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Your Top Questions Answered
Signing Charts; Understanding A/R; Space Requirements; Charity Defined
SIGNING CHARTS
QUESTION: Does every note of every visit transcribed necessarily have to be signed in some fashion other than the transcriptionist's indicator of the physician dictating?
ANSWER: Yes. According to Amy D. Berret, an associate with Kean, Miller, Hawthorne, D'Armond, McCowan & Jarman in Baton Rouge, La., this is a federal Medicare/Medicaid requirement and not just an insurance carrier or state stipulation. In general, the healthcare provider must sign the progress note as well as all reports of tests or test results. The purpose of the requirement is to confirm that the services were actually performed.
UNDERSTANDING DAYS IN A/R
QUESTION: Do we measure days in A/R starting from the date of service or the charge date? Also, should we demand information on individual A/R from our billing service, or is group A/R enough?
ANSWER: The industry standard is to start counting days in A/R from the date of service. You want to also work to eliminate any delay in getting the claims out the door. I should think group A/R is enough (you can divide by total number of physicians if you wish). But your staff and the billing staff presumably are not holding back on one physician's claims over another's. The physicians don't really control the speed of payment.
SQUARE-FOOTAGE REQUIREMENTS
QUESTION: In planning an office for a family practitioner, what is the industry standard for square footage, not including space for medical records?
ANSWER: The only industry standard I'm aware of is the median published by MGMA in its annual costs survey. For family practices, the median square footage per FTE physician among its respondents is 1,900.
Presumably, most of the practices surveyed do not have EMRs and need room for medical records.
Clearly, your space needs would depend on the number of physicians in your office, whether you plan to offer ancillary services that require procedure room or large equipment, your workflow, and your plans for growth. Is there a phlebotomist on staff, and would she draw blood in her own room or go to the patient? Do you have physician offices, or have you done away with them, like many practices have, in favor of standing dictation/EMR pods and hand-washing stations centrally located among a cluster of exam rooms? Are you thinking of adding new clinical staff?
Generally, expect exam rooms to turn around every 15 minutes. The number of exam rooms needed per physician will depend very much on their personal productivity rates, but I'd say at least three.
Physicians should share exam rooms, and smaller rooms are better. You want everyone taking as few steps as possible.
Try to avoid devoting much if any space to nonproductive physician offices. Patient consults can take place in small consult rooms or in exam rooms. Dictation and quick phone calls can happen in small stations near each set of exam rooms.
IS IT CHARITY?
QUESTION: Our providers sometimes see patients in the hospital who will never pay their bills. Is this considered charitable work, and is there a place for it in the financial statements for the practice?
ANSWER: Many practices break out both bad debt and a second category for professional courtesy and charity care. Charity care usually constitutes one-tenth or so of total gross charges for practices.
However, I think anything assigned to a charity-care category should be charitable on purpose. Debts that you tried to collect but could not should be designated bad debt, and it's ideal to track specific reasons for each occurrence. For example, if you can recognize that you write off as bad debt lots of care provided to the uninsured, you can consider creating a proactive collection policy in which you reach out to uninsured patients before they even leave the hospital, offering a uniformly discounted rate for payment within five days of service.
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