Practice Management Articles
PMI Certified Professional Shares Tips for Successful Office Management
Judy Lambert manages two busy pediatric practices for physicians Amanda Lovette, M.D., P.A., and Anissa G. August, M.D., P.A. in Decatur, Texas. She has eight staff members and does everything from practice management to working manager, billing and collections to accounts payable, posting of EOB’s, nursing to front desk receptionist – anything and everything. The new office building moved in April of 2009.
“There is a cost sharing advantage that benefits the practices, which have two separate employer tax IDs under one roof,” she says. The physicians share their day to day operational costs, but also share the cost of their employees saving thousands of $$$ per year. The employees work for both doctors. Their offices are totally electronic using three different software systems: two separate EMRs, and separate practice management systems. Each desk has double monitors on them allowing staff to have access to both practices at all times.
The best thing in our office, we verify every patient before they walk in the door and re-verify their insurance once every three weeks. “It makes it easier and more efficient when you’re trying to do the billing and verification process.” “We collect co-pays up front prior to the patient seeing the doctor; if a patient owes a deductible we collect 50% of what is due at the time of service. This maintains a good cash flow. We know ahead of time what our patients owe and how much we can collect for our services. We are generally on top of exactly what they owe. With them paying at the time of service we are not chasing them down, they know what to expect when they come to the doctor. They feel good about coming and we can feel good about them coming. It’s a win-win situation. It has made a big difference in our cash flow.”
Both physicians have over 10 years in practice as a pediatrician. Dr. Lovette has been in practice in Decatur for three and a half years while Dr. August has just completed 18 months in her private practice. Both physicians have profitable practices. Their software AllScripts Enterprise practice management, AllScripts EHR and JMJ’s EncounterPro has helped them keep their records in check. Both EMR’s send billing information to the practice management. Billing uses correct coding and bills through Navicure, our clearinghouse.
“Navicure performs an initial scrub and kicks it back if your subscriber ID or date of birth doesn’t match or you are using an invalid code. You know automatically what needs correcting and can re-bill faster and more efficiently. This has really helped bring our dollars back under control.”
Judy has more than 25 years of experience working with physicians. She attributes much of her success to a strong foundation in learning, hard work and years of experience managing different sizes and types of practices. Prior to moving to Decatur three years ago she was a business manager for a gastrointestinal physician managing both a busy clinic and an Ambulatory Surgical Clinic. At one time, she was a regional manager with large clinic of Internal Medicine physicians in Fort Worth where she had sixteen or more physicians in her charge. She has worked for multiple physicians at a Pulmonary and Critical Care clinic as a business manager. She has also worked in other specialities such as obstetrics and gynecology, otolaryngology (ENT), ophthalmology, cardiology as well as a helicopter air ambulance service.
She has been in and out of the medical field over the years. She has a background in nursing and her family lived oversees in Iran for four years. Shortly after she returned to Texas, she took a job with BHI (Bell Helicopter International), and then decided to go into the oil and gas industry. She was recruited by a company in Dallas that re-configured or modified helicopter interiors. From there she was recruited as coordinator for CareFlight Helicopter Air Ambulance Service in Dallas-Fort Worth. She worked as a liaison between Methodist Dallas & Methodist Fort Worth hospitals where she trained nurses to load supplies on the aircraft and become airborne within five minutes of receiving a call for help! After the first couple of years, she turned everything over to the pilots, nurses, physicians and returned to the medical field once again.
Judy has multiple certifications under her belt including Certified Medical Office Manager (CMOM)®, Certified Coding Specialist-Physician-based (CCS-P), and Certified Professional Coder (CPC™). She has been an American College of Chest Physicians Allied member (ACCP)and a member of the American Academy of Professional Coders (AAPC).
She studied nursing at Texas eastern School of Nursing, Scott and White School of Nursing and UT El Paso with a minor in psychology. She was within six months of graduating with a BSN degree when she moved to Iran.
“This program helped me tremendously in my profession because I understand both the clinical and administrative sides of the practice.”
She took a very in-depth nine month course in supervisory management and even has a certification as a Human Developmentalist.
“Truly by accident I got that. My son suffered a severe head injury in an automobile accident and I took time off to care for him. During that time I attended a two year course so I could learn how to help him. He was on a breathing machine, he could not speak or write, just blink his eyes and work problems in his head. He had a brilliant mind and a useless body. During this time we challenged the Texas Board of Education at the college level asking them to allow him a special exemption from the written essay on the college entrance exam. My son was the first student in the state of Texas to be given an exemption on the written essay portion of the college entrance exams. The state sent a proctor to monitor his testing. He took top honors on all of the college entrance exams including algebra and English among others. Because of my son’s exemption other special needs students were allowed to receive exemption on the written essay. We challenged and won! We tried to challenge him and he was able to take over 60 hours of college courses, including history, philosophy, math and English literature making A’s and B’s.”
Sadly, in 2004 he succumbed to his injuries.
Judy continued to work with medical and physician groups, and did some consulting with McVey and Associates in California as a national medical seminar specialist. She did specialty coding training with them for a short while but left shortly after the tragedy of 9-11.
“At the time I was working with the gastroenterologist physician in Grand Prairie I began to have horrible headaches, not migraines but extremely painful headaches. The physicians thought I had a pinched nerve in my neck. I would stumble and sway when walking across the room.”
Judy woke up one morning with a severe headache. Her husband was out of town so a neighbor took her to have some tests run. They did a brain scan that evening and the next morning she got a call from her doctor telling her she had a brain mass.
“I thought, ‘OK, that explains a lot,’ and hung up the phone not realizing that I was in shock. Needless to say I called back to ask where, how, why?” A week later, I went into surgery to remove the tumor. And 72 hours later I was back home. I began working from home six weeks later billing part-time for my physician. I went back to work full time two months later. My physician worked with me the entire time allowing me to heal. I owe her special thanks and gratitude for believing in me.
“At one point in my career I had worked with 18 physicians, and I decided that I wanted my life back. So I went to work for one pediatrician, then a second, which operated two separate practices under one roof. They hired me as their manager and I started billing, collections and accounts receivables for their new practice. We now have insurance verifiers and a billing specialist.”
When asked what she thinks is the key to running an efficient office, she said that they do a lot of checking beforehand.
“I think that the most important thing that keeps your practice flowing is the front desk. If you get everything you need up front, then the claims come back paid. This is the first quarter that I’ve been able to sit down and really analyze things. There was a time I was the only biller and the coder. I created a clean billing system, but I had to hire more people.
“There was a point not long ago when I was considering outsourcing all collections that were aged more than 60 days. I spoke with a gentleman named Bob Smullin from a company called MediGain. I did a demo of his software, Advanced MD, and it looked really good. It was one of the better ones I had seen in many years. There is a good flow to it that is beneficial, especially when you have nursing managers and administrators working with it. It automatically batches information and comes right back to you verified or corrected. But as Bob looked over my financials, he shrugged a little. ‘You can’t help me can you?’ I said. We were in better shape than we thought. He said that our internal collections were excellent and our need was so small it did not justify outsourcing. “
She attributes a balanced practice cash flow to a number of things. For example, they always make sure we get a new copy of patient insurance cards, front and back, so they can refer to it if there is any question. Pediatric appeals cost too much so the front office is diligent about getting our dollars up front so they are not sitting around wondering where the income is.
“We also maintain a healthy balance of managed care contracts at about 18-22 percent per contract. So if a contract backs out of our area, we don’t feel such a crunch. I think this so important. It’s something that I learned during my CMOM course 10 years ago.”
She says they do not program contract amounts. We keep track of percentage’s each company pays.
“Most payers don’t want to send you their fee schedule. We know that some are 130, 160, or 190 percent above Medicare. Our systems tell us what the percentage is so if we take 50 percent of the charges on a patient deductible, we are almost always within $5 or $10 one way or the other.”
She provides her physicians with a monthly report that gives them a snapshot of their financial status.
“We do a review of our contract payer allowances each year along with fee schedules. This is so important because when practices forget to review those, two or three years later they are losing dollars. I always do a fee schedule analysis at the end of the year.”
She stresses the importance of keeping verification current and collecting deductibles up front to increase cash flow and to avoid having to chase patients for payment.
“The patients feel good and you feel good.”
Judy also believes that staying current with the latest rules and coding changes keeps their practice in line. She keeps herself on track by reading the CMS site, Pediatrics Online, and Code-it Right.
“McVey Associates used to send me reading materials, where I got a lot of info. And I have a network of people that send me tidbits and resources, especially pertinent to pediatrics.”
Her staff tries to attend one to two seminars a year, mainly those that teach skills for our medical secretaries, coding/insurance specialist, specialty coding in pediatrics. The nursing staff is given the opportunity to go to clinical seminars. They also stay current with OSHA annual training.
“It helps us learn how to code better for our practice. I go to two or three seminars a year to stay abreast of changes, and keep up with the latest techniques and trends.”
She says her staff works very hard and thinks she probably asks more of them than other offices might. For example, she says most offices don’t do verifications but it is required in their office so that their claims are sent out clean the first time.
“We have some great incentives that help contribute to an efficient and fun workplace. Sometimes we block the schedule until nine and make a surprise breakfast for our employees. We serve them in appreciation of them serving us. We try to do something like that about once every other month. Our office is open 36 hours a week and we offer four hours of bonus pay for our employees who are present all week long. They can finish work at noon on Friday. It is a good incentive that results in very low absenteeism.”
Other incentives include providing a Christmas bonus and a half-day off to get holiday shopping done.
“We often hear other physicians complain that they can’t keep good employees. We are fortunate to have a very low turnover rate. It took us a while to build a good team but we have one of the best teams I’ve ever worked with.”
Judy tries to stay engaged in her profession for about 60 hours a week and keep an open door policy.
“I try to lead by example. To me, there’s no such thing as a dumb question. I try to coach my staff to stand on their own so they would know what to do if I weren’t there. My staff is very open minded. They let me know if I step out of line and we have a good enough rapport with them to sit down, teach, train and delegate. I try to spend at least eight to twelve hours of individual training with each employee during their first week of employment. I think no matter where we go we can never stop learning.”