Hi Anthony,
I also feel your pain. We were lucky as our governor is big on small business and OKd the Medicaid increase another year. In fact, it is our best insurance. I hope you don't mind, but I am kinda on the other side on everything.
While we charge for patients who leave the practice (not for leaving town or other bonafide reasons -- mostly due to passive-aggressive behavior on my part), we do not charge for patient records if they ask within reason. Most of our pediatric patients (the parents) do not request them. Actually, almost none. We will write nearly any excuse letter -- usually takes about ten seconds using a template. Haven't thought much about longer ones, but I have written longer ones in the past.
I am not sure about Florida, but you can NOT charge Medicaid patients for ANYTHING. Even a penny. It is considered fraud here, and MaineCare will come down on your hard if they find out. They may not. For example, I used to charge everyone for records for transfers. When the patients got the letters, they would mostly pay. Some wouldn't and those didn't get a copy of their records. Since 99% of the MaineCare (Medicaid) patients didn't know their rights, they paid as well. Until that 1% called MaineCare. MaineCare was on the phone with me that very day and threatened a complete audit of six years of MaineCare charges if I collected the money. So, I didn't.
I would have a difficult time charging patients for no shows. It would be just one more example of how paying for insurance is actually worse than living off the state. Just doesn't seem fair that the MaineCare patient doesn't have to pay but the Aetna patient does. We just have a three-strike rule.
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I separate this because, if there is ONE thing I can do to help you, it is the following. I would highly recommend that you at least think about it. You are losing way more money with inefficiency than by buying another printer. Our office is a bit over the top in printers. We have seven black and white laser printers, one color laser printer, two Star printers and six Dymo label printers. Some of the printers were purchased for particular reasons that would not have had to be purchased in the beginning. It sounds as if you had more regular printers or even one networked printer, you would at least not have to have everyone not print. That is time consuming right there. And, if someone did, wouldn't that ruin the entire sheet of tamper-proof paper? Are you using an 8 1/2 by 11 sheet of four scripts? That seems like it would be wasteful as well.
This would be my suggestion. It will help with your office flow tremendously. While the Star TSP800x printers have crazy-difficult drivers, once set up via your network, they are invaluable. Once set up, they are flawless. You can print one or fifty scripts at a time. It is just so helpful to (as you likely do) print the same script from AC each time. I not only print to my receptionist's Star printer, my MA has her own. When I print them, I walk up to her desk, she already has them stamped for what month they can be filled, and I sign them in seconds. It's also nice, because she has proofread it, and I do, and the patient does.
I generally see about three to four ADHD patients a day. If the patient is doing well, my MA has already printed the scripts and stamped them, and paper-clipped them to the chart. You have no idea how happy I am when I see the chart on the door with scripts on them. This means a ten-second visit. Literally, a ten-second visit. "Everything OK? Great? How is school? Super." Hand them the scripts. I don't even log onto the computer. I was behind thirty minutes, now I am only behind 15 minutes. Of course, if it says med check on the Superbill, and there are no scripts pre-printed, then I know, I have to spend the 15 minutes going over what their issues are.
I also don't blame MaineCare patients too much. Yes, I cringe a bit when they have their cigarettes, etc. But, I always tell my staff if someone handed me the keys to a Porsche 911 for free, I wouldn't hesitate to drive off in it. And, if the state is going to continue to encourage entitlement and Methadone clinics, etc., then people are going to take advantage of it. I am not saying it isn't wrong. It is. But....what can I do?
Hope this helps.
