Thursday, February 26, 2015

What All Dentists Need To Know About Medicare Enrollment

Does your practice service patients 65&over who have medicare coverage? 

Here are some important details that our friends at Veros Dental recently shared about the 2015 Medicare Enrollment

 Any dentist, including a specialist, who treats Medicare beneficiaries must either enroll in the Medicare program or opt out in order to prescribe medication to their qualifying patients with Part D drug plans. Most every patient 65 years of age and older is a Medicare beneficiary. 

This decision should be made promptly and the process should be undertaken now to ensure implementation by the June 1, 2015 deadline.

Only those dentists who do not treat Medicare eligible beneficiaries (65 years or older patients and certain disabled individuals) are free from making a decision and acting. By not acting (creating a formal status with Medicare), Medicare eligible patients will not be covered for prescriptions you write for them (this will tend to irritate them as their coverage should cover most all prescriptions and will not be covered solely because of your failure to act).

If you treat Medicare beneficiaries and must make a decision, there are actually two decisions you have to make. The first is whether to enroll or opt out. The second, if you enroll, is whether to enroll as a Medicare provider or enroll as an ordering/referring provider.

ENROLL - Medicare Provider

By enrolling as a Medicare provider, you are agreeing to accept the Medicare fee schedule for covered procedures you perform for these patients. Dentists perform few of these services but may include biopsies, some TMJ services and sleep apnea. If you do enroll, you'll have to follow Medicare procedures for claim submission. This enrollment then also allows your Medicare patient prescription to be covered.

ENROLL - Ordering/Referring Provider

If you do not perform any Medicare covered services, you may choose to enroll as an ordering/referring provider. This allows service providers to whom you refer Medicare patients to get paid (labs, imaging services, other procedures). It also allows your Medicare beneficiary patients to have their prescriptions covered. You will not be able to perform Medicare-covered services under this status, however. 

OPT-OUT

At first take, choosing to opt out sounds like it would be the easy approach. It isn't that simple. By choosing to opt out, your practice will actually be required to send an affidavit to the Medicare carrier in your region. The opt out affidavit lasts for two years. At the end of the two-year period, you are faced with the same decision again -- to enroll or opt out.
In addition to the document you must file with Medicare, you also need to inform your Medicare beneficiary patients and have each of them enter into a written private contract. This contract is an agreement that you are not an enrolled Medicare provider and that the patient won't submit any covered treatment claims to Medicare. These contracts will need to be kept as records of the practice and also need to be renewed every two years. This contract must follow all of the specific Medicare stipulations (even including the appropriate font size!) for it to be valid.
By having these contracts in place, the practice can follow their own fee schedule for the Medicare covered procedures, and the patients can have their Part D prescriptions covered under Medicare.

How to Decide?

Each practice will need to formulate their best approach to what to do. Here are some considerations:
  • Do you or will you see a Medicare eligible patient in the next two years? If yes, you have to make a decision. If not, there is nothing for you to do from here.
  • How many Medicare eligible patients will you see? Run a demographic report to learn how many active patients you have over the age of 65. If this is low, consider opting out. Opting out actually will result in more work, as every patient over 65 will need to sign an agreement with you every two years. So depending on the numbers, opting out could possibly cost a lot of time.
  • Do you perform Medicare procedures? If you do, you'll need to consider whether you want to accept their fee schedule (enroll) or not (opt out). If you do perform these procedures, a thorough analysis of your fees and the Medicare fee schedule should be considered.
  • If you do not perform the Medicare procedures but don't want the ongoing burden of the opt-out paperwork, then enrolling as an ordering/referring provider is likely the best option. You won't be able to send claims to Medicare, but your referred service providers will get paid and your patients' prescriptions will be covered. You can enroll later as a Medicare provider, if necessary.
If your your patients are affected, be sure to make the implementation by the June 1, 2015 deadline

For additional information and/or questions specific to your practice,contact one of our Dental CPA team members at 800-772-1065 or info@dentalcpas.com. Don't delay your decision, give us a call and we can help guide you to the best solution that works for your practice. 

Also visit the ADA website as well as DentistryIQ for additional articles related to the medicare enrollment

Tuesday, February 10, 2015

QuickBooks Tips Reloaded- Part 1

One of our Dental CPAs, Deana Jordan, posted an article in the January issue of Dentaltown magazine discussing QuickBooks: 10 Tips to Stay Organized and Efficient. We received so much great feedback from clients and others in the dental community who found the article really helpful. So we decided to further discuss Deana’s QuickBooks tips in a 3-part series blog post!

These tips help educate dental practice QuickBooks users on what they should be doing to not only better manage and organize practice finances but also help the practice advisers, especially in regard to practice decisions. 

Here is Part 1 of Deana’s QuickBooks Best Practices Tips:

.     1..     The Beginning: Basic Booking Tips to Jump Start Your Journey

o   Maintain separate accounts
The rule of thumb for any business is to always keep personal and practice checking accounts separate. Your business is a separate entity, so never comingle funds. 

o   Keep Track of your receipts to support your expenses
Keeping accurate expense records and updating your records regularly is the best way to ensure organization and efficiency.  Whether it’s scanning your receipts or using a filing system- don’t throw them away. They can be used for record verification when you least expect it.

o   Have a spare credit card for practice transactions
Using a separate credit card for your professional practice expenses is key. Also reconcile your credit card’s expense statements monthly- even if you can only spare 30 minutes to do so. By reconciling your expenses on a monthly basis, your records will remain up to date and accurate. So when your financial manager goes in to pull reports, they can do so more efficiently without waiting time digging around to find missing receipts.

     2.       Selecting the best QuickBooks Software Version

o   Choose the version of QuickBooks that best suits your practice’s needs
§  QuickBooks Pro- For practices that are just starting out and are more focused on getting up and running
§  QuickBooks Premier- For more established practices that are expanding their business and service offerings
§  QuickBooks Enterprise- For practices that have more complex levels of record keeping and need more flexibility in targeting the software specifically to their needs
§  QuickBooks Online – For online access for dental practices on any level

o   Our Dental CPA team recommends QuickBooks online, so you can login anywhere at anytime. There is no software data to manage and the system is automatically upgraded. Your data is stored on the Intuit servers so there is no need to process manual backups. If you have an offsite bookkeeper, QuickBooks online makes it easier for them to access your books from anywhere, that’s less time spent commuting to the office!

-        3.   Creating Customizable Chart of Accounts
o   If your practice is in its early stages, and you are not sure as yet which reports you prefer to see, start with a Standard Dental Chart of Accounts. QuickBooks will generate a chart of accounts based on the type of business entered at initial startup, in this case, a dental practice. Here is an example of a Chart of accounts for a general dentist.


With QuickBooks, and a trusted Dental CPA on your side, being organized and ensuring that your practice’s finances are accurately managed is simple. Regardless of the size of your Dental practice, you want to ensure that you are running your business efficiently by having good bookkeeping and accounting practices. 

Stay Tuned for part 2 of our three part series on Ten Tips to Stay Organized and Efficient. You can also check out Deana’s original Dentaltown article here

For information on questions specific to your practice’s accounting needs, contact Deana or reach out to any of our Dental CPAs by emailing info@dentalcpas.com

Monday, September 29, 2014

Finding an Associate Dentist Job - It's not Just What You Do, It is How You Do It

Here is another guest blog from our friend Morgan Pace at ETS Dental.
Dentistry is a highly technical field requiring extensive training to hone clinical techniques and skills, yet it is often not these technical skills that determine who get the best jobs after dental school. Generally, the “soft skills” are what will make or break your chances of landing an ideal associate position. To separate yourself from other associate candidates, it is important to recognize what these skills are and why they matter.
What are “Soft Skills?” Soft skills, or people skills, are what inspire trust from patients. They make someone an effective communicator and a productive part of a team. There are many soft skills needed to be an effective dentist, but here are the leading soft skills requested by the practice owners for whom we consult.

Communication skills

Patients will take it for granted that the “Dr.” in front of your name means that you are qualified to drill a tooth or seat a crown. They do not become long-term patients because your margins are perfect. They come back to you because you are a pleasant person who understands your patient’s apprehension and takes the time to answer his or her questions. When interviewing a potential associate, a practice owner will look for these characteristics to determine the quality of your communication skills:

  • Clear articulation: Can you convey ideas so that others easily understand?
  • Expressiveness: Do you use voice inflection and descriptive language to avoid sounding “dry?"
  • Empathy: Do you inspire trust by accurately reading the emotions of others and respond appropriately?
  • Confidence: Do you exude self-assurance in your abilities?

Attitude and Outlook
Practice owners need their associates to be an asset to their practice. Most genuinely want the associate arrangement to be a “win-win” arrangement where everyone profits. Hiring a clinically exceptional but emotionally-taxing associate will not be sustainably beneficial to the practice. To avoid this, practice owners will look for the following:
  • Positive Attitude: Are you generally optimistic or are you overly critical? Will it be fun to work with you?
  • Willingness to learn: Are you accepting of feedback and helpful criticism or do you become defensive?
  • Flexibility: Can you adapt to changing circumstances and new challenges?
  • Work ethic: Will you exceed the minimum expectations? Will you go above and beyond for your patients when necessary?
  • Motivation: Will you continuously strive for improvement? Do you set challenging personal and professional goals? Will you be satisfied if you fail to achieve those goals?
Professionalism

Even the freshest new dental school graduate is a doctor and so has earned the respect of the dental practice staff and the larger community. With this respect comes the demand of maintaining a professional demeanor. Beyond that, you are a highly compensated professional with a public profile. You are a pillar of the community who will be a leader in the office. Can a practice owner trust you to maintain this esteem? Here is what he or she will look for:
  • Time Management: Can you be trusted to be ready to see patients as soon as the practice opens?
  • Team Player: Will you be cooperative and respectful when working toward greater group goals?
  • Leadership: Will you lead the office staff by example? Will you avoid petty squabbles? Will you have the courage to address problems and work towards solutions?
  • Problem Solving: Will you apply your training in a creative manner to drive innovation and improvement?
  • Work under pressure: Can you be trusted to maintain decorum under deadlines and through difficulties?
The more of these skills you display, the more comfortable a practice owner will be in choosing you for his or her practice. Remember - it is not what a practice can do for you, it is what you can do for a practice. 

Posted by Morgan Pace, Vice President and Senior Dentist Recruitment Consultant with ETS Dental. To find out more, call Morgan at (540) 491-9102 or email at mpace@etsdental.com.

Friday, September 26, 2014

The 9 Dos and Don'ts of Divorcing Your Business Partner

This is a guest blog from Melanie Glickson, ESQ.

            The dissolution of a business can be just as harrowing as divorcing your spouse.  Business partners split up for any number of reasons.  Sometimes one partner is not producing.  This might be due to personal troubles, like addiction to drugs or alcohol, which leads a breakdown in the business relationship.  Sometimes one partner becomes embroiled in an inappropriate romantic relationship with an employee, or otherwise engages in unprofessional behavior that places the practice at risk.  Sometimes financial wrongdoing (or perceived financial wrongdoing) is involved.  And from time to time, partners split up with each other simply because they have gotten on each other’s nerves over the years, with minor resentments building to excessive levels – again, not unlike many marriages. 

            If you find yourself in a situation where you feel you need to divorce your business partner, consider the following “dos” and “don’ts” to mitigate the cost and the stress associated with dissolution.

            1.         DO consult with a business attorney once you decide to ditch your partner.

            It can be challenging to effectuate a dissolution: you want to keep it quick and simple – all the while paying attention to the details. Add to this, managing the emotional and interpersonal stress associated with the separation.  Consult with a business attorney early.  You will be so glad you did.  A good business lawyer can help you clarify the steps to wind up the business and dissolve.  She should also be able to advise you about restructuring the business after dissolution - if you want to continue with the business afterwards.   If things become contentious, a litigator will probably need to get involved.  On the other hand, if you read, understand and act on the advice in this article, it might not have come to that.  While it is prudent to seek advice and counsel from an attorney at the beginning of the process, in most cases actually involving the court system should be seen as a last resort

            Each state has its own procedures for terminating a business entity, depending on the type of entity (LLC, corporation, general partnership, etc.).  The partnership agreement or operating agreement controls these terms, but if there is no agreement, or the agreement does not address dissolution, then the default rules provided in the state statute apply.  There are rules pertaining to voluntary dissolution (where the members consent) as well as court-ordered dissolution.  For voluntary dissolution, these procedures are not complicated, but there are certain necessary steps that need to be followed depending on the state and the type of entity.  For example, in Maryland, an LLC’s creditors must be provided with 19 days’ advance notice of dissolution.  You can consult your state’s business database to learn more about these procedures.

            2.         DO have an agreement in place that addresses dissolution.

            A good partnership agreement or operating agreement will address dissolution, like a prenuptial agreement in a marriage.  While not required by law, it can be risky to conduct business without one.  The agreement can provide a set of steps to end the relationship and repurchase the interest of a partner who is not performing or is unsatisfactory for reasons the agreement provides (i.e., conviction of a crime, loss of license, sleeping with the receptionist, a burgeoning addiction to mouthwash, or any other specified conduct). 

      If you never had an agreement with your partner, or if your agreement does not address dissolution, try to negotiate the terms of dissolution together with your partner.  Your attorney will memorialize these terms into a formal agreement in which you and your partner release each other from any claim relating to dissolution.

      If you are unsure about whether you want to separate with your partner, but you do not have any agreement governing your business relationship, have one drafted immediately.  While it’s better to draft these agreements in the beginning of the business relationship, it is never too late, until it is too late.  Simply advise your partner that you heard horror stories about practices that had no agreement, or say you are trying to boost the level of professionalism of the practice in general.

3.   DO elicit assistance from third-parties.

      Rather than arguing with your partner back and forth or losing sleep over the details of dissolution, utilize third-parties who are well-versed in issues surrounding dissolutions, and who can look at the situation without emotion.  Examples include attorneys, accountants, appraisers and mediators.  As an example, don’t tear your hair out trying to determine a range of value for the business – consult with your accountant.    

      If you are unable to come to mutually agreeable terms with your partner regarding dissolution, a neutral third-party in the form of a private mediator can cut short legal fees and resolve the matter quickly.  Parties typically fail to take advantage of mediation early enough, and could have saved significant legal fees and stress had they chosen to mediate early in the dispute.  Mediation sessions can often be scheduled at the last minute with a mediator that is mutually agreeable to both sides.  Many mediators are retired judges.  They are very knowledgeable and experienced at defusing tension and arriving at a settlement.  Your attorney can fill you in on the background of the potential mediators.  The mediator is paid an hourly rate that the parties often agree to split, or to count as a business expense associated with winding up.  The mediator puts the parties in different rooms with his or her attorney and goes back and forth to discuss the matter privately with each party to try to resolve the dispute.  Unlike arbitration, which is binding according to what the arbitrator decides, mediation yields a resolution only if the parties agree.  Mediation is confidential and the communications that take place cannot be used in litigation, in the event the case does not resolve and the parties move forward with a suit.

      If you are unable to negotiate the terms of dissolution directly or through a mediator, or through counsel, the dissolution will need to occur through the court system.  This should be seen as a last resort, as it is costly, public, and often involves mudslinging by both parties.

4.   DO review leases, contracts, and loan agreements to see how dissolution will affect them.

      Before you discuss a business divorce with your partner, you should review any leases, loan agreements, and contracts to determine the impact of dissolution.  Often, the business is still bound by the contract or lease through the end of the contract period or lease period, regardless of dissolution.  Sometimes you can negotiate with your landlord, but these are all subjects you need to discuss with your partner.  You should approach your partner about dissolution having reviewed these documents in advance.

5.   DO try to be direct and communicate with your partner about separating as soon as you decide.

      Once you decide to separate from your partner, sit down with your partner and have an honest, direct discussion.  Be tactful but truthful.  Allow time for the news to sink in and then address the details. 

      The break-up discussion is difficult, but important to conduct.  Consider the following example of how complicated things can get, very quickly, in a business breakup when the lines of communication are not left open.  One particular individual decided to break up with her partner.  She was so worried about her partner’s reaction that she never actually sat down and communicated her desire to separate.  Instead, over a weekend, she unilaterally moved half of the office property into storage and transferred half of the money out of the bank accounts.  On Monday morning, the partner walked into the office to find half of the furniture gone, half of the money gone from the accounts, and a letter on her desk announcing the split, asking for consent to dissolve, and threatening to seek judicial dissolution of the business if she did not give consent.  The surprised partner called the police and tried to have her partner arrested for embezzlement.  Then, she (the surprised partner) hired a lawyer who threatened to file a temporary restraining order against the unilateral-acting partner, preventing her from earning any income until she returned the office furniture and the money.  Both parties threatened to file breach of fiduciary duty claims against each other.  Both the tension and the attorney’s fees escalated at breakneck speed. 

      6.  DON’T communicate directly with your partner once lawyers are involved.

            While open, honest, direct communication is key at the beginning stages of a dissolution, if the split becomes acrimonious, both sides need to communicate only through counsel.  It is not unusual for the attorneys to pass along telephone messages and mail on behalf of their client, to the other business partner, so that the parties do not have to communicate directly.  While this may seem unnecessary and juvenile, for various reasons, adverse parties should not be communicating except through counsel.  Moreover, if the relationship has truly devolved, even communications about ordinary office banalities while the parties are still in business together can lead to knock-down, drag out arguments.

            7.         DON’T allow personal feelings to draw out the process.

            At the end of the day, you don’t want to wind up in a situation where you are paying your lawyers large sums to fight about who gets the copier and who gets the office chairs.  Just like when a marriage ends, distribution of the assets can be wrought with the emotion over the breakup.  Don’t succumb.  Tell your attorney what you are willing to compromise about and let her do the negotiating.  You can give your attorney the authority to negotiate on your behalf without necessarily giving you a detailed play-by-play of every detail and every discussion.  You, not your lawyer, will have ultimate approval authority over any agreement proposed.  Take a step back, and don’t get lost in the details. 

            8.         DON’T lose sight of the bigger picture.

            When you are negotiating the terms of dissolution with your partner, whether it is directly, through counsel, or through mediation, keep in mind that it is usually worth it to give up something in exchange for peace of mind.  Orient your frame of mind on your next chapter.

            9.         DON’T overthink it. 

            You should give careful consideration to the prospect of separating from your business partner, but don’t obsess.  As painful as it can be to split with your partner, if your gut tells you it’s necessary, you will probably be better off in the long run.  People torture themselves for years wondering “should I, or shouldn’t I?”  It’s better to act quickly and move forward toward the goal of achieving business success.
           

 For more information about your particular situation, contact Melanie Glickson, ESQ.

Tuesday, September 9, 2014

IRS Pays Taxpayer's Legal Bills - Tax Court Ruling

Chalk one up for the taxpayers.

Penalties—Taxpayer Awarded Attorneys' Fees after IRS Refuses to Abate Incorrect Assessment: A taxpayer, whose son lived with him most of the year, claimed Head of Household (HOH) filing status but did not claim his son as a dependent. (He and the child's mother had agreed that she could claim the dependency exemption.) The IRS issued a math error notice to the taxpayer, indicating that it had changed his filing status to single because the name of the dependent who qualified him for HOH status was not reported on the return. The taxpayer made a timely request for abatement and included the reasons for claiming HOH status. During a collection due process hearing, the IRS refused to abate the assessed tax, despite the taxpayer's support for filing as HOH (e.g., name and Social Security of his son). Upon filing a petition with the Tax Court, the IRS conceded to abate the assessment. The taxpayer requested reimbursement for his attorney's fees under IRC Sec. 7430(a), which the IRS challenged. The Court sided with the taxpayer because the taxpayer was the prevailing party, exhausted all administrative remedies available to him within the IRS, and did not unreasonably delay the proceedings. Michael Swiggart , TC Memo 2014-172 (Tax Ct.).