Lucrative Practices: The Comprehensive Handbook for Healthcare Executives

TABLE OF CONTENTS

Acknowledgments

About the Authors

Chapter 1: Becoming a Healthcare Entrepreneur

• Your Vision
• Your Business Plan
• Naming Your Business and Choosing a d/b/a
• Legally Organizing Your Business
• Sole Proprietorships
• General Partnerships
• LLCs, PLLCs, PAs, and PCs
• Corporations
• S-Corps versus C-Corps
• Permits, Licenses, and Numbers
• National Provider Identifier Number (NPI)
• Provider Enrollment, Chain, and Ownership System (PECOS) Registration
• Provider Transaction Access Number (PTAN)
• Unique Physician Identification Number (UPIN)
• Professional Licenses
• Drug Enforcement Agency Number
• Taxpayer Identification Number (TIN) and Employer
• Identification Number (EIN)
• Business Licenses
• Certificates of Occupancy (CO)

Chapter 2: Starting Up Your Business

• Finding and Making a Home for Your Practice
• Choosing Office Space: The Cost-to-Benefit Ratio
• Buy, Rent, or Lease
• Leasing or Renting Office Space
• Reviewing a Real Estate Lease
• Property Insurance for Leased Space
• What About Parking?
• The Importance of Signage
• Equipping Your Office
• Lease or Buy?
• Considering Telephone Systems
• Computer Software and Website Resources
• Software for Billing
• Software for Scheduling Appointments
• Electronic Health Records
• Insurance Confirmation Websites
• Accounting and Payroll Software
• Card Scanner Software
• Credit Card Payment Processors
• Email Programs
• Instant Messaging and Text Messaging
• Telehealth Programs
• Contact-Tracking Software
• Productivity-Enhancing Software
• Basic Office Software
• Miscellaneous Office Software
• Data Storage and Destruction

Chapter 3: Relationships With Banks

• The Business of Banking and Finance
• Understanding Banking Fees
• Choosing a Checking Account
• Using Sweep Accounts
• Making Deposits
• Paying Bills Online
• Loans and Other Forms of Credit
• Lines of Credit
• Business Term Loans
• Credit Card Account Management

Chapter 4: Sales, Marketing, Branding, And Community Relations

• Marketing Is Not Sales
• Marketing Activities
• Marketing for Healthcare Entrepreneurs
• Sales Activities
• Networking and Community Relations
• Reputation Management

Chapter 5: Patient Relations

• Understanding Your Customers and Constituents
• Patient Retention: A Patient’s-Eye View of Your Practice
• Keeping Patients Informed – No Surprises
• Managing No-Shows and Late Cancellations
• Gauging Patient Satisfaction
• Avoiding Malpractice Claims and Licensing Board Complaints
• Addressing Complaints and Malpractice Claims
• Terminating Patient Care

Chapter 6: Labor Relations

• Hiring and Retaining Valuable Employees
• Determining Salaries and Wages
• Employing Other Professionals
• The Progressive Corrective Action Plan
• Hiring Independent Contractors
• Outsourcing Work
• Hiring Consultants
• When Employees Leave or Retire
• A Word About Contracts and Trust

Chapter 7: Working With Insurance Companies

• Insurance Company Relationships
• Glossary of Health Insurance Terms
• Allowed Amount
• Appeals
• Assignment
• Balance Billing
• Burden of Enrollment
• Capitation
• Coinsurance
• Coordination of Benefits
• Copayment
• Deductible Amount
• Diagnosis-Related Groups
• Fee For Service
• In-Network and Out-of-Network
• Modifiers
• Noncovered Services
• Not Medically Necessary
• Place of Service
• Preauthorization
• Precertification
• Relative Value Units
• Single-Case Agreements
• Utilization Reviews
• What Is Health Insurance?
• Insurance Industry Organizational Structures
• Indemnity Plans
• Managed Care Organizations
• Health Maintenance Organizations
• Preferred Provider Organizations
• Exclusive Provider Organizations

Chapter 8: The Cash Flow Cycle

• Billing and Collections
• Billing and Collections Are Not the Same Thing
• Essential References and Guides for Billing
• Billing Procedures
• The Minimum Data Set for Successful Billing
• Before Your Patient Arrives
• Billing – The Back-Office View
• Collections
• How Money Flows In
• When Your Patient Arrives
• Letters of Protection
• Payments from Insurance Companies
• Explanations of Benefits and Electronic Remittance Advice
• Coordination of Benefits
• Successful Collections from Insurance Companies
• Collecting Past-Due Accounts
• Past-Due Insurance Claims
• Past-Due Patient Balances
• Tracking Accounts Receivable
• Credit Balances
• Cash Outflow
• Accounts Payable
• Paying Employees and Contractors
• Paying Yourself
• Dividends and Bonuses in Multi-Partner Group

Chapter 9: Laws And Government Relations

• Disclaimer
• Paying Taxes
• Income Taxes
• Payroll Taxes
• Transmitting Taxes
• Types of Laws
• Statutory Law
• Regulatory Law
• Case Law
• An Annotated Glossary of Some Legal Concepts and Terminology
• Laws Addressing Fraud and Abuse
• The False Claims Act of 1863
• Federal Anti-Kickback Statute
• Stark Laws
• Laws Addressing Healthcare Delivery
• The Medicare Access and CHIP Reauthorization Act of 2015
• Laws Governing Patient Rights
• The Health Insurance Portability and Accountability Act of 1996
• The 21st Century Cures Act (PL 114-255)
• The Health Information Technology for Economic and Clinical Health Act of 2009
• The Fair Debt Collection Practices Act of 1977
• The Controlling the Assault of Nonsolicited Pornography and Marketing Act of 2003 (CAN-SPAM)
• Business Laws
• The Sherman Antitrust Act
• The Clayton Antitrust Act
• Potentially Monopolistic or Anticompetitive Practices
• Labor and Employment Laws
• The Fair Labor Standards Act
• The Occupational Safety and Health Act of 1970
• The Employee Retirement Income Security Act of 1974
• The Americans with Disabilities Act
• Whistleblower Protections

Chapter 10: Retirement And Long-Range Planning

• Retirement Planning
• Individual Retirement Plans
• Simplified Employee Pension IRA
• 401(k) Plans
• Transition and Exit Planning
• Professional Wills
• Selling Your Business
• Asset Sales and Stock Sales
• SWOT Analyses
• Valuing Your Practice

Chapter 11: Future Directions

• The Blurring of Lines and Roles
• Delivery Models of the Future
• A Word About Single-Payer System (SPS)

Dr. Spellman is a Healthcare Practice Consultant with over 30 years of experience in a wide range of healthcare practice types and settings. He is fond of saying that “Practice consultancy provides the best possible education. Where else can you learn from other’s successes and from their mistakes?”

Having founded, purchased, sold, and consulted to practices of all sizes, Dr. Spellman is a “doctorpreneur.” He knows first-hand what it takes to be successful as a healthcare professional starting, running, and ultimately selling a healthcare business.

A frequent speaker on the subject of The Business of Practice, Dr. Spellman continues to practice part-time. His training as a Psychologist adds an understanding of human motivations and human behaviors to his writings, lectures, and to his recommendations. His experiences as a Commissioner on Florida’s Commission on Mental Health and Substance Abuse and as the longstanding Chairman of a Political Action Committee, allow Dr. Spellman to understand and make use of the political, regulatory, economic, and social forces that influence the healthcare industry.