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Physician Practice Management-Tom Cook
Thomas E. Cook, Jr., is co-founder, president and CEO of Raven HealthCare Management, Inc. After more than 15 years as an administrator for physician and hospital-owned practices, Mr. Cook created Raven HealthCare to fill the need for an operational approach to managing physician practices.

Most recently, he served as vice president and corporate clinic director for Community Health Systems. He has also held management positions with Columbia HCA and three large physician-owned multi-specialty practices in Ohio, Iowa and Tennessee. While an administrator for these organizations, he gave corporate guidance to hundreds of practices and coordinated the start-ups of hundreds of physician practices. Mr. Cook also saw a significant improvement in reimbursement and overall operations for the practices he supervised.

He holds an MBA from the University of Dallas in Dallas, Texas, and a BA degree in business administration from Baylor University in Waco, Texas. In his spare time he teaches an adult Sunday school class and leads the music for his church. He lives in Dickson, Tenn., with his wife and son.

Tom Cook
CEO-Raven HealthCare
161 Belle Forest Circle, Suite 204
Nashville, TN 37221

Question 1 - Good Morning Tom, What are the current issues in billing practices you see frequently that need continued improvement?

Could you recommend a good billing program for small practices with limited capital? by tammy on March 27, 2000

Answer 1 - The issues that most frequently need to be addressed are:

1. Coding and Documentation -If a practices medical record doesn't support the level of service billed, then the OIG considers it "fraudulent". Fraudulent billing is punishable by $10,000 per occurance and triple the amount billed. This can add up to significant financial penalties. On the other hand, if the practice focuses on coding and documentation and does it correctly, our history is that the practice can increase it's net revenue by 10% - 20%. This increase can occur while improving its compliance

2. Program - There are several options for a small physician practice with limited resources. Using a billing service, timesharing with another practice or billing service, or inexpensive software. Although many physicians are trying cheap systems like the "Medisoft" program, these systems have extremely limited functionality. I recommend using a billing service or timeshare until one of the internet versions becomes available (hopefully in the next 6-12 months). by Tom Cook on March 27, 2000
Question 2 - Do you see cost accounting becoming more of required managerial accounting tool for physician and medical group practice management? Do you think there will be any internet based, shared software systems in the area of decision support? by buckcarper on March 29, 2000

Answer 2 - Cost accounting should be a part of any medical group practice management. No practice/group can manage its financial affairs if it doesn't know what/where its costs are. This will directly affect decisions regarding the adding or expansion of services. The level of detail required will be directly affected by the size of the practice. By using cost accounting and comparing it to national standards (MGMA, etc) the practice can significantly improve its performance. You can't manage what you don't measure.

Internet based software is currently being developed and tested that will be usable for decision support. The problem is to determine what your needs are and then finding the software to help. I anticipate that the next 6-9 months will provide a great deal of options in this area. by Tom Cook on March 29, 2000
Question 3 - Hello Tom, We are seeing a lot in the media about opening the NPDB, hospital / physician error information to the public. Do you think this will come to pass and what kind of effect will this have on the current credentialing and review processes? Also, what is a billing time share? by yvette on March 29, 2000

Answer 3 - Unfortunately, I believe that the NPDB information will eventually be provided to the public. Originally, it was to be restricted information, but the political atmosphere has changed. Since some of the information can be misinterpreted by uninformed individuals, I believe that the way the information is provided will need to be changed. Since credentialing organizations already use this information, any change in the way the information is provided may change what they use.

A billing time share is when a practice/group does not have its own computer, but ties into another computer through one of a number of type of phone lines. The practice still does its own billing but doesn't have to purchase the hardware and software. In most cases this is cheaper than purchasing an individual box and paying people to do back-ups, etc. by Tom Cook on March 29, 2000
Question 4 - Hi there. How involved do you think a physician should be in the billing process? Should the doctor focus more on the patient's needs, and let the office manager deal with the billing process? Of course, I think the doctor should be aware of the business aspect of the practice, but I also wonder if separating the two things--caregiving and billing--would work better in the long run for the patient-doctor relationship. Your thoughts would be appreciated. Thanks. by Ingolfsson on March 29, 2000

Answer 4 - The optimal situation is that the physician be significantly involved with the coding and billing process.

First, the physician is the one who will be penalized if his coding is determined to be "fraudulent". He/She cannot pass that responsibility on to any one else. Second, the physician is the one who has provided the service. If he/she knows coding then he/she will know that certain things can or cannot be billed for. Third, if he/she understands coding then the documentation will more likely support the code/bill. I always strongly recommend that the physician understand the coding process. I usually don't recommend that the physician get involved with the collections, but gives the office manager the flexibility to process/apply discounts, write offs, etc. This provides the physician with a soft wall that will not effect the Dr/Patient relationship. by Tom Cook on March 29, 2000
Question 5 - So you see a difference between coding/billing and collecting? I agree that the office manager should be able to focus more on the business aspects of collection, while allowing the doctor to focus on the patient. I also agree that the doctor should be responsible for knowing coding and billing information. How many doctors do you encounter that don't know this type of information? by Ingolfsson on March 29, 2000

Answer 5 - Over the last three years, I estimate that only 25% of the physicians I worked with had more than a minimal knowledge of documentation and coding and how it effected what they received in renumeration or even the possible effect it had on potential fines. I routinely find physicians who can increase their reimbursement by 10%-20% if they coded correctly. We recently did chart audits for approximately 30 physicians and found an average of $75,000 increase per physician could have been achieved if they had coded correctly. This doesn't even count the financial exposure that they have with "fraudulent" claims. I am not suggesting that the office manager not be significantly involved, but that this needs both physician and administration being actively involved. by Tom Cook on March 29, 2000
Question 6 - As physicians explore ways to improve the overhead costs of their practice, do you see more using advance practice nurses and physician
assistants as extenders? Does it translate into improved profits? And, do the patients feel they are receiving high quality of care? by Artemis on March 30, 2000

Answer 6 - For over ten years, I have been a strong advocate of using appropriately supervised mid-level practitioners (NPs & PAs). I have used them in fairly independent situations in small rural clinics in Iowa and Tennessee as well as working daily in the same office as the physician. I have found that they are profitable. In most cases patients feel that they are getting as good care as if they were seeing the physician, especially since the mid-level practitioners usually are stronger on education and often spend more time with the patient. The key to success is 1)the person you hire, 2)establishing the practice limits of the mid-level, 3) educating the patients as to the training and supervision that the mid-level receives and 4) having the right supervising physician (too much or too little supervision can be a disaster) by Tom Cook on March 31, 2000

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