“Lucrative Practices:  The Comprehensive Handbook for Healthcare Executives”

The American Association for Physician Leadership (AAPL) announces the publication of Lucrative Practices: The Comprehensive Handbook for Healthcare Executives. Written as a business reference guide for healthcare executives, office managers and professionals in independent practice, Lucrative Practices includes detailed “how to” discussions and instructions, tips, forms, templates and guides.

Starting and owning a well-run, successful practice are two of the most rewarding activities in which a healthcare professional can engage. However, staying ahead of the curve in our ever-changing industry environment can feel burdensome and can be disheartening. The fact is that at the end of the day, clinicians are trained in their science, not in business. This can ultimately result in a costly, inefficient, trial-and-error approach to practice management.

The American Association for Physician Leadership (AAPL) announces the publication of Lucrative Practices: The Comprehensive Handbook for Healthcare Executives. Written as a business reference guide for healthcare executives, office managers and professionals in independent practice, Lucrative Practices includes detailed “how to” discussions and instructions, tips, forms, templates and guides. This new book provides practical, rich content that boils down to immediately actionable solutions and helps reduce the drudgery of putting out the daily fires that weigh down so many practices.

There is no substitute for knowledge and experience. No matter how bright and clever a manager is, they are destined to make costly errors and miss valuable opportunities if they manage through trial-and-error and best guesses. Readers of Lucrative Practices will learn from the successes and failures of others how to organize, structure, and operate their business so that it is as profitable and rewarding as it can be.

Table of Contents

Acknowledgments

About the Author

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 Groups

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)

About Michael B. Spellman, Ph.D.

Dr. Spellman is a Healthcare Practice Consultant with more than 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.

About the American Association for Physician Leaders

The American Association for Physician Leadership (AAPL) is focused on the personal transformation of all physicians, and through them the organizations they serve. With the goal of improving patient outcomes, workforce wellness, and a refinement of all healthcare delivery, AAPL has remained the only association solely focused on providing professional development, leadership education, and management training exclusively for physicians. Since its founding in 1975, AAPL has educated 250,000+ physicians across 40 countries—including CEOs, chief medical officers and physicians at all levels of healthcare. www.physicianleaders.org