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According to a recent article on by practice management professional Jeffrey Denning, many physicians have trouble saying no to unreasonable requests from staff and partners.  Maybe it’s because doctors, who went into the medical profession to help people, feel that they have to help in any and every situation, and many are getting taken advantage of.  Doctors are businessmen too, after all, and need to learn how to make smart business decisions.  In his article, Mr. Denning talks about some situations where he has known doctors to have difficulty saying no.  The situations range from employees asking for shorter working hours or unmerited raises, partners retiring and requesting that their partner buy them out, or requests for changes in rental contracts. 

Denning urges physicians to make sure they have a detailed business plan and to gauge every request against that plan.  Obviously that requires having a business plan, which Denning encourages all physicians to do.  He also encourages doctors to consider hiring a practice management consultant to help design the plan and to help decide which requests fit with the plan and which don’t.

At MD Alliance Billing, LLC, we can partner with you to make sure you have an effective business plan and know what is working in your office and what is not.  This will help you to be prepared when you do receive requests and to be able to answer them firmly and confidently, whether the answer is “yes” or “no”.


2009 is drawing quickly to a close, and it is time for all individuals and businesses to be seriously planning for the upcoming tax season.  Private practice physicians are no exception, and because they often own their own businesses, the same tax rules for small businesses apply to physicians, and those can often be complicated and confusing. 

Below are some items to consider now as you are gathering info and making any end of year changes.  Keep in mind that each item will affect different doctors and situations in unique ways.  Our best advice is to have a tax professional (like us) assist you in completing your return.  But here are some tips to think about as the year comes to an end:

1. Business expenses – doctors who keep careful notes and records can deduct many of their business expenses including:

  • Office expenses – supplies, utilities, new equipment purchases, office improvements and remodeling, salaries and contract labor, etc.
  • Travel and entertainment – a portion of business related meal and entertainment expenses are deductible as well as travel for conferences and meetings.
  • Home office – do you meet patients in a designated area of your home?  If so, you may qualify for home office deductions.

2.  Health insurance- small business owners can deduct the premiums they pay for health insurance for themselves and their families.  Additional medical expenses may also be deductible.

3. Charitable contributions – any charitable contributions made by your practice that can be classified as “advertising and promotion” are fully deductible.  In addition, any out-of-pocket expenses incurred while donating your medical expertise may be deductible on your personal return.

4. Dependent care – if you and your spouse both work you can deduct expenses incurred for childcare.

5. Retirement accounts – small business owners have special rules when it comes to retirement accounts that may have more tax advantages.

For more info on these and other tax tips and advice for medical professionals, contact our office at

MD handshakeNo one can argue that health care costs are out of control.  Health care reform is being discussed in Washington, but is there anything we can do now about the average $15,000 of medical costs per year per family in the US?  Can you take matters into your own hands?  A recent article on CBS presents some great ideas for taking charge of what you’re charged for health care.  You don’t have to pay retail, they argue, if your insurance isn’t meeting your needs or you don’t have insurance.  If you properly educate yourself and learn to negotiate, some experts argue you could reduce your medical bills by as much as 80%.  So how do you do it?

1. Know the Real Cost – if you have insurance, start with your insurance carrier’s website – most companies let members see their negotiated rates.  You can also use sites like  Healthcare Blue Book, Vimo, and New Choice Health which provide information on how  much local hospitals and doctors charge and how large a discount insurers would receive.

2. Use the Right Words – once you know how things should be priced, it is important to actually visit with the billing staff and be as open and honest as possible.  Be clear, confident, and personal.  Offer to pay immediately in cash if they agree to a discount.

3. Ask About Outpatient – some procedures may be doable in an outpatient setting rather than an expensive hospital stay.  Don’t be afraid to ask if your procedure can be done outpatient.

4. Negotiate Afterwards – even if your bills have been piling up a while, it’s never too late to make an offer.  Be aggressive – offer to pay a percentage you can afford right now if they will write off the rest.  Often medical offices and hospitals are eager to get the charges off their books.  Continue up the chain of command if you don’t get a decent offer to begin with, and document everything you hear in writing as you go.

5. Don’t Pay By Credit Card – if they already have your money, they are less likely to negotiate, and you’ll be stuck paying off your bills and paying the outrageous credit card fees.

6. Ask About Payment Plans – most will be willing to set up one without interest, and if you faithfully make payments for a while, you might be able to negotiate a write-off of the rest of your bill.

7. Call in a Pro – if all else fails, there are people you can turn to for help.   Medical Billing Advocates of America has specialists who, for a percentage of the reduction they get you, can help you negotiate lower bills with your doctor.  The Access Project offers free information and advice about negotiating, including one on one coaching.

As a medical billing service, we are always willing to work with patients who show good faith, who are honest about what they can and cannot do, and who are willing to work with us to come up with a solution.  It is the patients who disappear and ignore their bills entirely that are the problem.  There is lots of flexibility, so don’t be afraid to advocate for yourself.

 Are you getting paid what you should be by the insurance companies?  Many physicians are not, and that’s why the beginning of the year is a critical time to reevaluate and, if necessary, renegotiate your insurance contracts.  Here are some simple tips to begin the process:

· Research Your Revenues—Find out what your average income per visit is for each insurance company.  Our office can assist you by auditing your EOB’s and payment vouchers.

· Find the Problem Payers—Compare average revenues and identify which companies are not reimbursing you at the same rate as the others.  Know what the payments for your specialty and geographical area should be.

· Re-read Your Contracts—Know what your insurance contracts say .  Make sure you have information on how the company compares before you meet with a representative.

· Partner with your Patients—If necessary, let your patients know you will be dropping their insurance if the company does not negotiate.  Get the patients on your team.

· Be Patient and Persistent—Don’t let the insurance companies bully you—be persistent, and get what you deserve.

Making sure you are current and competitive with your fee schedules is critical to successful renegotiation.  There are several helpful tools you can use to make sure you are  charging appropriately and receiving payment accordingly.  A fee analyzer can give you information about what physicians in your geographical area and specialty are charging and where you stand in comparison.  It can also help you identify the CPT and diagnostic codes most used in your specialty and the reimbursement rates you should expect for those codes.   MD Alliance Billing, LLC can help update your fee schedules with our current fee analyzer tools.

The 2006 Tax Relief and Health Care Act (TRHCA) required the establishment of a physician quality reporting system for services and patients covered by the Medicare program.  This reporting system includes incentive payments for eligible professionals who provide satisfactory reports on certain quality measures.  In plain English, this means the government will pay you for reporting on your treatments and/or the results of those treatments for certain conditions and procedures.  Many of the approved measures have to do with preventative care or treatments designed to prevent reoccurrences of the condition.  During the 2009 reporting period (January 1—December 31, 2009), eligible professionals who meet the criteria for satisfactory submission of quality measures data will earn a bonus payment of 2% of their total allowed charges for the procedure.  Detailed information on how PQRI works and how to implement a PQRI system in your office can be found at the Medicare website,

The first step in implementing a PQRI reporting system for your office is to familiarize yourself with the information provided by Medicare’s website,  The Educational Resources section has particularly helpful and relatively simple guides on how to begin coding and submitting these reports on your Medicare claims.

Eligible professionals do not have to enroll or file an intent to participate in PQRI.  Physicians who choose to submit the data through claims can simply report the appropriate codes on the service lines of Part B of the PFS claim.  In addition, there are several registries which have qualified to submit data for their participating physicians.  See Medicare’s website for a comprehensive list.


Some frequently asked questions:


Who is eligible to participate?

·     Any medical professional whose services are paid under or based on the Medicare Physician Fee Schedule.  Basically if you bill Medicare directly, you are eligible.


What services are eligible?

·     See Medicare’s website for a comprehensive list of covered measures and reporting requirements for covered services.


How do we submit the reports?

·     There is a coding system for the quality measures provided by CMS that is to be reported with all claims submitted to Medicare. 


How do I know which measures are specific to my specialty and practice?

·     Your professional organization or specialty association should be able to guide you.  Many associations already have PQRI information on their websites.


Why should I participate?

·     PQRI is paving the way for other pay-for-performance initiatives.  Get in on it now.


Doctors all over the country are already getting paid under this new law, and you should be, too.  PQRI is designed to reward physicians who are succeeding in caring for their patients.

Many doctors’ offices often find themselves putting the business side of their practices on the back burner.  Tax time is coming, and year end preparations can help make it go much more smoothly.  Avoid costly mistakes and delays by making sure all proper forms have been completed and your office information is up to date.  Some questions to consider:

· Have you done all your year end preparations in order to process forms for employees such as W-2s and 1099’s?

· Have you consulted with your accountant about upcoming tax changes that might affect you?

· Have you properly booked all new assets such as equipment?

· Have you done a physical count of all inventory, if applicable?

· Have you reconciled all bank accounts, notes, LOC, and credit cards?

Be ready for tax season!


With the year end in sight, it is time to evaluate your office’s financial position, and prepare your budget for 2009.  Budgets are a necessity, especially in larger practices.  They must be monitored to make sure spending is kept under control.   You need to know where your money is going.  A detailed evaluation of your current situation will help you to know if you budgeted appropriately this year.  Knowing where you are today can help you plan more effectively for tomorrow.

Consider the following areas:

· Accounts receivable —do you know the state of your accounts?

· Yearly increases—what will be your percent cost and income increase for 2009?

· Goals – what is your profit margin goal?

· Cost containment—do you have cost containment controls in place?  Is you staff aware of cost containment?  As an incentive, offer a bonus to any staff member who comes up with a cost containment idea that works.

Careful planning today can help your practice achieve its financial goals tomorrow.



It’s that time of year again.   The weather is getting colder, the days are getting shorter, and the time for year end preparation and next year planning is underway.

At MD Alliance Billing, LLC, we have the knowledge and expertise to help your office run smoothly and efficiently.  In the next few posts, we will be providing some helpful tips and information to get you started with your year end planning.  These are important areas to consider when reviewing your office’s effectiveness and efficiency.  Today’s doctors office’s are busy  places.  We hope this blog provides useful guidelines that you can implement to make your practice ready for success in 2009.