|
|
 |
|
Your Top Questions Answered
Lab Fees; Inpatient vs. Outpatient Work; Firing Patients; Walk-in Lab Work; Productivity-based Pay
LAB FEE SCHEDULES
QUESTION: This question regards fee-schedule creation. We use Quest for our labs, and it has provided client pricing for the labs we do. We then bill the insurance company, and we pay Quest the negotiated fee. We based our fees on Medicare's fee schedule, setting our labs at 300 percent of what Medicare pays. I think we're undercharging. Any ideas on how to base our lab fee schedule outside of Medicare's schedule? Is there another standard for lab fees/reimbursements?
ANSWER: Medicare pays for very few tests, so if it pays zero, your 300 percent multiplier still earns you zero.
With respect to what to charge, you can capture data from your EOBs regarding what you actually get paid.
You can also set your fees as a multiple of Quest charges.
INPATIENT VS. OUTPATIENT WORK
QUESTION: I am in family practice and just started a solo practice. The practice is picking up, but it is still somewhat slow. (I average of six to seven patients per day now.) I do see my patients in the hospital, but I am not sure if the hassle is worth it economically. I much prefer outpatient work, too. Do you have any figures or resources that can help me?
ANSWER: Run a report on all your inpatient codes. How much revenue have you earned in the past six months, and how many visits have you had? This information will help you determine what you earn per visit on average. You can then weigh whether the wear and tear is worth it to you. Also take a hard look at how your balance sheet would read without that revenue.
Do your hospital rounds keep you from filling outpatient appointments - that is, does your scheduler have to turn away potential patients at your office because you're doing rounds when they want to come in? You might try to capture that
somehow.
If no one is getting turned away, I'd generally say go to the hospital. You can work with a hospitalist when you are seeing more patients a day and don't need the money quite so much.
FIRING PATIENTS
QUESTION: If I have to fire a patient - say, someone I suspect of narcotics abuse - I follow the advice I've been given and send the patient a letter of dismissal by registered mail. But sometimes when I use registered mail and require the recipient's signature so I have proof that the patient received the letter, the patient refuses to sign it and claims never to have received my correspondence. What should I do to make sure patients do not have a way to claim they did not get my letter?
ANSWER: With both certified and registered mail, you should be able to confirm delivery even if you don't get a signature.
In addition to sending a certified letter, send a letter by "regular" mail. Sometimes patients will not open or sign for a certified letter, but they will get a letter through regular mail. If the letter sent via regular mail is not returned, you can assume it was delivered.
Of course, if the patient does show up at the practice, the manager should bring him into her office and tell him he is being terminated.
Either way, document what you have done and why. You can do only so much.
You should also contact the risk management folks at your malpractice carrier for their advice.
WALK-IN LAB WORK
QUESTION: We have a question regarding office work flow for walk-ins needing lab work. We are a four-physician group of internists. We have patients walking in all day for lab draws. This is making our front office a mess and throws the back office behind all day. What's the best way to streamline our processes?
ANSWER: The first thing you need to understand is why all these people are wandering in for lab work. Is it all Coumadin-related? Can some of the lab work be grouped into office visits that will occur a few days before or after? I'm not sure how that would fit into your work flow, but it certainly might be more efficient to know when to expect your patients to arrive.
You also can consider Coumadin (or other) clinics. Tell patients to come only during specific hours on specific days. Staff your lab with a nurse or phlebotomist whose only task during those days is to process those patients. Some practices are hiring pharmacists to handle this task.
Some hospitals have opened Coumadin clinics as a benefit to community physicians. Talk to yours.
You could also do the financial analysis to see if it's worth keeping this lab work in-house in the first place.
PRODUCTIVITY-BASED PAY
QUESTION: When you are paying an employee using productivity standards, should you include the receipts from vaccines or IUDs in the pot from which the salary is paid? For example, a DTAP vaccine for adults costs my practice $35. My employee orders it for a patient, and it is billed under her name. The insurance company pays $35 (maybe $40 if I'm lucky). Now, this employee gets 40 percent of her receivables, so she will get 40 percent of $35, or $14. But I, the owner of the practice, paid $35 for the vaccine, and now I'm paying her an additional $14. I lose money on the deal, and all those little vaccines add up.
So what do people do? Do you just lump it all under overhead? Or do people separate out the actual cost of items such as vaccines with the assumption that overhead is for rent, staff salaries, malpractice, and so on?
ANSWER: One solution would be to switch the productivity formula altogether. Instead of basing it on receivables, you can offer a base salary and then a profit share (a pre-set percentage of the practice's profit after expenses) if employees exceed a certain productivity level based on work relative value units, or RVUs.
By offering a profit share at the end of each quarter or year, you share only profits. Basing profit shares on RVUs means you reimburse the employee for her effort, not for how many vaccines she gives.
Either way, openly address your concern with your employee, and ask her to help you think through a solution that is fair to both of you. The fact that the current system isn't working is not her fault, but she'll surely balk if you insist on a change that has a negative impact on her salary and also seems to discourage her from giving vaccinations.
Copyright © 2007 Physicians Practice Inc. www.PhysiciansPractice.com All rights reserved.
Republication or redistribution of Physicians Practice content, including by framing, is prohibited without prior written consent. Physicians Practice shall not be liable for any errors or delays in the content, or for any actions taken in reliance
thereon.
« Back | Top
|
|
|
|
|
|
