicians who bring with them new values, needs and expectations.

How to contract with an associate physician

A poorly drafted contract can have devastating consequences if the relationship dissolves in the early years. If the relationship survives, the terms of the initial contract often heavily influence subsequent documents.

Curb skyrocketing workers' comp costs

You can't reduce the level of workers' comp benefits, as you can with health insurance. That's because states mandate full coverage for treatment of on-the-job injuries. So how can you control costs?

Choosing your medical practice entity

A dizzying array of choices is available with respect to the selection of a legal entity for your medical practice.

Stark changes require quality customer service

With the removal or reduction in financial incentives for physicians to self-refer, the competition for patients is expected to increase. Effective competition will require patients to be viewed as consumers, as effective marketing, branding and quality of service will have an increased impact on patient decision-making.

Choosing a physician compensation plan

The general trend in physician compensation has been to simplify and standardize policies and procedures, but there is a new frontier and new challenges.

Pay up, self insure, go bare or quit medicine

To best judge the alternatives, you need to understand the pros and cons as well as the costs and benefits of each alternative.

Successful medical practice valuation

Failure by one valuator or another to understand these factors can lead to an incorrect valuation, usually an overstatement of the true value of the medical practice.

Documenting a solid H&P, Part I

Learning to document for payment must be done ethically, efficiently and legitimately.

Recruiting and retaining physicians

Even as the baby-boomer generation requires more physicians to treat chronic illnesses, the health care workforce is increasingly comprised of physicians seeking to balance time within clinical practice with other interests and commitments.

Protecting patient information privacy

Doctors and health care providers have an obligation to address both the handling of the information by staff and authorized agents, and also the physical and technical safeguards in place to protect electronic health information.

Patent laws for physician inventors

Success is more likely to come to physician inventors who understand the criteria for patentability, avoid prematurely publicizing their ideas, clear up ownership issues early on, and who are prepared to be in it for the long haul.

Outsource to a professional employer organization

It’s a challenge to keep up with new regulations, administer the payroll, make certain your own staff has proper health coverage, and know how to ensure your staff is receiving competitive benefits – even when you have a competent office manager.

Understanding 'own-occupation' disability insurance

Not all “own-occupation” definitions are the same, and understanding the subtle differences between each contract is critical to selecting the correct policy.

Are independent practice associations still viable?

Gain-share contracts allow the IPA to share the financial benefits of more efficient care, while most physicians believe that the greater reward lies in obtaining the ability to truly manage and improve the care of their patients.

The financial contract every practice must have

At a time when the family is grieving or caring for a disabled family member and possibly struggling to pay their bills, the absence of a Buy-Sell agreement can cause bankruptcies of the families of all of the partners.

Measuring a practice's financial progress

With a solid, qualified team, a well-monitored budget and the basic understanding of business ratios, a physician can very quickly and routinely know exactly where the business is, where it is going and what may need adjusting to improve the operation.

Marketing your practice

Invest in your practice with careful planning, empowering the staff, following proven marketing ideas, and most of all, keep the patients happy by providing quality care and service.

How to do a medical practice buy-in

The first partner’s buy-in establishes the “template” for the second and subsequent partners. Assuming that the first buy-in worked well, the template can be re-employed with confidence.

An overview of Stark regulations

The good news is the latest changes generally are intended to fine-tune the existing prohibitions.

Dealing with low-literacy patients

Tools to help the low-literate person in the physician office setting come in two varieties: human and technological.

Interviewing for cultural fit and retention

“Poor cultural fit” is the leading cause of turnover among physicians and causes endless hours of trauma and the breakup of many a professional match that seemed made in heaven. It is important that an incoming physician exemplifies the basic character traits of the collective organization, or a serious misfit will occur.

How to achieve patient satisfaction

Patient satisfaction pays, economically and clinically. It solidifies loyalty and compliance. It attracts new patients and can improve productivity.

Health system implications for physicians

Many physicians find their practices significantly impacted by the development of health systems in their communities. The most direct effect may be the opening or closing of a particular service, but a number of other events can impact a physicians’ practice of medicine as well.

Drafting your practice continuity plan

Do you have a plan in place to survive financial shortfalls and emergencies? Are shareholders best-positioned for what happens after exiting the practice?

Why you need an employee manual

Clearly outlining benefits, duties and responsibilities can save you time, improve employee morale, prevent disagreements, and help you avoid costly lawsuits by nipping the “I-didn't-know-that-was-office-policy" defense right in the bud.

New Joint Commission medical staff standards

There are now two types of physician evaluations, and hospitals and clinics must now address conflict of interest when credentialing, privileging and conducting peer reviews of physicians.

Handling bank debt in your medical practice

If you are going to borrow, what precautions should you take?

Don't be a target for E&M fraud investigation

The ability to properly respond to a Medicare intermediary’s request for additional information with regard to the E&M coding decision-making process starts before the patient comes in the door.

Healthy physician practice financial formulas

Taking a fresh look at the basics of billing and collections is the first step in re-acquainting yourself with financial formulas that indicate how a practice is performing.

Valuation discounts for lack of marketability

The careful consideration of an adjustment reflecting a DLOM in the valuation of a health care enterprise is especially important in light of significant regulatory restrictions on the transfer of closely held interests which are unique to health care.

How to divide the practice pie

As the pie shrinks or stays the same, it becomes more important to implement a fair and reasonable net income division formula. While most practices can accomplish that, others cannot, which can lead to practice split-ups, partners leaving and buy-in deals not coming to fruition.

What does non-profit status really mean?

Confusion results from the need of hospitals and health systems to meet technical and legal requirements to be classified a non-profit, charitable entity.

Considerations when becoming a partner

Congratulations! Your colleagues have now finished “kicking the tires” on you for several years and are prepared to let you “join the club.” Now what?

Insolvency and business valuation

The valuation process involves making assumptions about an entity’s financial future which are of necessity different from its financial past. Thus, a rigorous analysis of those assumptions is requisite to a thorough understanding of the reliability of the conclusion of value.

Physician demographics and turnover rates

Compensation and a desirable work schedule are typically discussed in great detail during recruitment. But a practice’s ability to clearly assess cultural fit and family needs is becoming even more important in determining if a physician will stay beyond those critical first three years with the practice.

Use and abuse of modifiers

Modifiers are an essential part of coding and can not only cause delays and denials in reimbursement, but can also be considered abuse by some carriers. It is imperative that these modifiers are understood and correctly appended to the service and procedure codes.

What is my practice worth?

Let’s explore what influences the answer to this question so that the next time your partner, a prospective partner, a prospective buyer, the IRS, or a disgruntled spouse asks the question, you’ll be better able to respond.

Issues in estates and trusts

The estate planning process can greatly enhance the overall financial wealth of the family, and allows for a variety of tools to be used to make certain that the individual’s desires are as closely met as possible.

Tricks and traps in office real estate leases

They can and should be negotiated. If the physician-lessee simply signs on the dotted line, he or she will be living with the consequences for years to come.

Strategic evaluation of your practice

Understanding the strategic value of your practice is the single most valuable methodology to employ to become a key member of the hospital’s medical staff. Once you achieve this status, you can expect to be consulted about hospital decisions, and can broaden and solidify your influence to the institution, and also to your colleagues.

Hiring a certified registered nurse practitioner

A physician must be aware of the parameters of the physician-CRNP relationship before determining if a CRNP is right for his or her practice.

Medicare Advantage claims reimbursement

With the recent proliferation of Medicare Advantage Plans into the payer market and the steady migration of patients leaving the traditional government-run Medicare program and entering private payer MAPs, the claims game is getting tricky again.

Preparing to leave a medical practice

If your contract is fair and complete, you diligently prepare for your departure well in advance with the assistance of your attorney, and the other doctors are reasonable, leaving need not be a nightmare.

Current state of affairs for estate planning

While many physicians may have recently updated their estate plans, there are some issues that really need to be reviewed periodically in order to make certain that your plan is current with regard to both the law and concepts that may have come in to use since the last full estate plan update was done.

Adding subspecialty services to your practice

While the benefits to patients are substantial and real, the new endeavor must be approached carefully.

How does a hospital make money?

Hospitals that do not have a patient population that follows these rules will have a more difficult time making a profit and can often be in financial difficulty. Physicians and hospitals need to work together to best take care of their patients within the constructs presented here for all parties to have a harmonious relationship and a successful financial result.

Diagnosis coding update 2006

Realizing that diagnosis coding translates into the financial success or failure of a medical practice, we must continually strive to assign accurate codes to services and procedures that we perform. Many new codes were added, some codes were deleted, and many codes were revised.

Meeting the physician retention challenge

A survey of nearly 100 medical group leaders now shows growing concern about retaining the valuable physicians they have worked so hard to recruit, train and integrate into their practices.

Independent review organizations for peer review

Hospitals and medical practices wanting to raise the quality of care, improve patient safety, deal with sentinel events and address negative outcomes quickly and efficiently are outsourcing their peer reviews to IROs routinely.

Electronic health record license agreements

The license agreement is the backbone of the relationship between the practice and the vendor. As with any other contract, some terms will be negotiable and some terms are non-negotiable. It is therefore essential to understand the impact of the license’s language on this relationship.

Managing collection of payments from HSA patients

With the advent of consumer-directed health plans, diligent payment collection management is even more important as patients will be assuming more financial responsibility for their health care expenses.

Working with residents, hospitalists and intensivists

These people are physician colleagues, but play very specific roles in the hospital setting, often exercising authority over your patients, while controlling assets and resources you may want access to.

Health care environment’s 
impact on practice values

The biggest thing that has changed in the valuation of medical practices world has been the intangible/goodwill element of practices.

Collecting accounts receivable efficiently

The ability to maximize the use of staff time and optimize the efficiency and effectiveness of the billing department relies upon a complete and coordinated cycle in the collection process.

Physician employment contract issues

The employment agreement is a key document that needs to be drafted with care, as any of these provisions can cost the practice considerable money.

A primer on 'silent PPOs'

Physician practices must be vigilant to assure that only patients entitled to a discount are receiving the negotiated fee. Otherwise, your practice will be extending a discount to individuals and payors who should be paying your billed charges in full.

Joint ventures with tax-exempt hospitals

The IRS position regarding the tax implications to tax-exempt hospitals created uncertainty and slowed the number of joint ventures with physician groups. That is, until a recent IRS ruling which is widely viewed as providing more flexibility in structuring joint venture arrangements of this type.

Quality assurance committee in a physician's office

Physicians can get to the root cause of frequency and severity, and use the committee as a vehicle for changing the liability equation.

Disaster recovery planning for business continuity

Ensuring the continuity of your practice requires planning that addresses key aspects of your operation, including facilities and equipment, key employees, communications, and paper-based records.

Physician executive compensation survey

Health care organizations are placing greater emphasis on quality outcomes, with boards and chief executives developing compensation strategies to recruit and retain physician executives capable of driving their organizations to achieve their quality objectives.

Physician impacts of consumer-directed health plans

Accurate and meaningful information will strengthen the doctor-patient relationship while misleading or inaccurate information may complicate that relationship considerably. Physicians need to act quickly to influence what standards, data and measures are used and push accrediting agencies to police CDST effectively.

Web-based surveys to monitor patient satisfaction

Practices of all shapes and sizes can use the Internet to conduct economical, reliable surveys that give your patients a voice, and provide valuable information on improving service and care.

Defending your professional license

The MCARE Act’s self-reporting requirement increases the chances that the Bureau of Professional and Occupational Affairs will open an investigation file that could potentially lead to a disciplinary action against a professional’s license to practice.

Alternatives to electronic medical records

You may not have the time, resources or budget to implement an EMR system now, but that shouldn’t stop you from being able to move toward being paperless and electronic.

Changes to the ICD-9 Clinical Modification System

Such changes add not only to complexity in the system, but also to financial and legal exposures as the providers of the care.

When was your last financial check-up?

How often do you consider the need for a review of your personal finances?

What does a hospital trustee do?

Who are trustees, what role do they play in the hospital, and how should physicians interact with them?

Industry trends in health care staffing

The expected increase in the medical staffing industry offers a positive outlook for recruitment firms. However, long-term indicators point to an imbalance in the years ahead due to increased demand for medical services combined with shortages in the physician workforce.

Key issues in merging medical practices

Many potential mergers never happen because the parties lack sufficient guidance to plow through and resolve the many business and legal decisions that need to be made.

Expectation management to reduce liability risk 

By instituting certain strategies, one can increase patient understanding, increase patient compliance and increase better outcomes, all at the same time that liability risk is reduced.

Managing third-party payor relationships

You can keep payors honest by reviewing and understanding your payor agreements, monitoring reimbursements and taking payors to task when they fail to abide by agreement terms and applicable insurance laws.

Control the growth of your practice 

Setting goals, having realistic expectations and implementing the plans you make will determine your growth pattern.

Keys to debt management

Debt by itself is not automatically a good or bad thing, but rather, the type of debt, the reason for incurring it, as well as the ability of the practice to pay it off all roll together to understand debt management.

Sarbanes-Oxley Act's impact on physicians

A growing number of health care organizations have begun to adopt its principles in their corporate governance programs. Physicians are becoming increasingly involved as CEOs, directors and committee members in a number of these enterprises.

Selecting a partner in a medical practice

Take to heart how important the partnership decision is and the pain (financially, emotionally and otherwise) you may suffer if the wrong decision is made.

Claims made v. occurrence malpractice coverage

For the physician who is in a stable environment and will continue to work in the same practice or stay in Pennsylvania for their entire career, the financial issues related to the shift from Occurrence to Claims Made may be minimized.

Understanding changes in office costs

You need to understand how each expense area impacts the operation of your office and your overall efficiency to earn a living from your professional practice.

Alternatives to cash compensation

While salary and bonuses are of primary importance to a physician, other non-monetary forms of compensation can make all the difference.

Have you renewed your partner agreements?

A junior physician could leave with no notice without a restrictive covenant, a senior physician could retire or die with no entitlement to a buy-out, or existing documents may be old and outdated in light of the current legal and economic environment.

Expectations of Gen-X recruitment candidates

By addressing the relationship orientation and desire for skill-sets common among younger physicians, organizations can cultivate loyalty and productivity to help offset the inconvenience of accommodating candidates’ lifestyle issues.

Best practices for electronic billing

An efficient e-billing process leads to a faster reimbursement turnaround, as it reduces billing errors, increases claim submission throughput, and improves claim acceptance rates.

Patient care compliance risk assessment

The government has begun to focus on patient care (or lack thereof) as a compliance issue. Can the government really mean to put itself in the minds of clinicians?

Diagnosis coding changes for 2005

We must all continue to follow the biannual updates to the ICD-9-CM, remembering that there is no grace period for implementation.

Perfect medical office corporate structure

The “perfect corporate structure” exchanges a Professional Corporation (P.C.) for the physician as the entity to receive income that the physician would normally receive.

Role of productivity in compensation arrangements

How physicians are paid in relationship to others in their practice can range from a "purely equal" approach that pays all "full partners" the same amount of compensation, to the other extreme of paying compensation purely on the basis of relative productivity. There are pros and cons to either approach.

Understanding COBRA coverage

COBRA provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. However, it is only available when coverage is lost due to specific qualifying events.

Enhancing physician productivity & profitability

The types of patients that are being seen, the methods and methodologies for contracting, and the determination of when and whether to expand or contract specific services will ultimately lead to a more cost-effective practice.

Successfully implementing an outside vendor

Outsourcing should be viewed as a strategic initiative, as opposed to a purely tactical decision to eliminate the responsibility of completing a process.

Billing for care in skilled nursing facilities

Meeting the criteria involves more than just the care of the clinical condition of the resident. It involves every level of service delivery in the facility, including the physician.

Billing for services of physical therapists

An up-to-date primer on the rules and regulations governing Medicare billing for services rendered on behalf of physical therapists.

Hiring an executive in a medical practice

While there is no perfect candidate, here are some attributes to look for when hiring an executive to administer a medical practice.

Valuation of medical practices

Many unique factors affect a medical practice's value, which tends to be based on both tangible and intangible assets.

Physician employment trends

The supply of physicians is tightening, job opportunities are increasing and job attractiveness is decreasing. As the market acclimates to these changes, expect to see a continual demand for physicians and a difficulty in recruiting the right person for the right opportunity, especially in smaller towns.

Malpractice tails in employment contracts

Physician groups are torn over the issue as to how to handle the payment of tail coverage. Determination of who should pay for the tail policy is not as easy as it once was.

Health savings account option

HSAs will be good for some individuals and very well could have an effect on intangibles such as incentives to stay healthy.

Stay off this year's OIG hit list

In these more litigious times, it certainly is important for the physician and their staff to continue to be vigilant and to make certain that they don’t inadvertently get involved in fraudulent matters.

Should you consider concierge medicine?

We have generally seen this concept make the most sense for primary care physicians and those specialists who have ongoing and regular relationships with their patients.

Strong physician recruitment and retention

Organizations destined for the greatest success with physician staffing will devote at least as much attention to retention as they place on recruitment. With every month that an open physician position remains unfilled impacting the bottom line, effective retention will be essential to each organization’s financial stability.

Entering a family practice

Some issues to consider - whether you plan to become an employee of an already established family medical practice, purchase a practice, start a practice or become an equity member of a practice.

Profit centers as a performance measure

In multiple doctor medical practices, setting up the recordkeeping system to reflect each doctor as her own profit center will give insight into the expenses each doctor is absorbing against revenue directly generated by her.

Post-employment issues for physicians 

An important aspect of determining what options to pursue relates to restrictions in the employment agreement.

Enhancing communication to reduce liability

Studies reveal a distinct correlation between communication issues and malpractice claims.

Electronic medical error tracking for outpatients 

Early data suggest that major problems in hospitals, such as medical errors, are equally as large in outpatient venues. An electronic medical error tracking system allows for easier quality control over multiple and disparate facilities.

Smart hiring for physician practices

No medical practice is immune from the challenges surrounding hiring new employees.

Segregate building costs and capture savings 

Cost segregation studies – a means of breaking down total building costs and categorizing them into structural and nonstructural assets – are designed to accelerate income tax depreciation deductions, providing you with maximum cash flow.

Risk assumption in shareholder buyouts

Many practices' shareholder documents call for buyout formulas/prices which are unrealistically high in today's weaker health care economic climate.

In-office imaging center investment

The greatest and most efficient way to enhance a practice, especially for primary care physicians, is through procedures and diagnostic testing

Effective compliance plan development

Physician practices should consider using OIG guidance as a foundation when developing a more customized program to meet their practice needs. A properly developed and effective physician compliance program will improve operational processes and practices, demonstrate provider trustworthiness and reduce risk exposures.

Better time management to enhance revenue

The best way for you to generate additional revenue is by eliminating unnecessary downtime and improving productivity. Here's how you can examine ways to turn your greatest resource into higher profits.

How to protect yourself against fraud

A good system of internal controls goes a long way toward deterring fraud and detecting it if it occurs

Physician and practice administrator partnership

As physicians become engulfed by "marching orders" of patients, payors, insurers and regulators they must delegate more functions to the practice administrator.

Billing Medicare for the services of NPs & PAs

An up-to-date primer on billing Medicare for services rendered on behalf of physician practices by nurse practitioners and physician assistants, with a focus on the Medicare rules and regulations governing the use of these physician extenders

Independent reviewer opportunity

Independent review stands as a means for the health care community to become involved with the evaluation of medical decisions made by health plan medical directors.

Your first employment contract

Your job satisfaction is likely to be enhanced if you feel comfortable that the employment relationship is a fair and equitable one for both you and the practice.

Signs that your practice is headed for trouble

To avoid being blind-sided with a sudden deterioration in the practice's performance, here are seven telltale signs that a practice is headed for trouble.

Understanding medical office leases II

An understanding of some of the more esoteric provisions when negotiating a medical office lease can translate into real dollars saved.

Start-up and funding issues for entrepreneurs

Entrepreneurial health care providers face daunting issues as they attempt to commercialize their ideas while simultaneously working in their practice or other regular job

Maximizing return on accounts receivables

If the focus of your attention to increase your practice's bottom line is cost cutting, cost cutting and more cost cutting, you most likely are leaving money on the table that would be available for increased physician compensation and don't even know it.

Avoiding common coding mistakes

Although these basic rules are brought to the attention of physicians at many different venues, the same mistakes keep showing up in patient charts. Here are some examples that are easily correctable

Understanding medical office leases

One day a realtor shows you the perfect space, in the perfect location, and assures you that the lease will need to be signed as quickly as possible if you are not to lose the space to one of your competitors. Having a little understanding of the implications of the key legal provisions can save you a lot of money in the long run.

Bringing your medical device to the marketplace

A physician entrepreneur must be sure to take the necessary steps to protect his or her employment and intellectual property rights, develop a sound strategic business plan and work proactively with the FDA and payors to help ensure the medical device is positioned property to make an impact in the marketplace

Customer service for building your practice

Three phases are involved in building your practice through quality customer service: developing your customer network, maintaining quality customer service and evaluating your practice's effectiveness at customer relations.

Procedures to improve your claims

The complexity of physician practice operations and the complicated procedures and rules governing claims development, submission and reimbursement can make ensuring the consistent submission of 100 percent "clean claims" seriously challenging. As a result, practices should implement simple internal procedures for identifying common claims development and submission issues on a timely basis.

Should you sign a letter of intent?

Too often, parties will sign such a document, feeling that they have little or nothing to lose by doing so. Proceed with caution before signing any such document.

Employing a public relations firm

The still lucrative practices prepared themselves and employed a public relations firm to ensure that their practice would thrive independent of a challenging economic climate.

Employee policy and procedure manuals

The more informed your employees are, the more efficiently your practice will operate. Written policies and procedures are not legally mandated, but in today's litigious society, having a formalized policy and procedure manual is simply a good idea

Recruiting physicians in difficult times

After you have laid all the groundwork by placing your practice ads or hiring a recruiter, hopefully the resumes will begin to roll in.

Is online learning for you?

For physicians, there are three areas to consider: personal qualities, professional characteristics and the reality of the unexpected.

A typical practice buy-in

Many physicians are surprised when they discover that they may make less money after factoring in the buy-in and that they have no additional security. Of course, that should not be the case.

Embracing complementary medicine

If carefully examined, complementary medicine could be the answer to your practice's shrinking revenues. Consider data on its revenues and utilization since 1990, as well as trends in the government, scientific and educational environments.

What is your practice's financial IQ?

Just as they recommend preventative steps for their patients, so too should physicians follow a series of steps to prevent financial health problems in their practices.

Would a practice merger make sense for you?

Skyrocketing costs, increasing governmental regulations and legislation, managed care and other third party payors, and increased competition are all important factors which contribute to the drive towards larger medical groups. Innovative thinking and good business planning are necessary to meet the future challenges, and one strong option is for practitioners to become larger through merger.

Empowering patients as financial advocates

By working with your patients through education and supportive customer service, and by communicating financial expectations and outcomes, your practice can redirect their loyalty, strengthen the patient-doctor relationship and create additional financial advocates for your practice.

HIPAA & your practice management software

Installation of a HIPAA-compliant software system may actually help a practice reduce its administrative costs. Two of the principal areas of a physician's practice affected by HIPAA are the practice's billing software and practice management software.

Developments in physician practice valuation

The process of determining the fair market value of corporate stock is an imprecise science. Thrown into the fire of complex litigation and the scrutiny of federal and state taxing authorities, the process becomes incredibly controversial.

Creating a staff plan for integrating practices

While the behind-the-scenes work of integrating staff may not be easy, the end result is worth the effort.

Using HIPAA technology upgrades to advantage

In planning for HIPAA, physicians and practice managers should consider acquiring a computer system that will go beyond basic compliance. Instead, take advantage of the new standardization and mass exchange of electronic data and acquire a combination of computer systems that can provide new financial management capabilities and opportunities

New performance standards for MD billing

Significant differences exist in the billing performance of physician group practices. Some practices are struggling to maintain a basic level of billing effectiveness while others have made significant improvements in their billing operations--improvements evident in rock bottom accounts receivable, a higher collection ratio and decreased billing errors.

Marketing strategies for your medical practice 

Many physicians have reached a time when they expected to take it easy, yet they find themselves working harder than ever. Others are concerned about a continued decline in their patient base. Here are a few suggestions to help you jumpstart your practice.

Avoiding top violations of OSHA audits

Many of the most common violations are simple to correct, but being prepared and constantly evaluating your readiness is essential.

Considering physician extenders in your practice 

Physician assistants and nurse practitioners, when properly trained and utilized, enable practices to provide a higher quality of services and allow the physician to treat more patients in a timely manner.

Health care business method patents

Patents covering business methods and models may in the end be the most valuable corporate asset. What many health care and medical providers are now learning is that this powerful piece of intellectual property protection is available to them as well.

Improving physician billing departments 

Physician billing departments generally have not kept up with changes in their operating procedures to accommodate the hurdles put up by insurance companies or the problems that arise internally.

Building a successful IPA 

If the complement of physicians is structured appropriately and the right combination of financial stability, physician leadership and management skills are present, an IPA can be an effective model for physicians and physician practices to better serve their patients and successfully work with the third-party payors in their community, and with vendors.

Part-time practice options for physicians 

A physician no longer desiring full time work with on call responsibilities may still benefit the practice. The economic arrangements to make things work fairly for the parties involved can be worked out if the parties are motivated to do so.

Managed care credentialing of physicians

The credentialing process should be designed to aid an MCO in choosing competent providers and to ensure providers a fair application of the selection criteria. An MCO that exercises reasonable care in credentialing and monitoring its providers reduces its risk of malpractice liability.

Product line approach to building a practice 

New ancillary services are one approach to a product line practice expansion, presenting operational and economic benefits.

Tips to assist specialists move to private practice

There are specific things specialists can do to successfully "survive" the transition from residency or fellowship to private practice.

Non-conventional contracting strategies 

Here are two ideas for generating additional revenue for your practice when working with contract issues and health plans. One concerns the relevancy of your fee schedule and its applicability when contracting with a health plan. The second concerns adherence to clinical guidelines as an unconventional contracting strategy.

Buying in to medical real estate

After working as an employee for two to three years, the young doctor will often become a partner while buying in to the practice over another three to five years. With some practices, the partners own the real estate and the issue arises as to whether the young doctor will become an owner of the real estate as well, and if so, how.

Transitioning into primary care practice 

In addition to the clinical challenges, the first year of practice is most likely the physician's initial exposure to the "business" of medicine. This article provides insights for smoothly navigating the transition from resident or fellow to successful first-year primary care practitioner.

New physician practice business models 

The focus on providing more comprehensive medical services or restructuring the delivery of care is a dramatic and positive improvement over previous generations of business ventures.

The streetwise rules to management

It is time to throw away some of those past management habits and move into the future. Here’s how to begin.

Removing obstacles to a paperless office

The use of electronic medical records has been slowly growing but is not expanding as quickly as many expected. There are several potential reasons for this.

Effective billing on a shoestring budget 

Essential components of an effective billing system that can operate on a shoestring budget include equipment needs, personnel training, relationship development and use of computer

Essentials of end of year planning 

By beginning to focus on corporate, financial and operational planning now, your practice will hopefully sail into 2001 with little fuss.

Nonqualified deferred compensation plans 

Any physician faced with an opportunity to participate in a nonqualified plan should have a basic understanding of the tension between the taxation of nonqualified benefits and the security of such benefit

Semi-retirement options for senior MDs 

One option might entail a semi-retired doctor electing to work a certain percentage of a full workload (e.g., day schedule, weekend call, night call, etc.). Another option might entail the semi-retiring doctor dropping procedures (e.g., dropping OB, no longer doing surgical cases, etc.), while maintaining an office-only practice.

Develop a budget to market your practice 

The question to address is whether or not the current resources dedicated to marketing are used wisely and whether they are sufficient for you to grow and sustain the practice.

New information technology solutions

Application Services Provider is a relatively new type of outsource provider that delivers and supports software as a service over a network, such as the Internet. This trend is beginning to offer physician practices new and attractive alternatives for changing or upgrading management information system.

Protecting your practice from billing company errors 

Physicians who fail to take proper precautions and to correctly structure their practices' relationships with their billing companies risk significant legal and financial liability.

Life after having your practice owned 

The big question is, how can one recognize a prudent opportunity when it appears, after having gone through a bad experience.

The role of the front office in reimbursement 

There are six essential roles or functions in the front office. With proper data collection tools, education and defined job functions, the front office staff can and will be a cash flow powerhouse.

Business advice for residents and fellows

Many residents and fellows have received very little formal education regarding an array of non-clinical business subjects. A senior resident or fellow is likely to be surprised as he or she transition into the professional world. Consider five survival tips to make the transition smoother.

When to firm up partnership arrangements 

From a resident’s standpoint, if you are looking for a long-term relationship, you should at least ask a lot of questions about the practice’s future plans. From the practice’s standpoint, you may not want to commit to a particular course of action before the "honeymoon" period of associateship.

Branding the identity of your practice 

Branding strategies have long been used in large industry but can be easily modified to meet the needs of today’s medical practices and organizations.

Use every tool to verify patient eligibility 

Every time a payor rejects a claim, your practice is not only inconvenienced, but also short-changed. Consider practical steps to prevent your practice from providing services to ineligible health plan enrollees

Creating outpatient clinics for ancillary services

Ancillary services can assist the physicians in their ultimate goal of providing quality medical care, often in their own office setting, while producing a profit for their efforts.

What should go into a shareholder agreement

By committing various concerns of the shareholders to a written document, potential problems are anticipated and dealt with as designated in advance by the involved parties

Minimize your risk of being decredentialed

How physicians can avoid adverse credentialing decisions and what they can do if one is received

Is now the time to hire a new associate?

To determine if you need a new associate, focus on how many patient encounters your practice will need to break even, your workload and backlog, support costs of a new partner, recruiting expenses, compensation packages and other issues.

Business outlook for medical specialists

The survivors will be the ones who run their practices like businesses, who negotiate the most lucrative contracts and who find the appropriate mix of patients to ensure an optimal use of resources.

Financing start-up and break-away practices

Regardless of whether a practice is a start-up or a break-away, a revolving line of credit that provides short-term flexibility and a long-term payback is the best way to go.

Promises and pitfalls of MD-owned real estate

Physician group ownership of practice offices has its share of potential pitfalls, i.e., costs (including increased exposure to liability), tax concerns and equity lock-up.

Benchmarking your medical practice

Formal benchmarking techniques offer a more structured approach to the establishment of business parameters and the review of financial progress against baseline values

Negotiating a co-ownership arrangement

Many physicians are surprised to learn that they may make less money after factoring in the buy-in and that they have no additional security. Of course, that should not be the case.

Marketing your medical practice on the Internet

If you use it correctly, the website you establish on the Internet can be an extremely effective marketing tool for your medical practice.

Selecting & implementing a billing system

Once general selection considerations are made, you will want to consider specific features and functions of a billing system from the various users’ perspectives.

Benchmarking physician practice expenses

There are several important steps to making an expense budget work for your practice. Consider how to benchmark your expenses.

Medical practice leadership & the will to act

The best performance of physician organizations will not be found in the new idea. It will be found through leadership within your organization that elects to use the information you have assembled.

Is an equity MSO the right choice for you?

With the equity MSO, physicians still decide how patients are managed, with no corporation lurking around the corner to tell them how to practice medicine.

How to perform a practice assessment

A practice assessment can identify trends, provide process improvements and provide recommendations to improve cash flow and reduce costs of your medical practice.

Surveying patients and staff for strategic planning

Before embarking on the long, somewhat tedious and costly road of developing a written strategic plan, find out what your patients and your staff think of both the practice and you.

Toward an ideal accounts receivable process

Managing your accounts receivable process effectively and efficiently may require you to change your thinking about third party follow-up

Implement random billing audits

Developing a well-planned billing audit process is the best way to increase productivity and profitability of a physician practice.

Options for health system MD practices

Hospitals are exploring options for financial improvement of their controlled primary care physician groups. Four fundamental options exist for organizations to make material change

Personally preparing for Year 2000

Instead of complaining about it, let’s ask what each of us can do for self-protection.

What you should know about practice mergers

Without central governance and physical integration, a merged group is nothing more than a collection of independent practices whose collective expenses will ultimately be greater than the sum of the individual practice expenses.

Managing successful compensation plans

The key to successfully managing under capitation lies in the development of a systematic and comprehensive medical management strategy that includes an incentive plan which empowers physicians.

Developing a triage system

In general, triaging from a central unit and within departments, such as scheduling, billing and nursing is important. But where do you start?

Checklist for the year 2000 problem

What should be done to prepare for this event, if it has not already been done? Here is a brief summary

Practice management company partnerships

Practice management companies are no longer the financial darlings they once were. As an alternative, local health systems offer management services organizations. Preventive maintenance is essential, whichever the choice.

Relations between MDs and health systems

There is a confluence of economic interest between physicians and hospital systems that can replace an historical climate of conflict between them.

Medicare documentation guideline changes

On April 27, the AMA and HCFA, together with more than 275 representatives of specialty societies, unveiled some important proposed changes to the 1997 Medicare evaluation and documentation guidelines. While a major re-design of the coding system is under way, a number of changes under consideration are likely.

Advice for hiring physician assistants

Non-physician advanced practice providers have often been inappropriately utilized, leading to disappointing enhancements in a practice’s revenue and low physician confidence in their performance. How can physicians correct this deficit?

Impact of quality trends on physicians

The development and expansion of credentialing programs will define, measure and monitor quality indicators that relate to physician performance. Physicians will find patients, employers, government, the media and MCOs demanding quality and increasing their expectations of care

Training staff for medical billing

If the correct questions are asked, the appropriate information is given and the data is documented accurately, the subsequent collection process will be nil or minimal.

Consider cash-based subspecialties

A well conceived and managed service for which patients pay cash can add thousands of dollars a year to your bottom line. Consider several issues in order to develop such a service that is both responsible and beneficial to you and your patients.

Choosing health insurance for your practice

Key questions to ask when choosing a health plan for your employees or when switching plans.

Implementing a cafeteria health plan

How to implement a successful flexible health spending plan for your employees.

Purchasing provider excess loss insurance

While similar coverage is typically offered with a capitation contract from an HMO, there are clear benefits to securing excess loss coverage from an insurance company.

The emerging role of the hospitalist

Specializing in the management of hospitalized patients, a hospitalist takes over for a primary care physician when it comes time to admit a patient.

Characterisitics of successful physician organizations

Some of the distinguishing characteristics of future, successful physician organizations are clear: they’re found in the organizations that perform well today. Some predictions of what the best organizations will look like in the second generation

Vertical vs. virtual integration

Vertical integration, as an asset-based method of organizing health care delivery, has some drawbacks. Virtual integration may be one alternative solution, emphasizing coordination through patient management agreements, provider incentives and information systems, rather than investment in large numbers of facilities and people.

Common PO mistakes

Sadly, most physician organizations will fail for what appear to be predictable and correctable reasons.

Red flags in practice performance

Faced with reduced reimbursement and increasing operating expenses, physicians and administrators are fast discovering ways to adjust their use of staff and ancillary services wisely.

Locum tenens physician staffing option

For physicians who wish to practice medicine with great flexibility, the locum tenens option, or temporary physician staffing, may be most appealing. Here are key considerations when selecting the best locum tenens firm.

Cutting overtime compensation

Employers often make mistakes when dealing with an employee’s status as exempt from overtime pay, which can be as costly as they are unforeseen. Some cautionary advice on how to reclassify employees from non-exempt to exempt status.

Why physicians get deselected

As managed care plans step up their cost containment efforts and scrutiny of physician performance, it is wise to understand the ways in which they may attempt to shrink their panel of physicians. Board certification, utilization management, patient satisfaction and preventive health programs are criteria with which health plans use to do so.

Forging hospital-medical community partnerships

Effective collaboration goes beyond accepting capitation and restructuring provider incentives. Consider what the hospital and the medical community must offer each other to ensure smooth partnerships.

Making the right career choice demands that you self-test for solo practice, partnership and equity relationship potential. Consider your ideal balance of flexibility, autonomy, risk and income.

HCFA has released the long-awaited guidelines for coding of evaluation and management services by specialists. In light of the rapidly expanding number of federal coding audits, the new guidelines send important messages about the expectations for scope of work in and documentation of patient examinations.

One of the key threshold issues any medical group must face is what kind of management is needed to make the practice successful. By having a good office manager and delegating managerial responsibilities, physicians can find relief from many of the aggravating day-to-day hassles.

Patient care management can be made more cost-effective while affording a reasonable lifestyle for physicians and maintaining quality of care by adding a physician extender to the practice’s team. Consider the economic rationales, as well as licensure and reimbursement parameters.

Rapid development and disintegration of physician partnerships and changing alliances among physicians and institutions often fail to secure optimal cultural fit, or consider leadership succession, or anticipate ease of integration into a network. Three phases of organizational development are attentive to these problems: pre-deal, during the transaction and post-affiliation.

The merger of physicians or their acquisition by hospitals often encounter logistical and bureaucratic obstacles to meaningful unity. Those problems can be overcome by consolidating sites into strategically located ambulatory care centers, an approach that has competitive advantages to the sponsoring organization.

If you are a specialist, consider the advantages offered by single specialty networks, which include increased control in a managed care environment, enhanced negotiation clout with health plans or primary care groups, shared administrative resources and marketing leverage.

How to weigh advantages and disadvantages of practice mergers. Specific traps to watch out for include ownership, governance, compensation, liability, fraud and abuse, reimbursement, taxation, benefits, antitrust and personnel.

Managing capitated high-risk enrollees

The first step is identifying high-risk enrollees with self-administered surveys. The authors discuss population-based screening instruments and probability of repeat hospitalizations surveys. The second step is following the at-risk patient. Interviews and case management programs are appraised.

Specialists bear special burdens when health systems administer risk contracts: information risk, market share risk and financial risk. How specialists need to position themselves in anticipation of these burdens.

How to prepare for the shifting managed care market by putting together a strategic plan. Aspects to consider include the managed care environment, comparative performance, practice performance and contract performance.

A strategic look at office layout: what your office should have—and what it should avoid.

Managing parallel payment systems

How to track services, billing and financial operations while integrating fee-for-service and capitated medicine in a medical practice. Understand the distinctions and respond to the variables involved.

Examines obstacles to the lastest management rage and offers a wiser approach to personnel management.

Fine-tune your practice through realistic performance standards, shorter meetings, bottom-up communication, multi-purpose bulletin boards, structured salaries and management ratings.

A case study illustrating the use of organizational development within an MSO at an academic medical center.

Concrete suggestions you can implement to foster patient cooperation in following your advice and staying healthier.