Its been a while!!

Sorry folks for the long pause.... its been just a little over a year since updating!

Here's whats happened. We opened our practice in the First Quarter of 2010... right when we opened, we headed into a whirlwind of a year. As you can imagine, we've been busy.. I've been averaging 60-70 hour weeks doing business stuff and practicing. You really wear two hats :)

Quick Highlights:

• Our practice grossed $550,000 in its first year. We are just seeing some of our patients come back (20-30% returning, but I guess not everyone comes back every year). Overall we are up 20% from Year 1.
• Hire slow, fire FAST!!!
• It took us a year to get on every medical panel
• Its a good idea to have $40,000 in working capital. We had a $300K loan 

I'll let you know which months are slow and what my thoughts are on timing. I have so much to share, and I haven't forgot about you guys.... I've kept meticulous records, so stay tuned!

Its been a while!!

Sorry folks for the long pause.... its been almost a year since updating!

Here's whats happened. We opened our practice in the First Quarter of 2010. I'll let you know which months are slow and what my thoughts are on timing.

Our practice grossed $550,000 in its first year. We are just seeing some of our patients come back (20-30% returning, but I guess not everyone comes back every year). Overall we are up 20% from Year 1.

I have so much to share, and I haven't forgot about you guys.... I've kept meticulous records, so stay tuned!

Enrolling in Medicare with a partner

Here are the forms you have to fill out, if you are partners in a company:

1. 855B - One group application form
2. 855R - Each doctor has to fill one out
3. CMS588 - Electronic Funds Transfer form
4. CMS460 - Participating provider agreement

Permit approved

The City approved our renovation permit! We are good to go, but are still "negotiating" our estimate with our general contractor. They added in few things that we didn't originally call for, and we are less than content with how this process has transpired so far.

In the future, I would conduct business like this:

1. Architect. Approve all architectural plans (scan through this stuff with a fine tooth comb, and question everything)
2. Input from your interior designer with the finishes
3. Submit the plans, and finish schedule to several different contractors for bids.

We did everything backwards, and only got one bid..only because the contractor we chose had done a few friends and several optometrists office. Last week, I invited another contractor to bid.. for obvious reasons!!

We also got our phone number hooked up!! I just got one phone number for now, so that I can fill in all my insurance applications and make business cards to handout. When we get closer to the date, I will add another phone line and a fax line.

General contractor & Eyedesigns

Eyedesigns sent us a post card saying that our project will be ready April 1st, and to allow an additional 3-10 business days for shipping.

Our general contractor also came back to us with our renovation budget. Initially we were given a $97,000 estimate in November/December. Since then, the designer had added some extra finishes, niches, etc. and we changed the floorplan. Well yesterday, we get an updated budget for $157,000. Needless to say, we were shocked and upset. After speaking with the GC, he mentioned how changes and add-on's cause "budget creep." So we are scaling back on certain areas to stay within budget.

The City should have our permit ready for demolition next week.

Using Quickbooks, and tracking all of your expenses

It took me more time than I wanted to grasp Quickbooks. But here are some important tips, to help you get started:

• Any money that you spend before the formation date of your company should be entered into the Journal Entry (Company-->Make General Journal Entries). Under the "Account" it should be labeled as 18000 - Organizational Expenses, put in how much you spent in the "Debit" column, then type in a Memo (ex. computers, or incorporation of company). Quickbooks will then create a line below it automatically that will "Credit" it, so just make sure you label the "Account" as 31000 - Owner Equity.

• If you put in any of your personal Cash or Capital after the formation of your company, this is entered into the Journal Entry also. The "Account" should be labeled as "Owner Equity"

Happy belated New Year!

Sorry, I haven't posted much. But as you've probably guessed much has changed! For my readers that are concerned, I will never post wholesale costs.  Our tenants officially vacated our property in December, so we were able to get moving with the build out of our office. We are permitting with the City this week and should have an open private practice (*fingers crossed*) by May 1st!!

General Rule: Always add a few weeks extra when general contractors tell you when you're buildout will be complete.

I've been practicing at a private practice $400 a day, for the last 3 months. Although he offered me a full time position, I declined. I've learned quite a few things from the seniordoc. He has an impeccable reputation with patients, and a devotedly loyal staff (unlike my previous employer), and his office grosses around $1.1 million on 4 days a week! I'll have to post more on his management techniques and what he does different.

Along with this, I took a one year lease at Wal-Mart, 2 days a week to "prep" me. I plan on testing out my exam forms, systems, patient flow and figure out how to verify/bill medical insurance before the private practice is open. I've been averaging about $400 day net profit there also.

So far I've:

1. Hired two employees. Lesson Learned: How to handle W-4's and do payroll www.paycycle.com
2. Averaged ~10 patients a day (in 3 months). Lesson Learned: How to manage a front desk, schedule appointments, learn what patients commonly ask, learn how patients treat the front desk, maximize appointments. I will make sure in my private practice that when every patient checks out that we ask "Does anyone else in the family need an appointment?" and I always ask patients to refer friends and family to me at the end of an exam: it works!!!
   
3. Become a medical provider (BC/BS). Lesson Learned: How to verify and file insurance. I use Availity.com to verify a patients insurance benefits, and to submit claims. The system is confusing and redundant, so I got on the phone and had Availity walk me through it.

You know what makes me sick though? My exam fees are $79, and the private practice doctors around me charge LESS!!!!  

I will post more on this!

Must read tax planning advice

http://www.wickenslaw.com/Format_2005/Dental_Practice/Dental_%20Law.htm

It's geared towards dentists but this is a definite MUST read!!

How to credential with insurances.. the easy way.

CAQH is a consortium of health associations that aim to streamline the credentialing process. Here's how it works. Providers (you) fill out one application online, and submit them to as many insurance panels as needed.

The tricky part? You have to first be given a CAQH ID, by an insurance company. I chose Humana, and was able to get a CAQH ID in 2 days. Look around, I believe Blue Cross also provides these ID's in a short amount of time. Once you've recieved a CAQH ID, you'll be able to log on and fill out everything about yourself, where you practice, etc.

You'll have to fax all of your supporting documents (DEA, Malpractice, etc) for them to review it. Presto! You're done.

Filling out Medicare's application

If anyone has done this in the past, you already know how tedious this process is. I'll try to simplify the process and go through each section that you need to fill.

Firstly, if you are a sole owner of a company (PLLC, LLC, PA, PC) then you will only need to fill out the 855R form.

Section 1A: Check the box that says you are a new enrollee in Medicare.
Section 1B: Check the box that says identifying information, and practice location
Section 2A: Fairly simple, fill out your personal information.
Section 2B: I used my home mailing address for correspondence. You can use your practice address also.
Section 2D: I selected Optometrist. Write Primary beside it.
Section 4A: Use the business name and its Type 2 (Group NPI). Where it says Medicare ID number, write pending.
Section 4B: Write the business name, pending where it says Medicare ID number, and use the Type 2 (Group NPI).
Section 4C: Fairly simple here. In the NPI box, use your Type 1 (Individual NPI). Write pending where it says Medicare ID number.
Section 4E: If you want your payments sent to your house, or your practice select the appropriate check box.
Section 4F: Not necessary
Section 8: If you are not using a billing agency (likely NOT, if you are a startup). Check the box that says it does not apply.
Section 15: SIGN and done!

VOILA!!