Practice Management

Medical Economics, September 11, 1995 | Go to article overview

Practice Management


A new pay scale for merging practices' staffers

Q: How can three merging practices determine pay scales for staffers, some of whom have been paid varying wages for similar jobs in our previously separate offices?

A: No matter how you do this, someone could end up unhappy. Here's the fairest method.

Set a pay range for each position that includes the salary each employee was previously paid, and allow for cost-of-living increases. Within each range, gradually raise the lower-paid staffers until they're on a par with the higher-paid ones who have comparable experience and ability.

Can you keep these Medicare reimbursements?

Q: I've been treating an elderly couple who were injured in an auto accident. Until their car insurance coverage comes through, Medicare has been paying me on a conditional basis. A colleague told me that because of a decision reached in a recent court case, I won't have to return Medicare's money once the patients' car insurance comes through. Is this true?

A: No. The decision your colleague mentioned applies only to Medicare patients also covered by employer-sponsored group health plans. You'll have to return the Medicare money once the car insurer pays. Furthermore, if you expected reimbursement from the insurer within 120 days of beginning treatment, you shouldn't have billed Medicare at all.

Reasonable fees to pay an MSO

Q: Right after I agreed to pay a management-services organization 60 percent of my gross receipts, I read in your magazine that 50 to 55 percent is the going rate in most places. What services are considered standard for a 50 to 55 percent fee? I'm wondering whether I was cheated or am paying for additional services.

A: The percentage may vary from that range depending on specialty and size of practice, but for a management fee of 50 to 55 percent, an MSO typically provides everything needed to operate the practice. That includes equipment, supplies, and staff (exclusive of physicians, physician assistants, and nurse practitioners). The organization is responsible for all billing and collections, all practice-related accounting and payroll, and furnishing and maintaining the office space. It also handles hiring and firing and benefits administration, and may manage the doctors' personal tax preparation or financial planning or the practice's pension-plan investments.

The MSO's fee doesn't cover insurance premiums (malpractice, disability, life, health), personal expenses such as continuing education, retirement-plan contributions and fees, and legal expenses.

When a patient tries to skip out on the bill

Q: What should I do if a patient writes "payment in full" on a check that doesn't cover his entire bill?

A: It depends on your state's laws. Check with your bank to find out what rules you must follow. In most places, "payment in full" doesn't prohibit you from collecting on the remainder. Protect yourself by writing "under protest" or "reservation of rights" on the check before you deposit it. Have your office manager call the patient and remind him how much he still owes. She should follow up the call with a letter, sent certified mail, return receipt requested.

How PAs affect the way doctors share overhead

Q: The six physicians in our family practice share expenses according to a sliding scale based on individual income. Three doctors employ physician assistants, receive the income from their services, and pay their salaries directly.

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