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Part B Insider (Multispecialty) Coding Alert

Practice Management:

Make Sure Personalities, Health Plans Mesh Before Hiring New Doc

Published on Mon Apr 05, 2004

8 tips for bringing a new doctor to your practice

  •  Define an evaluation period in advance. This can be anywhere from 30 days to six months, says Keith Borglum, a consultant with Professional Management and Marketing in Santa Rosa, CA. Also, define what the physician's buy-in amount will be, the period of buy-in, the value of the practice and the terms of purchase. "Everything gets determined in advance, but unless you really know them you still want to check them out because they could be a wacko," Borglum says.
     
    One evaluation technique: Set it up so that the new doctor becomes eligible to become part-owner of the practice after a year, but agree to notify him or her after six months whether you'll actually offer this option at the year's end. Six months is plenty of  time to get to know the doctor, and at some point they may be able to sit in on partners' meetings without voting.
     
  •  Clarify evaluation criteria in advance. Give the incoming physician a list of qualities that he or she will be evaluated on six months from now. This should include "not just clinical skills, but collegiality, proper attitude to employees" and "showing some entrepreneurial effort to go out and develop referral sources," says Borglum.
     
  •  Set up hospital privileges and insurance coverage right away. It can take up to six months to redo all the contracts with insurers and gain hospital privileges for a new physician, says consultant Phyllis Yingling with Apple A Day in Bluffton, SC. Some payors look at physicians by Tax ID, others by Social Security number. But if you're not careful about updating all records, the physician's payments can be mailed to the wrong address for over a year.

    And if it turns out that your local health plans aren't accepting new providers, you should know this before you hire a new physician. "I've gone to places where there's four physicians on a plan, and a fifth comes on and the HMO or PPO won't let them in," says Borglum. All of a sudden, the front desk has to sort out which physicians in the practice can see patients from that health plan and it becomes a nightmare.

    "If you can't get them on the plan you don't want to go ahead with your recruitment," Borglum adds.
     
  •  Medicare enrollment is another ball of wax, says Yingling. The doctor will need a new Medicare provider number and will have to fill out all the CMS 5500 enrollment forms, including assignment of benefits and Medicare participating status.
     
  •  Obtain copies of all documents, including physician license, and make sure the physician's drug number and malpractice insurance are up to date, Yingling adds.
     
  •  Find out how much the new doctor knows about coding, and make him/her aware of what tools you're using, including routing slips and superbills. If the physician needs to be able to choose CPT codes him- or herself, make sure he or she knows this, advises Yingling.
     
  •  Make contact with the physician's former office (if he or she left on good terms) and establish a relationship with someone over there, such as the office manager. That way, if things are sent to the wrong place, you can straighten it out.
     
  •  Make sure the new physician understands that fees will be based on the practice's fee schedule and not his or her own.

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