Medical Practice Management Handbook

by Tinsley, Reed

• ISBN13: 9780735532960
• ISBN10: 0735532966
• Edition: 8th
• Format: Paperback
• Copyright: 2002-04-01
• Publisher: Wolters Kluwer

Summary

Reed Tinsley & Assoc. Written for CPAs, consultants, and healthcare managers. Provides expanded coverage of financial accounting and management reports, CPT and coding rules, and filing insurance claims. New information on topics includes analysis for recent U.S. Tax Court cases, tips on office start-up costs, and more. CD-ROM contains practice aids. Softcover.

Table of Contents

Preface	xi
About the Author	xiii
Part I: Medical Practice Financial Management
Developing a Health Care Niche for the CPA or Consultant Reader
Specialized Needs of a Medical Practice	1	(5)
Developing a Health Care Niche in a Small Professional or Consulting Firm	6	(3)
Developing a Health Care Niche in a Large Firm	9	(4)
A Common Obstacle-Making Time	13	(1)
Marketing Strategies	13	(18)
Developing Relationships-The Key to Success	31	(2)
Health Care Organizations and Publications	33
Financial Accounting and Management Reports
Numbers and Benchmarking	1	(1)
Medical Practice Statistical Report	2	(3)
Collections	5	(14)
Comparative Practice Management Report	19	(1)
Balance Sheet and Income Statement Preparation	20	(5)
Incurred But Not Reported (IBNR) Claims	25	(2)
Capitation Debits and Credits	27	(3)
Special Group Practice Accounting	30
Cost Containment in a Medical Practice
Payroll and Related Benefits	2	(6)
Medical and Office Supplies	8	(2)
Lease Agreements	10	(2)
Refunds to Patients	12	(1)
Other Costs	12	(2)
Merging Practices to Reduce Costs	14	(1)
Recruiting a New Physician to Reduce Costs	15	(1)
Office Sharing with Another Physician to Reduce Costs	15
Internal Controls in a Medical Practice
Computerized Practice	1	(5)
Manual Practice	6	(1)
Accounts Payable	6	(1)
Responsibility for Fraud and Embezzlement	7	(1)
Real-Life Examples	8	(1)
Dealing with Employee Theft	9
Projecting the Practice's Cash Flow
Gross Revenue (Charges)	2	(3)
Collected Revenue	5	(3)
Overhead and Other Cash Requirements	8
Business and Strategic Planning for Medical Practices
Business Planning	2	(10)
Strategic Planning	12
Setting Up a New Medical Practice
Tasks Involved in Setting Up the Practice	1	(6)
Timetable of Events	7
How to Set Physicians' Fees
Medical and Laboratory Fees	4	(3)
Procedure and Radiology Fees	7
Part II: Medical Office Operations, Policies, and Procedures
Basic Medical Office Procedures
Office Hours	1	(2)
Preparing for the Office Day	3	(1)
Shutting Down the Office	4	(1)
Telephone Management	4	(4)
Confidential Information	8	(3)
Scheduling Office Appointments	11	(7)
The Patient's Office Visit	18	(10)
Referrals from Other Physicians and Patients	28	(2)
Terminating a Patient Relationship	30
Basic CPT and Diagnosis-Coding Rules
Medical Terminology	1	(2)
CPT Codes	3	(19)
CPT Modifiers	22	(5)
Diagnosis Codes	27	(1)
HCPCS Codes	28	(1)
Documenting Services Rendered	29
Filing Insurance Claims
Insurance Verification	1	(2)
Preparing an Insurance Claim Form	3	(3)
Top Ten Billing Errors	6	(2)
Billing Medicare Correctly	8	(3)
Insurance Plans	11	(8)
Developing a Compliance Program	19	(11)
Preparing for Government Investigations	30	(3)
Billing Hospital Services	33	(3)
Time Limit for Filing Claims	36	(6)
Filing Primary Insurance Claims	42	(1)
Filing Secondary Insurance Claims	43	(2)
Organizing Office Copies of Insurance Claim Forms	45	(1)
Billing Process Questionnaire	46
Accounts Receivable Management
Information First	1	(1)
Handling Billing Inquiries by Phone	2	(1)
Patients' Account Statements	2	(2)
Collection Policies	4	(2)
Bad Debt Control	6	(3)
Professional Courtesy	9	(4)
Collection Procedures	13	(4)
Potential Problems with Hospital Consults	17	(1)
Unpaid Insurance Claims	18	(3)
Collection Process Questionnaire	21
Keeping the Books
Posting Payments	1	(1)
Is the Practice Getting Paid Properly?	2	(6)
Auditing Payment Postings	8	(1)
Reviewing the Explanation of Benefits	9	(3)
Banking	12	(1)
Closing the Books	13
Inventory and Purchasing
Inventory	1	(1)
Purchasing	2	(1)
Expenditures	3
Marketing the Medical Practice
Premarketing Considerations	1	(1)
Internal Marketing Strategies	2	(2)
External Marketing Strategies	4	(10)
Tracking the Effectiveness of Marketing Efforts	14
Personnel Management
The Hiring Process	1	(5)
Personnel Manuals	6	(1)
Hours and Compensation	6	(2)
Benefits	8	(5)
Performance Reviews	13	(1)
Termination of Employment	14	(1)
Family Leave Policy	15	(1)
Harassment Policy	16	(1)
Employee Job Descriptions	17	(8)
Employee Retention	25	(4)
Overtime Pay	29
Part III: Physicians Contracts, Relationships, and Related Issues
Buy/Sell Agreements for Medical Practices
By Practice's Buy-Out Amount	1	(7)
Payout Terms	8	(6)
Tax Deductibility of Buy-Out Payments	14	(2)
Other Provisions in Buy-Sell Agreements	16	(2)
Sale of the Practice	18
Physicians' Employment Agreements
Compensation	1	(6)
Compensation Formulas	7	(10)
Factors Impacting Physician Compensation	17	(5)
Components for Better Compensation Plans	22	(8)
Physician Compensation and the Stark Laws	30	(11)
Fringe Benefits	41	(2)
Practice Buy-In	43	(3)
Other Contract Provisions	46
Managed-Care Contracts and Contracting
Managed-Care Definitions	1	(6)
The Growth of Managed Care	7	(3)
Assessing a Managed-Care Plan	10	(11)
Evaluating the Contract Terms	21	(11)
Capitation	32	(18)
How to Develop a Capitation Term Sheet	50	(8)
Utilization	58	(2)
After the Contract Is Signed	60	(5)
What to Do If the Practice Is Deselected	65
Hospital Recruitment Agreements
General Recruitment Issues	1	(6)
Legal Contract Issues	7	(1)
Repaying Incentives	7	(3)
Tax Issues	10	(6)
For-Profit vs. Not-for-Profit Hospitals	16	(18)
Medicare Fraud and Abuse Issues	34
Medical Practice Consolidations and Office-Sharing Arrangements
The Explosion of Group Practices	1	(5)
Premerger Assessment (Due Diligence)	6	(6)
Financial and Legal Considerations	12	(10)
Operational Issues	22	(9)
Major Decisions by the Group	31	(1)
Dissolution of the Group Practice	31	(1)
Antitrust Concerns When Merging Medical Practices	32	(4)
Merger Time Line	36	(2)
Office-Sharing Relationships	38	(10)
Practice Continuation Agreements	48	(1)
Stark Rules and Regulations	48
Integrated Delivery Systems
What Payors Are Looking For	2	(1)
Should a Physician Network?	3	(1)
The Affiliation Decision	4	(5)
Antitrust	9	(12)
Causes of IDS Failure	21	(9)
Delivery Systems	30
Medical Practice Valuations
Regulatory Issues	2	(3)
Factors That Influence Practice Value	5	(21)
Information Needed to Conduct a Medical Practice Valuation	26	(1)
Developing the Capitalization Rate	27	(2)
Calculating Excess Earnings	29	(3)
Valuation Methods	32	(16)
Valuing Fixed Assets and Accounts Receivable	48	(1)
Weighing the Methods	49	(1)
The Impact of Transaction Contracts on Fair Market Value	50	(1)
Fair Market Value	51	(2)
Other Impacts of Transaction Contracts	53	(1)
IRS Tax-Exempt Appraisal Guidelines	53
Glossary	GL.01
Appendix A. Part I: Medical Practice Financial Management	APP.01
Appendix B. Part II: Medical Office Operations, Policies, and Procedures	APP.35
Appendix C. Part III: Physicians' Contracts, Relationships, and Related Issues	APP.75
Index	IND.01
About the CD-ROM	CD.01
CD-ROM Instructions	CD.03
CD-ROM Contents	CD.05