Written by Madeline Hyden, MGMA-ACMPE web content writer/editor

When managing patient flow, dealing with staff issues and figuring out how to get paid, every minute counts. By making a few small changes in your day-to-day operations, you can free up provider time, streamline your front office processes and create an opportunity to chip away at your own to-do list.

Do you have more cancellations on Fridays or more no-shows around lunch time? If you can determine when cancellations, no-shows or last-minute rescheduling happens most frequently during the week, you can double book or overlap appointments, eliminating open space in the schedule.

Before patients arrive, gather your administrative and clinical staffs together to review the day’s schedule. This is an opportunity for staff to give share details about patients that may affect other staff members’ time. For example, if a patient mentions on the phone that she's bringing a list of questions, the front office staff employee who took the call will be able to communicate that to the clinical staff in the morning huddle so that they can manage their time appropriately.

As an administrator, you wear many hats. This also means your staff comes to you for help and answers on just about anything. Unless it’s an emergency, encourage them to save questions and discussions for daily huddles or weekly meetings. A quick question can turn into an hour-long discussion, which, over the course of a week, can take up a lot of your work day.

Some providers may prefer a heavy schedule at the beginning of the day, while others may want a steady stream of back-to-back patients all day. Train your front office staff to schedule accordingly so providers don’t get over or underwhelmed by a schedule that doesn’t fit their needs.

Train front office staff to get as many details as possible from patients' about why they're booking an appointment. When appropriate, NPPs may be able to handle appointments and free up physicians to treat more time-consuming, complicated patient cases, potentially generating more revenue for the practice.

Clear expectations reduce duplications and confusion and ultimately save time. This is true whether you're dealing with expectations in employee performance plans or the expectations of day-to-day tasks. 

How do you improve your practice’s (or your own) time management? Share in the comments section below.

Visit our solutions pages for resources on staffing and   patient flow.

Written by Amber Taufen, MGMA-ACMPE assistant editor

Before Google, hypochondriacs had to flip through books or drill their physicians about what their symptoms could mean. Now anyone, not just hypochondriacs, can type their symptoms into a search engine and get a list of potential diseases and conditions they could be suffering from.

A February 2011 study indicates that eight out of 10 people use the web to search for health information, but only 25 percent of these searchers verify the credibility of the information they are reading. This can potentially spark arguments between providers and patients, extra-long appointment times because patients arrive with a stack of website print-offs and the potential for non-compliant patients who trust the web over their provider.

Here are a few ways to deal with self-diagnosers in your practice:

• Remind providers to be empathetic with cyber- or hypochondriacs. To them, their symptoms are real, and not taking their concerns seriously will frustrate them more. Praise patients for staying informed and be willing to discuss the information they bring with them.
• Recognize that patients are bombarded with mentions of potential medical problems through social media and advertising. It is not unreasonable for them to reference Facebook or Wikipedia during an appointment.
•  Encourage your providers to ask patients at each visit how they use Internet resources for their health. These questions could include:
  • “There are a number of ways to treat psoriasis. What medications or treatments have you heard or read about?”
  • “When you first noticed these headaches, did you do any research before scheduling an appointment?” 
• Provide resources for your patients that will ensure they go to your practice for advice instead of to a search engine. Or, teach your patients to search correctly using credible websites and sources, and share with them ways to identify unreliable sources. For example:
  • Pharmaceutical websites, medical device websites or websites with a lot of testimonials but little scientific information are all warning signs that you’re looking at an unreliable source.
  • Website advertisements can be disguised as content, so watch out for mentions of products or links to websites outside of the original source.
• Patients might seek information from the web because they don’t trust their provider’s advice or they feel as though their concerns were not taken seriously. Evaluate the provider-trust relationship in your practice, and encourage the front office and clinical staff to show trust in the providers.
• Be clear with patients about any potential side effects of new medications — or any symptoms they might experience as part of a condition you’ve already diagnosed. If your patients are warned that they might experience dizziness on a certain medication, then they will be less likely to Google their symptoms to see what pops up.

Read more about cyberchondria in last month’s issue of MGMA Connexion magazine.

How do you handle self-diagnosing patients in your practice? Share with us in the comments section below.

Written by Madeline Hyden, MGMA-ACMPE web content writer/editor

A clinic in New Jersey reduced its overall spending by 12 percent – all by putting the patient first.

A New Jersey organization that provides health benefits for Atlantic City’s 14,000 union workers was experiencing rising costs as a result of chronic disease care among members. In an attempt to lower healthcare costs by helping patients better manage their own conditions, the organization partnered with AtlantiCare, the largest healthcare provider in southern New Jersey, to create a clinic to serve the city’s union workers. In 2007, the Special Care Center (SCC) opened its doors.

The SCC’s mission to connect with patients and make them the center of their own health reduces duplication, improves compliance issues and streamlines patient care. Here’s how they do it:

Team huddles
Each morning all providers, health coaches, front office staff and administrators have a team huddle to discuss that day’s patients, including their care plans and all medical and psycho-social issues. Each provider reviews the patient’s chart in the EHR and they discuss the patient together.

Team huddles make it easier for providers to care for each other’s patients if someone is out or if they’re taking call, says Ines Digenio, MD, medical director, Special Care Center. They’re aware of each other’s cases and care plans. Discussing patients as a group prevents miscommunication and repetition of treatment plans later in the day.

Prescription drug management
The AtlantiCare pharmacy director is also an active member of the SCC team and provides ongoing support and communication to the clinical staff during morning huddles.

“The SCC couldn’t operate without the relationship with the pharmacy,” Digenio says. “The feedback they give us is invaluable.”

Every week the in-house pharmacy runs a report that shows how many patients failed to refill their medication on time, or did not pick it up at all. For example, if a patient receives a 30-day prescription for blood pressure medication but only refills it every 60 days, the pharmacy will alert the patient’s care team. The staff will work with the patient to find out why he or she is not taking the medication every day.

“Maybe they need home delivery or they’re experiencing a side effect that is causing them to avoid their medication,” Digenio says.

Regular communication with the pharmacy allows the care team to address medication compliance issues sooner, rather than just communicating with the patient, who may not be upfront about skipping doses or not picking up refills.

“If you ask a patient if they’re taking their medication, the answer is always, ‘yes’,” Digenio says. “In a traditional setting, the doctor may then think the medication isn’t working so they may prescribe a new, possibly more expensive one.”

Psychological services
Each SCC patient is assigned a health coach who works alongside the providers and guides patients through their care plans. The health coaches develop relationships with patients and their families, which make it easier for patients to discuss potential mental illnesses, too. The SCC provides mental health services to its patients as a part of its overall care and can set the patient up with an in-house counselor immediately.

Sandy Festa, administrative director, Special Care Center, says incorporating psychological services into patients’ care plans is important because unaddressed mental illness can cause patients to be noncompliant about other health issues.

“Patients can’t get better if they’re depressed or anxious,” Festa says. “It just prolongs care and uses more resources.”

The outcome
Since 2007, the SCC has seen positive patient outcomes, including:

• A 40 percent decrease in emergency room visits and hospitalization
• A 98 percent medication compliance rate
• An estimated $208 in payer savings per patient, per month

Payers join the capitated SCC program with the understanding that they will cover appointment co-pays and prescription medication.

“Covering that is cheaper than, say, a $20,000 hospital admittance,” Digenio adds. “It’s an incentive for the payer to join the program.”

The CEO of AtlantiCare will present the Special Care Center in a case study at the Forum on Innovation in Healthcare, May 22-23 in Dallas. 

Written by Madeline Hyden, MGMA-ACMPE web content writer/editor

Your billing staff ultimately controls the success of your revenue cycle. The most successful billing staff understands their individual expectations and those at the practice level. For you, the administrator, this means creating a detailed performance management plan and conducting regular skill assessments.

Before hiring new billing staff, ask potential hires to complete competency assessments in your practice management system (PMS). Most PMS software offers a test environment that doesn’t use actual patient data so potential employees can perform basic functions. It’s also helpful to assess their knowledge of general, insurance-related tasks, which may include:

• Determining eligibility
• Interpreting an insurance card
• Explaining a statement to a patient

Conduct periodic competency assessments for current staff, as well. Changes in billing and collection regulations, updates to your PMS and revisions in payer requirements all necessitate ongoing training. Incorporate these assessments or additional training in staff performance management plans.

As a part of the performance management plan, regularly monitor employee-specific performance indicators. Common indicators to track on a weekly or monthly basis include:

• Aged accounts receivable (A/R) by payer
• Percentage of A/R by payer greater than 90 days
• Bad debt percentage by collector responsibility
• Account adjustments by category

You may also want to establish specific expectations for indicators that align with practice goals. For example, keeping the percentage of A/R greater than 90 days at less 20 percent. At the end of the quarter or year, conduct a performance review with each billing staff member and discuss how he or she performed on these indicators throughout the allotted time period.

Creating incentive plans for billing staff may seem simple since their back-office work is based on data and is easier to track. However, it does not recognize that all practice staff contribute to the success of the revenue cycle. Instead, you may want to implement a revenue cycle incentive plan that involves the entire staff of the practice.

In one practice-wide incentive plan, you set of goals or results you want staff to achieve with certain parameters (e.g., daily patient volume) and attach a number of points for each one:

              Source: The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid

Set a dollar amount for the number of points earned and communicate that to staff each quarter based on the profit from the previous quarter. See other examples of revenue cycle incentive plans in The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid.

How do you keep your staff accountable? Share it in the comments section below.

More from the In Practice Blog:
The thief in your practice is most likely your most trusted, loyal employee
Increase revenue by improving billing functions

Written by Amber Taufen, MGMA-ACMPE assistant editor

Businesses can spend thousands (if not millions) of dollars every year attempting to capture information about their customers, efficiency and bottom line. But you don't have to do that. Widespread adoption of EHR and practice management software means that many medical practices have this information at their fingertips – they just don’t use it.

 “The data you have in your practice is an asset,” says Nate Moore, CPA, MBA, CMPE, president of Moore Solutions Inc., Centerville, Utah. “Practice management and EHR software are going to capture the information, and it’s going to spit back the data you need to attest and get meaningful use measures for the Health Information Technology for Economic and Clinical Health (HITECH) Act. The software’s sitting on all that data — and a ton more.”

In "Using data wisely," an article in the April 2012 MGMA Connexion magazine, Moore mentions several ways you can use this data to help improve your practice’s level of efficiency, your patient care and even your bottom line. Just crunch these numbers:

• “The low-hanging fruit is the financial-related information,” Moore notes. How long does it take to collect from certain payers? What are their rates of denial? How many days do claims stay in accounts receivable (A/R)? Are there patterns you can trace for the claims that stay in A/R for the longest amount of time?
• Look at your appointment information. “If you understand appointments, you can understand where your no-shows are coming from and where new patients are coming from,” Moore says. “Is a patient less likely to show up if they made the appointment yesterday? Or are they less likely to show up if they made the appointment two months ago?”
• Have physicians slice and dice the clinical data. “What treatment protocols are you using?” Moore asks. “Which protocols are more effective in terms of curing the patient? What side effects might occur from different protocols?” As you gather this data over time, you can start to compare how different protocols measure up – and learn which protocols are most effective in terms of outcomes.
• Moore advises practices to think about how you can integrate what you know about your patients with what you know about the clinical side and the financial sides. For example, cross-reference your phone records with your payer information: How much time do you spend on the phone with various payers?  Compare that information with the level of reimbursement you receive from each payer. Analyze whether you should consider re-negotiating your contract with a particular insurance company.

Moore will speak at the MGMA 2012 Annual Conference in San Antonio. Registration opens April 17.

Read Moore’s article, “Using data wisely” online on virtual Connexion.

By Heather Grimshaw, publications editorial manager

When assessing the best way to evaluate, track and report accounts receivable (A/R) in your practice—and how that metric fits into the larger financial picture—some professionals debate the value of re-aging accounts, says Sarah Holt, PhD, FACMPE, who spoke at the MGMA 2011 Financial Management and Payer Contracting (FMPC) Conference in Scottsdale, Ariz. in February.

“To do it effectively you have to be an interactive problem solver,” explains Holt, administrator of several healthcare organizations in Cape Girardeau, Mo.  She cited a lively debate on the MGMA Member Community about re-aging accounts and how that fits into the larger A/R umbrella.

Questions posed on the thread include how and when to re-age accounts, when to write off collections and when something should be classified as bad debt vs. contractual allowances.  The article “Don’t be deceived by billing metrics” in the April issue of MGMA Connexion magazine delves into these issues.

And while Holt says “there is no magic bullet” to creating a positive financial picture there are different opinions on how accounts should be classified once transferred from different payer buckets. And when collecting from patients, customer service issues should be a priority.  

 As soon as a patient appointment is complete, that claim enters into the aging process. Each section of the aging process, or aging bucket, holds claims that have been in existence for a certain number of days. This graph shows how a practice may divide its aging buckets of unpaid claims by payer:

Source: MGMA Medical Office Billing: A Self-Study Training Manual

Some practices “re-age” outstanding patient bills to zero days when they are shifted to patients for payment, which can avert patient confusion and frustration, Holt says. For example, if you do not re-age invoices, patients may receive bills that show overdue balances of 90 days or more.  

“Patients can become furious,” she adds. In addition to concerns over how the bill will affect their credit rating, patients may start to question how a practice is run. “You don’t want to do anything that jeopardizes the trust between the patient and the practice or the patient and the doctor,” Holt says, “and you do not want to deal with a patient who begins to think, if I can’t trust this practice’s finances, how can I trust the medical advice?”

To avoid that scenario, Holt encourages front office professionals to talk with patients before they leave the building about how outstanding balances will be paid, and explain how the billing system works so they are not surprised when they receive bills.

“It’s a patient-friendly thing to do,” she adds.

The aging metric should also be seen as one piece of the A/R puzzle, says Holt, who wrote Get the Money in the Door: Physician Billing Basics. It’s a quantitative process that should be considered within the context of other benchmarks, including RVUs, collection rates and denial rates that are checked against the practice and compared with other practices.

It’s also helpful to trend payers and see which companies are not paying large sums. Holt meets weekly with collections staff to, as she says, “find out what went down, what went up and why.”

For more advice on A/R, read the online exclusive article “Capitalize on the time value of money: Fine-tune your A/R” in the April issue of MGMA Connexion  written by Deborah Walker Keegan, PhD, MBA, FACMPE; and Elizabeth Woodcock, MBA, FACMPE, CPC.

Visit  our billing solutions page for articles and free downloads to improve your practice’s A/R.

Written by Madeline Hyden, MGMA-ACMPE web content writer/editor

Web-based patient portals that interface with your EHR can further improve your practice’s productivity, streamline patient communication and ultimately improve patient satisfaction.

Involving your patients in their own care means enhancing communication and accessibility. Web-based patient portals provide a secure way to connect patients to your practice 24 hours a day and have the potential to cut down on patient call volume.  Here’s what you need to know:

Connecting to your EHR

Cherie Stutesman, MGMA-ACMPE member and director of operations, Mt. Baker Planned Parenthood, Bellingham, Wash., implemented her practice’s patient portal two years after implementing an EHR.

Stutesman’s portal has the functionality for patient-clinic communication, lab results, medication lists, problem lists, online bill pay and prescription renewal requests. Once an item in the EHR is electronically signed by a provider, it’s available for viewing on the patient portal in a summarized format.

“It’s changed the way we look at communicating with patients,” she says. “It’s learning about what they want and how they want to get it.”

Stutesman says her practice’s portal allows patients to manage their health on their own time.

”We found right away that most of our patients are on the portal from 10 p.m. all the way to 3 or 4 a.m. making payments, sending messages and requesting appointments,” she says. “It works for them because they don’t have to wait until we’re open and risk sitting on hold.”

Avoid information overload

Stutesman’s portal summarizes notes from the EHR, so patients only see a limited amount of their health information, but other systems have the ability to upload a duplicate of the patient’s chart to the portal.

Robert Tennant, senior policy advisor, MGMA Government Affairs, says practices should be careful when determining what information to allow patients to access from the portal.

“There can be issues with giving unfiltered information to patients,” he says.

Giving patients too much information without explanation from a clinician, such as negative test results, can unnecessarily worry them and may encourage more phone calls, Tennant says, which is the opposite goal of a patient portal.

“Give your patients plenty of context for the information you provide,” he adds. This may include providing high, normal and low guidelines for measures such as blood pressure or cholesterol.

Establish a process for informing patients about portal

Once you implement your patient portal, the next challenge is to get patients to use it regularly.

Wendy Peterson, MGMA-ACMPE member, practice administrator, Women’s Health Specialists, Yuma, Ariz., randomly offers a gift card to a portal user every month as an incentive for people to submit their patient paperwork online.

To help market her portal, Stutesman plans to include messaging about the portal in all patient communications, including appointment reminders, follow-up letters for annual exams and immunizations and bills.

Stutesman also says implementing a portal included establishing the practice protocol for all of the portal features.

“We had to look at every step that a patient could take on the portal and make sure there’s someone on the practice end to facilitate that request,” she says.

This means developing a way to triage messages from the portal (front office vs. clinical), manage prescription refills from the portal and accommodate appointment requests.

Patient portal functions may include:

• Appointment requests
• Appointment pre-registration
• Prescription renewals
• Access to lab results
• Access to medical records
• Patient education and self-management tools
• Medication lists
• Pre-screening and surveys
• Bill paying
• Secure online communication
• Online office visits

Also, be sure to explain to patients that while the portal is a secure environment, access to their health information is now available outside of the practice.

“We have a lot of patients seeking confidential services,” Stutesman says. “So it was important that we explained that someone could access their health record if they reset their password via email and someone else read it.”

Stutesman has each patient sign a consent form before setting them up in the portal that explains all potential risks associated with the portal as well as what information is available to them. She also includes portal audits in her practice’s risk management plan and established “lock out” protocols for entering an incorrect password too many times.

Consider ROI

The proposed rule for Stage 2 of the meaningful use EHR incentive program includes providing patients with the ability to view online, download and transmit their health information within four business days of the information being available to the eligible professional (EP). Utilizing an online patient portal is one option for meeting this requirement.

Practices may see this as an incentive to implement a patient portal by the 2014 deadline. However, Tennant recommends that practices take a close look at the cost-benefit of implementing a patient portal.

“For example, if a patient portal costs $25,000, it might not be cost effective for the practice to implement a portal. They might be better served exploring other options of meeting this meaningful use requirement,” Tennant says.

Tennant also encourages practices to assess their patient demographics before considering implementing a patient portal.

If you have a significant elderly patient population, he says, do you anticipate that they will take advantage of online portal functionality? Be sure to ask your patients if a portal is something they would benefit from and whether it’s worth pursuing.

Know the difference between a PHR and a patient portal

The key difference between a patient portal and personal health record (PHR) centers around ownership of the data. Typically, once data is entered into a PHR from a patient or provider, it belongs to the patient in a system of the patient’s choosing, whereas patient portals are managed by the medical practice and they continue to control ownership of the data.

MGMA-ACMPE partnered with several healthcare organizations to create two brochures, one for patients and one for clinicians, to educate them about the benefit of PHRs. The brochures include screen shots of PHRs and testimonials from patients and industry organizations. 

Written by Barbara J. Robins, FACMPE, Administrator, Paseo Family Physicians Ltd. in Glendale, Ariz.

The challenge

Before we moved to an EHR our practice stored more than 22,000 paper charts on active patients. We also had 570 boxes of inactive-patient records stored at an off-site document management facility, which freed up office space but was not a solution for handling long-term records storage. We spent $6,000 a year on maintaining and retrieving charts from the off-site storage space. In addition to the efficiency and financial incentives of implementing an EHR, eliminating paper records would:

• Allow the practice to convert the chart storage room into three additional exam rooms
• Eliminate the cost of maintaining the off-site storage of inactive records

The practice needed to build the electronic medical record for existing charts as quickly as possible and retire the paper charts. This would minimize the amount of time the practice would operate in a hybrid paper-electronic environment.

First steps

1. Four months before our EHR go-live date we developed a multidepartment team consisting of a physician, myself and other key staff to define the paper chart transition strategy
2. The team reviewed the process flow of paper charts and staff access to them, as well as the definitions for active and inactive patient records
3.  The team determined that the electronic charts should be organized a way that was intuitive for providers

Alternatives considered

This seemed like the easiest option since there would be no additional costs with keeping the charts in the current file room, just the ongoing costs of maintaining an off-site storage facility for inactive records.

Scan the entire paper chart
Benefits of scanning the paper chart included:

• Minimizing or eliminating the need to pull the paper charts for viewing historical data, enabling the chart to be retired sooner
•  All records would be maintained in the same location, reducing the risks associated with a hybrid paper/EHR environment
• Once we scanned the medical records they could be destroyed, freeing up space in the file room for other purposes

This option would eliminate scanning costs, but the paper chart would still be necessary for reviewing historical data. It also would not allow for one complete medical record and would require the practice to continue to maintain paper charts for active patients. Lastly, data entry could require additional staff.

Chosen solution

The physician partners and I decided to have staff members scan the charts as patients came in for appointments, which would reduce the number of charts that need to be converted at one time. Charts for infrequent patients would be stored for the appropriate retention period and then destroyed.

This option would:

• Reduce risks associated with a hybrid paper/electronic record by having the entire medical record in one place
• Retire the paper charts as patients came in for services, thereby reducing paper chart handling costs
• Allow old charts to be professionally shredded, clearing out much-needed space in the practice

Staff started patient account entry two months prior to EHR go-live by active patients. The practice information technology (IT) staff and EHR vendor programmed and established how and where the scanned data would be stored and managed. The document management vendor provided protocols for what to expect in terms of access to the paper chart during scanning, how the record could be accessed after scanning and quality control methods. Practice management established written scanning protocols.

Lessons learned 

• The practice should have allowed more time for the chart transition planning and preparation prior to the EHR go-live date
• Work flow for each provider is different, which resulted in different methods for entering the information into the EHR
• We trained staff to prep and scan the paper chart two days prior to the scheduled appointment. This is not always possible since the practice offers same-day and walk-in appointments. In those cases, the paper chart was used.
• We found that EHR vendors only educated the practice on costs associated with their part of the EHR implementation. By interviewing evaluating and comparing costs, conversion methods and references for multiple document management vendors, we selected one who is local and helped us manage costs.

Removing the paper records from their storage space in the practice gave us room for three additional exam rooms, which could potentially result in $481,950 in additional gross revenue based on provider productivity.

More from the MGMA In Practice Blog:
How ‘better-performers’ use their EHRs

Simplify your EHR implementation

Written by Madeline Hyden, MGMA-ACMPE web content writer/editor

Practice administrators have the unique challenge of managing the work of their staffs and managing their bosses, who are often practice owners. While dealing with the ups and downs of physician behavior is an assumed part of the job, inappropriate or disruptive behavior from physicians can cause decreased morale and low staff retention. And some of the problems may be related to unwieldy egos, says Rosemarie Nelson, principal, MGMA Healthcare Consulting Group.

The good news is that you can have a positive impact. Altering the way you approach disruptive physicians can lower their defenses and set a good example for your staff.

Identify disruptive behavior
Disruptive physician behavior, which can take different forms, may include:

• Abusive language
• Unnecessary sarcasm or cynicism
• Blaming or shaming others for possible adverse outcomes
• Defiant or uncooperative approach to problems

Assess your own behavior
Nelson suggests putting a physicians’ needs first is the best way to achieve success.

“If you have physicians who need to have the last word, let them have it,” she says.

In other words, do not let your need to assert yourself get in the way. As long as the physician’s vision aligns with what’s best for the practice, be on his or her side, Nelson adds. As owners of the practice, they have a much larger stake in its success, which also adds stress. Acting defensive or critical toward them will just exacerbate the negative behavior.

Read Nelson’s article, “When dealing with ego problems, start with your own” in the April 2012 issue of MGMA Connexion magazine.

See it from their perspective
Let’s say a physician is dealing with the stress of a newly-implemented EHR, just finished a busy overnight call shift at the hospital, recently found out about a patient who is threatening a malpractice suit and arrives at the office to see the front office manager texting on her cell phone. A simple “please don’t use your cell phone during busy hours” request could turn into a scolding from the physician.

While there is not always (or ever) a valid  excuse for disruptive behavior, understanding it may give staff insight into what the physician is dealing  with, which can soften the blow.  Communicate those sometimes invisible factors to staff so they’re sensitive to the physicians’ needs and stress levels.

Understand their style
If a physician regularly asks for data to justify purchases, come to meetings prepared with estimates that outline return on investment or benchmarking information. If a physician enjoys participating in strategy planning and identifying long-term goals, allow them that creativity instead of asking them to focus on day-to-day operations, such as call schedules or dictations.

Create incident protocols
Some disruptive behavior can be managed, but if it escalates and crosses the line into harassment territory, it is important to have a process for documentation, including an incident report and a verbal warning report form. Below is an example of the latter:

Find examples of incident report forms in Physician Policies: A Practical Guide to Governance Issues.