Fam Pract Manag. 2003 May;10(5):77.

Transition to open access


How does a practice transition to open access? For example, if 85 percent of our daily visit slots are prescheduled and only 15 percent are open, how can we do “today’s work today”? How should we handle patients with chronic conditions who need follow-up visits?


There is only one way to reduce your percentage of prescheduled visits and be ready for open access: work down the backlog. The key word here is “work.” You and your staff have to work extra hours doing today’s work and yesterday’s work today. Do what suits your team and patients best. Work an extra hour in the morning or evening as many days a week as you can stand, or open the office on Saturday or Sunday until the “bad” backlog is gone.

For chronic disease management, booking follow-up appointments into the future is actually “good” backlog. Under open access, you can expect approximately 30 percent of your appointments to be prebooked with follow-up visits or with patients who simply preferred a future date when they called your office for an appointment. Do not tell these patients to call back on the day they want to be seen, as this will create additional phone calls for your front desk. Your staff must encourage patients to be seen today and schedule future visits only as a last resort.

Medicare Secondary Payer forms


If a patient has Medicare coverage and no secondary insurance, do I have to ask him or her to fill out the Medicare Secondary Payer (MSP) questionnaire?


You are not required to have your Medicare patients complete an MSP questionnaire. However, to determine whether Medicare is a beneficiary’s primary or secondary payer, you should screen all patients for other primary insurance information. One way to do this is to incorporate an MSP questionnaire into all patient health records.

Medicare sends an Initial Enrollment Questionnaire to beneficiaries approximately three months before they become entitled to Medicare that asks if they have any insurance that may be primary to Medicare. If the beneficiary fails to answer this question or Medicare does not have any information on the patient’s MSP status, the Medicare Coordination of Benefits Contractor will send a First Claim Development Questionnaire to the physician or other health care entity that submits the first Medicare claim for services for the beneficiary.

Billing for temporary physicians


As I search for a physician to work with me at my urgent care center, I’ve been “trying out” different physicians on my patients. However, I’ve run into some billing problems with the managed care organizations (MCOs) I contract with. I’ve been told that it’s illegal for temporary physicians to bill under my name. So, because these temporary physicians are not members of the health plan, either my patients will be getting a letter from the insurance company telling them their visit wasn’t covered or I’ll have to write off the bill. How should I handle this situation?


When you contract with a health plan, you are generally agreeing to hire only participating, credentialed physicians. The MCO doesn’t care whether you want to “try out” doctors before you hire them. It wants its subscribers to see in-network physicians.

That said, there is one approach you might consider. If you carefully read your MCO contracts, you may find that some plans allow you to obtain coverage for a nonparticipating physician as long as you agree to vouch for the substitute physician’s services. If you have a contract that allows this, carefully review the provider manual to ensure that the definition of “coverage” isn’t too restrictive.

Documentation forms for preventive exams


To reduce high transcription costs in our two-physician practice, we would like to use pre-printed, check-off style documentation forms for health care maintenance physicals. Where can we find such forms?


There are a number of sources of documentation forms for preventive exams, including the following:

  • Milcom Medical Record System from Hollister (, which is endorsed by the Society of Teachers of Family Medicine,

  • Formedic (, which provides free documentation forms that include product advertisements.

In addition, the Family Practice Management Toolbox ( offers several documentation forms, including a well-woman encounter form created by my practice. You can download the well-woman form at

* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.


Copyright © 2003 by the American Academy of Family Physicians.
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