The Business of Physician Recruitment

It’s my world, the world of physician recruitment, but here’s some information that maybe new to you.

Physician recruiters typically charge $20,000+ to recruit a doctor.  A hiring entity signs a contract with the physiatry recruiter.  The fee and contract terms include the identification of doctors, reference checking, helping coordinate communications between the doctors and the hiring entity, etc.  It does not include the cost of bringing in the doctor(s) in to interview.

It is a tax-deductible expense.  It is a lot of money but the time value of having manpower, in hopefully a short time than if you recruited yourself, is a consideration.  Plus, if you use a physician recruiter experienced in physiatry recruitment, then he/she may very well have knowledge of the candidate’s background and interests that the hiring entity might not.  Also, an experienced recruiter has the skills to detect good candidates from less good candidates as a result of developed listening skills.

There are just a few physiatry recruitment firms.  It is best to use a physiatry recruitment firm because they know more about the physiatrists and the lingo of physiatry terms and have more physiatry practice candidates and opportunities.

Sometimes, the hiring entity wants to hire a locum tenens doctor.  Locum tenens means to work on a temporary basis.  It can be to cover you during a vacation, while away for CME, until you find a permanent doctor, etc.  Locum tenens doctors usually expect $750/day – $1,000/day.

Our firm also helps find locum tenens doctors.  On top of the reimbursement, locum tenens doctors need housing and, if the term is for a few weeks or more, transportation costs back to his/her home every so often.  If the locum tenens doctor does not have or can not obtain professional malpractice insurance, then the hiring entity will need to secure it for him/her.  If the hiring entity can not get professional malpractice insurance for the locum tenens doctor, then the locum tenens recruitment firm can provide this insurance.

Home Health Certifications – Lost Income

Many physiatrists are unaware of their ability to bill for Certifications of Home Health Service, and have lost many thousands of dollars over the past ten years.

Background

Physicians have always been able to bill for Care Plan Oversight services.  However,the physician must meet and document that he/she has spent 30 minutes within the month providing these services.  Most physicians do not meet the 30-minute time requirement – and many feel that the effort to document the 30 minutes is just too difficult, and therefore do not bill.  However, since October 1, 2000, physicians have been able to bill for Home Health Certifications, defined as “Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per certification period (60 days).”

How it works

Physiatrists often receive Medicare Form CMS-485 which is entitled “Home Health Certificationa nd Plna of Care” for patients discharged from their inpatient service.  Physiatrists review these plans of care, sign them, and return them to their Home Health Agency.  Believe it or not, many physiatrists are not aware that they can bill for these services.  But wait, there’s more!  After 60 days, the patients may be Re-certified for another 60 days of home health services, and another Certification form will be signed by the physician.  This second 60-day Certification is ALSO billable, although with a different CPT code.

Reimbursement

Medicare reimbursement is over $50 for the initial Home Health Certification, and over $40 for each Re-certification.  If you have not been billing for these services for the past ten years, and if you have had an average of two Certifications per month, you have lost income of well over $10,000.  If so, don’t look back, but bill going forward.

Bruno Stillo, CPA is the owner of Physiatry Billing Specialists, 800-835-4482, [email protected]

INTERVIEW BLOOPERS

No one is perfect! However, an organization wants to contract with the physiatrist who is the best person they meet during the interview process. The best person has many qualities to include someone who interacts well with other doctors, staff and referral physicians, particularly in difficult or uncomfortable situations. Here are some suggestions to help you show the best side of yourself during your interview:

1. Interview Preparation Eliminates Stress
The best way to impress the hiring organization is to know as much as possible about them and their culture and about the work responsibilities. It’s best to know how the interview will be conducted, e.g. one-on-one or as a group. Identify interview mistakes such as a typo on your cv, getting stumped by a question, running late, etc. Then identify how you will act in each situation.

2. “Fess up or Hush Up If You Can’t Speak Up”
No one wants to seem like they don’t know the answer to a question, so they guess or mumble an answer. It’s OK to say “I don’t know, but I’d be happy to learn” or “I’m really not sure but I will think about it and get back to you.” It is not only OK but often very effective to politely ask for clarification on a question/scenario you don’t understand. When you ask for clarification, it may make the question clearer and enable you to provide a great response.

3. Play down mistakes
If and when you become flustered, don’t let it affect the rest of your time spent with the organization. A thank-you note is always in order after an interview and you can use it to reemphasize any points you think are appropriate. This action and other professional dialogue after an interview can change an organization’s average thoughts about you into positive thoughts. Any mistake during an interview should be addressed and then you can move on. Use your insight to determine whether a mistake requires further attention or not.

The job search process is time-consuming, requires patience, and can be stressful. Mistakes happen. Stay confident. Be yourself. Have a sense of humor.

Interview Tips

Self-confidence is very important during the interview process.  Use the interview to distinguish yourself from others and highlight your strengths.  As the saying goes, if you don’t believe in yourself, other people won’t believe in you either.

When answering questions or during the interview discussion show that you relate to the interviewer.  Nod your head during the discussion on points you agree.  Make an empathetic comment when you answer a question.

Try to find out during your initial phone conversation what the practice is searching for.  There is usually a key component that they’re looking for in the new person.  Use the interview to address who you are and that you have what they’re looking for.  You will have to convince the interviewer that you have what they’re looking for or else someone else may get the position.

Everyone likes people who are happy, enthusiastic and easy to talk with.  The same situation applies to your interview.  Try as much as possible not to be nervous and instead be relaxed and show your naturally good qualities.  If you don’t have these qualities, display them in the interview and work towards them in life.

Interview Questions

Interview Questions
By Linda Farr
The interview is often your only face-to-face meeting with the entity that you may end up spending several years or more working with. You’ll probably have spoken by phone with the entity before the interview so you’ll have some idea of their interests and what you might be asked at the interview.

Q: Tell me about yourself.

A: Use this as an opportunity to highlight your strengths. Don’t tell them what you’re done since you were born. It is ideal if you can inform the interviewer of your strengths by telling real-life scenarios you’ve experienced.

Q: What are your expectations of this position?

A: lf you have a clear understanding of the job expectations, then the answer is simple. However, most times you won’t. Don’t be afraid to tell them that and turn the question around to them.

Q: Why do you have an interest in this position?

A: Use this question to show the entity your knowledge of them. If, for example, their focus is Workers Compensation, then link that to your abilities in Workers Compensation. One of the practices that I worked with in Phoenix was concerned if the new doctor could tolerate the heat there. In this case, use this question to address any possible negatives of the position and how you enjoy what to others might be negative.

Q: Any question that you don’t have an answer for!

A: Don’t stumble to come up with an answer that you’re not sure of.   Interviews cause people to want to provide answers for every question. However, it is the wise interviewee who will confess that he/she doesn’t know. You could say “I don’t know, but I’d be happy to learn” or”I’m not sure but I’ll get back to you.”
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Physiatry Billing

Physiatry Billing – No Silver Bullet By Bruno M. Stillo, CPA, MBA
What is the magical way to improve your billing and collection function? Unfortunately, there is none – no hidden secret, no “silver bullet.” However, adherence to several fundamentals will work just as well.

How to maximize upfront billings:
Capture all performed services! For outpatient services, medical offices usually employ a pre-printed superbill which can easily be misplaced. Suggestion: Match each patient on the appointment schedule to a corresponding superbill.
For each patient admitted to a rehab facility, there is usually an initial charge, regular follayvups, and ultimately a discharge code. Suggestion: Any gap in inpatient billings should be brought to the provider’s attention.
Simple data entry errors can cost the practice thousands of dollars. Suggestion: Have a second person, not the data entry person, check all data entry.
How to maximize collections:
Followup, follayvup, follayvup!
Pursue vigorously by telephone or in ‘writing all insurance denials, and non-responses. Many billing personnel find calling insurance companies to be stressful and time-consuming, when in reality they are usually helpful in resolving problem claims. TELEPHONE FOLLOWUP IS A KEY COMPONENT OF THE COLLECTION FUNCTION. Suggestions: When calling the insurance carrier to reprocess the denied claim, get a reference number. When calling about a claim with no response, try to fax the claim.
If a telephone call cannot resolve the denied claim, then a written appeal should be sent. Suggestion: Design a preprinted Appeal Form which can be filled in with the necessary information.
Sometimes, the patient’s insurance information is incorrect. Although it is very easy to simply send a bill to the patient, it is not the most effective way. You have a better chance of collecting money from the insurance company than from the patient. Suggestion: Research thoroughly the insurance problem by calling the patient, and by calling the insurance company. Billing the patient should be the last resort.
As has been demonstrated, billings can be maximized by capturing all services performed.
Bruno Stillo,CPA is the owner of  Physiatry Billing Specialists, 800-835-4482, [email protected]

Interview Questions

Being prepared for an interview is vital to the success of the practice search process. Part of the preparation is practicing how to answer the questions during the interview. Here are some examples of interview questions and how to respond.

Q: Why do you want to change employment?

A: Don’t give them a horror story about your current employer. No one wants to hear negative stories. Negative stories in interviews make the person who is telling them seem negative. Instead give a generic answer such as: “I am looking for professional growth.”

Q: What do you wish to change about your present position?

A. This is another question where you dontyvant to present negative information. Frankly, interviews are not the place for much, if any, negative information. A good response could be “I’m looking for more inpatient world’ if you’re interviewing for a position which involves inpatient work and you’re currently doing more outpatient work.
Q. What are your professional goals?

A. Your goals should jive with the goals ofthe practice, e.g. to help grow the practice, to make patients satisfied with their visit, being active in the community. Therefore, to respond successfully, you must do your homework to find out what the practice’s goals are. This may not be available as is but you can make deductions about it from your initial conversation with the practice and the website. For example, the practice physician may have talked with you on the phone about how the practice just added a tluro suite. Given this expense, its no doubt a concern ofthe practice to pay offthis expense so their goal is to build the interventional referral base. Professional goals can be: patient education, to become Board Certified, to become a partner.

Q. What would a colleague say about your strengths and weaknesses?

A. This is another trick question. Most interview questions are seeking information which the answers indirectly provide the essence ofthe interviewee’s character and values. For example, you might respond to this question that your yveakness is that you’re impatient. Rather than say that you’re impatient, its better to say that you strive for perfection and that at times you become impatient with yourself when trying to get something done on time and well.
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Licensing

Some states such as NJ and CA take a half a year or more to get a license.  The usual time to get a state license is approximately 3 months.  States such as TX and FL which used to take a long time to get a license have changed, and barring any issues, will issue a license in a few months. I have listed on my website under Resources the name of a consultant in FL who can help expedite licensure in FL.  Some doctors use the Federal Credentialling Verification Service when getting a new license.  This service verifies your credentials and stores them so that if you apply for another state license later it expedites the process.

The time it takes for licensure is important for many reasons, chief among them being when you can start a new job. Until you’re licensed, the hiring entity typically can’t get you on the payor panels and don’t want you to start until that is accomplished and they can get paid for your work.

Why Do Doctors Need a Professional Third Party Business Valuation For Their Practice?

If you are considering selling your practice, you need a 3rd party valuation firm that specializes in valuing businesses to determine the selling price of your practice. Most other professionals such as business brokers, attorneys and CPA’s either don’t have experience with or access to nation-wide sold practices transaction data, the methodology used for asset based, income based and market based valuation calculations, or they are not in daily touch with the current lending market. The price and profitability of your practice must be an amount sufficient to support any acquisition debt service, a new owner’s compensation package and periodic additions to the working capital needs of the practice for growth.

A valuation identifies the total fair market value or selling price of your practice.  

You will receive separate values for the tangible and intangible assets of your practice. Since tangible assets are usually depreciated for tax proposes, the fair market value of all assets to be included in a sale is based upon today’s prices; not original purchase cost like accountants use. The intangible assets represent the “sweat equity” of the practice including goodwill, patient files and referral sources and the efficiency and profitability of your practice. The sum of tangible and intangible assets included in the sale equals the fair market value or selling price of your ‘practice.

A valuation helps you make an educated decision regarding the sale of your practice.

You may have a “hunch” about the selling price of your practice based upon speaking with colleagues and other professionals or reading about revenue/profitability multipliers but a “hunch” is not a reliable method for making the decision to sell or not to sell. You need a solid number concerning the amount of money for which your practice will sell in today’s market. Then you can make a fully informed decision to sell or not to sell your practice.

A valuation enables you to price your practice with confidence.

Once you know the selling price of your practice — you are in a very strong negotiating position. If you receive offers below your price, you can confidently stand your ground — knowing that the owner’s cash flow will support acquisition debt service and give the potential buyer a solid return on their investment, as compared to other investment opportunities the buyer may be evaluating.

Article contributed by Jeannette Engel, Business Broker at unionbaygroup.com, or (206) 783-1717.

The Components of a Successful Practice Search

How do you complete a successful practice search? The answer to this question begs the reader to define success. Everyone has a different definition of suc-cess, therefore, the parameters of a suc-cessful search will be very personal.

You must consider your vision of success to include your goals and the path you must take to accomplish them. Take the time to sit down and contemplate your val-ues. What is important and how important is it – finances, practice location, size, style, and type: proximity to family and friends, etc. Once you’ve identified your values, your practice search will be headed to-wards a successful completion.
Once you’ve identified your ideal practice situation, it’s time to find the ideal opportu-nity. The obvious methods are through the classified ads in the PM&R Journal and The Physiatrist, the AAPMR’s Job Board, recruiters, the Job Fair and bulletin board advertising at the Annual AAPMR Meet-ing.
Practice opportunities can also be found through a more active and, often, more productive approach. Talk with former classmates who are now in practice about opportunities they are aware of within
their own practice or elsewhere in their community. You should also talk with doctors in the area where you wish to practice
On to the interview . . . be prepared to discuss the current health care environ-ment. Engage in dialogues with practic-ing physicians so you can speak to the needs and issues of the practice. Give examples of how you can contribute to the practice’s ongoing success.
Know your references from the start. However, if the interviewer asks for them, you should request a day or two lead time so that you can notify your references of the impending calls. Also tell your references of the needs of the position and how your skill set matches them. You might need to coach them about the strengths they should empha-size.
In conclusion, take time in advance to identify your ideal practice situation. This soul-searching process will direct and streamline your practice search and save you time in the process. Your practice search will be much more enjoyable and rewarding.