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Answer:
You've discovered the perils of not having (or not following) a written policy on this subject. You should develop such a policy now. It will allow you to treat all your patients the same, and keep you from getting in this boat again. (Make sure you don't already have a policy that everyone has forgotten about. If you do, review it and either start enforcing it or replace it with something else.)

Here is the norm for written policies:
Detail the circumstances under which a patient will be dismissed and policies for making sure a dismissal letter is sent.

 If the patient has been dismissed for administrative reasons -- as opposed to clinical noncompliance -- the most common policy is to allow the patient to resume his care if 100 percent of the outstanding balance is taken care of.

 Moreover, some groups have decided that once a patient is dismissed, the practice will no longer agree to extend credit, even after readmitting the patient. That is, the patient has to pay 100 percent of his bill at the time of service, and he can file his own insurance if he so wishes. Further, some practices will no longer schedule an appointment with a previously dismissed patient, but treat the patient on a walk-in basis only.

 For clinical noncompliance, your policy should include review by the physician. The physician needs to decide whether to resume care. This issue of clinical noncompliance can be very sticky, and we recommend discussing it with your malpractice carrier.

As you do not have such a policy and did not formally dismiss her, why NOT treat her if she pays off her balance and pays upfront for her treatment this time around?

If you don't want to do that, yes, I'd suggest sending her a formal letter of dismissal that includes you continuing to see her for 30 days until she has time to find a new provider.

 Dictation turnaround
Question:
Are there any published statistics on the average turnaround time for postoperative reports for orthopedics? Some of our physicians turn them in on the same day, some almost a month later.

Answer:
We don't know of any published data. An informal survey of orthopedic practices says the norm is 24-48 hours from service to dictation.

If you want more official numbers, you could ask your transcription company -- if you have one -- if it can run a report showing the difference between date of service and date of submission to the transcriptionist for all orthopedic practices it serves.

However, allow me to suggest that it may be a moot point. I assume that your goal is to speed things up? If you throw benchmarks at your docs their reaction is likely to be to dither about the accuracy of the benchmark, complain about their schedule, or some
other such thing. It won't by itself change behavior.

What will? Money.

Institute a fine for anything more than, say, two days. Or if your compensation is production based at all, then don't process payment to them until the documentation is in and the claim is submitted. No ticket, no laundry.

Of course, you should make sure it's convenient for your surgeons to do their dictation. A physician who has scheduled time for it after each visit or surgery is more apt to get it done. Set up dictation pods on site that give physicians some privacy to do their reports without taking them completely off the floor. Give them handheld phones, recorders, or some other such mobile devices to dictate into.

Remember, this is not only a billing issue; it's a risk management issue for you. The longer physicians wait to do their dictation, the harder it is for them to remember all the important clinical details. It's important to take delays seriously.

 Physician advertising
Question:
I am opening up my private practice this month. I discovered an anti-acne herbal medicine. Can I advertise to give free samples to patients?

Answer:
For the most part, physician advertising is limited more by ethics than regulation.

Here is the AMA's statement on the proper bounds for self-promotion, which mostly says you have to be truthful: www.ama-assn.org/ama/pub/category/8348.html.

I'd also suggest that you should be careful to be very professional in how you do it. You don't want the other physicians in the area to whom you might refer or who might refer to you thinking you're some kind of cowboy. The fact that you're new and pushing an herbal  remedy only increases the chances that some of your more conservative peers will look askance at you.

Also, consider as you approach this whether you're targeting the population you want. If you position yourself for young-ish patients, or even middle-aged patients with acne and an interest in herbal solutions, that is what you'll get. Are you ready to provide other herbal remedies? Would you prefer an older, more complex patient base?

 Patient information updates
Question:
Major insurance carriers are constantly denying or delaying payment by asking for patient information to be updated. We ask patients to call the insurers and update their information; needless to say, patients don't follow up very frequently. How can we improve patient compliance, make the carrier responsible to obtain these updates, or somehow get paid?

Answer:
Unfortunately, there is no magical solution to the problem -- and it occurs a lot. We suggest you identify if there are certain factors that trigger this routinely -- missing phone numbers, haven't visited in six months -- and advise patients to call while they're in your office. Don't let them get home and forget about it.