As you open your office, you will want to make sure that certain functions are “audited” from time-to-time, especially during the first year of operations while staff are still learning the procedures you want to have in place and before things become routine. The following checklist will serve as a reminder to follow-up on important functional areas to make certain that policies have been correctly understood and consistently implemented. These items are primarily related to financial and personnel matters. Other issues such as marketing, patient satisfaction, certification, facilities, etc. should also be added to a routine review process.

Month One:

Your billing system should close by the end of business the last day of the month. All standard reports should be run, verified and copied to the appropriate staff and physicians. Certain key reports should be filed long-term for future reference.

Your bank statement should be balanced within two business days of receipt, and it should be tied to the deposits included in your month end billing system report.

Your income and expense statement should be available for physician review no later than the 15th of the month for the prior month’s business. It should be accompanied by a brief written narrative prepared by the office manager.

At the end of month one, your accountant, or other knowledgeable individual from outside the practice, should:

  1. Review the month end reports, comparing each to the other, and making certain that daily billing system and bank deposit slips match. He or she should look for the appropriate audit trail for deposits, adjustments to accounts and daily patient services. Has every patient been billed for a given day’s appointment list?
  2. Review paid bills randomly to assure that the paper trail is appropriate. Was there a handwritten purchase order to initiate the transaction signed by an individual with the authority to do so? Was there a packing slip, signed by an individual who is not the person who ordered the supplies initially? Was the packing slip matched to an invoice which was proofed for errors and initialed? Did the check have all that supporting documentation attached at the time it was presented to the physician for signature? Was the signature by the appropriate individual? Was the invoice charged to the correct account?
  3. Verify that purchasing systems have been developed. Are purchasing files/notebooks available? Do staff know where to find them when the staff member responsible for purchasing is absent? Can you tell what orders have been placed, received or are outstanding at any given point in time? Are there catalogs available in the same area? Does the pricing appear appropriate?
  4. Verify that income and expense statement is prepared in the correct format to allow physicians to easily review their financial position and monitor trends.
  5. Verify that the format for a monthly receivables report is in place.
  6. Assure that other important policies are being followed:
    Is staff time reporting being handled as instructed?
    Is staff overtime being approved in advance?
  7. Assure that personnel files are established and complete.
    Have all staff been appropriately trained regarding OSHA Bloodborne Pathogens?
    Have all staff been offered Hepatitis B as necessary? Are records complete?
    Have all staff been appropriately trained regarding handling and disposal of medical waste?

Three to Six Months:

  1. Review all of the areas noted above.
  2. In addition:

Nine Months:

  1. Begin year-end tax planning. Review needs for cash for physician bonuses and pension/profit-sharing contributions. Review line of credit needs.
  2. Review all financial ratios carefully.

Annually Thereafter:

  1. Spot audit receivables posting, especially adjustments.
  2. Check fee schedule. Is it still reasonable?
  3. If you are using multiple fee schedules on the billing system, are they current and complete? When were they last updated? (They should have been updated at year end or at the absolute beginning of the year.)
  4. Spot audit cash handling policies for accuracy (front desk, mail payments and purchasing).
  5. Spot audit payment and adjustment posting.
  6. Assure that your billing department staff attended at least one Medicare carrier in-service and at least one other billing seminar of reputable quality and appropriate to the needs of your practice.
  7. Assure that your manager is attending classes (at a local college) or seminars geared to enhancing his/her professional education and growth on a regular basis.
  8. Verify that your billing staff have access to a network of other physician offices who use the same billing software that they do. Are they meeting with these people on a regular basis (at least quarterly)?
  9. Review your insurance needs and their costs – comparison shop annually.
  10. Review your accounting and legal needs and the service you have received at least every three years – comparison shop.
  11. Verify that physicians are meeting regularly as a governance body, documenting those meetings with minutes, and following up with “accountable” agendas.
  12. Verify that physicians are meeting regularly (at least monthly) with management staff to keep staff apprized of changes in policy and procedure, changes planned, etc.
  13. Assure that patient satisfaction surveys are being conducted and reviewed and that changes are being made within the practice in response to concerns expressed.
  14. Assure that employees’ performance reviews have been conducted annually. Are they documented?
  15. Verify that medical records are being archived appropriately and in the most cost effective and reasonably safe manner possible.

For more information on this topic or additional material concerning Medical Staff Planning, please contact Dorothea Taylor of the La Penna Group at (800) 527-3662.

We would also welcome your comments and questions by E-Mail at Thank you for visiting our site.

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