Medical Practice Management Handbook: Complete Guide to Accounting, Tax Issues, Managed Care, and Daily Operations

by Tinsley, Reed

• ISBN13: 9780735525023
• ISBN10: 0735525021
• Edition: 7th
• Format: Paperback
• Copyright: 2001-06-01
• Publisher: Wolters Kluwer

Summary

Previously published as Medical Practice Management Handbook for CPAs, c2000. Written for CPAs, consultants, and healthcare managers. Provides expanded coverage of financial accounting and management reports, basic CPT and coding rules, and filing insurance claims. 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	3	(4)
Developing a Health Care Niche in a Small Professional or Consulting Firm	7	(4)
Developing a Health Care Niche in a Large Firm	11	(3)
A Common Obstacle-Making Time	14	(1)
Marketing Strategies	15	(11)
The Best Marketing Strategy	26	(1)
Developing Relationships-The Key to Success	26	(3)
Health Care Associations and Publications	29	(4)
Financial Accounting and Management Reports
Numbers and Benchmarking	33	(1)
Medical Practice Statistical Report	34	(3)
Collections	37	(14)
Comparative Practice Management Report	51	(1)
Balance Sheet and Income Statement Preparation	52	(5)
Incurred But Not Reported Claims	57	(2)
Capitation Debits and Credits	59	(3)
Special Group Practice Accounting	62	(8)
Cost Containment in a Medical Practice
Payroll and Related Benefits	70	(6)
Medical and Office Supplies	76	(2)
Lease Agreements	78	(1)
Refunds to Patients	79	(1)
Other Costs	80	(2)
Merging Practices to Reduce Costs	82	(1)
Internal Controls in a Medical Practice
Computerized Practice	83	(4)
Manual Practice	87	(1)
Accounts Payable	88	(1)
Responsibility for Fraud and Embezzlement	89	(1)
Real-Life Examples	89	(1)
Dealing with Employee Theft	90	(1)
Scope of Investigation	91	(5)
Projecting the Practice's Cash Flow
Gross Revenue (Charges)	96	(3)
Collected Revenue	99	(3)
Overhead and Other Cash Requirements	102	(3)
Business Planning for Medical Practices
Finances	105	(6)
Operations	111	(3)
Human Resources	114	(1)
Contracts	115	(1)
Marketing	116	(1)
Setting Up a New Medical Practice
Tasks Involved in Setting Up the Practice	117	(6)
Timetable of Events	123	(9)
How to Set Physicians' Fees
Medical and Laboratory Fees	132	(3)
Procedure and Radiology Fees	135	(8)
Part II: Medical Office Operations, Policies, and Procedures
Basic Medical Office Procedures
Office Hours	143	(2)
Preparing for the Office Day	145	(1)
Shutting Down the Office	146	(1)
Telephone Management	146	(3)
Confidential Information	149	(3)
Scheduling Office Appointments	152	(7)
The Patient's Office Visit	159	(9)
Referrals from Other Physicians and Patients	168	(3)
Basic CPT and Diagnosis-Coding Rules
Medical Terminology	171	(2)
CPT Codes	173	(23)
Diagnosis Codes	196	(1)
HCPCS Codes	196	(1)
Documenting Services Rendered	197	(4)
Filing Insurance Claims
Insurance Verification	201	(2)
Preparing an Insurance Claim Form	203	(3)
Top Ten Billing Errors	206	(2)
Billing Medicare Correctly	208	(3)
Insurance Plans	211	(9)
Developing a Compliance Program	220	(11)
Preparing for Government Investigations	231	(3)
Billing Hospital Services	234	(3)
Time Limit for Filing Claims	237	(6)
Filing Primary Insurance Claims	243	(1)
Filing Secondary Insurance Claims	244	(2)
Organizing Office Copies of Insurance Claim Forms	246	(1)
Billing Process Questionnaire	247	(2)
Accounts Receivable Management
Information First	249	(1)
Handling Billing Inquiries by Phone	250	(1)
Patient's Account Statements	250	(2)
Collection Policies	252	(2)
Bad-Debt Control	254	(3)
Professional Courtesy	257	(4)
Collection Procedures	261	(4)
Potential Problems with Hospital Consults	265	(1)
Unpaid Insurance Claims	266	(3)
Collection Process Questionnaire	269	(2)
Keeping the Books
Posting Payments	271	(1)
Is the Practice Getting Paid Properly?	272	(6)
Auditing Payment Postings	278	(1)
Reviewing the Explanation of Benefits	279	(3)
Banking	282	(1)
Closing the Books	283	(6)
Inventory and Purchasing
Inventory	289	(1)
Purchasing	290	(1)
Expenditures	291	(2)
Marketing the Medical Practice
Premarketing Considerations	293	(1)
Internal Marketing Strategies	294	(2)
External Marketing Strategies	296	(10)
Tracking the Effectiveness of Marketing Efforts	306	(3)
Personnel Management
The Hiring Process	309	(5)
Personnel Guides	314	(1)
Hours and Compensation	315	(1)
Benefits	316	(5)
Performance Reviews	321	(1)
Termination of Employment	322	(1)
Family Leave Policy	323	(1)
Harassment Policy	324	(1)
Employee Job Descriptions	325	(7)
Employee Retention	332	(3)
Overtime Pay	335	(10)
Part III: Physicians' Contracts, Relationships, and Related Issues
Buy/Sell Agreements for Medical Practices
The Practice's Buy-Out Amount	345	(6)
Payout Terms	351	(8)
Tax Deductibility of Buy-Out Payments	359	(1)
Other Provisions in Buy/Sell Agreements	360	(2)
Sale of the Practice	362	(1)
Physicians' Employment Agreements
Compensation	363	(6)
Compensation Formulas	369	(11)
Factors Impacting Physician Compensation	380	(3)
Components for Better Compensation Plans	383	(4)
Physician Compensation and the Stark Laws	387	(12)
Fringe Benefits	399	(1)
Practice Buy-In	400	(4)
Other Contract Provisions	404	(5)
Managed-Care Contracts and Contracting
Managed-Care Definitions	409	(4)
The Growth of Managed Care	413	(3)
Assessing a Managed-Care Plan	416	(11)
Evaluating the Contract Terms	427	(11)
Capitation	438	(18)
How to Develop a Capitation Term Sheet	456	(8)
Utilization	464	(2)
After the Contract Is Signed	466	(5)
What to Do If the Practice Is Deselected	471	(6)
Hospital Recruitment Agreements
General Recruitment Issues	477	(6)
Legal Contract Issues	483	(1)
Repaying Incentives	484	(2)
Tax Issues	486	(6)
For-Profit vs. Not-for-Profit Hospitals	492	(15)
Medicare Fraud and Abuse Issues	507	(6)
Medical Practice Consolidations and Office-Sharing Arrangements
The Explosion of Group Practices	513	(5)
Premerger Assessment (Due Diligence)	518	(6)
Financial and Legal Considerations	524	(10)
Operational Issues	534	(7)
Major Decisions by the Group	541	(1)
Dissolution of the Group Practice	542	(1)
Antitrust Concerns When Merging Medical Practices	543	(4)
Merger Time Line	547	(3)
Office-Sharing Relationships	550	(9)
Practice Continuation Agreements	559	(1)
Stark Rules and Regulations	560	(12)
Integrated Delivery Systems
What Payors Are Looking For	572	(1)
Should a Physician Network?	573	(1)
The Affiliation Decisions	574	(5)
Antitrust	579	(12)
Causes of IDS Failure	591	(9)
Delivery Systems	600	(38)
Medical Practice Valuations
Regulatory Issues	638	(3)
Factors That Influence Practice Value	641	(20)
Information Needed to Conduct a Medical Practice Valuation	661	(1)
Developing the Capitalization Rate	662	(3)
Calculating Excess Earnings	665	(3)
Valuation Methods	668	(12)
Valuing Fixed Assets and Accounts Receivable	680	(1)
Weighting the Methods	681	(1)
The Impact of Transaction Contracts on Fair Market Value	682	(1)
Fair Market Value	683	(2)
Other Impacts of Transaction Contracts	685	(1)
IRS Tax-Exempt Appraisal Guidelines	685	(6)
Retirement Planning for Medical Practices
How to Retirement Plans Work	691	(3)
Types of Retirement Plans	694	(11)
Contribution and Benefit Limitations	705	(2)
Tax Status of Contributions and Investment Returns	707	(1)
Government Reporting and Disclosure	708	(2)
Types of Plan Distributions	710	(5)
Plan Distribution Options	715	(4)
Taxes and Penalties on a Retirement Plan	719	(2)
Glossary	721	(12)
Appendix A. Part I: Medical Practice Financial Management	733	(74)
Appendix B. Part II: Medical Office Operations, Policies, and Procedures	807	(40)
Appendix C. Part III: Physicians' Contracts, Relationships, and Related Issues	847	(250)
Index	1097	(16)
About the CD-ROM	1113
CD-ROM Instructions	1115
CD-ROM Contents	1117