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All physicians are familiar with the concept of the Hippocratic Oath, a 2,500-year-old promise to uphold professional ethical standards. I have not reviewed the oath since I recited it at my graduation from medical school in 1985, but it came to mind as I faced a monthly red budget statement despite a full-capacity schedule with limited staff support, and low Press Ganey satisfaction scores about lengthy waits for appointments and service.

Dermatology practices across the country report a higher percentage of missed appointments than in the past. You may consider appointment no-shows a nuisance, but patients missing appointments may have a greater impact than you or your staff realize. Every appointment no-show is a revenue drain and a missed opportunity to contribute to your bottom line.

There is little doubt that every physician in the U.S. has an opinion on the recent healthcare legislation and its impact on medical care in this country. What is less clear is whether or not most physicians understand the tax ramifications of the new law.

If you've been on the fence about purchasing an electronic health record (EHR) for your dermatology practice, it's time to make your move. The federal government has pledged billions of dollars to finance the automation of medical practices. Also working in your favor now are the advances in the technology behind these sytems; today's systems are much better than what you could find just 12 or 18 months ago.

The newly passed federal healthcare legislation mandates changes that will impact dermatology practices to greater or lesser degrees, depending on practice size, patient base and other factors. But dermatologists say they're most concerned about what the legislation omits: an explanation of how the new Medicare Independent Payment Advisory Board will function, and a fix for Medicare's sustainable growth rate formula.

One of the main rallying cries for passage of healthcare reform legislation was to improve access to healthcare for the 47 million (or 32 million, depending on which source you happen to read) Americans who previously didn't have health insurance. Legislation that corrects this obvious shortcoming of our healthcare system is certainly welcomed. However, does this law accomplish that goal?

Dr. Eczema has a very large dermatology practice and performs studies on new treatments for a variety of dermatoses. Recently, one of the pharmaceutical companies with which Dr. Eczema works contacted his research nurse to ask her to provide a copy of all of this electronic data, which she does. A former research patient finds out and has an attorney inform Dr. Eczema he will sue for a HIPAA violation unless he settles with his client for $100,000.

As reimbursement declines and overhead rises, dermatologists can't afford anything short of a perfect billing and collections process. Successful billing outcomes depend on many factors, and entrusting the entire process to someone else without appropriate oversight simply isn't smart business.

As an attorney and a consultant to thousands of physicians across the country, we are constantly astounded by the attitudes of physicians regarding the sale of their medical practices. Most often, we hear the complaint that doctors do not feel they can sell their practice for any significant value.

Credentialing a new doctor with third-party payers (including Medicare) is a tedious but necessary process. Even small mistakes can result in setbacks - even worse, application denials - all of which can rob dermatology practices of precious revenue, experts say.

Could e-prescribing be a boon to the operation of your practice? Or is it one more layer of bureauracy the federal government is trying to lay on physicians? On Call wondered whether dermatologists are using e-prescriptions, and if so, whether they actually like them.

Just as patients are delaying or downsizing elective treatments, the economy is pushing dermatology practices to do more with less, sources say. From manpower to marketing dollars, practices are economizing while also seeking to maintain - if not improve - patient service.

Although a recent survey indicates many physicians are postponing retirement because of the recession, dermatologists say that - regardless - retirement in their specialty is rare.

Some time ago, I wrote an editorial in this magazine describing my early experience with the use of an electronic medical record. In the article, I indicated that this technology was a valuable addition to the medical office, but there was a fairly steep learning curve and some difficulties in creating a coherent and understandable document. After three years of using an EMR, much of what I said before remains valid.

Casselberry, Fla. - Incorrect use of modifier 59 in dermatology is the single most common reason for claim denials by Medicare and commercial insurance carriers, according to Inga C. Ellzey, M.P.A., R.H.I.A., C.D.C., president and chief executive officer of Inga Ellzey Practice Group, Casselberry, Fla.

Physicians are looking for ways to control costs and increase income as malpractice premiums and practice overhead costs skyrocket and rates paid by insurers decline. Many physicians have exhausted cost-control measures, and most are not aware that they can increase their revenue by improving coding and overall claim processing and reviewing their payer contracts.

The slide preparation lab seems a logical extension of dermatology practice, yet few dermatologists tap into this revenue-producing option. Adding a histopathology component to your practice generates long-term revenue to help make up for dwindling reimbursement and aesthetic devices.

Dermatologists say they will vigorously oppose many portions of the newly passed healthcare reform bill, although they say it's too soon to determine exactly how. Chief objections are the bill's creation of an independent payment advisory board (IPAB) for Medicare and lack of a fix for Medicare's sustainable growth rate (SGR), sources say.

Internet-based patient portals are Web sites with real horsepower. In addition to posting static information, such as office hours, physician and staff profiles and a list of services, portals deliver functionality to patients. These points of virtual access to your practice generate patient satisfaction because they provide convenient, 24-hour, self-service options to handle many interactions with your practice.