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is a question and answer forum featuring leading practice management experts who may or may not be employed by Physicians Practice. On average, Physicians Practice receives 250 questions per month from physicians, office managers, office administrators and others. Have a question about the operation of your practice? Visit www.PhysiciansPractice.com. Your question will be answered within three business days.

Q I understand the Health Insurance Portability and Accountability Act (HIPAA) has several parts, some of which are yet to be proposed. What are the parts, and where are we in the process?

A As of February 2003, three parts of HIPAA have been released in their final form. These are:

• The Standards for Electronic Transactions, published on August 17, 2000, and also called the “transaction rules;”
• The Standards for Privacy of Individually Identifiable Health Information, published on December 28, 2000;
• The Security Standards, published February 20, 2003.

Other components of the Act have been released in their proposed form, but not finalized:

• a rule establishing a unique identifier for employers to use in electronic health care transactions; and
• a rule establishing a unique identifier for providers for such transactions.

In addition, the Act called for these components. For now, though, there are no proposals, let alone final regulations, available:

• rules establishing a unique identifier for health plans for electronic transactions;
• standards for claims attachments; and
• standards for transferring among health plans appropriate standard data elements needed for coordination of benefits.

Q I’m thinking about hiring someone, or dedicating existing staff, to verify insurance on all new patients. How do I determine how much staff time or how many new employees verification will require?

A First, find out how many new patients you saw last year. If you can reasonably expect around the same number — that is, if you haven’t signed any huge, new contracts — use that as the basis for your calculation. Assume staff will work 250 days a year, completing the industry average of 75 verifications a day, or 18,750 verifications a year. If you saw more than 18,750 new patients last year, you will need more than one FTE to handle verifications.

Q Do I need to post notice of my privacy practices?

A Yes. According to the privacy regulations of the Health Insurance Portability and Accountability Act (HIPAA), providers covered by HIPAA who have a direct treatment relationship with an individual have to post a notice of privacy practices. You should post the notice in a clear and permanent position where patients can see and read it.

Also, patients must acknowledge the notice, by signing or initialing a copy, for example. This is not a consent, just an acknowledgement.

Q What is stop-loss insurance? Do I need it?

A Stop-loss insurance protects you if you accept capitation. It kicks in if your costs exceed a specific amount.

If you accept much capitation, especially if you have a poor record controlling costs or have lost money on previous contracts, it is definitely worth considering stop-loss coverage.

However, stop-loss has gotten very expensive and scarce. Insurers increasingly see it as too risky.

Payers may also include stop-loss provisions in their contracts, usually to the effect that its capitation rate will change once losses or usage reaches a certain level. Make sure you understand what this costs you and exactly how the rate will change. Will it revert to discounted fee-for-service or just be capitated at a different level?

Q Where can I find data to help me figure out how much to pay staff?

A The best place for staff salary surveys is The Health Care Group, www.healthcaregroup.com. They have a great salary survey that is published every year, and they can present it to you by region.

Q What is the average compensation rate for a part-time physician?

A According to the Medical Group Management Association’s (MGMA) “Physician Compensation and Production Survey: 2001 Based on 2000 Data,” the compensation for a 0.4 to 0.6 clinical FTE in internal medicine is $83,000 (excluding benefits). To ensure that this compares to your situation, the gross charges cited for this 0.4 to 0.6 part-time internist are $210,117.

MGMA’s survey also includes compensation figures for other specialties. You can buy their surveys online at www.mgma.com.

Q What should I expect to pay for outsourced billing services?

A Fees are usually based on a percentage of actual collections. This percentage will vary according to the size and specialty of the practice.

The following are fee percentage ranges for various specialties, according to the Healthcare Billing and Management Association (previously the International Billing Association), a trade group of billing professionals:

• Radiology 8.5% - 13%
• Anesthesiology 5.3% - 6.5%
• Pathology 9.5% - 10.5%
• Surgery 3.5% - 7.5%
• Emergency Medicine 10% - 13%
• Primary Care 10% - 15%

Q What, typically, is included on practice Web sites?

A Match the content of your Web site to your strategic reasons for having a site in the first place. Trying to attract patients? Post patient-centered information. Trying to attract referrals? Talk about the experience and expertise of your physicians and make it easy to contact you.

Also, search other sites and see what you like.

In general, though, physician Web sites include:

• address — add a map and directions;
• phone numbers — if you have just one number, post it prominently. If you have several numbers, list them all so everyone knows which one to dial;
• fax number and e-mail address(es);
• hours of operation;
• names of physicians and a description of their areas of interest;
• links to physicians’ specialty societies;
• a list of and photos of staff — they are part of the practice, too;
• a list of accepted payers, pricing and financial policies;
• a form, e-mail address or some way to get feedback and questions from users;
• patient education — write your own content for problems you commonly see in your practice, add content from the many vendors who provide content at no cost to physicians or send patients to other sites whose work you respect;
• upcoming lectures, drop-in appointment times and other schedules; and
• an employment section for staff and physicians including job descriptions, closing dates and instructions on how to apply for positions.

This material is provided by Physicians Practice and represents the views and opinions of Physicians Practice and not Humana.