Essential Office Policy Pearls

Implementing essential office policies for the practice is imperative to being able to run the business smoothly. At the recent American Society of Dermatologic Surgery (ASDS) virtual meeting, Brooke Jackson, MD, Vivian Bucay, MD, and others detailed the policies that keep their practices on track.

Maintain an Employee Handbook

Even if you only have one employee, it’s important to have an employee handbook. At some point, an employee may resign, or not know what to do in a certain circumstance. All of that information is available to them within the handbook to reference. Dr. Brooke Jackson recommends knowing what’s in your handbook and referring to it often. This creates needed boundaries and processes for managing staff.

When onboarding new employees, have them read through the entirety of the handbook and sign off to acknowledge that the policies have been read and understood.

Attendance

Define for employees what you consider a late-for-work or a no-show violation. Whether two days of no-shows equals a nonverbal resignation or showing up 15 minutes after their scheduled time results in disciplinary action, make those policies well known and documented. Dr. Jackson recommends using a time clock that cannot be used to clock in online or remotely as this can result in theft of time.

When an employee is notifying the practice of tardiness or absence, she recommends not accepting texts, or messages relayed through staff; instead, employees should talk directly with management.

Arbitration Agreement

Having an arbitration agreement prevents disgruntled employees from filing a lawsuit against the practice. Written in Dr. Jackson’s agreement, it states the shared cost of the arbitrator, meaning the employee would have to put in their own money for an arbitration claim. According to her, if a potential employee refuses to sign an arbitration agreement, they do not work in her office.

Cell Phones

Due to HIPPA regulations and the increased risk of employee distraction or error, cell phones should not be used outside of the breakroom. Apple Watches create another layer of difficulty because they are essentially cell phones on your wrist. Dr. Jackson includes them in her cell phone policy and they are only to be used in the breakroom.

Written Consents and Financial Obligations

Patients must be informed of the practice’s rules and regulations, and sign an agreement explicitly consenting to financial responsibility. This agreement should specify circumstances under which a patient can be billed, like no-show penalty rates.

Dr. Vivian Bucay’s financial regulations include:

• Payment at time of service
• Accepting all major credit cards, debit cards, cash and checks. However, if a patient is paying with a check, the funds must be in the account and the check cannot be backdated
• Patient-provided identification, such as a driver’s license number
• A reminder that health insurance does not pay for cosmetic procedures

Although there is no Current Procedural Terminology (CPT) code for late cancellations or no-show appointments, under CMS guidelines, Medicare allows a practice no-show fee. Insurance payers do not reimburse for this but usually don’t prevent physicians from imposing financial penalties.

If the practice keeps patient credit card information on file, it must comply with Payment Card Industry Data Security Standard (PCI DSS), which maintains a secure digital environment that reduces credit card fraud.

Social-Distancing

During the pandemic, if the waiting room is to be used, implement social distancing guidelines including signs, floor markings, and other standard measures to create a safer environment. Many practices are completely cutting out the use of waiting rooms and instead having patients wait in their cars until they can be escorted directly to an exam room. Aside from patients, all staff should be using all appropriate PPE and practicing social distancing when possible.