What benefits should you expect at your job?  The very basic benefits are malpractice, vacation, health insurance cost, and CME cost and travel. Malpractice and 1 week of CME to include the associated travel expense are standard.  The amount of vacation and health insurance vary.  I’d say the average vacation is 3 weeks.  Health insurance coverage varies from providing it just for the employee to providing it in full for the family.  Additional benefits include sick time, student loan assistance, a sign-on bonus, dental and vision insurance, life insurance, disability insurance, a retirement savings plan, a flexible spending account, long term care insurance and the list goes on.  Benefits maybe negotiable.

According to Elizabeth Lee, a physiatry practice management and billing consultant, typical benefits are generally  100% of malpractice, $450-$600 per month for health insurance,  paid CME for 1 week to include the travel expenses,  2 weeks off for paid time off not including CME.   Elizabeth Lee, President, Physiatry Reimbursement Specialists, Inc., A National Company serving Physiatrists all over the U.S. for 20 years, Fort Worth, TX, 1-800-324-4777, 817-284-9850, www.Prsinc.com

There are several considerations when deciding whether to add a new physiatrist.  First, are you ready financially to pay for a new doctor?  Has your practice or hospital census reached the point where adding someone is financially feasible?

Make sure that you have a sound reason for adding a new person.  What are your goals for the new position and how do they relate to your practice’s/hospital’s goals?  Without goals in mind, the hiring of a new associate may result in unintended consequences.

Hiring a new doctors takes alot of you and your staff’s time and energy.  Do you have the time and resources to guide a new physiatrist?  The new physiatrist will need to learn all the ropes from your office routine to the best business practices.

I’m sometimes asked what financial guarantee our company offers in cases when a new doctor doesn’t work out. This makes me write about why new doctors leave. It’s frustrating, costly and difficult when a new doctor leaves a practice or hospital after intensive interviewing, reference checking, etc. has occurred. Many hospitals and practices are now using psychological questions to try to reduce situations when doctors leave early.

Yet doctors continue to start work and leave early and this will probably never end. What can you do to better assure that your new doctor will stay?

Determine Who Will Be a Good Fit

First, determine who will be a good fit for you. Do you want a leader or a follower? Does your patient base demand a certain doctor type? Do you have a hard driving practice and want a person with similar qualities or not?

Hone Your Interviewing Skills

Second, hone your interviewing skills. It’s not just the questions you ask but your perception of what the doctor you’re interviewing doesn’t say. Have several people interview the doctor as they bring different perspectives and a greater understanding of the doctor. Listen more and talk less.

Consider Numerous Doctors

Third, don’t hire the first doctor who expresses an interest. Consider numerous doctors just like you would when make a purchasing decision.

Unfortunately, there isn’t a crystal ball and hiring mistakes occur. One of the reasons for this is that, due to human nature, the interviewer tends to see in the interviewee the qualities needed for the job regardless of whether the interviewee actually possesses the qualities.

Generally speaking, physiatrists have a very low overhead when practicing on their own. However, when you get into the multispecialty arena, and orthopedists are involved, the overhead skyrockets. Since physiatrists do not need alot of ancillary services, and your equipment is fairly low budget in comparison to surgeons, this should be reflected in what your share of the overhead is. Unfortunately, what happens over and over again, is that you end up sharing the overhead equally with the other physicians, but do not necessarily reap the same profits.

You have to isolate what components of the practice you are contributing to in order to determine what your share of the overhead should be. Do you oversee PT? Refer to them? Generate income for the practice from this cost center? Do you receive compensation for your involvement in this? Are the spinal injections being done under Fluoroscopy in an ASC owned by the Group, or in an Office based surgical suite? All of these things are vital to how you will evaluate what your overhead should be. How are the profits of the group distributed?
If you are sharing equal overhead, but are only reaping the benefits of your own billings, then this is definitely something you have to look at and find a way to get the overhead for you to a more manageable level. Determine what direct costs you have, and what cost centers produce revenue for you. The lease space should only reflect what you use. The equipment costs are one-time costs. The other cost allocation would be the surgical suite – depending on how this is set up. An in-office surgical suite would be simple; an ambulatory surgery center is another story, and would depend on if you have ownership interest, the same is true with MRI.
Contributed by Elizabeth Lee, President
Physiatry Reimbursement Specialists, Inc.
A National Company serving Physiatrists all over the U.S. for 25+ years
Fort Worth, TX
1-800-324-4777
www.Prsinc.com

A patient called regarding a bill for a co-insurance of $40. He advised that he had called his insurance company and they told him he didn’t have to pay that amount. I placed him on hold, and hurriedly pulled the EOB, which clearly showed that he owed a $40 co-insurance. I asked him to tell me who had told him that he didn’t have to pay, but he couldn’t tell me. This patient was intelligent, and was extremely well-spoken. After trying, in vain, to explain the EOB to him, he finally said:

“I can do either of two things: 1. I can pay the $40, and then I will write to the Attorney General of the state and lodge a complaint, and send you a copy of my complaint, or 2. You can write off the bill, and I will not write to the Attorney General.”
I was on firm ground, but I still checked with the client who agreed that we should not back down. I was surprised that the patient thought we would be intimidated by his empty threat. Does he really believe that the Attorney General has time to investigate $40 complaints? In any case, we received a check for $40 from the patient, and six months later, were still waiting for a copy of his complaint to the Attorney General.
Contributed by Bruno Stillo, Physiatry Billing Specialists, 800-835-4482 physiatrybillman@aol.com

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.

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, physiatrybillman@aol.com

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

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.