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Startup Spotlight | May/Jun '14

If I Knew Then What I Know Now

When starting a new practice, it’s helpful to get advice from as many people as possible. Nevertheless, there will be hurdles that you cannot be prepared for. Accepting this fact and mentally preparing yourself to handle anything that comes your way will make adapting to these challenges much easier.

To begin, when starting a new practice there is a chance you will see a patient you’ve seen in the past. Your National Provider Identifier (NPI) number, regardless of change in location, stays the same. Medicare only allows you to bill a patient as “new” if you haven’t treated him or her in the past 3 years. So, for example, let’s say you saw a patient 2 years ago while working at a practice in Maine. Now, you’re seeing that same patient in your new office in California. If you bill that patient as a new patient encounter (ie, 99203, 99204, 92004, etc), you will not be paid. Or worse, you may be paid and later receive a letter from the Centers for Medicare & Medicaid Services requesting a complete refund to them and the patient. Of course, this requires a lot of time, paperwork, and stress and is tough to avoid. Nevertheless, if you can screen every patient as to whether he or she is new, per Medicare guidelines, your coding/billing will be better and you will risk fewer audits.

Advertising is another way to build your practice. There are all forms of media—print, radio, TV, Internet, etc—with different costs. You should first decide what your advertising budget will be, and then decide which media will work best for you. In the beginning, it’s actually OK if the advertising is only bringing in enough patients to cover the advertising costs, because hopefully those new patients will become regular patients and bring more people to your practice. That said, as your practice grows, you want to cut those forms of advertising that do not yield a great return on your investment. A good example is ZocDoc. In some urban areas, ZocDoc is widely known and used and can bring a lot of new patients to a practice. In my area, ZocDoc is not heavily used by my demographic of patients, and so it was a relatively poor allocation of advertising dollars. You should continuously monitor how patients are coming to your practice and adjust your spending accordingly.

Ultimately, a successful practice requires improving your collections and decreasing your costs. By focusing your advertising money on bringing in more patients, and billing those patients appropriately, you can guarantee a great outcome.

David A. Goldman, MD

David A. Goldman, MD, is the founder of Goldman Eye in Palm Beach Gardens, Florida. Dr.Goldman may be reached at (561)630-7120;david@goldmaneye.com.