Magazine article Medical Economics

Practice Management Q&A

Magazine article Medical Economics

Practice Management Q&A

Article excerpt

Collecting from an out-of-state patient

I recently provided care for a patient visiting from another state. He filed an outof-network claim for my services, but his insurer refused to pay, and he hasn't responded to the bill I sent him. What should I do?

In this case, the patient is responsible for the bill. Most managed care contracts require patients to call for instructions before securing out-of-state care, or within, say, 72 hours of receiving emergency treatment.

Notify the patient that you expect payment for your services. Give him a detailed statement to present to his insurer or employer if he wants to appeal the denial of his claim. If he balks, send the account to an agency that handles interstate collections.

When a manager can't keep pace

Our practice has grown rapidly. We now have three offices and 40 employees, and our office manager-a former biller who moved up the ladder-can't keep up with the expanded responsibilities. How do we tell a loyal employee that she's no longer up to the job?

Present it to her this way: Because your practice has grown so much, its needs and problems go far beyond what your current administrative structure was set up to handle. To deal with this situation, you plan to establish a new top position of practice administrator. Explain that the person who assumes this role will not only have to supervise daily office functions-as your office manager does now-but also implement your strategic business plan, improve your practices operational effectiveness, oversee staff development, and represent the practice in its dealings with regulatory agencies, insurance carriers, and other organizations. Describe the skill set you expect this person to bring to these tasks.

You'll have to level with her, indicating that while she doesn't have the qualifications for this position, she's a valued employee and you recognize how much the success of the practice was due to her efforts over the years. …

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