The Private Medical Practice Academy

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Understanding your obligations surrounding employee taxes is crucial for operating a successful business, whether you're an employer or an aspiring entrepreneur.

In this episode, we explore the four primary types of employee taxes:
• Federal and State income tax

Withheld by employer
Employer responsible for submitting

• FICA

Funds Social Security and Medicare
Employer responsibility is 7.65%

• FUTA

Federal unemployment tax
Paid by employer to fund state unemployment programs

• State Unemployment tax

Based on employer payroll
And number of unemployment claims

As an employer, you're no stranger to the deductions made from your employees' paychecks. Being on the opposite side of the table, though, offers a whole different viewpoint on employee taxes.

Given the difficulty and significance of correctly filing employee taxes, it is understandable that doing so might take a lot of time and effort. There are several choices that can help make life easier and guarantee compliance. The process can be streamlined by using payroll software, outsourcing human resources and payroll to HR companies or CPAs, or hiring a qualified practice manager. Always remember that it is strongly advised to visit a tax specialist or have someone educated about tax issues.

Remember, mastering employee taxes is a crucial aspect of running a successful business, ensuring compliance, and fostering a healthy employer-employee relationship. Join us on this insightful episode as we equip you with the knowledge and understanding necessary to navigate the intricate realm of employee taxes.

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

Join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice. The course, How To Start Your Own Practice is included in the membership, as a bonus.

Rate, Review, & Follow on Apple Podcasts"I love Sandy Weitz and The Private Medical Practice Academy Podcast." <-- If that sounds like you, please consider rating and reviewing my show! This helps me support more people -- just like you -- move toward the practice they want . Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!

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The Stark Law prohibits physicians from referring patients to entities in which they have a financial interest to prevent financial incentives from driving medical decision-making. The Anti-Kickback Statute prohibits the exchange of anything of value in exchange for referrals for services.

Examples of Stark Law violations:

A cardiologist refers patients to a diagnostic testing facility in which he has a financial interest.
A physician is found to be billing Medicare for services provided by an unlicensed midlevel.

Other Exceptions to the Stark Law

"In-office ancillary services" allows physicians to refer patients for certain designated health services provided in the same building where the physician's medical practice is located if the service is furnished under the direct supervision of the referring physician or another provider in the same group practice and that the arrangement complies with fair market value (FMV).
Healthcare providers to give non-monetary compensation to physicians and their families up to the annual limit.
FMV compensation allows providers to enter into financial relationships with other providers if does not take into account the volume or value of referrals.
Academic medical centers that meet certain criteria may provide compensation to physicians who are engaged in teaching or research activities.
Rural providers may be able to enter into certain financial relationships that would otherwise be prohibited under the Stark Law provided certain criteria are met.

Safe harbor provisions that provide exceptions to the Anti-Kickback Statute :

Investments in entities that provide healthcare services if held for one year, and is not be tied to the volume or value of referrals.
Office space or equipment rented between providers if the rental amount is consistent with FMV and is for a period of at least one year.
Personal services and management contracts between healthcare providers if the compensation paid is at FMV and not be tied to the volume or value of referrals.

The key takeaways—you can’t do things that are tied to volume or referrals and any financial arrangement has to be at FMV.

I strongly urge you to discuss Stark and AntiKickback with your healthcare attorney so that you know what is required to be in compliance.

Earn credits: https://earnc.me/HnuHBD

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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Insurance is one of those things you never want to need or use. But, unfortunately, when life happens having insurance can save you. Some types are pretty obvious but there are some you probably haven’t thought yet. That doesn’t mean you don’t need them. In this episode, I'll tell you the types of insurance your practice needs to mitigate its risks.

Medical malpractice insurance protects healthcare providers from claims of negligence and medical errors. You want to have a separate policy protecting your practice--not just the individual provider.
General liability insurance covers your business from claims of property damage or bodily injury that may arise from accidents on your premises.
Cyber liability insurance provides coverage for data breaches and other cyber threats that could compromise your patients' confidential information.
Workers' compensation insurance is required by law in most states and provides coverage for your employees in case they are injured on the job.
Business interruption insurance can provide financial protection if your business is forced to temporarily close due to an unexpected event such as a natural disaster or a pandemic.
Employment practices liability insurance can protect your business from claims of discrimination, harassment, and wrongful termination brought by employees.
Business overhead expense disability insurance can cover operating expenses such as rent, utilities, and employee salaries, even if the owner or key employee becomes disabled and unable to work.

Find an insurance professional who can bundle all of the business-related insurances. They can help you assess your needs (the amount of coverage, deductible, etc.) and bundling will give you the lowest cost.

While hopefully you will never need to make a claim against any of your insurance policies, the cost of having the insurance is trivial compared to what it will cost to deal with any of these events without insurance.

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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Owning a private medical practice is a journey. Initially, you're focused on how to get the practice up and running. The next phase is how to best run the practice. Over time, you transition to how to grow and leverage the practice. And, at some point, you will want to leave the practice that you started.

Having a roadmap definitely makes the journey easier. That's where having a business plan helps. One of the key considerations, from the start, needs to be "what does my exit look like." Now I totally understand that this may be difficult to envision but many of your decisions will depend on where you want to head.

You wouldn't get in the car without knowing where you are going.

In today's episode, I speak with Eric Miller of Econologic Financial Advisors about the five most common options for exiting a private practice.

Die with your boots on
Just close your doors and turn off the lights
Bring on partner physicians and selling them shares of the practice
Sell the practice to private equity or other corporate entity
Sell the practice to a hospital system

It's exceedingly unlikely that you want to die while still owning/running your practice. If you simply turn off the lights then you don't get any sale price for having built this successful business. And, for most of us, it's unlikely that one or more of your children will join you.

Realistically, that leaves the last 3 options. Given that, how do you maximize your practice's EBITDA so that you get the biggest return on your investment? Because your practice is an investment.

There is no "right" answer for what your exit strategy should be. You need to educate yourself and understand the pros and cons of each option. Set yourself up from the start to have multiple options by having a well-defined operating agreement that spells out buy-in/buy-out, drag along rights, decision making, partnership and more. Understand what's need to sell your practice to others including partner physicians, physicians (not already in your practice) or corporate entity.

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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More patients equals more money. Right? Not necessarily.

If you want to grow your practice, you're probably thinking how do I get more patients. But is that really the right question to ask?

In today's episode, I had the pleasure of having Zed Williamson from TrackableMed back with me to address what you should be asking. For starters, increasing your practice's volume and revenue does not happen by chance. Here are some of the questions we address:

What type of patient do I want to bring into my practice?
- Better insurance/payer
- Need a specific procedure
- Have a certain diagnosis
Where do I find the patients that I want?
Why do they want to see me? And how do I communicate that?
- Hint-it's not about you. It's about them
Are there obstacles in your practice that limit your growth?
- Scheduling
- Space
- Staffing

Zed also shared how to determine the cost of acquisition of a new patient. You can reach out to Zed for his calculator at zed@trackablemed.com

Last, we discussed the invaluable task of writing out the step-by-step process that a new patient would go through so that you can identify any roadblocks that limit your practice's growth.

Zed Williamson founded TrackableMed in 2011, a patient demand acceleration platform rooted in neuroscience. Zed grew frustrated by the lack of accountability in the advertising industry and started TrackableMed to focus on results. TrackableMed helps private practices create patient demand for their therapies.

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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You've probably heard me say that medicine is a business. It takes work to run a successful business. There are good days and bad days. And, no matter how hard you try, like all business owners, you'll make mistakes. That's the truth.

But with mistakes comes experience. The key to running a successful private medical practice, or any business for that matter, is to learn from missteps. Ideally you learn how to grow from other people's mistakes rather than have to make them yourself.

Today I chat with Dr. Christine Meyer of Christine Meyer and Associates about her journey from being an employed physician to starting her own practice and ultimately growing it to the 19 providers she has today. While I want you to hear that it is really possible to have a phenomenally successful practice, the real goal of this episode is to talk about the mistakes she and I have both made along the way.

Dr. Meyer and I discuss everything from hiring providers, to figuring out space requirements to managing staff, how and what to delegate and more. You'll hear about the common pitfalls that many practice owners experience and how to avoid them.

One of the most important takeaways from my conversation with Dr. Meyer is, no matter what stage you are at in starting, running or growing your private practice, you need to be actively involved in the management and learn from every experience.

More about Dr. Meyer:
Dr. Meyer was born and raised in New Jersey to first-generation Egyptian parents. She received her Bachelor’s from Rutgers University and MD from Hahnemann University School of Medicine (now Drexel University). Dr. Meyer completed an Internal Medicine Residency at Thomas Jefferson University Hospital and is board certified in Internal Medicine.

She met her husband, Dr. Christopher Meyer, on the first day of medical school. In 2004, the Meyers realized their life-long dream to have a medical practice together. Christine Meyer, MD & Associates, and Healthy Steps Pediatrics are considered the premier primary-care practices in Chester County.

Her most recent passion has been the launch and growth of her podcast, Tell Me More: Better Conversations in Healthcare,

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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In this episode, I'll outline the key steps you need to develop your practice's strategic plan for the new year.

The first step: doing a review of the past year. For this you will need a few things:

2022 Profit and Loss statement
2021 Profit and Loss statement (so you can look at the year-over-year changes)
Year end billing reports

To develop this year's strategic plan we need to do a post-mortem on the prior year. We need to figure out what went right and what we can improve. Examples of what we're looking for:

Did you meet your 2022 goals?
Did your revenue grow?
How's your volume?
What's happening with your expenses? What expenses can be pruned?

One of the first goals should be your profit projection. How much money do you want to make this year?

This year's strategic plan involves setting both yearly and quarterly goals. These goals depend on the stage you are at.

The quarterly goals should build to achieve the yearly goals.

Examples of possible yearly goals:

Getting credentialed and contracted by Fill in the Date
Add a new physician and/or midlevel to my practice
Add a new revenue stream
Have X% year over year growth in Revenue &/or Volume

Examples of possible quarterly goals:

Increase volume by X%
Develop standard operating procedures for front desk (or whatever needs work)
Decrease average days in AR
Decrease number of days until claims are submitted
Decrease days to complete charts
Increase front desk collections

Mine last year's data to look for the good, bad and ugly of how things are going to help you determine the items to focus on this year.

If you have any questions about your practice's strategic plan for 2023 contact me at drweitz@drsandraweitz.com.

Earn 1 AMA CME when you learn and reflect: CMEfy link for it: https://earnc.me/tkXPli

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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You never know when your mother-in-law will turn out to be a valuable asset to your practice. Mine was a lab technologist who had started up and ran multiple medical labs. When we told her that I had decided to start my own practice, one of her first questions was "what labs are you planning to do?" followed by you need a CLIA Waiver.

Say what?

I had no idea what that was or how to get one. The test said was CLIA Waived. Doesn't that mean that you don't need a CLIA?

A CLIA Waived test just means that there are fewer associated rules to follow. You still need to apply for and get a CLIA Waiver. Even for real simple stuff like doing point-of-care lab tests in the office. You want to do a UA or a rapid strep test. Or maybe a urine drug screen or pregnancy test.

In this episode of The Private Medical Practice Academy, I chat with Dr. Heather Signorelli, a pathologist who has started and ran multiple labs. We discuss CLIA (Clinical Laboratory Improvement Amendments--in case you were wondering) and the different CLIA programs and their requirements.

Apply for a CLIA: https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/How_to_Apply_for_a_CLIA_Certificate_International_Laboratories

How to get a CLIA waiver: https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/HowObtainCertificateofWaiver.pdf

CLIA Waived tests: https://www.cdc.gov/clia/docs/tests-granted-waived-status-under-clia.pdf

If you are doing any labs in your office or are thinking about adding them, you won't want to miss this episode! Also, remember--you can earn 1 AMA PRA Category 1 CME for completing the reflection after listening to the podcast. Click here to reflect and unlock credits & more.

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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Finding space for your medical practice can seem very intimidating. So when someone asked me for a consultant in the Dallas-Ft. Worth area to help them figure out where to look for space for their new office I realized that I need to address this topic head on. You don't need to pay a consultant for this. You need a commercial realtor.

That's why I invited Colin Carr, the founder of Carr Healthcare, to join me today to discuss the nuts and bolts of finding a lease space for your practice.

In this episode we cover some of the topics you are frequently asking about. Here's just a sample of what we discussed.

Where should I choose a space to lease for my practice?
How does using a commercial realtor work?
Can I negotiate with multiple landlords at the same time?
Should I choose a gray shell or a turn-key space?
Do I have to pay for tenant improvements or does the landlord?
How much does a buildout cost?
Do I need an architect and/or contractor before I choose a space?
and so much more

If you ever need to look for space for your medical practice you are not going to want to miss this episode!

Colin's firm only represents physicians who are looking to rent or buy medical office space. Here's the link to Carr Healthcare Realty-- https://carr.us. (I have no affiliate relationship with Carr Healthcare Realty)

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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Drug and Device reps often drop into medical offices--usually uninvited. And they seem to always to be there at the most inopportune times. Most annoying is when they camp out in the back waiting for you. It's no wonder that many physicians have disdain for Drug and Device reps.

If this is your attitude, you're missing out on a great (free) opportunity to grow your practice.

In this episode, I chat with Omar Khateeb who helps med tech companies grow sales and drive product adoption using social media. Omar is an interesting guy. His dad is a vascular surgeon and Omar went to med school before becoming a device rep. Omar ultimately transitioned to marketing and teaching reps how to interact with physicians.

Drug and device reps can help you grow your practice in multiple ways. They can:

help you assess your draw area
give you insight into your competition and community in general
help market you
do research for you--about reimbursement, new procedures, demographics
help you recruit new physicians
help you determine where to open a satellite clinic
help you with social media posts
help you with social media content including testimonials, videos of procedures

Key point: Make the rep part of your team rather than view them as a nuisance.

Here's some suggestions for how to make the rep part of your team:

Set parameters for when you are available to meet with them
Be explicit in what your needs and wants are
Understand they may not have dollars to spend but they have time
Empower them to help you
Be nice. Get to know them.
Give them something back. Sure they want you to use their product more. But aside from that--a Linkedin pat on the back, a written or verbal compliment to their manager, inviting them for a cup of coffee. All of these things are either free or low cost to you and high value to them.

I know that all of this may seem counter-intuitive and burdensome. That's exactly why you need to listen to this episode. I don't want you to miss out on this opportunity to grow your practice!

Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com

Join my FB group, The Private Medical Practice Academy.

Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.

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I’m frequently asked about the benefits of hiring employees versus having independent contractors.

Many physicians are under the impression that hiring someone as an independent contractor is going to be less expensive than as an employee. But not so fast. The IRS has rules that define whether someone is truly an independent contractor or an employee. The employer is responsible for determining if the new hire meets the criteria to be treated as an independent contractor. Choose the wrong status and you may be liable for past taxes and the associated penalties.

What does it mean to be an Independent Contractor?

The IRS and many states have adopted common law principles to define an independent contractor. These rules focus primarily on the level of control an employer has over a service or product. In other words, do you the employer defines what is being done and how it will be accomplished.

The nature of the work that you expect this new hire to perform also helps to define the employment status. When work is considered integral to the business, it is more likely that the person is an employee. On the other hand, work that is temporary and non-integral may imply independent contractor status.

Another factor that helps define employment status is the method of compensation. For example, if a person is on your payroll and receives a steady paycheck then that person is clearly an employee and not an independent contractor.

The Economic Realities Test

The “economic realities test” looks at the dependence of the worker on the business they work for. If a person gains a large portion of their salary from that business, chances are that person qualifies as an employee. The test also factors in such things as level of skill, integral nature of the work, intent of the parties and payment of social security taxes and benefits.

The Right to Control Test

Courts also use the "right to control" test. When an employer controls the way work is carried out and a product is delivered, the relationship between the parties is employer/employee.

On the other hand, if an employer doesn’t have authority over how a party accomplishes their work but simply requests or gives an outline, the person could be considered an independent contractor.

Employer Responsibilities
As an employer, your tax liability is determined by your worker's employment status. When a worker is an employee, you are required to pay state and federal unemployment tax, social security tax, as well as workers compensation and disability premiums to your state’s insurance fund. When a worker is an independent contractor, the hiring party is not required to make any of these payments.

The Law Is Clear

Certain factors define a worker as an independent contractor: not relying on the business as the sole source of income, working at his or her pace as defined by an agreement, and retaining a degree of control and independence. An employee, on the other hand, relies on the business for steady income, gives up elements of control and independence and works within constraint of workplace.

Most of the staff that you would hire for your medical practice are most likely going to be employees. I would strongly encourage you to review the IRS guidelines and have a conversation with your CPA prior to hiring any new staff.

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When I started my medical practice I quickly learned that there's much more to accounting than quickbooks. My CPA firm, with its extensive healthcare experience, has served a phenomenal business advisors. In this episode of The Private Medical Practice Academy, Jeremy Klibert CPA and I discuss some of the pressing questions that private practice physicians have.

Are you wondering what the right structure is for your medical practice?
Do you know the difference between cash and accrual based accounting?
Are you trying to figure out whether you should buy or lease equipment?
Do the depreciation rules confuse you?

Jeremy Klibert is a Tax Partner with Faulk & Winkler, LLC. He is responsible for providing tax return review, tax research, tax planning, and consulting services for the firm. Jeremy works with a wide range of clients and focuses his efforts on serving high net-worth individuals, nonprofit organizations and closely held small businesses including medical practices. In his client relationships, Jeremy provides invaluable insight on tax, accounting and consulting issues. You can reach him at jklibert@fw-cpa.com

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

Be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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You want to offer a service to a patient but you aren’t sure that Medicare will reimburse you. Is there something you can do to increase the chances of getting paid? The answer is an advanced beneficiary notice of non-coverage (ABN).

You use an ABN when you are offering a service that is usually reimbursed by Medicare but may not be reimbursed by Medicare in this particular case.

Voluntary use of an ABN
When you know, in advance, that the service is not covered by Medicare you voluntarily use an ABN to notify the patient. The ABN puts the patient on notice that they are financially responsible.

Mandatory use of an ABN
An ABN is required when Medicare covers the service but may not be in this case. For example, Medicare may determine that the service or treatment was not reasonable and medically necessary for this patient. If you know, from the outset that something may potentially not be considered medically necessary by Medicare you must get that ABN signed.

Importance of local carrier determinations (LCD)

I previously explained Medicare LCDs . LCDs may account for why something is not covered by Medicare. Understand LCDs can help you navigate when an ABN is required.

For any service or item that Medicare covers but you are concerned that they won’t cover in this case, you will want the patient to sign an ABN. If you did not get the patient to sign the ABN before the service or item was provided, then you cannot demand payment from the patient.

Key point-- You must have informed the patient before the service was provided that this is typically paid for by Medicare but that there is a chance in this case that it will not be covered and they and must sign the ABN form.

The ABN isn’t a blanket form. Avoid the temptation of thinking, “I'm not sure what’s covered so I'm just going to get everybody to sign this form.” The ABN needs to specific. Identify what service or item is being offered and communicate that to the patient. The patient needs to understand that you will transfer the liability to them for that specific thing if it isn’t covered by Medicare.

It’s your responsibility to know what is and isn’t covered. changes in what Medicare pays for to you.

Medicare Advantage plans and commercial insurers do not follow CMS but rather have their own set of rules. Some require an ABN. Some don't. Others have their own version of an ABN. Read your contracts to determine what is required.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

If you enjoy this podcast, please help spread the word and leave a review :)

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We've all heard, "First impressions matter." Calling your office to schedule an appointment is your patient's first interaction with you and your practice. That call defines whether the patient schedules an appointment. And, their attitude toward future interactions with you and your office.

Today, Zed Williamson from TrackableMed joins me to discuss how your staff can improve the impression patients get when they call your office. One of the most valuable suggestions is to train your staff to answer the phone with a full-on smile. Now this may seem silly but if you try it you'll see the difference in the tone of your voice.

Between automated phone attendants and online scheduling tools, patients have precious little interaction with your office. Those initial few words of greeting can make or break your success.

Other valuable tips from this episode include:

Call your own office as a secret shopper
Have calls answered by a live person
If someone is put on hold, tell them how long it will be
Fill the dead space so they know they're still connected

As you'll hear, "First impressions" do matter. Listen to this episode to learn what steps you need to have your staff take to get that patient's needs addressed and loving your practice.

After spending years in advertising, Zed Williamson founded TrackableMed in 2011, a patient demand acceleration platform rooted in neuroscience. Zed grew frustrated by the lack of accountability in the advertising industry and started TrackableMed to focus on results. Today, you can find him reading, spending time with his wife and teenage sons, and running a highly innovative business that helps private practices create patient demand for their therapies.
https://www.trackablemed.com/patient-engagement-solutions

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

Be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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One of my greatest frustration with practicing medicine is poor patient compliance. You spend time educating the patient and discussing the treatment plan. When you see them back in follow up you discover they haven't followed through. If you are lucky, they are the same. Unfortunately, sometimes they are worse.

Using FDA-approved devices, remote monitoring remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) patients can alert physicians to any concerning data between visits. That way, physicians can intervene before things spiral out of control. The goal behind remote monitoring programs is to improve patient care, decrease healthcare spending by being proactive and improving patient compliance.

And while I'm sure that we are all for improved patient care and outcomes, I know that nobody wants to do more work. Or do it for free.

Here's the good news:

Implementing RPM/RTM does not require more physician time. When set up correctly, you only have to write the order. You can use your staff to do the rest.
RPM/RTM can significantly increase your revenue.

In this episode I'll tell you the key differences between RPM and RTM and how to utilize them in your practice.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

Be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Are you afraid of getting audited by insurance companies or Medicare? Do you get anxious when one of the payers sends you a request to audit 5 of your charts? Have you heard horror stories of the Feds knocking on a physician's door? Don't worry--you are not alone.

But not all audits are created equal.

Today David Vaughn joins me to discuss what you need to know about the different types of payer audits. David is both an attorney and certified professional coder and has been my healthcare attorney for 20+ years. David has been instrumental in helping my practice's billing compliance.

Here are some of the topics we discussed during our conversation:

the difference between a benign audit and the one you should be worried about
what to do if you get audited
what your liability is with regard to coding
the importance of self-audit
how denials may give you insight into your audit risk
the difference between federal payers and private payers
in-network vs. out-of-network audit risks

If you are in private practice you will not want to miss this episode!

More about David Vaughn: David is one of a limited number of healthcare attorneys in the United States who is also a Certified Professional Coder®, certified by the American Academy of Professional Coders® (“AAPC®”).

David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.

You can reach David at david@lalawfirm.net.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

Be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced Chronic Care Management (known as CCM) with the intent of improving the care of patients with chronic conditions. CCM offers physicians an opportunity to be compensated for the work that they were doing between office visits including but of course, not limited to calls, education, coordination, and pre-authorizations. In 2020, CMS rolled out Principal Care Management (PCM).

What is Chronic Care Management?
CMS defines CCM as care coordination services done outside of the regular office visit for patients with two or more chronic conditions that are expected to last at least 12 months or until the death of the patient. In addition, these conditions need to place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

You can bill for CCM when a physician or qualified health care professional directs your staff to spend at least 20 minutes of non-face-to-face clinical time treating the patient per calendar month.

CMS distinguishes between complex and non-complex care. The key differences between them are the:

Amount of clinical staff service time provided
The Involvement and work of the billing practitioner
And The extent of care planning performed

Wondering how much you can increase your revenue by?

Currently CMS reimburses $42.00 for providing a minimum of 20 minutes of CCM per patient per month. Provide 60 minutes of CCM per patient per month and your practice will get $117.60. Let’s say you have a practice with100 CCM patients you could earn an additional $4,200-$11,760 per month for work you are likely doing anyway.

What is Principal Care Management (PCM)?

PCM is similar to CCM because both services are intended for patients requiring ongoing clinical monitoring and care coordination. One of the key differences, however, is that PCM only requires patients to have one complex chronic condition.

There are 6 criteria for PCM:

The condition is expected to last at least three months.
The condition places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death.
The condition requires the development, monitoring, or revision of a disease-specific care plan.
The condition requires frequent adjustments in medication regimens, and/or the management of this condition is unusually complex due to the patient’s comorbidities.
The condition requires ongoing communication and care coordination between the relevant providers who are involved in the patient’s care.
The condition requires at least 30 minutes of PCM services per calendar month.

To incorporate CCM and/or PCM into your practice, you will need to develop processes for implementation, tracking and billing. Tracking time and then using the appropriate codes is probably the most difficult part. You have to document the name of the staff member, the time spent, what they did specifically and their credentials.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

Be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

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If you are an employed physician, chances are your employer purchases malpractice insurance for you. Your first introduction to the complexities of malpractice insurance may come when you leave that employer and have to buy a "tail." And, if when you start your own practice you'll need to understand how to get the best malpractice insurance.

Today, I chat with Jennifer Wiggins from Aegis Malpractice to help demystify malpractice insurance. Jennifer has over 16 years experience working for one of the country's largest malpractice insurers. In 2018, she left to start Aegis Malpractice, a broker specializing in malpractice insurance.

Here are some highlights:

Difference between claims-made and occurrence malpractice insurance
When do you need a tail?
How often you should shop your malpractice insurance
The key elements of a malpractice policy
Attorneys and who decides when to settle a case
Why your practice needs a malpractice policy (and not just the individual physicians)
How to choose a malpractice carrier
Do you need a broker and if so, how do you which one

We all know that malpractice insurance is a major expense. You want to make sure that your money is buying you the best policy for your practice. Jennifer and Aegis are offering a free, no obligation review of your current malpractice insurance policy. You can learn more at https://www.aegismalpractice.com and be sure to mention this podcast.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

Reflect and earn CME here https://earnc.me/H64Hxk

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Today I had a great chat with Dr. John Lin about how to think about choosing to be In-Network vs. Out-of-Network. We all know that dealing with health insurance companies can be very frustrating. But reimbursement rates are only a part of what makes dealing with these companies a headache.

Trying to decide whether it makes sense for you and your practice to be In-Network or Out-of-Network has to be an informed calculation rather than an emotional decision. Here are some of the topics we hit on:

What is the demographics of your practice?
- Can you "afford" to lose that patient population?
What percentage of your payor mix does the insurance company make up?
How much time (% of an FTE) does it take you and your staff to get prior authorizations and payment for this insurance company?

One of the key points of our discussion is that being In-Network or Out-of-Network is not an all or none decision. Both Dr. Lin and I started our practices In-Network with most payors in order to get our practices full. And then, with time and experience, evaluated and re-evaluated each payor and their contracts to decide whether it was beneficial to our practices.

You'll want to listen to our discussion of the decision-making process as you consider these choices for yourself.

Dr. Lin is a private practice urologist in Gilbert, Arizona. He is also an immigrant, operates multiple businesses, is an angel investor, and is a very grateful winner. He is an avid student of efficient practice management and frequently speaks on coding, billing, practice management, and online reputation management.

Urologists from across the U.S. and the U.K. have visited his practice to learn about practice efficiencies.

Dr. Lin consults for numerous physicians who are starting and running successful practices.

He believes in sharing knowledge and paying it forward.

Dr. Lin helps urology practices throughout the U.S. as the host of The Thriving Urology Practice Facebook Group. He runs multiple YouTube channels. You can also find him on all the popular social media channels as @jclinmd.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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You’re a Medicare provider. And you know that the Centers for Medicare and Medicaid Services (CMS) runs Medicare. But did you know that CMS is just the umbrella organization? The actual administration is done by a Medicare Administrative Contractor (MAC.)

What is a MAC?
A MAC is a private health care insurer that’s been awarded a geographic jurisdiction to process claims for Medicare Fee-For-Service beneficiaries.

CMS relies on the network of MACs to serve as the primary operational contact between the Medicare Fee-For-Services program and providers enrolled in the program. Some of the activities the MACs include:

Processing claims, enrolling providers, handling 1st stage appeals redetermination requests, responding to provider inquiries, educating providers about Medicare billing requirements, reviewing medical records for selected claims and establishing local coverage determinations

One of the functions of each MAC is to establish local coverage determinations (LCD.) An LCD is a determination of whether a particular item or service is going to be covered on a contractor–wide basis.

Before an LCD can be put in place, there's a whole process:

The Proposed LCD describes the MAC’s proposed determination regarding coverage, non-coverage or limited coverage for a particular item or service. The public announcement begins with the date the proposed LCD is published on the Medicare Coverage Database.
After the proposed LCD is published, the MAC has to provide a minimum of 45 calendar days for public comment.
The MAC has to establish a Contractor Advisory Committeeto discuss the quality of evidence used to make a determination. You can volunteer to be part of the CAC.
The MAC holds open meetings to discuss the review of the evidence and the rationale for the proposed LCD.
Once these steps are completed, the final LCD and the response to comment is published. This marks the beginning of the required notice period of a minimum 45 calendar days before the LCD can take effect.

There is an LCD reconsideration process. As a physician you can request a revision to an LCD—either in its entirety or any provision.

An LCD can definitely throw a wrench into your revenue cycle management if it takes you by surprise. It’s imperative that your billing folks keep you abreast of any new LCDs or changes to an existing one.

You want to make sure that your billers are checking the MAC website regularly. While it may seem that an LCD is merely a billing thing, that’s a very simplistic and largely incorrect view. LCDs have a direct impact on how you practice medicine. The more informed you are the easier it is to evaluate how an LCD effects your practice and can respond pre-emptively.

Here is a list of the MACs: https://www.cms.gov/files/document/macs-state-jun-2021.pdf

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

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To start with, make a list of supplies that you everything you need: drugs, syringes, gloves, paper for your exam table, cleaning supplies and more. Include how often you are using these supplies because we’ll need this info to figure out the quantities you need to order.

You’ll want to develop an inventory system will help you track how often you use each item and when you need to reorder.

Before I talk about where to buy supplies—buying for your practice is no different than buying anything else. You need to comparison shop. There is tremendous variability in pricing.

You can buy from individual vendors. Create an excel spreadsheet –put the item name in each row and the vendor in the column so that you can compare prices of vendors. You will also want to consider buying from a General Purchasing Organization (GPO).

How do GPOs source and negotiate prices for products and services?

GPOs help source and negotiate prices for drugs, medical devices, and other products and services for healthcare providers. GPOs don’t take own or take possession of the product. They are the middlemen.

If GPOs are middlemen, how do they save healthcare providers money?

It is simply an economy of scale issue. It takes time and effort fr a supplier to negotiate a price for every item it sells with every healthcare provider that wants to purchase that item. GPOs can decrease costs by lowering transaction costs and prices through joint negotiation.

How much can I save with a GPO?
GPOs can save providers 10% to 18%.

How else can a GPO benefit me?
As a small private practice, you may discover that it is difficult to obtain certain products at the scale you need them. Joining a GPO can help you procure the product because they have a steady inventory and a lower per unit cost on each order.

GPOs pre-screen vendors to reduce the risk of working with a problematic supplier. GPOs also has access to more member reviews. You can save time and manpower because your staff doesn’t have to screen each vendor for every purchase.

How to choose a GPO?
You will need to vet any GPO that you want to join. Start by asking other medical practices that you know. There are many large national, regional and local GPOs. Combine that with the ability to join multiple GPOs, easily switch from one to another and the result is competition for members and greater incentives for providers.

Can I belong to more than one GPO?
In case I haven’t been clear enough, you can belong to more than one GPO. You can belong to multiple GPOs and still buy from individual vendors.

How much does it cost to join a GPO?
Some GPOs are free, some charge a membership fee. The membership costs usually pay for themselves after the first order so the fees should not be your defining consideration.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Here are some strategies that can help keep you on schedule.

Get to clinic before your first scheduled patient. Preferably you get to clinic early. If you show up at 8 am, your first patient is at 8am and then you first need put out whatever this morning’s fire is, you start the day off behind and you will be all day long. The other advantage to getting in early is to huddle with your MA so that you have a game plan for potential bottlenecks.
Create a block schedule. Train your scheduler the rules of the block schedule.
Communicate scheduling issues with your scheduler. If you have a patient that always takes more time, schedule them in a longer slot.
Don't routinely double book. If it takes you 15 min to see a follow-up and you put 2 patients in every 15 min slot you will invariably run behind.
There will be times that you have to double-book. Have a code so you don't double book one of those patients that always takes longer.
When you enter the room, set an agenda by greeting the patient, and asking them what they are here for today. The better you define and manage the expectations of the visit, the greater the patient satisfaction.
Set the timer on your phone. The vibrating phone is a gentle reminder that time is up.
Have a plan with your MA-instant message, a knock on the door, a "call."
Do your absolute best to not answer calls in the middle of clinic. Use HIPAA compliant email and text messaging for quick questions. If you must talk on the phone, set up a time—before patients, after patients or as a scheduled appointment.
Have information about diseases and procedures ready to print during the visit. Discussing the patient handout(s) and then handing it to the patient at discharge with improve patient comprehension, decrease phone calls to your office and improve patient satisfaction and outcomes.
Most EMRs have instant messaging. If yours doesn’t, install a HIPAA compliant instant messaging application. We all know how questions, unplanned tests and procedures can disrupt your otherwise perfectly flowing day. With instant messaging you can be in an EMR chart and have a separate window open for instant messages to communicate with your staff without leaving the room.
Create a list of supplies that every exam room should be stocked with. Standardize your rooms by labeling the drawers and putting supplies in the same place in every room so you don’t have to search for things. Train your staff to check supplies and re-stock daily. Have a tray/cart stocked with supplies for your most commonly performed procedures.
Understand that most “practice management emergencies” that occur during the day are not true emergencies.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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To reduce the volume of after-hour phone calls, you need to have a policy that implements these strategies.

Implement strategies that help reduce after-hour call volume without sacrificing patient care.

1. Set up your phone system's phone tree
When a patient calls after hours, your phone system should answer and give the patient a set of instructions. The message should start with, “If this is a medical emergency, please hang up and dial 911 or go to the nearest emergency room.”

2. Automate commonly requested information

Your after-hours message should include the information that patients are routinely looking for like your address, office hours, directions to the office, your fax number and your website URL. Mention your website multiple times during the message to direct patients to that site. The person recording this message must articulate clearly and speak slowly so. this automated message can be easily understood.

3. Divert non-clinical calls

Non-clinical calls, including requests to change, cancel and schedule appointments, requests for medical records, and billing questions can account for a significant percentage of your after-hours calls. Set up a phone tree prompt that sends people to a voicemail box that the staff will answer during regular office hours.

Automate medication refills

Ideally, refills are timed to patient follow-ups. Have all refill requests come from the pharmacy. Adopt a policy of no refills on nights, weekends and holidays. Employ a phone tree prompt that sends patients to a voicemail box for non-urgent refill requests.

Indicate that you may bill for non-urgent calls

Another strategy is to inform the caller that if they chose to contact the on-call provider, there will be a charge for the service. You can decide whether you want this to apply to all calls or only ones that are not urgent. You can also decide whether or not you actually want to drop a charge.

5. Instruct callers to hang up and dial the answering service directly

If you are going to use an answering service, I would suggest having a pre-recorded message on your phone system that directs patients who still want to speak with the on-call provider to hang up and call the answering service directly.

Target high utilizers

Track your after-hours calls to know who’s calling you and you'll likely discover a handful of patients make up the majority of calls.

Differentiate patient versus consult calls

If your practice accepts consult calls from the ER or inpatient units, you will want to set up your after-hours phone tree to include a separate option for these calls.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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When you run a private medical practice, you’re invariably going to need services and vendors outside of your practice. What you need to know is that any person or organization that you hire to handle, use, distribute, or access protected health information is a Business Associate (BA) and that you need to have a Business Associate Agreement (BAA.)

You need to have a Business Associate Agreement in place before you share protected health information.

The goal behind the Business Associate Agreement is to acknowledge that both parties are obligated to follow federal HIPAA regulations and to protect both parties in the event of a breach.

According to HHS, the Business Associate Agreement must:

Describe the permitted and required protected health information uses by the Business Associate and /or their subcontractors
State that the Business Associate and their Subcontractors will not use or further disclose protected health information beyond what is permitted or required by the contract or as required by law;
And require the Business Associate and their Subcontractors to use appropriate safeguards to prevent inappropriate protected health information use or disclosure

A Business Associate Subcontractor is a person or entity to that the BA delegates to perform a function, activity or service.

Contractors and Confidentiality Agreements

Your employees, independent contractors who work exclusively for your company or a sole proprietor with other clients are not BAs. In this case your practice is solely responsible if someone breaches protected health information. One way to address this from a compliance perspective is to have your employees and independent contractors sign a confidentiality agreement. The confidentiality agreements should:

Clarify the type of information the agreement covers.
Describe what type of information cannot be copied, downloaded or modified. As an aside, this is a very common source of a HIPAA breach—when some piece of protected health information is downloaded onto a desktop because its “easier” to access but it’s not secured.
Address issues like not removing a laptop containing protected health information from your office
State information must be returned upon employer’s request
Disciplinary action for persons responsible for a breach of confidential information

Your Business Associate Agreement should be written so that it’s “evergreen,” meaning that it renews automatically and doesn’t require a new signature to remain valid.

While the business associate has the liability, you as the covered entity are still required to take reasonable steps to cure the breach or end the violation.

Download the Business Associate Security Questionnaire to help you do your due diligence in choosing a Business Associate.
If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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We send and receive email every day so it would seem natural to send emails to your patients. But what if the emails contain protected health information? How do you make email HIPAA compliant?

How you will use email with protected health information

The first questions to ask are, “Is my email network is behind a firewall?” Are you only emailing protected health information between you and your staff within the confines of the firewall? If you answer yes to both questions, then you don’t need to encrypt your emails. But, you do need access controls for email accounts so that only those individuals who are authorized have access to protected health information.

On the other hand, if you intend to use email to send protected health information externally, you are responsible for protecting the protected health information—in other words, making it HIPAA compliant. Encryption is the key to making your email HIPAA-compliant but it’s not that simple. Many email service providers that offer an encrypted email service are not HIPAA compliant because they do not incorporate all the necessary safeguards to meet the requirements of the HIPAA Privacy and Security Rules.

Here are some of the things you will want to consider to make your email is HIPAA compliant

Ensure you have end-to-end encryption for email
Enter into a HIPAA-compliant business associate agreement with your email provider
The most important step—Develop policies on the use of email and train your staff
Emails containing PHI need to be retained for 6 years
Secure, encrypted email archiving saves storage space and is indexed making its easier to search
Obtain consent from patients before communicating with them by email

HIPAA email compliance should be included in your compliance plan. You don’t want something we all do every day—send and receive emails to get you into HIPAA trouble. If you are unsure of the requirements of HIPAA compliant speak with a healthcare attorney that specializes in HIPAA to advise you of your responsibilities and the requirements of HIPAA with respect to email.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Trying to figure out how the digital world fits into your private practice can seem very overwhelming. Today, I had a great conversation with Dr. Dana Corriel, a board certified internist, entrepreneur, digital stratgeist and the founder of doctorsonsocialmedia.com to get her insights.

Here are some of the key points we discussed:

Social Media is Media. It's a form of advertising. Don't think about it as "Social"
Whatever content you put into the digital space represents you and your brand
Your priority is the prime real estate you own--your website
- Make your website unique
- Provide content geared to the audience you want to read it
You can re-purpose content from your website
- Post it on one of the social media channels--Facebook, Instagram, Linkedin, etc.
- Be consistent
Establish yourself as an expert
- Publish articles on doctorsonsocialmedia.com and other sites so that you are identified as an expert in your field
You never know who will see your content--patients, referral sources, others.
Use social media to drive people back to your website.
People may not find you on social media but your patients and referral sources will definitely check out your website before coming to see you or referring patients.

Dana Corriel, MD, is a board certified internist, entrepreneur & digital stratgeist. She is the founder of DoctorsonSocialMedia.com, an online platform that functions as a mix of media outlet, marketplace, & talent agency for “medical brains”, serving both a physicians and public audience. Over the years, Dr. Corriel has learned how to create truly stand-out content online & has expanded her own career in just a few short years, using simple online tools. Her company has helped numerous physician influencers and innovative new healthcare businesses grow, thanks to its communities and networking power. Many of these experts now successfully occupy top healthcare positions, appear in influential outlets, and accomplish feats doctors never thought possible.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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I’m sure that you’ve heard the expression: build it and they will come. You started your private practice because you want to see patients. But how do you build your patient volume?

In this episode, you'll learn 6 steps to accelerate your ramp-up.

Define your message
- Differentiate yourself from the competition
Create your brand
- The name of your business
- Your tagline
- Your domain name
- Your logo
You need printed materials. This isn't old-fashioned.
- Business cards
- Appointment cards
- Stationary
- Brochures
Your website is your digital business card
Promote early and often
- Tell people where you are
- Schedule appointments before your opening day
Your open house
- Not just a celebration
- It's a powerful form of advertisement

You will want to implement these 6 steps before you open your business in order to maximize the likelihood that you will be busy straight from the start.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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In this episode, I had the pleasure of chatting with Wendy Margolin who owns Sparkr Marketing and is the founder of The Clinician’s Social Media Club. I asked Wendy to join me to discuss where social media fits into the private practice physician's business plan. Here are some of the topics we discussed:

How to choose which social media channel(s) should you choose
What content should you post
How to get your posts seen
Should you spend money on ads (and how much)
Your personal FB profile vs. your practice's business page
How to use your practice's FB page to engage with your community
How to monitor whether your SM posts are working for you.

One of the key points we discussed was using your personal FB profile to share your business info. Unfortunately, your FB business page is much more likely to get folks that are already interested in hearing from you. So how do you connect with others? You can use your personal FB profile. But--how do you separate your posts about the info you want to share about your practice and your truly personal info? You can divide your FB contacts into FB audiences. Here’s a link to how to divide Facebook audiences.

My take-home message to you about social media: It's a top in your tool chest. Even if a new patient doesn't find you on social media, they probably checked out your website and FB page.

Click here if you'd like to know more about Wendy Margolin's The Clinician’s Social Media Club for monthly fill-in-the-blank social media captions and customizable Canva templates.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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The Notice of Privacy Practices is a form that many patients toss in the garbage but that can you into a lot of trouble and costs an enormous amount of money. HIPAA guarantees a variety of patient rights--including a patient’s right to know how you’re going to use their Protected Health Information (PHI.) As part of that, you are required to describe your office’s privacy practices in writing in an easy-to-read document called a Notice of Privacy Practices.

The HIPAA guidelines state that you must “do your best” to get your patients to sign an acknowledgment that indicates that they have

received a copy of your Notice of Privacy Practices
been made aware of a notice copy posted in your waiting area, or
been informed that a copy is available on your practice’s website

What should you include in your privacy notice:

Rights: Your privacy notice must clearly spell out your patients’ rights
Choice: Patient privacy choices must also be clearly listed
Use: You are required to tell your patients how you will use their information
Date and Sign: Although your patients are not required to sign and date your privacy notice, there must be a place for them to do so on the document
Change: Your patients have the right to change the instructions on how you are authorized to utilize their information

Here's a HIPAA-compliant sample Notice of Privacy Practices form.

How to use the form correctly:

Timing: Every new patient packet must contain a complete copy of your privacy notice. Have patients review your privacy notice again at least every three years.
Availability: Post a copy of your Notice of Privacy Practices where your patients can easily see it.
Signature: Make a “good faith” effort to document acknowledgment of your privacy notice by getting your patient to sign and date it.
Refusal to Sign: If they refuse to sign, document the reasons.
Language: Your Notice of Privacy Practices form needs to be available in other language options as your practice represents.

Who can Sign a Privacy Notice?

Adults: All patients who are competent adults.
Minors: The legal parent(s) may sign for non-emancipated children.
Emancipated minor. The definition of an “emancipated minor” differs from state to state. Know your state requirements to avoid getting into trouble.
Next of Kin: The designated representative of a seriously ill or comatose patient.
Legal guardian: The designated legal guardian of an incompetent patient.
Executor or administrator: The legal executor or administrator of the estate of a deceased person.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

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If you practice medicine, sooner or later you’ll get to the point that you want to fire a patient. Whatever the reason that you may have for terminating the physician-patient relationship, there needs to a clear and consistent policy and procedure for doing so or you're exposing yourself to hassles and unnecessary potential liability.

Once you have made the difficult decision to end the doctor-patient relationship, there are a number of steps you need to take:

Understand the legal standards for duty of care and for patient termination.
- Duty of care—this refers to the doctors responsibility to provide patients with treatment. In order for a physician to be obligated to a patient, you must either:
  - have a pre-existing relationship with the patient
  - have a commitment to the patient by proxy
  - take affirmative action to treat the patient
You need to send out a termination letter to the patient.
Notify all office staff about the termination.
If you have more than one physician, you absolutely want to notify all practice physicians about the termination.
Your next step is to remove the patient from your roster of active patients.
After you have fired the patient, i.e. sent the termination letter, it’s imperative that you document All Post-Firing Encounters.
You need to use a disclaimer for Emergency Care.
You need to know how much notice you need to give the patient.
- There’s no federal standard that defines “reasonable notice"
- Know your state's requirements
- Look to your payor contracts for guidance
- Contact a healthcare attorney in your state

Here's a list of dos and don’ts for you, as the treating physician to keep in mind as you interact with your soon-to-be ex-patient:

Never discuss the patient’s health or wellbeing if you encounter him or outside of the office.
If you participate in health fairs, online medical discussions or any other situation in which there is the potential for your opinions to be interpreted as medical advice, you will want to include a disclaimer.

In the end, there will be occasions where you want to and are justified in firing a patient. You just want to make sure that you do it the right way.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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New ventures require money. The question is always where does that money come from. It may come from your savings, a loan or other investors. Regardless of whether you are starting your own practice, buying into a practice or related business (ASC, Imaging Center, etc)--you will need to make a capital investment.

In this episode, Dr. Brent Lacey and I discuss personal finances and financing your business ventures. Dr. Lacey is a gastroenterologist and founder of The Scope of Practice. He has coached hundreds of families to succeed in building personal wealth and stellar careers.

One of the important topics we address is money and your significant other. Money matters are often a source of strife in a relationship. And talking about money can make people uncomfortable.

Join us as we have an in-depth conversation about how to address both personal and business related money issues.

Dr. Lacey is hosting a free summit, Marriage and Money, M.D. on Nov 15-17, 2021. You can find out more by clicking here.

You can join me in The Private Medical Practice Academy membershipto how to maximize your practice's success. Enrollment for the next cohort will open in January. Be sure to sign up for the waitlist.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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What is the difference between an office manager and a practice manager. If you hire someone to help manage your practice—regardless of how small it is—that employee is a practice manager.

What are the tasks that practice managers may be responsible for? Here's just a short list:

All things Human Resources
Oversee billing and understand revenue cycle management.
Medical records management

One of the questions that I’m frequently asked is, “How much should I pay my practice manager?” In my experience, there are 3 general categories of practice managers.

The starter—when you are first getting started and have only a few employees and the complexity of the tasks is limited.
The growing manager—more staff, billing, expenses, and providers to manage.
The scaling manager- adding new providers, satellite offices and multiple additional revenue streams requires a whole new list of competencies. At this stage, you need someone who has the ability to help you grow rather than simply manage the practice.

Now that I’ve told you the list of potential tasks you’re going to want your new practice manager to take on, I’m sure you’re wondering where you are going to find a person who possesses all the required characteristics you should be looking for. The answer is that it’s incredibly unlikely that you will find someone who checks off every single box.

What's the one quality that’s essential in a good practice manager? Regardless of what stage you’re at, your practice manager needs to have excellent communication skills in order effortlessly communicate with everyone in your practice including patients, physicians, and other administrative staff.

Here are some of the things you’ll want to consider when hiring a practice manager:

Check the candidate’s previous work experience. Even in the beginning stages, you are going to want a practice manager with at least two to five years of prior work experience And, you want to specifically know what tasks they were previously responsible for.
Look for the necessary personality characteristics: Hiring the right person is all about fit. In order for your practice manager to be successful, they must be empathetic, compassionate, and pay attention to detail.
Your practice manager is really your right hand person. You want someone with shared values who can embrace your vision.
You want to be sure that your successful candidate is able to delegate tasks. You are hiring a practice manager to help run the practice. The ideal practice manager has excellent task delegation capabilities and must be able to judge when it’s best to handle a task on their own and when it’s better to delegate.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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In this episode, I have the great pleasure of chatting with Dr. Cheng Ruan, the founder of Texas Center for Lifestyle Medicine. Dr. Ruan started out in an internal medicine practice before starting his extremely successful and lucrative lifestyle medicine practice.

Here are some of the key points we touched on:

The importance of understanding every aspect of how a private practice functions before starting your own
How to get patients BEFORE you open your doors
How to create the right culture for your employees
How to leverage yourself with physician extenders (and get paid)

Dr. Ruan is hosting the Physician Practice Automation Summit Oct. 17-24, 2021. He's put together 40 experts including doctors, lawyers, marketing executives and more to help teach how to grow and scale private practices and I'm thrilled to be one of the speakers.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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You need to hire someone for your front desk. But before you sit down to write the ad for that position you first need to understand what it is that you want that front office person to do.

The first impression that people have of you is their experience when they walk in your front door. The person at the front desk is the first person from your office that someone is going to meet.

By far, the MOST important skill set is communication. Aside from the fact that great communication skills are the backbone to professionalism and excellent customer service, it’s probably the hardest one to actually teach. Regardless of the exhaustive list of tasks and responsibilities that you want to assign to your front office staff, absolutely none of their skills is going to be more important than their ability to communicate.

Patients, just like any other customer, do not want to feel like they are a transaction. When you are interviewing potential staff—especially for your front desk, I want you to think about whether they are easy to connect with.

Connection is all about communication. But communication is so much more than simply what comes out of someone’s mouth. What’s more important than words? Body language and tone.

Whether your patients trust you, the physician, starts with your (front desk) staff. Every message has to have both content and feeling.

Patient satisfaction and retention is directly related to their interaction with your staff. Patient trust stems from confidence in your staff’s competence and communication skills.

What are key components needed for great communication? Active listening, empathy, confidence, friendliness, respect, responsiveness, and ability to adapt communication style to the audience.

Let’s dissect this into things you can do to train people and skills they inherently need to have. You can empower your staff and give them confidence by developing processes.

But friendliness, empathy and respect are not qualities that you can easily teach.

I know that when you need to hire an employee, you’re preoccupied with what should the job description include. And, of course, you’ll need that list of responsibilities to write the job description and the ad.

But it’s really the intangible qualities that you are going to want to evaluate when you are interviewing potential front desk candidates.

Just remember, this person is going to be the face of your practice. If you were the patient would you feel that this person is friendly, empathetic and respectful? Would you feel that they are genuine and genuinely interested? You want the answer to be a resounding yes!

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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If you are like me, you never carry cash. I pay for EVERYTHING with my credit card. And, as a consumer, I get annoyed if a place doesn't take credit cards. I never actually think about the vendor side of things. I figure they bundle the cost of taking credit cards into whatever they're charging me.

The problem for physicians who are in-network is that they get paid according to their contracted rates. They can't pass the credit card fees they pay for accepting this form of payment to the patient.

But patients expect that you will take credit and debit cards for their co-pays, co-insurance or deductible. It's part of doing business, right?

I know that when you are busy starting or running a practice you're not thinking about how much you pay for accepting credit cards. That said, there's no reason to pay more than you have to.

Yes, but not all credit card processing fees are the same. In this episode of The Private Medical Practice Academy, I sat down with Dr. Jennifer Mogan of Park Place Payments to talk about how credit card processing fees are structured and how to figure out whether you are getting the lowest possible rate.

Dr. Mogan is an anesthesiologist in a private practice group in Rochester, NY where she has been practicing for the last 15 years. She attended college at Colgate University, and medical school and residency at the University of Rochester. On the side, she is also working with Park Place Payments, a women-founded and women-run credit card processing company built with the core mission to bring honesty and transparency to this industry. Dr. Mogan has been using what she has learned about the payments industry over the past year and a half to help her colleagues in medicine become more informed and make wise choices for their payment processing. She is happy to do a complimentary consultation for your practice with a full analysis and side by side comparison to make sure your practice is receiving the rates and service you deserve. https://www.parkplacepayments.com/contactjennifermogan/

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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If you are an out-of-network provider for an insurance company you may perceive that you can get better reimbursement--in large part because, in some states, you can balance bill the patient.

But all of that's about to change. When the No Surprises Act, a federal law, goes into effect on Jan 1, 2022, you'll no longer be allowed to balance bill. But that's not all. This law, as the name states, is meant to protect consumers from the cost of unanticipated out-of-network medical bills.

The No Surprises Act extends to most out-of-network providers.

Under the new law, if you're an out-of-network provider, you can't bill patients more than in-network cost-sharing amounts. While the No Surprises Act only holds the patient responsible for their in-network cost-sharing amount, you'll have the opportunity to negotiate reimbursement with insurers through an arbitration process.

With arbitration, both the provider and the insurance company submit an amount to be paid to an independent arbitrator. The independent arbitrator chooses one payment or the other with no ability to split the difference. The party whose offer is not chosen is responsible for the costs of arbitration.

What this does is put the burden on you, the out-of-network provider to determine a patient’s insurance status and the applicable in-network cost-sharing for the surprise medical bill. This means that your staff and billing folks are going to have to do more work to potentially get no more than if you are in-network. You will want to carefully monitor changes in reimbursement and changes in expense required to collect that reimbursement.

You can be out-of-network and get around this by providing the patient with written notice that you are out-of-network, disclose the charges and obtain consent at least 72 hours in advance of the appointment.

How to deal with the No Surprises Act:

Review your process for eligibility and insurance verification.
Provide a timely Advanced EOB notification to the patient and include:
- Good-faith estimates of:
  - costs based on the codes you expect to use
  - what the insurance company is responsible for paying
  - cost-sharing –basically what you expect that the patient’s responsibility is
  - the amount the patient has met towards out-of-pocket maximum and deductible
  - A disclaimer that coverage is subject to medical management requirements
  - A disclaimer that the information is only an estimate and may be subject to change
Review your contracts. Decide whether you want to go in-network and negotiate your rates.

In order to not be surprised by the No Surprises Act you need to prepare now.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Submitting clean claims is key to maximizing your ability to collect the money that is due to you.

What is a clean claim?

The claim for payment has to be submitted via an acceptable claim form or electronic format with all required fields completed with accurate and complete information in accordance with the insurer's requirements.

What is the significance of a clean claim?

Most practices have a clean-claim submission rate of 75-85% which means that 15-25% of submitted claims are not clean.

Claim rejections actually cost you money. When a claim is rejected, it means that those claims have to be reworked and resubmitted. Your clean claim rate should be 95%. Anything lower than this means that you are losing money.

Your clean claims rate directly affects your practice’s overall revenue. Problematic billing and coding practices on result in delayed or denied claims that can have devastating results for your practice.

Let’s put things in perspective. Every claim that is not paid on the first submittal wastes your practice’s valuable time and money. Many rejected claims are resubmitted multiple times, often without their errors even being addressed or corrected. I also want to point out that when a rejected claim needs to be reworked beyond its timely filing deadline you end up not getting paid.

What Clean Claim Rate should do I need (want)?

In the ideal world you would have a 100% clean claim rate. But let's be real--errors happen. That said, you should not be satisfied with a clean claims rate under 95%, and especially anything under 90%. Anything above a 5% claims rate is costing your business money and time. Your overall profitability depends on having your clean claims rate under control.

So how do you achieve that 95% clean claims rate?

Keep patient information updated
Verify eligibility prior to the date of service
Provide detailed documentation of medical information
Be mindful of insurance claim filing timelines
Double-check modifiers

You want and deserve to be paid for the work you do. Having a 95% clean claim rate will increase your profitability by increasing your collections and decreasing the expenses incurred collecting your money. And, of course, it will shorten your revenue cycle—said another way—you’ll get your money faster.

If you want to learn how to implement the processes to increase your clean claim rate and maximize your practice’s revenue, join me in The Private Medical Practice Academy membership.
https://www.thepracticebuildingmd.com/Work%20With%20Me#two-step
For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast
If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Employees often ask about taking leave through the Family Medical Leave Act, otherwise known as FMLA. As the employer, like when you own your own practice, you need to understand FMLA and everything that goes along with it.

FMLA allows employees to take an unpaid leave of absence for up to 12 weeks for medical reasons or family reasons. The first thing I want to point out is that FMLA is only applicable to employers who have 50 or more employees working at least 20 hours per week to comply with FMLA. Employees who have worked at a company for at least 1,250 hours during a 12-month period are eligible for FMLA.

Realistically, many smaller medical practices aren’t legally required to provide their employees with FMLA. It'a very likely that your employees will think they’re entitled to FMLA regardless of the size of your practice. This is why you need to have clear cut policies about leave and what your practice offers if you are not obligated by law to offer FMLA.

1. Develop comprehensive policies

Have a written policy that defines what type and amount of unpaid leave you will be offering
The policy needs to apply to all employees
Include the policy in your employee handbook

**2. Define the 12-month period in which the employee can access it

Determine the parameters of your policy**
Will you require your employee to exhaust all of their paid-time-off benefits before accessing unpaid leave?
Or can the employee choose whether to use PTO or unpaid leave? Now you may be thinking why would any employee want to take unpaid leave if they can get paid?

The whole reason is all of this is important is that you are trying to run a business. In order for your practice to run efficiently, you need to understand your staffing requirements. You need to think about how long you realistically can hold a job for someone who is out. And, of course, how you are going to staff their position during their absence. Having a well-defined policy will help prevent misunderstandings.

One of the most difficult situations though, is when, near the end of their leave, the employee requests that they need a different schedule. Under FMLA, the law states that you only have to guarantee that the employee has the same position to return to, or a similar position with the same hours and benefits. They are not obligated to accommodate a new work schedule after the FMLA leave is complete. If you have less than 50 full-time employees, you’ll still want a policy statement and I would recommend using FMLA as a guideline.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast
If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Types of malpractice insurance policies:

Claims-Made Coverage
- With a claims-made policy, your insurer will only cover malpractice claims if the claim is made against you while you are covered. With claims-made coverage you will need tail coverage if you leave the practice or insurance company.
Occurrence Coverage
- This is the broadest and most protective type of medical malpractice policy. With this policy, it does not matter when a medical malpractice lawsuit files, so long as the incident occurred during the policy period.
Claims-Paid Coverage
- With this coverage, the claim is not recognized until the indemnity pays out or the claim closes. The downside of this type of coverage is that if you do have a claim made against you, as long as your claim remains open, you will need to maintain coverage with the claims paid insurance carrier. This could mean years of paying premiums that you don’t want to pay until the claim is closed (often 3-4 years) or an even larger tail payment to get out of the policy if needed.

Factors affecting malpractice insurance costs

How much coverage you need will directly affect how much you will pay in insurance premiums.
Your prior claims history.
Where you work also factors into how much you’ll pay in insurance premiums.
Regardless of your location, claims history, and coverage amounts, certain specialties are always going to pay more than others.

Bring down the cost of your malpractice premiums when you are first starting out by selecting a claims-made policy with a maturation date. With this policy, the rates you pay increase over time from year one to year five.

What your malpractice insurance policy will cover and what it won’t

Will cover:

Any claim made against the medical provider because of bodily injury based on: the services provided, a lack of services provided or medical negligence on the physician’s part.
Legal counsel and covers your defense costs, both preceding and during trial (should your claim go that far).

Won't:

Sexual misconduct on the part of the physician
Illegal acts
Services performed while under the influence of alcohol or drugs

You need malpractice insurance for your practice in addition to each individual provider.

Before You Sign Up for a Policy:

Be sure to compare prices and policy terms from different insurers in order to make the most informed decision.
Read it thoroughly and make sure you are getting the most value for your money and that you understand what your policy covers (and what it doesn’t cover) before you sign up.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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There are several reasons that you should want to add RPM to your practice:

You can take better care of your patients
RPM can improve patient accountability
RPM can improve patient satisfaction
RPM can help your practice meet value-based reimbursement criteria
You can get paid for RPM

RPM refers to technology and practices that help practitioners track their patients’ health data remotely to design a treatment plan. It’s the process of combining remote patient monitoring technology with devices, and it enables the doctor to monitor vitals and other critical data remotely without the physician actually having to provide the service.

How does RPM work?

A device transmits patient information, usually through a mobile app, which in turn sends the data to the provider’s office.
Core requirements include being HIPAA compliant and EMR compatible.
The provider-side of the application must have these modules:
- analytics
- notification
- decision support
- report

How RPM actually works:

Physician writes an order for RPM
Patient receives the device.
Physician office can bill for set up/education as one time charge 99453
Patient sends 16 readings/transmissions to physician office and physician office spends 20 minutes on RPM per calendar month in order to bill 99457
If an additional 20 minutes are spent, you can bill 99458 (up to 2 x 99458 or 1 hour spent on RPM/month)

Things you’ll want to think about when choosing an RPM vendor:

What services does the vendor provide?
- Some vendors provide a software platform
- Some provide software + device
- Some vendors offer a completely turnkey solution
What is the fee structure for the vendor's services?
What additional staff do you need?

You will want to build out the revenue and overhead to understand your financial projections from the RPM component of your practice.

The key takeaways:

Remote Patient Monitoring provides many benefits for you and your patients.
There are many conditions that can be monitored and a variety of devices to assess them.
For RPM to be successful it requires the patient to be compliant with transmitting their data points. That means that everything about RPM needs to be easy for that patient or they will drop out. This should be your first and foremost consideration when choosing both the device and any vendor that you choose for your practice.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Physician compensation is often based on RVUs. But, in reality, RVUs actually have no monetary value. So in order to understand productivity and revenue you have to know what an RVU is, how it’s determined and how to determine what it’s worth. In this episode, you'll get all this info and more.

RVU stands for relative value units and are basic component of the Resource-Based Relative Value Scale (RBRVS.) RVUs define the value of a service or procedure relative to all services and procedures. It’s based on the extent of physician work, the clinical and nonclinical resources needed and the expertise required to deliver the service to the patient.

When you are actually coding and billing for a service, you do not assign an RVU code. You assign a CPT code. And each and every CPT code has a dollar amount assigned to it by CMS. When your practice receives reimbursement from Medicare or a commercial payor, they pay you according to the CPT code. There is no direct payment for any service based on an RVU.

Key point: You need to be able to convert back and forth between CPT codes and RVUs—it’s nothing more than a formula. Here's a link that will allow you to convert from CPT to RVU.

Under the RBRVS, payment for physician services is determined by:

Total RVUs
Geographic Practice Cost Indices (GPCIs)
A conversion factor

There are actually 3 types of RVUs that go into the calculation of the total RVU.

Work RVU
Practice expense RVU
Malpractice RVU

Key Point: The place of service significantly factors into reimbursement. CMS makes a distinction and organizes all places of service into 2 categories:

· Non-facility- usually refers to the physician’s office

· Facility - inpatient hospital—even if its an outpatient clinic in an inpatient hospital, ambulatory surgery center or skilled nursing facility

If you go to the CMS physician fee schedule lookup you’ll notice that for each CPT code there’s one amount of payment if done in your office (the non-facility) and another for the facility. Essentially CMS compensates you more if you perform the service in your office because you are incurring the overhead.

An RVU has to be multiplied by a dollar conversion factor (CF) to become a payment. The conversion factor converts the value expressed in RVUs to dollars and you can see the conversion factor on the CMS physician lookup schedule.

The final Medicare payment for each CPT code is the sum of the 3 geographically weighted RVU types multiplied by the Medicare CF.

[(work RVU x work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)] x CF = final payment

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the ste

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Baby boomers and household decision makers--the target demographic for most medical practices are on Facebook. In other words, your ideal patients are on Facebook right now. That’s why I want to talk to you about why you need a Facebook business page and what you are supposed to do with it.

First, Facebook is free. There’s no charge to create a Facebook business page. All you need is a Facebook account. And it’s quick to get started. There’s not a lot of time and effort required to set it up.

Reasons to have a Facebook Business Page:

You can build your patient community by posting content, engaging with your audience, and sharing. You can share knowledge and expertise that’s unique to your practice and skill set. This will immediately establish your competence, know-how, and authority as an expert.
Facebook provides a “voice of the customer”. One of the things that Facebook does is to facilitate communication in many directions…from you to them…from them to others…and from them to you. Listening to this interaction and feedback can really help you understand the needs and wants of your patients.
Facebook extends your reputation and branding message.
Facebook boosts search engine visibility and visitor traffic.
Prospective new patients come from Facebook.
And of course, Facebook is a great way to keep tabs on the competition.

What to post on your Facebook Business Page

Communicate how patients can make an appointment to see you, your hours, address, and any other information that you want patients to have.
Announcements--closures, practice updates
Share Facts About Your Practice
Highlight You and any other providers you have.
Provide information about your specialty and services you offer
Use your Facebook page to sharing patient testimonials
Share interesting articles that relate to your specialty

When you should post on Facebook, the best time to post on Facebook is between 12 p.m. and 3 p.m. Monday, Wednesday, Thursday, and Friday, and on Saturday and Sunday between 12 p.m. and 1 p.m.

Your Facebook Business Page is a great way to communicate with your patients and provides you with free marketing.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Salary is only part of the overall compensation package. Potential hires often rank benefits as one of the top factors impacting their decision to accept a job offer. Today I'll tell you about how to figure out what you want to include in your benefits package so that you can recruit and retain quality staff while being financially responsible.

When you are considering which benefits to provide, recognize that there are certain benefits that are required either by state or federal law:

Social Security
Medicare
Unemployment insurance
Workers’ compensation
Others:
- Uniforms
- Employment Training Tax
- Several states require compensating employees for time spent voting or serving on a jury
- Several states have health insurance required by law

Voluntary benefits:

Health insurance
Paid holidays
Paid time off
Retirement plan

When you are deciding on which benefits to offer, you will need to understand their costs. Each benefit, regardless of whether it is mandated by law or voluntary, can affect the profitability of your business. Make sure to assign a dollar value to each benefit when you are doing your financial projections.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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One of the questions that I’m frequently asked is whether physicians should join a provider network? First, let’s get the alphabet soup mumbo jumbo out of the way. IPA stands for Independent Practice Association and CIN stands for Clinically Integrated Network. Today, I’m going to talk about the things that you will want to think about when considering if you should sign up for one of these networks.

As a physician participating in one of these networks, you’ll be paid according to the provider network’s master contracts. I also want to be clear that you can also see patients outside of the insurers contracted through the provider network. You don’t have to limit your practice to only patients within the network.

Independent Practice Association (IPA)

Loosely formed alliances among physicians
Primarily focused on independent private practicing physicians
Main purpose for forming an IPA is for payer contracting
With the recent changes in reimbursement from fee-for-service to value-based, IPAs that aren’t not clinically integrated can’t effectively negotiate payer contracts

Clinically Integrated Network (CIN):

Consists of a group of providers who come together to improve quality and cost efficiency in healthcare delivery
Provide higher value to the consumer of healthcare services
Employ best practice, process improvement methodologies and measure true cost and outcome metrics via direct methods such as patient surveys and activity-based cost accounting methods
Facilitate referral optimization by matching patient needs with those providers best capable of meeting those needs
Contract for services on behalf of their members
Usually include a care management or care coordination infrastructure as well as an IT infrastructure that serves multiple purposes

In the end, you have to do the due diligence to make sure that you will be gaining enough—either in better contracted rates or reduced overhead—to make it worth joining a provider network.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Trying to figure out how much to pay your employees can be a very daunting task. On one hand, you want to pay enough to get the best possible talent. On the other hand, you don't want to overpay. In this episode, I’ll walk through how to figure out what salary to offer.

Establish a salary range
Salary.com will give you salary ranges by position and geography.

Decide the top amount you'd be willing to pay. The next step is to figure out the least you'll pay. You need to decide where that person falls on the spectrum with regard to your pre-determined salary range.

Decide How You'll Pay Your Employees

There are basically two types of employees: salaried and hourly.

Your office manager and other high level staff are typically salaried
Front office staff, medical assistants and any billing staff are typically paid hourly

Bonuses
Bonuses should be considered as part of your employees’ compensation packages. One major advantage of offering bonuses is that they give you, the employer, flexibility.

There are three major categories: p

Performance Bonuses
Non-performance based bonuses
Non-monetary bonuses

The takeaway messages are that you want to define a clear salary range with a set upper and lower limit for each position. Match jobs whose value comes with hours to hourly pay and jobs whose value comes in insight or skill to salaried pay. Use bonuses to align everyone around your business’ goals.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Everyone knows that there are lots of rules and regulations in healthcare. In order to help you complying with all of the complicated healthcare laws, I'm going to tell you why you need a compliance plan and what it needs to include.

Before I get started, I want to get one common misconception out of the way. A lot of people think that you only need to have a compliance plan if you participate in government insurance plans. The truth--every practice needs a compliance plan.

Why?
A formal compliance program is an indispensible part of an overall risk management plan for your medical practice.

Compliance programs address billing practices, anti- kickback compliance, state and federal self-referral prohibitions, state fee-splitting laws, licensure and accreditation requirements, labor relations matters, antitrust and price fixing prohibitions, HIPAA and medical records issues and a whole host of other state and federal laws.

The very first thing you need to do is select a compliance officer.

What goes into a compliance plan?

Standards of conduct for your employees
Determining what is medically necessary
Compliance plan for billing--regardless of whether you take government and third party payor or only cash
Compliance plan for how you market

Now that you know what needs to be included, how do you come up with the compliance plan?
You have to have written guidelines and manuals
You need to train your employees

What happens if there is non-compliance?
Your have to have a plan to address non-compliance is handled that defines how issues are reported and evaluated. And, of course, every aspect of the investigation requires a paper trail.

And one of the most important parts of a complete compliance plan is the audit. You can demonstrate your compliance by being proactive and auditing yourself. This goes a long way if you are ever involved in an investigation.

In the end, being compliant really is nothing more than having a tangible, systematic plan for doing the right thing.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Your website serves as the central hub for information about your business and a direct impact on your marketing efforts. You own your domain name and your website. Because of this, you control the content and who sees it.

Do I really need to have a website when first starting out? Yes!

Even if you are employed you can use your website to provide information. When you leave your current job, your website still belongs to you and your patients will find you.
Use your website before you open to market--"Coming Soon"
Provide information on scheduling and access to things like your new patient packet with its relevant forms and policies. And
Your website will help you compete with other practices.

What you need to launch a website:

A domain name
Verify the domain name you want is available
Purchase the domain name and related variations (if possible)
Sign up for auto-renew of the domain name
Website host service
Design the website--either do-it-yourself or outsource

Website tips:

Make sure your website is mobile-device friendly
Key information conveyed on your home page
Easy to navigate content
Search engine optimization (SEO)
- Add a blog
- Add custom content
Regularly update your website

Make sure to claim and verify your local listings in the various search engines like Google, Bing and Yahoo.

After your listing is claimed and verified, you'll need to fill out as much information as possible to make your listing stand out and improve your chances of showing up in search results.

Add photos of your practice
Add the hours you are open
Add a short description about your practice

Once your website is up and running, be sure to tell everyone about it. Put signs up all over your office including in every exam room. Talk about it on your various social media platforms.
In the end, you want to drive any and all potential patients to your website.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Here are 3 key things that you want to assess when assessing a bank’s quality of service:

You want a bank that demonstrates a firm understanding of a medical practice’s unique cash flow needs. As we all know, medical businesses function differently than a typical business. What services are offered to you and how much they cost is largely impacted by how familiar the financial institution is with medical businesses.
You want to understand the bank’s responsiveness. For example, how quickly are deposits credited to your account? Are capital requirements met in a timely and efficient manner? For example, if you have a line of credit with them—how easy is it to access? If you need a loan—how many hoops do you need to jump through. Everything — from tracking an important wire transfer to helping finance an expansion project — should be addressed with speed and efficiency. The bank is there to make your life easier—not be a nosebleed.
The bank should be easily accessible to answer questions; provide training on any account-related technologies; and offer insights into how it can meet your banking, financing and treasury management needs. Having a dedicated, single point of contact to address your businesses unique needs is crucial to understanding and anticipating challenges. Your financial partner should be easily accessible to answer questions.

Before deciding on a bank ask for references from other medical businesses.

Now I want to talk about products and services that you want your bank to offer in order to address the unique financial needs of your medical business.

Business checking
There are several factors that you are going to want to consider:

Is a Minimum Balance Required?
How quickly do You Have Access to the Funds?
How Often Will You Make Withdrawals?
How many deposits Will You Be Making?

Now that I’ve talked about banking (and essentially money coming into the bank), let’s talk about loans.

Revolving line of credit- borrow as much or as little as you need to meet your working capital needs
Term loan- to finance longer term investments like an expansion of your office or opening a new satellite office

Full suite of treasury management products and other services:

Lockbox services
Remote deposit capture
Biller and payment solutions
Fed EDI
Fraud protection services

While most physician business owners don’t spend a lot of time or effort in choosing the right bank for their business doing your due diligence will pay dividends. A good banker will improve your workflow, your revenue cycle management and compliance.

For a full searchable copy of the transcript, https://www.thepracticebuildingmd.com/podcast

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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You’ve scheduled your first patient. But that's only the first step in getting them to that first visit. You need a new patient packet.

The new patient packet has two purposes:

To collect information from the patient
To provide information to the patient

There are several ways in which your patient can access the new patient packet:

Through your EMR's patient portal
On your website
On your Facebook business page
A physical, printed folder

What goes in the new patient packet?

Information you get from the patient
- Registration form
- Insurance information
- Patient questionnaire and history intake form
- Medical records release form on file
- Release of information form
Information you give to the patient
- A comprehensive financial policy statement
- Credit card on file policy
- HIPAA policy statement
- Controlled substance agreement
- Patient responsibilities form
- Brochure with a practice overview and provider bio(s)
- Educational materials
- Directions to your office

The two key takeaways from this episode are that a professional, comprehensive new patient packet will help

You and your practice make a great first impression
Improve your practice’s workflow

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Revenue cycle management refers to the process of identifying, collecting and managing a practice’s revenue from payers based on the services provided.

The revenue cycle begins when the patient makes the appointment and ends with successful payment collection.

The first step in the revenue cycle happens when the patient schedules an appointment. Your best chance of beating the revenue cycle management game is to collect your money upfront. Pre-registering patients allows you to determine the patient’s financial responsibility.

Key points:

You need to have explicitly spelled out policies and procedures for your staff to follow.
You need someone in your office figuring out eligibility and then coordinating that information.
Know and collect what is due upfront

The patient visit

Complete your notes and drop the charge in a timely fashion. The clock doesn’t start ticking with regard to when the insurance company has to pay you until they get your claim.

Coding mistakes, billing errors because of duplicate data, missing information and misspellings all result in lost revenue. In order for a claim to go to the insurance company and be processed, it has to be a clean claim.

Once the claim get to the insurance company, the provider has less control over how long it takes for payment. However, knowing the rules of what’s a covered benefit, what’s defined as medically necessary and what documentation you need can go along way to saving you and your staff from the denial-appeal cycle.

Communicating with health insurance companies is a key component. Neglecting to manage the claims process after submission can result in pending, rejected or denied claims, or ones that were never received. In addition, you need to determine where problems originate if there are issues with specific procedures or codes, can help increase awareness and reduce recurrences.

Once the insurance company pays the claim, they'll send you an electronic payment directly into your practice checking account and an explanation of benefits. From there you either submit the claim to the secondary or move the accounts receivable to the patient's responsibility.

If you collected the money that the patient is responsible for upfront, there should be nothing left after the insurance pays. But, if this is not the case, you now need to send the patient statements.

Send out three statements—every 2 weeks. After that, decide whether you want to write off the remainder or turn them over to collections.

But the key is having a clear set of policies and procedures for every step of it that you control and actively manage it. Nobody watches your money like you.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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If you take any form of insurance as payment for your services then you need to understand MACRA and MIPS. MACRA is the law and MIPS is the implementation.

Key Points:

If you see more than 200 Medicare patients and/or bill more than $90,000 annually in Medicare Part B allowed charges, you’re automatically enrolled.
MIPS collects data and then you see the effect on your reimbursement 2 years later.

Why is participating in MIPS a big deal:

MIPS results in Medicare Part B incentive payments and penalties.
MIPS scores effectively market you—free advertising for exceptional performers, as well as potential liability for underperformers.
MACRA requires CMS to publish MIPS final scores and performance category scores on every MIPS participant within 12 months of the performance year through CMS’ online portal, Physician Compare and the database is available to third-party physician rating websites
You can use your MIPS when negotiating commercial insurance contracts.
MIPS scores are irrevocable since they become a permanent part of public record.
CMS ties MIPS scores to the practitioner so that scores follow the practitioner from one practice to another.
Key point: MIPS scores will impact patient attraction and retention, insurance contracting AND physician recruiting, contracting, and compensation plans.

How MIPS Works?

MIPS is a performance-based payment system that includes four categories. You as the clinician have the flexibility to choose the activities and measures that are most meaningful to your practice.

The four weighted performance categories are combined to create the MIPS Composite Performance Score (MIPS Final Score) and used in determining future Medicare Part B payment adjustments.

How many points do you need to be eligible to get the incentive?

Performance threshold: 60 points to avoid a penalty and start to earn an incentive.
Additional performance threshold: 85 points to earn additional incentives from the additional incentive pool of $500m.

Key Points:

Your final total score is compared to everyone else participating in MIPS. If there are more people who meet each threshold, then the pot of money for bonuses gets divided by that many people.
Higher scores earn higher additional incentives.

Links for more MIPS details:
https://qpp.cms.gov/mips/explore-measures?tab=qualityMeasures&py=2021
https://qpp.cms.gov/mips/explore-measures?tab=advancingCareInformation&py=2021
https://qpp.cms.gov/mips/explore-measures?tab=improvementActivities&py=2021
https://qpp.cms.gov/mips/explore-measures?tab=costMeasures&py=2021

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Today I'm going to talk to you about the steps you'll want to consider when setting up the process for scheduling a new patient.

There are 3 basic ways for a new patient to come into your practice:

Self-scheduled via your website or portal
Call your office and speak to a live person
Referral from another physician

Things you'll need to consider when setting up the process for scheduling new patient appointments:

Will the patient self-schedule or talk to a live person to schedule?
Do you want relevant medical records to review in advance of their initial visit?
How are you going to request those records?
How do those records get into your system?
How does the patient complete your new patient forms?
How do the forms get put into the EMR?
You need to inform the patient whether you take insurance and who you are in and out of network with.

Key points:

If your forms are not completed via a portal, they will need to be manually placed into the patient chart.
If records or forms come as paper, they will need to be scanned into the system first.
You will need a HIPAA compliant secured email server to send emails.
Collect the patient's insurance information at the time of scheduling and communicate your financial policy.
Make sure it's easy for patients to schedule, reschedule and cancel appointments.

No matter how robust your EMR/practice management software, you have to define the process. Going through and setting up each and every step from the very beginning will improve your efficiency and productivity and greatly improve your patient's satisfaction.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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With all of the choices out there, choosing an EMR can be a daunting proposition.

Today I'll talk to you about the key features that will impact your workflow and ultimately your profitability.

But first, I want to address everyone's biggest concern—the cost. Don't sacrifice functionality, integration and flexibility for price. Your lost productivity will cost your more in the long run.

Software that knows the order of operations for your practice and helps guide users through them can save time for current users and decrease training time for new users.
You want an EMR that can be customized to your practice's workflow.

Scheduling Features

You want your scheduling to be done through your EMR.
You want to make sure that the scheduling feature tool can be customized to meet your practice’s specific needs.

The key takeaway here is that the scheduling features should improve your productivity by centralizing a lot of your workflow processes.

Charting

How many keystrokes are needed to complete a note?
How many pull down menus are there?
How many pop-up windows there are when you complete a routine note?
If you click on something does it take you to a totally separate page for you only to have to navigate back to the main page?

Each of these questions translate into a time calculation. If your EMR is cumbersome, you won’t be able to actively engage with patients, your patient satisfaction will be poor and you’ll be charting long after the visit is over.

Customizable templates that are capable of learning are the key to speeding up the charting process and improving your productivity.

E-Prescribing

The EMR should track medications that have been prescribed to your patients, notify you if any of their medications have potential interactions with other medications they’re taking, or with any allergies they may have and, offer an alternative if available.

E/M Coding

One of my favorite features is the ability for the EMR to suggest an E & M code based on your documentation.

Lab Integration

If you have a lab or imaging-dependent practice, you are going to want an EMR that is capable of automatically adding ordering tests and receiving results that are placed into the patient’s chart. This saves time by not having to manually enter each lab/image result.

Patient Portal

Patient portals are a great way to:

Help educate patients
Book, reschedule and cancel appointments
Allow patients' access to their medical health information
Share newsletters, offer preventative care recalls and targeted health promotions

The takeaway #1 EMR feature that you want is flexibility.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Every healthcare provider I know complains about the hassles associated with their EHR charting.

When you’re an employed physician, you basically get stuck using whatever software your employer has purchased, and it’s super easy to complain about something that you have no control over.

But when you are the practice owner, you choose the EHR--an admittedly overwhelming process. And before we get started, let me explain the difference between EMR and EHR. EMR stands for electronic medical record. Restated, this is your note. EHR stands for Electronic health record. This includes all sorts of other documents including lab and imaging results, notes from other providers and all sorts of miscellaneous documentation.

Determine whether you want an EHR that’s enterprise or cloud based. enterprise-based
Enterprise-based EHRs live on your server or servers in your office
- Do you have a server?
- How much does a server cost?
- What happens when the server goes down?
- Do you have in-house IT person for when your server isn’t working?
Cloud based EHR sits in the cloud and can be accessed from any device.
- You don’t need a server.
- You need a stable internet connection
- Bandwidth and internet speed affect performance

There are obvious differences in the costs between enterprise- and cloud-based products but the cost differences may not be as great as you would initially think.

Tip: Create a spreadsheet so that you can compare all of the costs.

What type of infrastructure do you need and what does that cost? (Servers vs. wiring for the fastest internet connection)
Cost of the internet service with the bandwidth needed to run a cloud-based program.
What is the purchase price? And what does that include?
For the enterprise-based is there a yearly maintenance fee?
Costs associated with cloud based—how much do you pay per month? Is it by user? How often do they raise their prices?
Determine whether you want a standalone EHR and standalone Practice Management Software or an integrated product.

EHR and Practice Management Software are not the same thing.

EHR--all of the clinical info
Practice Management--the business side of medicine
- Eligibility, prior authorization, billing, and patient statements
Scheduling can be part of EHR and/or Practice Management Software
And you need both in order for your practice to function.

Deciding whether you want an enterprise based system or cloud based system and whether you want a standalone EHR with standalone Practice Management software vs. an integrated product will have the biggest impacts on your budget and workflow. These decisions will also guide your consideration of specific vendors and their products.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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One of the first questions that everyone asks is—"how much staff do I need?" You’re not going to be able to answer this question without defining your work flow. This is obviously a multi-step process so I'm going to break it down into segments.

First, you need to think through every step that occurs. Then, you’ll need to drill down and identify each task that goes into completing that step. From there, think about how long each task takes to complete for each step. With this information you will be able to write the job description for each position you need to fill and how many man hours are required. Then you'll know how many full-time equivalents (FTEs) you need.

The first step we are going to consider is your referral process.

For patients who self-refer:

How does that patient make that first appointment?
Do they schedule directly using one of the online scheduling services or do enter their data through a portal on your website?
How does that integration happen with your practice management software?

And to go along with this—the patient may have created an appointment, but someone needs to make sure that a patient record is created in the EMR and populated with the correct demographic and insurance info.

For patients referred by another provider:

How does that referral come in?
Is it on a referral form that the other physician’s office faxes to your office?
How is that referral form going to get to the potential referral source?
Can the referral source complete a form on your website that gets transmitted to your office?
Do they have to print out the form and fax it? Or do they fill out the form and efax it?

Ultimately, someone has to convert that referral into an appointment. And create a patient record in your EMR.

Do you want to review medical records before the initial visit?

How are you going to educate your referral sources to send the relevant medical records with the referral?
How do the records get to your office?

How does that referral in turn convert to a scheduled patient?

Online scheduling software
Through your EHR portal
Does someone call the patient to make the appointment?

How is the amount that the patient owes you at the time of the initial visit determined?
How is that information communicated with the patient?

Once you are have worked through the answers to the above questions, you will have the framework for writing out your referral process. That, in turn, will help you as you work through your staffing needs.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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The recent ice storm and its devastating aftermath is a great reminder for why every medical practice (and actually any business) needs to have a plan for deciding whether to close in the context of a natural disaster.

When Hurricane Katrina hit Louisiana in August 2005, I had 7 providers and 30 staff members. At that time, I didn’t know what to anticipate nor did I have a well-designed plan. The good news is I learned some very valuable lessons and I’m going to share them with you.

Lesson 1: Identify the decision maker

And then, decide when the determination to close is going to be made and communicate that.

Lesson 2: Clearly communicate with your staff

Once you've made the decision, you need to have a communication plan

If everybody is still at work, here are some options:

You can have a 5 minute staff meeting where you communicate the plan.
You can send out an email.
You also want to know what each person's plan is so that you can plan accordingly. It’s hard to reopen if you have no staff or providers available.

If a decision whether to remain open or close is made after hours:

You need to have a list with every member of your staff’s contact information including cell phone number, home phone and email address.
Identify who is responsible for contacting providers and staff.
If there are more than a couple of people to contact, create a phone tree.

Lesson 3: Let your patients know the plan

If you are going to remain open, there are a number of ways you can let your patients know what’s happening.

Post on your website.
Use your social media channels to post notifications.
Change the auto attendant message on your phone to convey the information.
Use your patient reminder software to either call or text people with a status update.
Don’t be surprised if many of your patients cancel or no-show.

If the decision is to close your office, you will want to add some additional steps.

Set up a pre-recorded automated message using your patient reminder software.
The message should also instruct the patient on how their appointment is going to be rescheduled.
You need a written protocol for how to implement the deployment of this message.
Notify your local radio and TV stations as well as the newspapers.
If you have an answering service, make sure you have a script with a clear set of instructions for patients so they can communicate with the patient without forwarding those calls on.
Equip whoever will be contacting patients with a clear script that includes how to handle questions about rescheduling and med refills.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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How you design and equip your space speaks volumes about you. And, while you don't have to be an interior decorator, there are a couple of key things you want to consider: comfort and functionality.

In this episode, I will give you practical tips for designing and equipping your space.

Here are the highlights:

Entrance to your space:. You need very clear signage to your business
Your waiting room
- Paint over wallpaper
- Carpets, drapes, upholstered furniture and acoustic ceiling tiles decrease sound absorption.
- Seating-fabric (durable, stain resistant and washable) chairs
- Distractions-reading materials and medical TV services
Front Desk
- Work chairs--ergonomics are the key
- Equipment layout--position so your staff can reach everything
Exam Rooms
- Exam table--comfort and easy to adjust are the most important features
- Two side chairs
- An adjustable stool
- EHR-desktop vs. portable
- Waste receptacles and Sharps
Break Room-yes you need one
- Coffee maker
- Fridge
- Microwave
General Office Space-create open workspaces
Your office-the one room you can decorate any way you like

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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How large does your office need to be? The general rule of thumb is 1200 to 1500 square feet for the first physician and 1000 to 1200 square feet for each additional provider. In order to drill down to your specific needs, you'll need to understand your clinic's flow.

First impression--your waiting room
Your waiting room is where your patients get their first impression, so you are going to want it to be inviting. How big does your waiting room need to be? The optimal size depends on a few factors, including the number of providers in the practice, your visit volume and the overall efficiency of the practice.

Next—Think through your operational needs

Long before you ever go to look for space, sit down and write out every step of your clinic flow. How do patients move from one part of your space to another? How much staff will you have? What are their roles? How many patients will you see in an hour? What equipment will you have? How much space does it take up?

Traffic flow & accessibility in the clinicProductivity is enhanced with every step you save. Having a circular traffic flow that leads from the waiting room, through reception to exam rooms, and back out the reception is a particularly effective layout.

How many exam rooms do I need?

As a general rule, the optimal number of exam rooms to start with is 3. One room for the patient who being teed up for you to see, one for you to be in and one for the patient you just saw and who needs to be checked out. Now obviously that does not take into account any other factors like having a room for procedures, x-rays or non-invasive testing. You will need to take those additional services into consideration when deciding on the number of rooms.

An exam room should be at least 10 feet by 10 feet. You’ll want each room should have enough space to comfortably accommodate you, an assistant, your patient and at least one family member. You will also need to think about wheelchair accessibility.

Workstations
This is where thinking through your work flow is so absolutely important. I’m sure that you have been to medical offices where all of the office equipment is grouped together in the receptionist area, there’s one space as the nurses’ station and another for the doctors’ work area. If you critically evaluate this set-up you’ll see that this is probably not the most efficient use of their space.

When you or your staff need to go to a central hub, bottlenecks form. Instead of keeping all of your fax machines, printers, files, and office supplies and computers in the front office, think about moving some of those resources back to the work area. And, everything patient-related needs to happen in private. Keep the workstation area clear of any sensitive information. Store all private patient information, diagnoses, billing, treatments or medications in locked cabinets.

The key: efficiency and productivity is all about the flow.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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You’ve decided to rent a space for your new business. Now you need to negotiate the lease terms. One of the most significant components is going to be the tenant improvement (TI) allowance.

One of the first things you want to understand the difference between grey shell and vanilla shell and the impact on your lease rate and tenant allowance. Most landlords offer some type of allowance to finish the space and this needs to be negotiated into the lease or purchase terms. Typically, the longer the lease term, the more generous your landlord is going to be.

Because tenant improvements are part of the lease agreement and negotiated along with the rental rate and lease term, the tenant improvement allowance does not have to be repaid.

And, when you are comparing different properties, key in mind that you need to look at the total cost of the rental package. And obviously, lease rate, lease duration and amount of tenant allowance are all linked.

As a tenant, your goals for negotiating tenant improvements should be to 1) get an allowance sufficient to cover planned improvements, and 2) maintain a high amount of control of the build-out.

In order to negotiate, we need to understand how tenant improvement allowances are typically calculated. The average tenant improvement allowance amount is based on a negotiated dollar amount per square foot. depending on the property condition and the state of the real estate market.

Alternatively, you may ask for a turnkey buildout rather than an allowance per square foot. In this case, the property owner is responsible for financing and completing all the negotiated improvements before you move in. However, this method is usually negotiated along with a higher rental rate because the owner takes the risk of the upfront improvement costs.

Here are some other details you are going to want to consider:

When negotiating over construction details you want to put in language that speaks to liability for delays and cost overruns. As delays cause you to incur holdover costs and office set-up inconveniences, you’ll want accountability for delays from the landlord if the landlord is managing the construction.

The date of first rent paid can be a contentious negotiation point, as landlords will expect rent as soon as their architect declares the space to be ready. On the other hand, you will want to wait until you’re moved in and operational to write the first check.

If you are looking for a shorter lease you have less bargaining power. On the other hand, the tenant improvement allowance is an outstanding benefit, and you should enter negotiations prepared to negotiate hard for it—especially if you are planning to sign a 5 year lease.

Remember, TI allowances can be written off by the landlord as a capital improvement expenses or lease acquisition expenses, and are considered part of the cost of doing business.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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There are 4 basic lease types--gross lease, full service lease, gross industrial lease, and triple net lease-- and it's imperative that you know the differences between them in order to compare the rates and understand what you are getting for you money. You need to know the terms that are most commonly used in leases because they ultimately impact the quoted rate.

Gross lease is the simplest lease form. The tenant simply pays a stated amount each month. The landlord takes care of everything else; the rate does not change. Any increase in the cost of these items is simply absorbed by the landlord.
Triple net lease is almost the reverse of the gross lease. There is a quoted base rent but that’s all you get. The tenant’s responsible for all the costs incurred in order to operate the space. The landlord also will provide some of the services needed for the common area and the costs associated with maintaining these areas are known as the common area maintenance charges (CAM). These CAM charges the expenses not specific to a tenant. They are split on a pro rata basis.
Full service lease is similar to the gross lease except that it contains provisions to pass on escalating costs to the tenant. The landlord quotes a rate that includes paying the taxes, insurance premiums, utilities, and CAM. In order to protect themselves from escalating costs the landlord will include either a base year or expense stop. A base year approach, the landlord represents that the quoted rate will include the costs that were incurred for taxes, insurance and CAM equal to what was spent in a given year. An expense stop is similar to a base year except that instead of using the actual number for a given year the landlord simply quotes an amount. If the expenses are higher than that the expense stop amount the tenant has to pay their prorata share of the increase.
Gross industrial lease which is similar to the triple net lease except that the lease rate includes the payment of taxes and insurance. And, the tenant is responsible for paying any increase over the amount of taxes and insurance for a given year much like a base year.

One of the major differences between the four types of lease relates to repairs and maintenance. In the full service lease and gross lease the landlord is responsible for repairs and maintenance and the estimated cost of these is included in the quoted rate and the quoted base year or expense stop. In a triple-net or gross industrial lease the tenant is responsible for the repair and maintenance of the space.

A quoted rate of $18.00 has different implications based on the lease type. You have to understand the lease type and how the expenses are going to be handled to accurately project your expenses.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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I’m frequently asked—Should I rent or buy the space for my new practice or business?

Regardless of whether or not you want to initially rent or buy, there are a number of considerations:

How soon do you want to move into the space?

Let’s say that you want to start your practice or business in the next 6 months. If you want to buy the space, you’ll need to go through the due diligence, get financing, and do the buildout you want--a process that's likely to take more than 6 months.

On the other hand, if you are looking to rent, you’re likely to find the space in a much shorter time period. The only significant time-limiting factor is the time that you’ll need for tenant improvements.

Do you know where the best location is for your new business?

You need to think about things like the ease of getting to your location, getting into your parking lot, getting to your space and more. Look, you could have the nicest space but if it’s a pain to get to, you’ll lose patients. People follow the path of least resistance. If it’s a hassle to turn into your parking lot or there isn’t enough parking spots, people will get turned off.

Do you understand your clinic flow?

When you are starting a new practice or related business, you need really understand your business’ flow. You need to walk it, do it –exactly as you would once you move in so you can identify the limitations. I can’t stress enough how important it is to do this. You can think it, and you’ll fool yourself into thinking you have every step down. I’m here to tell you that unless you physically walk through each step and write it down, you will miss something. And you want to know what you’re missing before you move in—especially if you are buying a place.

Fourth, how much space do you need?

When you are first starting out, how much space do I need is one of the hardest questions to answer. On one hand, you want to have enough space to function efficiently. You want to utilize all the space that you have. On the other hand, you don’t want to have more space than you need.

Yet, you want to have enough space so that your business can grow and expand without you having to move. You don’t want lack of space to limit your productivity.

Lets talk money.

Remember that you will have other start-up costs before you open and then operating costs that you will need to cover until you turn a profit. If you buy a property you may end up with a mortgage for the property in addition to a loan for your initial business costs.

Buying straight out of the gate definitely increases your risk relative to renting. When you rent, you minimize your risk. It takes time to really understand your business needs. Renting until you know what you truly want out of the space and what your growth is going to look like. It is by far the easiest, least expensive way to get started and to be able to scale.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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As of Jan 1, 2021, E & M coding has changed and I’m willing to make a bet that you find the whole thing confusing. Honestly, E &M coding has ALWAYS been a source of confusion.

The good news? The new changes have actually streamlined the process (to some extent.) But, as with all changes--you have to learn the new rules.

While there are multiple changes, the 3 big ones are:

99201 (Level 1 new patient visit) has been deleted. I doubt this affects most physicians—I can’t really think of an instance where anyone was billing this code—which is probably why they got rid of it.
You can now bill an additional 15-minute prolonged services code with 99205 and 99215.
The biggest however are the changes in how you code for E &M office-based services.

In this episode I'll tell you about what these changes mean to you.

The new guidelines have eliminated the history and physical as elements for code selection.
Yes, you will still have to include these sections because it's part of good patient care.
Yes, you'll still get coding credit because both the pertinent history and relevant physical exam contribute to both time and medical decision making which are the new criteria for coding.

Coding E & M office visits will be either by total time or medical decision making (MDM):

You can bill by time--but the definition of time has changed
- Face-to-face: Time a provider spends directly interacting with the patient and/or family or caregiver.
- Non-face-to-face: Time the provider spends managing the patient outside of an encounter, such as before and after direct patient care.
- Total time: is defined as the overall time on the day of the encounter during which a provider provides services related to patient care, even if the times are not consecutive. The time spent over the course of the day is totaled, with the day starting at 12:01 am and ending at midnight. The time calculation includes a provider’s face-to-face and non-face-to-face time.
- Total visit time is the only thing that counts now.
You can bill by the level of medical decision-making--but there are changes
- Fewer ambiguous terms and concepts
- Better definition of several important terms
- Redefined data elements move from simply adding up tasks to focusing on how tasks affect patient management.
- There will still be three MDM subcomponents number/complexity of problems, data, and risk.

The changes to the E/M office/outpatient CPT codes and guidelines for new and established patients apply to all traditional Medicare and Medicare Advantage plans, Medicaid, and all commercial payers.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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More likely than not, you are trying to get contracts with multiple insurance companies. And, in case you haven't figured it out yet--there are multiple steps in the contracting process.

At this point you may have already made the initial contact to provider relations department requesting a contract. The health insurance company will send you a contract. You may be wondering...and then what?

During this episode, I'll walk you through your next steps to making the contracting process easier.

Step 1: Be organized

Print the contract and all communication
Put the contract in order
Use a color-coded binder to differentiate between insurance companies
Label everything, use dividers
Don't throw anything away--keep all documentation for future reference
Memorialize every conversation with the insurance company including names, dates and summary of the verbal statements

Step 2: Assess your and the payer's positions

Avoid the temptation to think "I HAVE to be in network"
Evaluate the health insurance company's network.

The goal here is to make sure that you are signing up to be in network with an insurance company that is actually to your benefit rather than just signing up to sign up. This is ultimately one of the keys to working smarter, not harder.

Step 3: Understand the Key Terms in a contract before you start to read it

Type of Agreement:
Amendment
Term, Termination, and Renewal
Claim Filing and Payment
Compensation

Step 4: Skim the Contract

Skim the agreement the first time through, locating the key data that you outlined in your checklist. Focus on what matters most, and don’t get lost in the verbiage. You’ll notice that the reimbursement is always an attachment at the very back of the agreement. Don't allow yourself to get bogged down by the recitals and definitions at the very beginning.

Step 5: Read the contract

Get an electronic copy of the contract and make red-lined changes as you go. Make sure that you turn on your track changes so that it's easier to identify changes.
It's better to give your own proposed language rather than allow the other side to paraphrase your thoughts.

Click here to get your checklist of the key contract terms.

If you would like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.drsandraweitz.com .

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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When you are first getting started you are so preoccupied that it's easy to lose sight of how important it is to nail down your payor agreements.

You may be thinking, "let's just get a contract in place so I can start getting paid." Or, "I HAVE to participate with this payor."

But I want you to take a step back to realize that you are literally making a decision that's going to potentially cost you 10-20% of your professional fees from that payor for the next 10-20 years.

Why? Because you are establishing your base rate. So when you go back to renegotiate your rates in the future--the initial (low) rate is where you are starting from.

Once you get your initial contract offer, you are likely going to want to negotiate the details. In this episode, I am going to tell you the first steps to getting better rates.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Sign up for the How To Start Your Own Private Practice waitlist! People on the waitlist get early-bird access to the Course starting December 16, 2020, receive a waitlist-only di$count on the Course and additional bonuses!

One of the questions that everyone asks is "How long is it going to take?" And the question is the same regardless of whether you are looking to start your practice, add a provider or satellite or totally new revenue stream.

You can't decide run a marathon if your idea of exercise is pushing the buttons on the remote control. The answer to how long it takes is similar to a "Couch to 5K" except in this case it's Couch to Opening Your Doors.

Realistically, from idea to implementation, on average, takes six months. But I want you to recognize that there are a few key steps that affect this timeline and that really require your attention at the very beginning.

Your decision on whether to take only cash or accept insurance
- If you are planning a cash only business--no worries
- If you are planning to take insurance--regardless of whether you will be in-network or out-of-network--this step takes at least 3 months.Start now!
Figure out your new space
- How much space do you need?
- Are you renting or buying a space?
- How much renovation is needed?
- Obviously, some renovations may take longer. You may need permitting and the renovations themselves take time.
- If you are buying a space this will also take longer especially if you need financing.
Money (that dirty word)
- If you don't need financing for your start-up and initial operating costs and you don't need a mortgage (if you are buying)--great--this won't affect your time to open.
- If you are need financing from a bank to cover your start-up, initial operating costs or mortgage--this step can take a significant amount of time. You will need to have:
  - Your financial projections for your revenue ramp-up
  - Projected start-up expenses and operating expenses
- In order to have your projected start-up expenses and operating expenses you will have to estimate your personnel needs, furniture and equipment and other expenses.
Furniture and equipment
- Determine whether you need some special piece of furniture (like a built-in) or a specific piece of equipment in order to open your doors as early as possible. This is the last thing that you want to stand in the way of getting your doors open.

You can mitigate the issues that are most likely to cause a slow down by being proactive.

For a complete list of the steps to starting your own practice, download my free cheat sheet here.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Doctors are sometimes so focused on delivering their medical expertise as a commodity that they seem to forget the customer service component of providing care. Have you ever thought about whether patients are clients or customers?

In this episode, I am going to tell you the very personal story of my recent visit to the ER with acute onset complete heart block. My (surgeon) husband and I will tell you that being a patient and family member gives you a totally different perspective.

The key takeaways are:

Communication is key between all team members
Make sure that your messaging (as the physician) is consistent
Patients need explicit instructions (even doctor patients) and are looking to you for clear, definitive answers.
Patients don't like the run around or having to make multiple calls to your office. I know that we all get annoyed by those patients that are difficult or who are repeatedly calling our offices. But having been on the other side I will tell you that you need to make sure that your staff is not contributing to the repeated calling and patient frustration.
Your office staff is a reflection on you. Make sure that they are delivering the best customer service.
Act like a secret shopper and assess your office's customer service
Do patient satisfaction surveys so you understand (and correct) any weaknesses--before the poor online review.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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What is CAQH?
CAQH (Council for Affordable Quality Healthcare) is nothing more than a giant database of credentialing information. Insurance companies and other credentialing entities pay to access the information but is free for YOU, the provider.

What does CAQH do and why is it important to you?

If you want to be credentialed by an insurance company, you have to send them a whole bunch of documentation--licenses, proof of malpractice, your DEA/state CDS and more. And when each document expires, you have to provided updated documents.
Using CAQH allows you to upload the documents in one central location and have them disseminated to insurance companies rather than having to send the documents to each individual insurance company. It will save you a huge amount of time.
CAQH does not submit application to the insurance companies or complete the credentialing process for you.

How to register with CAQH?

Have all of your documents ready for uploading. Make sure your CV is updated. You'll need your license, DEA/CDS, proof of malpractice, CV, W9, proof of board certification, diplomas, and proof of hospital privileges (if applicable.)
Have three professional references
If you are starting a practice you'll also need information about the new entity: the legal entity info, tax id #, address (including payment and correspondence if they're different), billing company info if you are outsourcing, credentialing contact, billing contact, hours of operation, phone/fax, group NPI (if you have multiple providers) and your NPI.
Once you have everything ready, go to https://proview.caqh.org/pr/registration/selfregistration
At the end of your application you need to grant access to the payers. In order to do this you MUST submit a signed ATTESTATION form provided by CAQH.
Once you have signed and dated the attestation, make sure to upload the document (or nothing will happen).
Save your CAQH ID#, user id and password in a safe place. Check CAQH at least every 60 days to make sure there's nothing that needs attention.

Can you do this yourself? Yes, absolutely. The majority of the time and effort comes from gathering all of the information. You will need to do this part regardless of whether you enter the data in the portal or you outsource it.

Click here to get my free How To Start Your Own Private Practice Cheat Sheet.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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You have made one of your first major decisions. You want to take be in network with at least one insurance company. But now what? I bet you are wondering where do I start?

In this episode, I will walk you through

When you should start the whole contracting process
How to figure out who are the insurers in your area
How many insurance companies you should initially contract with
And, the steps you need to take to get a contract

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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The reason to write a business plan is for you. Sure--you may eventually show it to someone else--like a partner or if you are trying to get financing. But the real reason is that it is a road map for you and your business.

Your "why" for writing a business plan is that the clearer the plan, the more detailed with the specifics of execution, the more likely you are to succeed. Why? Because business success is based on data driven analysis--not wishful thinking and an idea. And, of course you want to have a plan to set yourself up transform your idea into a successful reality.

Here are the key components of the business plan:

Executive Summary
- Even though this is first, write it last
- Essentially this is your elevator pitch
Company Description
- What problem do you solve?
- Who is your ideal client?
- What's your niche?
Market Analysis
- Who's your competition?
- What can you do better?
Organization
- How is your business organized?
- Who's responsible for running the business?
Service
- What service do you provide?
Marketing
- What is your marketing plan?
Financial Projections
- First year--monthly--outlining your ramp up of revenue, your start up and operating expenses
- Subsequent years can be projected either quarterly or annually

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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How many patients or clients do you need in order for your practice or business to be full (at capacity)?

In order to figure out how successful your business is going to be or how to scale it depends on understanding your capacity.

The answer is--it depends. Now there are some simple formulas to figure out the panel size that you will need but they really don't flesh out the whole picture. Panel size refers to the number of patients or clients that you need to have a full business. Here is one of those formulas:

Panel size × visits per patient per year (demand) = visits per provider per day × number of days worked per year (supply).

For example, if a physician provides 20 visits per day, 220 days per year, and see the average patient for two visits per patient per year, the ideal panel size would be 2,200.

You can quickly see from this example that it does not take into consideration the type of visit (new patient, follow-up or procedure), how much time is spent per visit (which obviously depends on the service offered) and more.

In this episode, I talk about some of the considerations when figuring out what your capacity is. You will need to consider how many people can utilize your service in any given day, how often they will need the service and how many people you can accommodate in any given day.

So why do you need to figure this out? For a couple of big reasons:

You will need this information in order to come up with your financial projections including your ramp up.
Everything from space to number of employees and more depends on understanding this number.

I totally get that you may not have all of the answers. You will have to make assumptions. But let me reassure you that these assumptions can be based on information that you have readily available. Where? Right in front of you. Look at your current situation--how many new patients and follow-ups? How long do you spend with each of them? If you are looking to add a service or another business--what does that utilization look like. For example, if you want to start a Physical Therapy center and are currently referring to PT--what does your script look like. Hint--I would write for 3x per week. And most commercial insurances and Medicare will cover up to 12 weeks.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Take advantage of my free masterclass on How to Write a Business Plan:. Register here.

Are you thinking about starting a new business? Really, it doesn't matter whether it's a new practice or one of the multiple medically related businesses (Imaging Center, Surgery Center, Physical Therapy, Massage and more)--you will need to figure out who your competition is.

In this episode, I discuss how to assess your competition and ways to position yourself.
Three of the big takeaways--

The more you can identify the holes in what your competition has to offer and then use them to define your niche--the easier to compete
The client customer service experience will help differentiate you from everyone else
You can compete with the big organizations by offering better customer service--even if you just get their overflow. You can have a very successful business just from overflow.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Are you trying to figure out whether you should take insurance? Are you considering having a cash only business? How do you figure out the right answer?

In this episode, I'll address the factors that are fundamental to making the decision of whether you should take insurance.

The most obvious factor is whether the service you are offering is covered by insurance. If the service or business (e.g. float center or yoga studio) is not covered then of course it's cash pay. On the other hand, if you are thinking about starting a private medical practice where most of the services you will offer are going to be covered by insurance. In this case, it is your choice whether you want to accept insurance.

Here are some of the factors that should go into your decision-making:

What is the service or business you are offering?
Who is your ideal client?
- Demographics
  - Do they have insurance?
  - What is their Income level?
What is your competition doing?
- Do they take insurance?
- How do you figure that out?
How many patients do you need in order to make the service or business profitable?
- How large is the catch area?
- How much competition is there?

Deciding whether you should take insurance needs to be based on real data rather than emotion. Understanding and evaluating these factors will help you to mitigate the risks of starting any new venture.

Look out for my FB Live where I will be answering questions about this podcast episode.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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There always seems to be a great deal of confusion about credentialing and contracting. In this episode, I'll talk you through the differences and give you some pearls on navigating the "system." Really--it is very straightforward.

If you are all Cash Pay--you don't need to worry about being either credentialed or contracted.
Credentialing is the equivalent of the good housekeeping seal of approval. It means that the insurance company "recognizes" you. It has absolutely nothing to do with money--meaning how much the insurance company is going to pay you.
You need to be credentialed regardless of whether you plan to be in network or out of network.
You can use CAQH Pro to apply for credentialing with multiple insurers--and it's a free service. Here the link: https://proview.caqh.org/Login/Index?ReturnUrl=%2f
Get all of your documents together before you even start--this is the part that takes the longest time.
Here's a list of the documents/info you need to get started:
- License to practice
- DEA and CDS certificates
- Education and training
- Board certification
- Work history
- Malpractice history (NPDB)
- License sanctions (NPDB)
- Medicare/Medicaid Sanctions (NPDB)
- Hospital privileges
- Current malpractice coverage
If you are going to be out of network, you do not need a contract. You only need to be credentialed.
If you want to be in network, you need to have a contract.
Many insurers will allow you to go through the credentialing and contracting process simultaneously
Credentialing and Contracting take a long time--way longer than you think (like 3-6 months)--Plan ahead

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Are you thinking about starting a new practice or adding an ancillary service? Are you considering adding an additional business like an imaging center or ambulatory surgery center? Understanding your payor mix is fundamental to any financial projections for your new project.

What does payor mix mean? The breakdown of all of the sources paying for your service. There are basically 3 categories: cash, insurance (out-of-network), and insurance (in network). Out of network insurance is essentially the same as cash since you can balance bill.
What is an example of a payor mix?
- Medicare-25%
- Commercial-55%
  - Blue Cross-28%
  - United-18%
  - Aetna-9%
- Self-pay (Cash)-20%
Why is the payor mix important? If you accept insurance then you are likely to have different contracted amounts for the same code. Therefore, your overall reimbursement is going to be a blend of rates based on your payor mix. As you build out your financial projections for your business plan you will need to have this information.
How do I figure out the demographics? Here is a link that will give you a breakdown in your catch area.
Where can I find the Medicare fee schedule? Click here to access the Medicare fee schedule. Make sure to look for the rates for your specific geographic area. This fee schedule will give you a starting place for understanding rates.
What is an example of blended reimbursement? The blend of reimbursement as a function of your payor mix percentage. Use my calculator to determine this.
I have created a plug-and-play calculator for you to determine your payor mix and to determine your blended reimbursement rate. Click here to get your calculator.

The purpose of this episode is to show you how understanding your projected payor mix will help you assess opportunities. I will discuss strategies for changing your payor mix to maximize revenue in a future episode.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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In this episode, I talk about assessing an opportunity. For starters, what is an opportunity? Anything that you want to invest in. This may include starting a private practice, adding providers as well as adding a new service line or business. Regardless of what opportunity you are thinking about, the factors to consider are the same.

So what are those factors?

Demographics--who exactly is your ideal client for this new opportunity? You can check out https://datausa.io for demographic info. Using this site you can get information regarding age, gender, employment, healthcare and more.
Catch Area--how large is the geographical area needed to provide enough clients to make your new opportunity successful
Payor Mix--the same website, https://datausa.io, will give you information regarding what is the % uninsured, Medicare and commercial insurance for a particular demographic or catch area.
Competition--don't let competition scare you. But you do need to understand it.
Cost of Doing Business--obviously, places with a higher cost of doing business require better demographics, more patients, larger catch area and/or better payor mix

The purpose of this episode is to help you understand the information you need to collect in order to make the most educated decisions in evaluating how great an opportunity is.

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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When I moved to Baton Rouge, I was the only fellowship-trained pain management specialist. My multi-disciplinary, multi-modality approach to treating chronic pain also allowed me to differentiate myself. Marketing was super easy because I offered tangible advantages. When I negotiated with insurance companies, I was able to secure better contracted rates by spotlighting how I was different.

Carving out a niche for yourself can be an excellent way to increase patient referrals and command higher paying rates from insurance companies. In this episode, I'll tell you about how to identify/craft a niche for yourself.
If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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Getting your business started is fast and easy. In this episode, I will walk you through the steps so you can do it yourself.

Here are the key steps:

Choose your company name
Check the Secretary of State website for your state to determine if the name is available.
Obtain the domain name(s) for your company
Talk to your CPA and determine whether you want to have an LLC or an S-Corporation
Complete the Articles of Incorporation (sometimes called Articles of Organization) on the Secretary of State website and any other required steps for becoming incorporated
Apply for an EIN (Employer Identification Number)--your business tax ID. Here is the link to get your EIN https://www.irs.gov/businesses/small-businesses-self-employed/apply-for-an-employer-identification-number-ein-online
Apply for a business NPI (different than your individual NPI). Here is the link: https://nppes.cms.hhs.gov/webhelp/nppeshelp/MAIN%20PAGE.html If you are a sole proprietor you don't need this (yet).

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

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At some point, most of us think about the possibility of starting our own private practice. The first, and probably the most important question, is WHY? In this episode, I discuss the two major motivators to start your own practice: autonomy and money. Autonomy takes on many forms including the ability to: practice medicine the way you want, control your schedule, manage your staff, decide whether to take insurance, manage expenses and more. And, of course, I talk about the elephant in the room. Can you make more money if you own your own private practice? The answer--an emphatic YES!

If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.

And, be sure to join my FB group, The Private Medical Practice Academy.

Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.

Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

The Private Medical Practice Academy: Recent Episodes

Sandra Weitz MD