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You might be under the false impression that because someone owns a medical practice they are very wealthy. It might be true, but just as easily it might not. If a physician isn’t making the kind of money he should it might be because he doesn’t have the skills necessary to take care of the business side of his business.

A physician who recognizes this weakness will use the services of a medical billing company to take care of the details of his office.

These companies have a trained staff of medical billing professionals who are trained to take care of every billing need a medical practice would have. They can handle the insurance details as well as the medical coding part of the business.

Insurance companies can be very difficult to work with. They will deny a claim for the slightest reason and some of those reasons border on the ridiculous.

A medical practice that is quite busy with patients and chooses to submit their own claims to insurance companies will find that their claims are denied a good deal of the time. If a medical billing company is used, however, this does not happen as often.

A medical practice that sees a great many patients must fill out the insurance claim forms for every one of those patients. One person could be responsible for filling out the forms for every patient that visits the practice. That person must write out the insurance forms and send them off to the insurance company. If one error is made on those insurance forms the claim will be automatically denied. It is then sent back to be corrected and filled out again.

This can often overload the person that is responsible for handling the medical insurance forms.

When the claims are all filled out properly and everything is fine it can still take the insurance company months to send a check. If the practice is relatively small this can wreak havoc on the budget of the small practice. Especially, if there are claims that are denied all in the same time period.

When a medical billing company does the work the practice is relieved of the duty to handle the insurance forms and all of the problems that are associated with it. There are professionals working on the claims and getting them to the insurance company through electronic methods. This eliminates the need to enter the claims manually to the insurance company.

A medical billing company will also make sure that the claim goes through the process error and problem free. They will constantly monitor the claims to make sure that there is no problem. Most of these businesses have a success rate of more than ninety percent.

An electronic submittal of a claim gets either rejected or accepted right away. If it is accepted the check will be sent to the practice in days not months as happens with a manual system.

If the practice is small a business that will get them their checks from the insurance company quickly is the difference between success and failure. If the practice thinks that the cost of a medical billing company is too much for the small business to afford they should consider what is at stake and then analyze the cost.

A medical billing company will work for any type of practice no matter what kind of medicine they practice.

Peter Geisheker is CEO of The Geisheker Group marketing firm. One of the types of clients that Peter helps are medical billing services

“Just when you thought Sarbanes Oxley concerns had been sufficiently addressed so that non-public companies could take the issue off their dashboard, things have changed, ” says Gary W. Patterson, Enterprise Risk Management expert and speaker. He forewarns that Enterprise Risk Management (also referred to as ERM) will soon become a business issue for almost every business on the planet, including family-owned businesses, private companies, and nonprofits. This is a strategy shift for many of these organizations, which up until this point thought Sarbanes Oxley (sometimes affectionately known as Sarbox) applied only to public companies, and big ones at that.

One major reason for this sea change in philosophy is that both Standard & Poor and Moody are soliciting comments on their approach to ERM analysis and how they plan to factor it into their ratings. Their discussions will accelerate activity under way where bankers, governmental organizations, and regulators, in particular, have been considering the need for stronger corporate governance. For them Sarbox is an easily obtainable platform to use for drafting programs they believe should exist in corporations directly or indirectly under their jurisdiction. Lest you have any doubts, note how user friendly definitions from Wikipedia describe this trend.

“In business, enterprise risk management (ERM) includes the methods and processes used by organizations to manage risks (or seize opportunities) related to the achievement of their objectives. ERM provides a framework for risk management, which typically involves identifying particular events or circumstances relevant to the organization’s objectives (risks and opportunities), assessing them in terms of likelihood and magnitude of impact, determining a response strategy, and monitoring progress. ERM can also be described as a risk-based approach to managing an enterprise, integrating concepts of strategic planning, operations management, and internal control. ERM is evolving to address the needs of various stakeholders, who want to understand the broad spectrum of risks facing complex organizations to ensure they are appropriately managed. Regulators and debt rating agencies have increased their scrutiny on the risk management processes of companies.” per wikipedia.

Exactly when ERM programs will be implemented is a tougher question. Understandably, non-public companies have a range of reasons for preferring to delay the time when ERM factors will apply to them. However, the question is WHEN - not IF - some form of Enterprise Risk Management requirements will be applied. Family-owned business, other forms of private companies, and non-profits have been forewarned in a number of publications, speeches, and white papers over the last two years.

Some will say that we are drowning in white papers on ERM, corporate governance, Board of Directors, and risk analysis available and dismiss the issue. But those who are proactive, not reactive, will find the time well spent if they begin some level of enterprise risk management dialogue before something critical happens and your company is being second guessed by the ratings agencies, your auditors, or worse yet, a trial attorney.

The topic most companies neglect at their peril is the impact of a fast-approaching clean-energy-influenced economy. Here, we must reassess how much sooner we need to think about a renewable energy world as it relates to areas of your business that will be impacted both positively and negatively, and how that will change your company’s current and long range business plans, including the magnitude of those changes. After all, most C-level executives and their top management teams that I know do not like being second guessed and blind sided.

Gary W. Patterson has helped companies improve their profitability, reengineer their business models, and strengthen or gain competitive advantage in the marketplace. You can reach Gary at www.FiscalDoctor.com or take the free Fiscal Test at http://fiscaldoctor.com/fiscaltest.html.

The following item was reported in a recent American Institute of Certified Public Accountants communication:

“The Exempt Organizations Division of the IRS had posted on the IRS web site a controversial document setting forth the Service’s view on what constitutes good governance practices for tax-exempt entities. Included in the document was the suggestion that audit firms be rotated on a regular basis, with five years as the suggested term. The Institute protested the inclusion of this item in face-to-face meetings and in writing. Last month, the IRS dropped the document from its website, explaining that the new Form 990 sets forth the IRS’ current position on good governance practices which do not include the five-year rotation suggestion. ”

This is another sad example of a professional organization placing the good of its members over the public interest. The Institute has a long history of this type of advocacy. Why would the IRS recommended a five year audit rotation as a good governance practice for non profit organizations?

Audit rotation is designed to overcome two problems that can occur if an organization hires the same audit firm year in and year out. The first problem is that there is a tendency for audit firms to get too cozy with the management of the organizations they are assigned to audit. Personal and professional ties can easily impede auditor independence. Secondly, audit rotation provides the opportunity for the organization to be examined with a fresh pair of eyes.

This second issue is subtle. Accountants are creatures of habit and checklists. Things are done the same way as they were last year and often in a very mechanical and non critical manner. Many audit procedures and tests are numbingly mechanical and clerical and it is very easy to not view the audit process from a sufficiently critical and analytical point of view. Sometimes the most glaring internal control weaknesses can be overlooked simply because the auditors were not looking at the big picture but only concentrating on the minutia. A change in auditors guarantees that the organization in its entirety will get a fresh look and glaring internal control problems that may have been overlooked by the prior auditor may get picked up by the new one.

Of course CPA firms with long standing engagements with non profit organizations do not want to give up them up for obvious financial reasons. So these firms use their professional association, the Institute, to advocate against the obvious good governance practice that is clearly in the public interest. Such cynicism is sadly the rule not the exception for most professional organizations.

The IRS also should share some of the blame for caving into the audit firms on this issue. But it probably was not the IRS staff that caved but the higher ups who were pressured from the Bush administration. Whenever there is a divergence between private sector interests and the public interest you can pretty much count on the Bush administration siding with the private interests.

In any event the IRS had the right idea to begin with. Non profits should rotate their audit firms on a regular basis.

Michael Sack Elmaleh is a Certified Public Accountant and Certified Valuation Analyst. His book, “Financial Accounting: A Mercifully Brief Introduction”, has received wide critical acclaim. He has nearly 30 years of accounting and 10 years of teaching experience.His web site is understand-accounting.net

This article examines the impact on taxpayers and appraisers as well as their advisors of the new Federal provisions of the Pension Protection Act. For appraisers performing valuations for federal tax purposes in accordance with the Pension Protection Act (PPA), signed into law in August 2006, stipulates new penalties and stiff sanctions if the appraisers or appraisals fail to meet the new qualifications.

The Backdrop

The Congress and IRS, to safeguard the U.S. tax system and force taxpayers to straighten up, have introduced new rules and restrictions that impact lawyers and accountants as well as taxpayers. The Pension Protection Act (PPA) of 2006 establishes severe penalties for unethical conduct on the part of accountants involved in federal tax information consultancy to private firms.

Previously, the government’s targets for tax abuse were various corporate transactions. But now it has trained its guns on the venerable charitable contribution deduction as well. The act attempts to prevent overvaluing the property given to charity to take advantage of the fair market value deduction. According to Section 170(f)(16)(B), Congress has invited the IRS to stop the deduction completely. In the middle of the gun battle are the appraisers who opine for the taxpayers about the values of property that they give to charity.

Qualified appraisers
PPA also requires that appraisals need to be prepared by qualified appraisers.1 A qualified appraiser is defined in the Act to mean a person who has earned an appraisal designation from a recognized professional organization or has met minimum education and experience requirements established by the Treasury Secretary through regulations. An appraiser will not be treated as a qualified appraiser unless the appraiser demonstrates verifiable education and experience for valuing the type of property subject to the appraisal. Also, the appraiser must not have been prohibited from practicing before the IRS at any time during a three-year period prior to the date of the appraisal.

To sum it up, it is now required that an appraiser valuing property for charitable deduction must be trained and experienced and a vague representation by the appraiser will no longer suffice.

Appraisal Impact on Charitable Contributions
PPA has led to an increase in mandatory requirements for appraisals and appraisers to meet Internal Revenue Code Section 170, which covers charitable requirements.

It is now required that all claimed deductions in excess of $5,000 must be accompanied by a “qualified appraisal.” The regulations have duly defined the terms “qualified appraisal” and “qualified appraiser.”

All appraisals to qualify must fully comply with Uniform Standards of Professional Appraisal Practice (USPAP). Those that do not fully comply but are “consistent with the substance and principles of USPAP also satisfy this requirement.

Qualified Appraiser:

According to the Act for a person to be a “qualified appraiser” must meet 5 requirements as laid down in the code. According to these requirements, an appraiser must:

1. Have earned an appraisal designation from a recognized professional appraiser organization
2. Demonstrate “verifiable education and experience” in valuing the type of property subject to the appraisal
3. Regularly performs appraisals for compensation
4. Not appear on the IRS’s disqualification list at anytime during the three years prior to the date of appraisal
5. Meet other requirements [to be] prescribed by Secretary

However there is an exception available to taxpayers when the appraiser fails to meet the Act’s rigorous requirements. The denial of the deduction is inapplicable “if it is shown that the failure to meet such requirements is due to reasonable cause and not to willful neglect.”

Further, Notice 2006-96 states that the designation must be “awarded on the basis of demonstrated competency in valuing the type of property for which the appraisal is performed.” Additionally, the Notice notes that alternative education and experience requirements are met if the appraiser has done each of the following:

1. Successfully completed college or professional level course work that is relevant to the property being valued.
2. Gained at least two years experience in the trade or business of buying, selling or valuing the type of property being valued.
3. Fully described his or her relevant education and experience in the appraisal.

Prevention is better than cure. By adhering to norms and being organized and cautious about the whole process would ensure that you have nothing to fear. Educating yourself about the new law and its implications will further minimize your chances of getting in the way of PPA radar and getting penalized heavily.

Mel Abraham CPA, CVA, ABV, ASA, CSP - author & Adjunct Professor (USD Law School. Further, for access to an audio presentation on IRS penalties and the Pension Protection Act visit http://www.valuationeducation.com/penalties.html. He can be reached at mel@melabraham.com.