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Industry: Email Alert RSS FeedAn RN first assistant's guide to private practice - registered nurse
AORN Journal, April, 2003 by Sheila Hughes
Tax obligations include self-employment tax and state and federal tax. Self-employment tax is a social security and Medicare tax assessed against individuals who work for themselves. This tax must be paid if an individual is self-employed and his or her net earnings are more than $400. State tax is reported quarterly with a percentage requirement for each state, and federal tax is based on quarterly estimated earnings. Self-employed RNFAs should consult an accountant regarding social security obligations and the process for submitting and paying quarterly taxes. The Small Business/Self-Employed Division of the IRS helps people who are self-employed by providing education and information about their tax obligations. (18)
Marketing. Marketing should include, at a minimum, distributing RNFA brochures and business cards, making telephone calls, and sending letters of introduction to colleagues and surgeons. Additional strategies include developing a personal web site, placing advertisements in newspapers, making public presentations, giving lectures involving the community, and arranging personal meetings with surgeons and their surgery schedulers. Self-promotion and establishing and maintaining good rapport with RNFA colleagues and other surgical assistants are additional strategies for success.
Office. Setting up a home office is recommended because it is affordable, simple, and convenient; however, obtaining a post office box may be the best option for receiving business mail. A post office box offers security and privacy, and the rental cost is considered a business expense. Initial office supplies needed include a travel and procedure log (eg, a computer-generated spreadsheet, ledger book), a desktop or laptop computer with a quality printer, a file cabinet, a fax machine, and a copy machine.
Billing. Professional billing services can be used for account management and usually provide comprehensive services based on a percentage ranging from an average of 7% to 10%. (19) Using a billing service can be advantageous in regard to time management and familiarity with billing codes and procedures. Many large surgeon's groups and anesthesia groups use such services, but they may prove too costly for a small business owner.
If an RNFA decides to do his or her own billing, he or she should choose accounting and management systems that allow for tracking of revenue, expenses, taxes, and insurance company statistics, including the name of the insurance company, type of coverage, method of payment, percentage paid for services, turnaround time for receiving payment, adjustments, and write-offs. Write-offs are fee adjustments (ie, the difference between the full fee and the allowed fee), and they have important business and income tax implications. Full fees, adjustments, and write-offs must be documented clearly for each patient account, and reporting must be in accordance with local, state, and federal tax laws. (20) Systems that allow for easy retrieval of data are important for projecting revenue, creating operational and capital budget plans, and reporting quarterly taxes. In addition, accurate documentation of assisting hours is beneficial when recertifying.
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