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, jazshah@yahoo.corn

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.

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, physiatrybillman@aol.com

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, physiatrybillman@aol.com

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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