Journal Articles and Essays
Though most of my writing has been for professional journals in ophthalmology, optometry, dermatology, and podiatry, virtually every article here applies in one way or another to all medical specialties. After all, change the CPT and ICD-9 codes and the business-of-medicine issues that challenge eye doctors really are not dramatically different from those affecting dermatologists, podiatrists, cardiologists, urologists, physician assistants, or any other healthcare professional.
These articles highlight important business issues I've identified over the years. Please invest some time reading these articles and the "pearls" I offer as solutions. You will find your time is well spent.
- Managed Care Contracting
- Getting Reimbursed By Third-Party Payors
- The Physician-Administrator Team
- Physician Compensation
- Employment Contracts
- Practice Development and Expansion
- Office Computer Security
- Evolution of Managed Care
- Optical Dispensing
Managed Care Contracting
Making Your Case With Managed Care
Negotiating with insurance companies is still an option, but requires preparation and perspective.
Think You've Negotiated A Favorable Managed Care Provider Agreement? Then What's That "Tick, Tick, Tick?"
When reviewing a provider agreement, I don't first turn to the reimbursement schedule. Rather, I look at the termination protocols to see how my client can get out of the deal if things should go wrong.
There's No Such Thing as Trust in Managed Care
You must be resolute when negotiating with third party payors, and be willing to say "No" to protect the financial interests of your practice.
How to Request Necessary Contract Information from Third-Party Payors.
Here are some useful methods, especially when dealing with uncooperative carriers.
Taking an Aggressive Approach to Managed Care Contracting
What can a one or two-doctor practice do?
Limiting a Payer's Ability to Unilaterally Deduct or Offset Disputed Amounts from Future Payments
Here's some helpful advice on fighting back against unjust reimbursement practices
What to Do When a Third-Party Payor Says Your U&C is Unreasonably High
Use this letter when you are underpaid based on your fee schedule.
Eye on Managed Care: Preventing Arbitrary Downcoding
Third-party payers sometimes change the rules of the game without warning. Here’s a way to fight back.
Ending a Managed Care Contract
Termination can be unexpectedly complicated. Knowing your responsibilities and your rights will help.
Unforseen Business Interruptions
When problems compound upon problems, how bad can things get?
When Payment Adjustments Keep Coming Back
Place constraints on retroactive adjustments before they wreak havoc on your monthly financials.
Eye on Managed Care: Your check is in the Mail
Slowly but surely, states are beginning to enforce prompt payment laws. Here's the latest.
Eye on Managed Care: More Vision Plan Woes
Often times you'll find nasty surprises in the Provider Manual.
Like a thief in the night, third-party administrators are practicing a new method of creatively discounting your reimbursements. Here's what to watch for.
Eye on Managed Care: Old Headaches, New Headaches
More nasty surprises in the collateral documentation.
Give Payors What They’re Not Expecting
Using some creative tactics can keep more of your time and money from vanishing.
Eye on Managed Care: Be Careful What You Wish For
Changing or eliminating a poor contract may involve hidden pitfalls. Here are two things to look out for.
Use Legal Precedent to Fight Payer Takebacks
An Indiana case illustrates how you can win.
Thinking About Creating Your Own Vision or Eyecare Plan?
Understand the populations you'd be trying to capture. Learn the legal and financial constraints that state law might impose when contracting directly with self-insured entities.
Swimming Against Downstream Risk
The failure rate of managed care intermediaries is increasing, but you can take steps to avoid losing all payments for services.
Special Contractual Concerns for Risk Contracting (Parts 1 and 2)
If you're considering a contract that does not pay fee-for-service, you must understand these critical issues.
Getting a Grip On Payor Take-Backs
Want to limit retroactive adjustments from third-party payors? Here's help.
Eliminating the All Products Clause
For years, physicians have been forced to accept unacceptable contract provisions. Finally, the tide may be starting to turn.
Firing an HMO
A story about one doctor who did the inconceivable and increased profitability as a result. Here's how you can do the same.
Key Information Necessary For Successful Capitation Contracting
Don't even think of negotiating a capitated contract unless you can get this information from the payor.
Getting Reimbursed By Third-Party Payors
Managing Your A/R For Greater Profitability
Here's how to get a grip on your uncollected balances.
Should You Consider Going Non-Par?
Going out of network is not a simple decision.
When a Covered Service is not a Covered Service
Be Careful of this Insurance "Booby-Trap"
What to Do When a Payor Denies Your Recommended Care as "Experimental or Investigational"
Take these steps when your proven treatments are unfairly denied.
Get Paid For New Technologies and Services
Don't let third-party payors "wiggle-out" of compensating you for state-of-the-art patient care.
Fair and Proper Claims Payment
When it comes to payment, it’s a two-way street.
Cut Your Best Deal for Out-of-Network Services
When dealing with repricers you have the upper hand
Treating Out-of-Network Patients
The U.S. Court of Appeals Issued a Decision That Could Make it Easier for Dermatologists to Get Paid for Treating These Out-of-Network Patients.
The Notice Prejudice Rule
A little-known rule out of California that could result in both fewer claims rejections and increased revenue for your practice.
CPT 92135: What to Do When You're Denied Compensation
Some payers deny compensation for proper patient care and also declare that you can’t bill the patient.
Are You Losing Out?
Keeping your payment cycle complete when a health plan sub-contractor "goes under."
Eye on Managed Care: Third-Party Plans and M.D.s
Reimbursement for routine vision exams is slowly rising. But will it be enough to entice you to join?
Nasty Payor Tricks: Delayed, Denied and Downcoded Reimbursements
Payors are incredibly creative with the ways they'll "massage" your reimbursements. Here are suggestions on how to fight back!
Eye on Managed Care: Third-Party Negotiations
An opportunity, albeit a small one, for physicians to collectively negotiate with payors?
Eye on Managed Care: Getting Reimbursed On Time It all starts with a "clean" claim (whatever "clean" means).
Eye on Managed Care: Concern For HMOs' Financial Status
You need to monitor the financial stability of the payors with whom you contract.
When Price Shoppers Come Home
They may expect you to provide LASIK follow-up care for just a copay. Take these steps before they come knocking.
Who Will Control Refractive Surgery: HMOs or You?
Find out how managed care's rush into LASIK could affect you.
How to protect yourself against an ugly little practice that’s costing O.D.s revenue.
Beware of the HMO Intermediary
More of these agencies are going belly up as the managed care market consolidates. Learn what to watch for.
Is That Plan Worth Signing?
Quick and dirty methods for evaluating a plan's proposal
When Payors Don't Pay
How do they get away with it? And what can you do to get your money sooner?
HMO Bankruptcy: Don’t Get Left Holding the Bag
Here’s how to protect your practice from insolvent payors.
The Physician-Administrator Team
Positioning Your Administrator For Success
How to avoid mistakes that can render this key practice manager ineffective.
Eight issues you should discuss with your administrator every week.
Pay For Performance: Can It Work?
Some see it as the future of physician compensation.
Creating a Viable, At-Risk Compensation System
If your group is to go at-risk then it will require a complete rethink of how the physicians will be compensated.
How to Secure a Top-Notch Employment Agreement
The best employment agreement is much more than a conglomeration of wage and benefit information.
Compensation and Your First Employment Contract
Proper design, implementation, and follow-up are crucial if you're to benefit from the data.
Practice Development and Expansion
Move to the Medical Model
Evolve product-based ophthalmic practices to increase profitability and tap non-traditional revenue streams.
When is the Right Time to Acquire New Technologies and Tools?
Determining the appropriateness of making a purchase.
Effective Patient and Referring Provider Satisfaction Surveys
It's more than simply asking a few questions.
Office Computer Security
Prevent Intrusions Into Your Computer System (Part 1)
A step-by-step guide to stopping both external and internal mischief
Prevent Intrusions Into Your Computer System (Part 2)
Additional suggestions for safeguarding your office computers and practice data.
Evolution of Managed Care
"Collect, Collect, Collect (Up-Front)!"
The emergence of consumer-directed health care plans adds a new incentive for every podiatry practice to refocus on the importance of managing all patient-owed balances.
Recasting Your Practice for Consumer-Driven Health Care
What you need to do to stay successful in this changing healthcare environment.
Defined Contribution Plans
Could these recent innovations in health insurance bring more patients and better margins to your practice?
Managed Care is Changing: Are You Ready?
Consumer-driven plans create new challenges for physicians.
How Far Could This Pendulum Swing
The Supreme Court’s ruling on "any willing provider" laws could prove significant to some dermatologists in the short term and to many in the long term.
Point/Counterpoint: VSP Helps VSP
Is optometry's "friend" still friendly?
Eye on Managed Care: Despised Policy Gets Dropped
Aetna drops the "all products" clause from Provider Agreements.
Eye on Managed Care: Managed care bombshell
Eye doctors refuse to accept lower reimbursements from Pacificare and VSP
HMOs and LASIK: Behind the Alliances
Where ties between managed care, vision plans, and corporate providers might take the market.
Blending LASIK With Traditional Vision Plans
Is this a healthy match for your practice?
Is the End of the Road Near?
HMO enrollments are dropping. Is the end of managed care in sight?
United Healthcare's announcement that it was returning medical decision-making to doctors was met with cheers. But will HMOs really let you call the shots?
Specialty Service Carve-Outs: Fad or Fixture?
Does a vision or eye care carve-out contract make sense for your group?
Scope of Practice and Credentialing By CPT
Might this become a methodology adopted by some or many third-party payors?
Medicare Risk HMOs and AAPCC
If you're going to contract with a Medicare HMO and argue for higher reimbursements, it's essential that you know the financial facts.
A New Kind of Optical: Virtual Dispensing
Virtual dispensing can remove the barriers between you and a substantial revenue source.
Two New Threats to HIPAA Compliance
Wireless technology and Microsoft are creating serious new computer security risks.
Avoiding a HIPAA Nightmare
An unbelievable example of what can go very wrong.
Eye on Managed Care: Protect Yourself On HIPAA Issues
Some third-party payers might overreact as they amend their provider agreements.
Take These First Steps Toward HIPAA Compliance
Several everyday office situations represent noncompliance risks.
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