Consultations fall in the category of a higher-paying E/M service because a consultation usually requires more of the physician's time and involvement. Therefore, proper documentation and coding is essential to receive deserved reimbursement. And because of the higher reimbursement associated with consultations, these visits face increased regulatory scrutiny, making accuracy all the more important.

With many already facing financial uncertainties, physician practices nationwide are now bracing for Medicare's proposed 10.6% cut to physician payments set to take effect in July. Although, as in years past, Congress may avert the cut for now, another 5.4% cut is scheduled for January 2009. As long as the sustainable growth rate formula remains in effect, providers will continue to face this threat to their income and prepare for the worst.

The financial success of any practice depends upon a balanced operation between the billing department and the front desk. Each department is important to the overall fiscal goals of the practice, and they must work together to achieve those goals. In order to keep the cost of employee benefits down in today's healthcare market, companies have chosen health plans for their employees with higher out-of-pocket expenses in the form of deductibles, copays, and coinsurance. Copays for office visits can be as high as $50.

In the healthcare industry, physicians run tests and analyze results to help diagnose a patient. An A/R analysis can work the same way by offering ways to identify and ultimately repair the billing processes in your practice. "The fundamental problem starts with bad management," says Chris Zaenger, practice management consultant at Z Management Group Ltd. in Barrington, IL. "Practices are disorganized. They don't have copies of their contracts. All they know is that they're getting paid less and they don't have enough staff to monitor it."

If you are thinking about accepting a job offer that requires relocation, you will probably want to sell your house as soon as possible-a challenge in today's slow housing market. Time pressures and the prospect of paying two mortgages can be daunting. However, by working with an expert to develop an organized plan and following a few best practices, you can increase your chances of selling your house in time for your expected move.

Your work as a physician can be taxing to your body and mind. Your days require repetitive movements in less-than-ideal postures, such as during surgery, while examining a patient, sitting in front of a computer, or driving to the office or the hospital. And the stress of caring for others can compound physical strain and discomfort. Mary Pullig Schatz, MD, a practicing surgical pathologist at Associated Pathologists, PLC, in Nashville, can attest to this experience. For years, she suffered back pain as a result of countless hours of examining microscope slides. But by practicing yoga and various relaxation techniques, she found a way to manage the problem.

There are two ways to improve your net income: increase your revenue and decrease your expenses. In theory, the po-tential to do the former is infinite, whereas the latter is limited by the minimum cash necessary to run your practice. But the reality many physicians face is that they can only see so many more patients, launch so many ancillary services, and so on. Therefore, overhead management is crucial.

Q: When you realize that a new practice's reimbursement is getting hit by silent PPOs, what's the best way to determine how many patients are affected without looking at every explanation of benefits (EOB)? Our practice management system does not have the ability to track these silent PPOs. Before I came on as administrator, the physicians signed every managed care contract without fully recognizing the effect of these agreements. What steps should I follow to protect our revenue gain and to take control of this problem?