Practical Advice From the Practice Trenches

Synopsis of  “Improving Your Bottom Line” Conference Presentation by Debbie Khan, Practice Manager for Golden Triangle Family Care Center

Operations/Compliance Manual:

  • Create an Operations Manual (multiple copies if needed) that is accessible to all employees. Review it by sections in monthly staff meetings, answer questions and have employees sign off that it has been reviewed.  Useful when performing evaluations or Performance Correction Notices.
  • Include all practice policies and procedures.  Review daily, weekly and monthly operations.
  • Tabs for all key items, including payer information for all your major payers.
  • Include the items below.

Social Media:

  • Have a policy on Social Media, including use inside the office, references to the practice and/or patients.  Review the policy every quarter during a staff meeting and have every team member sign the policy every year.  Make sure your staff understand it extends beyond their employment.
  • Consider eliminating access from the office (there are free tools to enable you to do this).
  • If you allow access from the office check to see who is posting – your employees are on your time and dollar.
  • Make sure all providers are on board and hold EVERYONE to the same standards.

Smart Phones/Cell Phones:

  • Have a policy on use of personal phones while at work – Debbie suggests limiting their use to official breaks and lunch.  The policy states cell phone cannot be out – they must be in the desk drawer or purse on vibrate.
  • Have a special emergency/backline telephone that your staff (and their family) can use for emergencies so they don’t have to use their personal telephones.
  • Make sure all providers are on board and hold EVERYONE to the same standards.

Patient Collections:

  • Use your EHR to keep a running dated list of patient collection notes (Debbie and her staff use the Notes under Demographics in Sevocity to do this).  Do this in a field/place that is easily editable.  Including insurance verification.
  • Train staff to not take any action without checking the patient’s notes – this includes scheduling an appointment, collecting co-pays at the visit and checkout at the end of the visit.  Debbie’s practice management software allows us to enter a “pop up note” which shows up when we are attempting to make an appointment.  We keep important information there as well.
  • Train your staff to collect and expect them to collect – revenue is the lifeblood of your practice and no one will have a job if you don’t stay in business.  Know your most common payers and the terms of the insurance policy.   If an employee isn’t collecting – make sure you review the process with them, however if they just can’t collect, then you need to reassign them.
  • Appointment Requests: Discuss the balance to the patient and ask them how they will pay (cash, check, and/or credit card) at check-in when they arrive.
  • Verify benefits (eligibility checking) on every patient the day before or immediately before each visit.  Document in your notes, including the source of the information, reference number and the first and last name of anyone you spoke with).
  • Ensure your staff understands how HSAs and HRAs work and you document (in your Operations Manual) how each works – with some the patient pays with their debit card initially, some you file the claim, etc.).
  • Debbie personally calls every patient with a past-due balance (after insurance has settled) of $150 or more.  Document in their patient’s notes.
  • Set-up and maintain an open Telephone Encounter on patient’s with billing issues until resolved or the patient comes in.  Patients are required to satisfy balances prior to obtaining additional services.
  • Get providers to finalize their encounters timely – print an Open Encounters report and multiply by your average office visit charges to enable them to see the $s they are currently leaving on the table.
  • When a provider is going out of town make sure all Billable Open Encounters are resolved.

Dismissing a Patient:

  • Debbie recommends automatically dismissing a patient that writes a check on a closed account or issues a stop pay – they knew what they were doing.  If the check is on a Closed Account – that is a theft of services in Texas.
  • NSF – 3 strikes and you’re either out or a Cash Only patient (document each strike in the patient’s notes)
  • Only do what your state law requires for dismissed patients
  • Have a Dismissal letter template in your EHR.  Use this when you dismiss a patient and save to the patient’s chart and route to your entire staff so they are fully aware.  Appoint a person to interact with dismissed patients.  Not the provider.

Buying New Equipment and Services:

  • Ask the exact Assessments – ICD9 Code and/or procedures that qualified for reimbursement.
  • Run reports in your EHR or billing to determine your applicable patient volume – will you make money?  Use the last one to two years only.

Marketing Your Practice:

  • Your staff is your sales team – train them as such.
  • Hold orientation meetings for new services
  • Where possible offer new services for free trial to your staff
  • Set-up and maintain a solid website:
  1. Have your staff critique the new website and then make adjustments
  2. Include a link to your Patient Portal
  3. Offer online payment opportunity
  4. Include registration forms for new patients so they can download and complete from home before their first visit
  • When you receive a patient from another practice ask the patient why they are changing:
  1. Is this a problem patient you would rather not have?
  2. Is there something your practice can learn to improve your retention?
  3. Texas has a DPS database we can check for patients that obtain narcotics from multiple


  • If your EHR has a special Login message like Sevocity, use it and change it every day.  You can use it to announce items such as:
  1. Plans for the morning
  2. Lunch plans
  3. Plans for the afternoon
  4. Patient issues to be on the lookout
  5. Staff time off and who is covering
  • Send messages to staff using the EHR and copy yourself (then no one can say they didn’t know).  Useful for evaluations and Performance Corrective Notices.
  • Try out ALL of the reports from your EHR and Billing systems.  You may have very valuable information you can use to improve your practice already at our fingertips.  If you have a specific call your experts at Sevocity they will help you.
  • Push your Patient Portal as it is much more efficient than phone calls – let patients know that Portal messages take priority over phone calls.
  • Remember it is always best to work smarter not harder.  Proper utilization of the tools you already have can make your life easier if you know them.