Finding a good match for your practice opportunity continues to be a challenging endeavor. If you want to add a new graduate, this process becomes even more challenging as most residents go onto do a fellowship. It’s best to look for a new doctor as soon as you know you have a need. I suggest that you start your search at least a year before you need the doctor.
The Offer
The Offer
One of the goals of a practice search is to obtain an offer. An offer can be in verbal form, a letter of intent or an agreement. A verbal offer should always be followed-up by a written offer. The letter of intent is often a brief summary of the terms of employment to include the benefits. If this is acceptable to both parties, then an agreement typically follows.
You should expect to receive an offer either at the end of your interview(s) or shortly after your interview(s). However, if the hiring entity is interviewing several doctors, it could be months before an offer is extended. It is not forward to ask the hiring entity where it is in the search process so you can have an idea as to when a decision will be made.
Don’t be surprised if it takes awhile to receive the agreement. The hiring entity often seeks legal input to prepare the agreement and this adds time to the practice search process. Again, ask when you might receive it and use this time frame as a benchmark. If the time to get the agreement goes past the unreasonably past the benchmark time, then you should further engage discussions with the other practice opportunities you’re considering.
Once you have an offer, ask for some time to consider it. Be open with them about any other interviews you might have planned before you make a decision so they also have a time frame. If you decide against accepting the offer, do it graciously as possible as rehab is a small world and, who knows, you might find yourself working with the practice in the future!
Interview Question and Dialogue
The typical interview starts with the question, “Tell me about yourself.” This is the perfect entree for you to highlight your accomplishments and abilities. Rather than starting with I was born in XYZ town and decided early on that I wanted to be a doctor, start by highlighting your most significant accomplishment. If possible, your accomplishment should be quantifiable as well as 0ne of quality. For example, “I have published 10 research papers or . . . developed a rehab unit whose census climbed to 20 in the first year.
If you are on experienced doctor, try not to overload the interviewer with your knowledge of the field. Sometimes when you say too much, it uncovers information which may not be accurate and therefore to your disadvantage. Even though you are an expert, the interviewer ultimately wants to feel that you will be a team player and not always wanting the limelight.
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Lioresal Pump Management – Coding Changes
Some physiatrists have developed a boutique practice in analyzing, reprogramming, and refilling
implanted Lioresal (generic name is Baclofen) Pumps. CPT coding changes effective
January 1, 2012 no longer split the “Refill” and the “Reprogramming” when done together.
A list of CPT Coding for Lioresal Pump Management follows:
Approx
Medicare-2015
CPT Code CPT Summary Description Allowed
95990 Refill & maintenance ONLY with or without 90
Analysis, no reprogramming (by Non-physician)
95991 Refill & maintenance ONLY with or without 120
Analysis, no reprogramming (by Physician)
————————————————————————————————————-
62367 Analysis, no Reprogramming, 40
no Refill
62368 Analysis + Reprogramming, no Refill 60
————————————————————————————————————-
62369 Analysis + Reprogramming + Refill 120
(performed by Non-physician)
62370 Analysis + Reprogramming + Refill 130
(performed by Physician)
Examples for Coders/Billers
If a physician performs the Refill alone, no Analysis, no Reprogramming, then code 95991.
If a physician performs the Refill + Analysis, no Reprogramming, then STILL code 95991.
If a physician performs the Analysis, no Reprogramming, no Refill, then code 62367.
If a physician performs the Analysis + Reprogramming, no Refill, then code 62368.
If a physician performs the Refill + Analysis + Reprogramming, then code 62370.
Lioresal Medication – J0475
Lioresal medication is EXTREMELY expensive, and can cost from $200 to $1600 per visit. It is
important to bill the correct quantities of the J0475 code to obtain the correct insurance
reimbursement. Since the billings to Medicare must be reported as units, the correct drug code
must be converted to the correct number of units. The 2015 Medicare allowed amount for CPT
J0475 is approximately $210 per unit, which may assist you in converting the medication to units.
An incorrect conversion to units can easily cost the practice thousands of dollars. As it relates to
practice income, the profit on the medication is small, barring any appreciable discount from
Medtronic.
Summary
A physiatry practice can make good income from the procedures related to analyzing,
reprogramming, and refilling implanted Lioresal pumps, along with a small income from
billing the medication itself.
Contributed by Bruno Stillo, CPA, MBA, Physiatry Billing Specialists, 800-835-4482, www.physiatrymedicalbilling.com, [email protected]
The Interview
Preparation is the key to a successful interview. Go through a mock interview, pretending to be in the interview and answering the questions that might be posed. Use past interviews to inform you of what questions might be asked. Situational questions may be asked such as “How do you handle a difficult patient? ” These are often questions with no easy answers and no right or wrong answers. Think what answer best portrays your ethics and personality.
Be prepared with your own questions. The interview should be more like a conversation than one-sided by the employer. Questions about the doctor’s medical philosophy and treatment patterns are extremely important to see if you fit their practice and if their practice fits you.
Asking about compensation is tricky. When should it be raised? Follow the lead of the employer but don’t go past the phone conversation after the first interview without asking this question. Working with a recruiter often helps because the recruiter can often obtain this information for you.
The Practice Search Timeline
I’m often asked by practices and hospitals who are looking for doctors about how long it will take to find physiatrists. The answer depends on alot of factors to include. how rural the location is. how competitive the compensation is, how attractive the services are, e.g. outpatient and interventional are more attractive these days to most physiatrists. etc. Once candidates have been identified. then it’s a matter of how responsive the practice is with follow-up, whether the new doctor is licensed in the state or not, how long it takes to provide the new doctor with a contract. etc. Usually the process takes about 6 months.
From a doctor who is looking for a new position. the timeline is also usually longer than anticipated. This is for all of the reasons above and the multitude of other possibilities that could be the case. Usually it takes a practice/hospital about 2 weeks before they review your curriculum vitae. Then, the practice might ask Farr Healthcare. Inc. to do a preliminary interview. The next step if all goes well is the scheduling of a phone interview between the candidate and the practice/hospital. Often. this involves many individuals at the practice/hospital so it may take several weeks or more to identify a mutually satisfactory phone interview date. The same is true for when an on-site interview is scheduled. Before the on-site interview, references will be requested and checked. Again, the timing of their completion is dependent on the availability of the parties involved. Once an on-site visit is completed satisfactorily, then a contract will be presented. Some practices/hospitals have contracts prepared and other practices/hospitals have to go to their lawyer which may take awhile. Contract negotiation also may take weeks into months.
The Work of a Physician Recruiter
The physician recruiter is hired by the entity looking for a physiatrist. The compensation is a flat fee which is paid when the position is filled. The fee for physician recruitment is tax deductible. The physician recruiter has an obligation to find a physician for the entity. The recruiter should have the best interests of both the hiring entity and the new doctor in mind. If a new doctor starts and leaves shortly thereafter, it doesn’t serve anyone well. Depending on the area of the country and the nature of the position, anywhere from a few to many candidates will be presented to the hiring entity.
How to Tell if a Practice is a Good Fit
Sometimes, it’s obvious that a practice may not be the best for you. Other times, its more difficult to tell. Try to find out about physician and staff retention in the practice. I can often help you to find out this information and more which may be a bit sensitive for you to ask directly.
There is no perfect practice. Rather, just like with marriage, there is someone for everyone. However, there are signs to look for and questions to ask yourself when considering a new practice. First, do the doctors get along and seem to have common goals. Is there a good flow and energy between the doctors and the stall’?
lf the practice is busy and therefore has a lot of referral sources, then that’s a positive sign. If not and the practice is asking you to develop referrals, this is more of a challenge and you should try to find out all you can about the referral network during your discussions with the practice.
Negotiation Contract Tips
Negotiating a contract can be a very anxiety-provoking task but can result in major rewards. My approach to negotiating contracts for my clients is to be assertive yet willing to compromise to achieve the most effective results. The key to successful negotiations is perseverance, ingenuity and finesse. Almost every contract that is written can be improved with the addition or enhancement of provisions therein. At the end of the negotiation process, all parties involved should feel like they reached a solution that makes them feel like they won something.
My clients always ask for some initial tips when negotiating contracts. I often state the following:
1. Before you interview for a job, always explore the marketplace to determine what you are actually worth. How you may ask? Network with as many people in your field of expertise, converse with friends, acquaintances, cold call other professionals in the area you want to work to learn their ball park salaries and browse the internet.
2. Do not be too eager to inform the employer what you are worth. Wait to hear what they think you are worth. To your surprise, they may give you what you think you are worth and the negotiations may go much smoother. On the flip side if they are underpaying you then realize that negotiating contracts is a process and you have to allow it to runs its course. There can be several offers and counteroffers which may seem tedious but be patient as it will be well worth it in the end. If you accept your employer’s offer too early in the game, you may be undercutting yourself and will enter into a contract that is less favorable to your interests.
3. When you are offered an interview, research the organization by reviewing their websites to determine whether the organization is amenable to negotiations. If you learn that their offers are firm and inflexible then you have to craft changes to the contract to improve the side bar offered benefits: money given to achieve CME credits, paid vacation time, sick leave, transportation allowances, relocation expenses, stock options, partnership requirements, or malpractice insurance.
4. When negotiating, always address all of your concerns.
5. When reviewing a contract, please be advised that all parties’ expectations must be clearly outlined and quantifiable. Nothing should be left to the imagination. All the benefits and penalties should be explicit.
6. My clients are always worried about how they may come across to the employer if they negotiate contracts. In their desire to keep things amicable, some individuals forgo several benefits. I always advise my clients not to worry about offending the employer and allow your attorney to serve as your mouth piece so they can engage in the whole negotiating game on your behalf. People get too worked up about whether they seem reasonable and in many cases this concern causes them to surrender some key points they desire from their employer contract. Do not fall into this trap. Employers hope that you will be nervous and weak throughout the negotiation process. Be friendly but remember what is important to you. You can make concessions if it allows you to keep the negotiation doors open and enables you to achieve other benefits that in the long run may be more beneficial to you.
7. Don’t get so caught up in the process that you are quick to accept offers that are unfavorable only because you want the process to end quickly. Take it one day at a time. You have to allow negotiating contracts to runs its course. It takes time and in order to achieve favorable results, you need to let things move in their own pace. Do not let the negotiation fires burn out. Your goal is keep the other side engaged.
8. When reviewing contracts always know what you want achieved at the end of the negotiating process and know that if you do not get what you want that you always have the choice to walk away from the deal. Keep your goals clear and do not become a victim of indecisiveness.
By Monica Malhotra, Esquire, Gillette, NJ (908)-705-0914, [email protected]
The Interview
Here are some tips about when you go for an interview.
Arrive Ahead of Time– Make sure you arrive about 10 minutes ahead of time. It used to be that being on time was the norm. Now hospital/practices note when candidates arrive ahead of time for an interview. A message of strong interest and professionalism is shown when you arrive 10 – 15 minutes early.
Don’t Make any Negative Comments – Even though you may have been right in a work situation that had a negative result, don’t speak negatively or even about a negative situation when on an interview. Just the mention of a negative situation is not positive. It draws attention to the possibility that your interpersonal skills are not that great.
Ask Questions that will Land you the Position – Of course, you should ask informed questions during an interview. Don’t ask questions for which the answers could be obtained by online research. Listen during the interview and don’t ask questions that were already discussed. Some hospital/practice representatives are watching for how well you listen, a skill critical to being a good practitioner and business associate. Asking good questions shows the hospital/practice your true interest in the opportunity. However, there are some questions that will actually help you get the position. Questions such as ‘What could I say that would convince you that I am the one for the position?” or ‘What are you looking for in the person to take this position?” Ask questions and make statements that will show that you are authentic and confident.