A. Automated voice-messaging services are offered by many vendors. For the type you describe, all you need is a touch-tone telephone. You or a staffer simply calls into the service and records a message, or selects a canned message, leaving the patient's lab results. The service operates 24 hours a day, so the patient can call at his convenience and retrieve his results, using a special password for confidentiality. To hear a demonstration of such an exchange, go to http://www.patientresultsnetwork.com/how.html and select "Click here for Demo."

Firing a no-show patient

Q. Can I terminate a patient who fails to keep appointments?

How much will another doctor cost?

Q. My group practice is thinking of adding another doctor, but we're worried that the new doctor may end up costing more in additional overhead than he'll bring in. What should we do?

A. A new doctor doesn't have to mean large extra expenses, if you set things up right. Assuming you won't need a larger office, your fixed expenses—for equipment, phone system, computers, and the like—probably won't increase much. Neither will costs for medical and office supplies, unless you expect the new doctor to bring in a substantial number of new patients, rather than just absorb the current patient overflow.

Your largest expense will be for extra staff. But you might need only one additional clinical staffer. The trick is to maximize the productivity of your current office staff by cross-training, efficient patient scheduling, and automating your office procedures.

Hospital collections: How are you doing?

Q. Over a 15-month period, I billed $240,000 worth of hospital charges. I collected 59 percent of that amount—$142,000. Is that collections ratio satisfactory?

A. You're asking the wrong question. There's no point in looking at the amount you billed (your "gross collection ratio"). You'll never collect every cent of this, because it doesn't take into account the adjustments you agreed to with your insurance companies. Instead, you should be looking at your net collection ratio. To calculate this, subtract insurance adjustments from your total billings before dividing by your actual reimbursements. Your net collections ratio should be about 90 percent.

When two partners care for the same patient

Q. A Medicare patient I'm currently treating for diabetes and hypertension is also being treated post-MI by a cardiologist in my multispecialty group. We know we both should code for all three of the patient's conditions so that we can accurately document the complexity of the visits. But I'm concerned that Medicare may reject the claims because this has happened to me in the past when two doctors were involved with one patient's treatment. What's the best way to code these claims so we'll both get paid?

A. The secret lies in the sequence of your codes. Assuming that all three conditions affect your evaluation and management of the patient that day, you should code first for diabetes, then hypertension, then myocardial infarction. The cardiologist should code for MI first, hypertension second, and diabetes last. Don't forget to enter the diagnosis information in order of importance to the procedure or service you provided during that visit, and attach the correct diagnosis to any diagnostics ordered.

Explaining your fees for "new patient" visits