LAS VEGAS One of the best ways to improve your office efficiency is to train and retain good staff, Dr. David M. Pariser advised at the Fall Clinical Dermatology Conference.

"You spend more time with your staff than you spend with your family," noted Dr. Pariser, professor of dermatology at Eastern Virginia Medical School in Norfolk. "You want your employees to know what your expectations are, and you would love for them to be able to exceed those expectations."

Written job descriptions are important no matter what the size of your practice. "People need to know what the scope of their job is," said Dr. Pariser, who is the senior partner in a group of 11 dermatologists who practice in southeastern Virginia. "Cross training is essential. You also need to have a policy and procedures manual."

Other tips that he shared for improving office efficiency include the following:

▸ Develop an employee recognition program. Recognizing behavior that exceeds expectations or good work performance can boost morale in the office. This can be as simple as awarding a pin to outstanding employees to wear on their lapel. "It sounds corny, but it really helps morale," he said at the conference, sponsored by the Center for Bio-Medical Communication Inc.

▸ Hire a physician extender. "This can help your quality of life in the office more than any other thing," he said. "The key is [that you have to] train and supervise."

Adding a physician extender lets you delegate routine tasks, such as patient histories, procedure setup and assistance, and the screening of after-hours telephone calls.

▸ Preregister and overbook all patients. Have someone review the appointment book for the next 23 days and fill out the necessary paperwork to ensure that patients are properly referred and have the right insurance. This strategy is especially helpful if you practice in an area with a lot of managed care.

"I think some of the best money you can spend in office management is at the front end, anticipating problems rather than dealing with them," Dr. Pariser said. "If you find your day is interrupted by a patient who shows up out of referral or who needs something recertified that you can't do at that moment, then you're wasting time."

Dr. Pariser prefers overbooking patients, because he considers reconfirming their appointments "a very time-consuming process. If you expect that your employees are going to be able to reach everybody who has an appointment … it's going to take them hours to do that, probably half a day," he explained. "It's not possible to reconfirm every single appointment. I prefer the airline style of overbooking. In my practice, the no-show rate is different on a Monday than it is on a Tuesday."

Have a giveaway item for those times when everyone shows up or for when you are running behind. The giveaway at his office is a small gift bag of moisturizer and sunscreen samples.

▸ Manage your managed care contracts. "Keep them all in one place," Dr. Pariser said. "Have a tickler file to know when they renew. Evaluate each contract every year to see how they're paying and to see what their procedures are and decide if you want to [sign a contract] or not. Learn to say no to the ones who don't pay up."

▸ Accurately code before you file the claims. Don't wait for your claims to be denied or sent back because you didn't file it right. "Your coder needs to be dermatology certified," he said. "Do as much as you can on the front end. I still hear of people who file claims for a procedure before they get the results of a biopsy back. If you do that, how do you know if it was benign or malignant?"

Instituting a coding compliance program can help you maximize the claims process. "We have our senior coding person give the doctors feedback every so often as to how well they've been coding," he said.

Know the CPT codes for site-specific biopsy. When used appropriately, the reimbursement rate is much higher for skin biopsy than when the site is not identified.

Know the CPT codes for site-specific destruction. When used appropriately, reimbursement is often higher than is the rate for general destruction codes.

▸ Manage your phone calls. A call to your office may be your only chance to make a good first impression. "Often the person who answers the phone is the lowest paid, newest person to the practice," Dr. Pariser said. "I think that's a mistake, because patients will form their opinions about how they like the practice and how they like you [from] their first impressions."

Staff members who answer the phone should be trained how to answer common questions in a consistent, friendly way.

"I also think it's very helpful to have extended phone coverage hours," he added. "We have somebody who starts to answer the phone at 7 in the morning, and we have people who stay until 6 at night. This allows our patients better access."

Overbooking, Physician Extenders Boost Office Efficiency