There are many physicians who believe that the business end of their practice will simply run itself. Their job is to see patients, and provide medical care and the rest of their shop is left to the staff, without any intervention at all. Other physicians micro-mange their practice to death, so they are left doing everything and their staff may as well be mannequins, since they never have the support or initiative to solve any problems on their own.
Both of these situations do great damage to the practice and doctors must find a balance between apathy and complete control. It is very important to take a careful look at the outer edges of the day to day operations, since you can be assured that your practice will be in great danger unless this situation is addressed.
A few years ago I took a position in a large Long Island hospital with a great reputation for patient care. My job was to oversee the billing department and to assess why the physician's revenue stream was declining. The practice had purchased a new medical software in 2004 and as part of their purchase agreement allowed the software seller to perform the billing data entry and accounts receivable follow up. As always, my first step was to run an accounts receivable and make a careful examination of practice billing trends. What I discovered was unbelievable ! From 2004 until the start of my tenure in 2007, the practice had not been paid for 1 claim for their nurse practitioners who followed patients in the hospital post cath and bypass surgery. Not 1 claim !!!!! Why? In the set up of the new software, nurse practitioners were entered into the system with their social security numbers, rather than the practice Tax ID. No one had noticed, either in house or through the billing department. Not 1 claim was paid for the radioactive isotopes used in Nuclear Stress Testing ! Not 1 claim ! Why? The description for the isotope was not standard for CMS approval so all claims were denied. In addition, 2 physicians were transmitting claims with the same NPI number, also resulting in claim denial!
These problems resulted in hundreds of thousands of dollars in write offs for timely filing and the consequences of these errors would be felt in practice revenue for some time. Eventually, I was able to correct these problems, but you cannot fix the mentality behind them. There needs to be a vested interest in the practice that involves checking the details over and over again until you are certain that your data is correct and your claims will be paid. Print out your HCFA's and examine each physician detail and use resource materials if you are not sure how your information should be entered. If you think this is an isolated incident you are sadly mistaken.
Simply transposing a physicians Medicare or commercial ID number can result in a disaster for the practice and in a single physician practice, you may lose everything! This is what happens when any physician simply shrugs off the danger signs or doesn't educate themselves, or trusts their practice to staff that doesn't have enough information or education to assure success. Physicians need to know that their office is a business and they need to arm themselves with enough information to run this business correctly or look for another career ! There is absolutely no excuse for practicing medicine year after year and claiming ignorance of what makes a practice work.. Once your staff knows that you have no idea of what's going on in your business, you can rest assured that they will adopt the same apathetic attitude that you have. For those employees who want a productive active day and who would add value to your practice, you can expect their resignation shortly after their start date. Staff can sniff out a practice that's a loser in one week and will either ride the tide until the practice closes, or they will look for another job.
Your patients will also read the climate of your room and if your staff is apathetic and doesn't return phone calls, or make timely appointments, they will bolt for the nearest exit and you will never see them again.
In this healthcare climate, where vendors are rushing to market with sub-standard software, where the unemployment rate is at an all time high, and cut backs and changes are like a great flood, all practices are finding themselves in a sink or swim situation.
The decision to survive is up to you....
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