A practice manager's job is to make sure the whole practice runs smoothly. The physician has to wear two hats: the physician and the businessperson. Any business is made up of a series of processes. From the first patient call until the check clears, there are many steps, disconnects and diversions in the process that practice managers have to navigate. 

•Do you have a training or orientation program for all new employees? Even if a new employee has worked in a practice before, they have not worked in your practice.

•Do you give each staff member a job description when they start? You and the office manager should sit with each employee once a year to go over their job description and discuss their performance. 

•Scheduling patients: All the same amount of time or different times for different reasons? Someone or a service should call two days before the patient's appointment to confirm the appointment.

•Phone calls: Do they interrupt you? Have you prioritized who can get through and communicated it to staff?

•Front desk co-pay collection: Does the staff know how to ask for it?

•Front desk: Do they know how to check eligibility online when an appointment is made?

•Do the patients sign in at the front desk or a kiosk? 

•Do the patients acknowledge that they have received the HIPAA notification?

•Do patients receive a receipt for what they pay?

•When a patient leaves, is there a method to determine if the next appointment has to be made and when?

•Is there a protocol for walk-ins and for friends and relatives who want to go into the exam room with the patient?

•Does the front desk staff have a view of the waiting room?

•When a front desk staff person answers the phone, do they know to keep their voice low so that others waiting do not hear any names or conditions?

•Is there a protocol for those who come early and want to be seen before those who are present and have an appointment time?

•The front desk is the stress spot. What is done to keep morale and attitude positive?

•Does the MA/nurse get the patient from the waiting room and take them to the exam room and prep them?

•When you are running late, do staff keep the patients in the exam room informed so they do not feel like they were forgotten?

•Does the MA/nurse enter as much information into the system or chart as legally allowed?

•Does the clinical staff track supplies and perform inventory management?

•Does the clinical support staff answer telephone calls so the doctor does not have to be interrupted?

•If a referral is made, does your staff take care of it while the patient is in the office?

•At the end of the day, does someone other than the front desk person close and reconcile payments posted in the system?

•Who makes the deposit and how often is money deposited in the bank? 

•Who keeps track of payroll? Consider an electronic system that may be connected to your PMS/EHR in which the staff member has to log in and log out for payroll and accounting purposes.

•Does your staff include a compliance officer and are they trained in HIPAA, corporate, billing and OSHA compliance? 

•When a staff member leaves the practice, who disables their ability to get into the PMS/EHR system?

Most importantly, spread out the work in your office fairly and strategically. Recently, I assisted a practice with relieving an overburdened employee from many of her mundane tasks by advising them to hire a part-time employee. Despite initial apprehension, the new hire improved the functionality of the whole practice. Remember: If one person is stuck doing the lion's share of the work, something is not going to get done.