Practice Management

We're planning to hire several midlevel providers for our rapidly growing five-doctor practice, mostly to help with the influx of new patients. How should we divvy up the income from the midlevels, since reimbursements for new-patient visits are usually higher than those for returning patients?

How the shift from the "physician as wise parent" model to one of more shared responsibility is playing out in the exam room.

Do hospitalists provide continuity of care?

After this man's wife died, he received an upsetting call about his outstanding bill.

Going without staff, using technology, and spending more time with fewer patients characterize the micropractice model.

I sometimes give immune globulin injections to patients traveling outside the US. I use the 90281 (immune globulin) code plus 90471 (immunization administration), in addition to the code for the visit, but the administration is always denied. Can you tell me why?

When evaluating our allergy patients, we normally order spirometry (94010). If it's warranted, we then order a bronchodilator (94060), followed by a second spirometry to assess the treatment's effectiveness. The charge for the initial spirometry is always rejected, as is the office visit. The first spirometry is to determine if a bronchodilator is indicated, so we consider it a separate service; the visit evaluates their overall status, so that should be a separate service as well. The visits are usually paid on appeal, but not the spirometry. Any suggestions?

Our pain management group is considering a merger with a profitable two-provider physical therapy practice. Before moving ahead, we have two concerns. First, how would we report the PTs' services? Second, the practice's charges are well above the national average--a fact the PTs attribute to hard work, long hours, and multiple locations. Should we be concerned?

I loaned $4,000 to an employee and she never repaid me. Is there any statute of limitation that indicates how long I have to take her to court to recover what she owes me?

I've decided not to renew credentialing with one of the two hospitals in my town. If one of my patients is admitted to that hospital and the attending physician there calls me for a consult, do I have an obligation (professional or legal) to go? I'd like to just say that I don't go to that hospital, the attending physician should get another specialist for the consult, and I will take over the patient's care when he or she is discharged. Is there anything wrong with that?

I've been called to appear before my state's Board of Medical Examiners regarding a patient I treated for depression. The board stated no specific reason. Should I bring an attorney with me?

Parents going through divorce and custody battles have been requesting immunization records and letters about treatment of their kids' health conditions, primarily to prove that they're adequate caregivers. What are the legal implications for me? What are my obligations? To whom may I give this information?

I'm frustrated with patients who refuse to pay their outstanding bills. I'd like to report their overdue balances to the three major credit bureaus as bad debts. What do you think of this idea?

How long is a HIPAA-compliant, signed medical release valid?

Until I get an EHR, I've been typing my care notes into a Microsoft Word template. Then I print them out, sign them, and store them in the patient's chart. I save the electronic copy in read-only format on a network server that's password protected. Do you see any weaknesses in this system that, in a malpractice trial, might give a plaintiffs' attorney the opportunity to suggest that I could have altered records?

I accept Medicare patients, but I don't participate in any private health plans. When I'm called to the ED to perform surgery on a patient covered by a Medicare HMO, who's responsible for paying me?

The author's extra effort to get low-cost drugs for her patients works to her detriment under P4P.

Help ease your patients' money problems, and you may improve their health, says the author.

Don't stew in anger over your annoying call coverage schedule. Here's how to improve the situation.

We're about to take on nursing home patients and have the following billing questions: Is billing different for patients in a nursing home versus a skilled nursing home, and what's the difference between the two? Do we bill the nursing home or the insurer?

Our large cardiology group encompasses numerous subspecialties, invasive and noninvasive cardiology and cardiac electrophysiology among them. When one of our general cardiologists refers a patient to our cardiac EP, who sees the patient on the same day, our claims are often rejected. Both the generalist's visit and the EP consult are typically paid on appeal, but we'd like to avoid having to file an appeal. What's happening, and what do you suggest?

Our pathology group is a private practice, not part of the hospital where we perform our services. Our new biller maintains that since we're an independent entity, it's not necessary to use any modifiers when billing our services. But we've experienced massive claims rejections recently. Could this be due to the lack of modifier use? If so, should our new biller have anticipated this?

Hospitals known as "safety net" facilities for the poor and uninsured are working with these patients in an attempt to prevent them from clogging busy EDs with their nonurgent needs, finds a new study from the Center for Studying Health System Change.

Do you have space in your medical building that you'd like to rent to another doctor?

Georgia's $350,000 cap on noneconomic damages in malpractice cases gives doctors special protections that other professions don't enjoy, and is therefore unconstitutional.

Amoxicillin, lovastatin, propranolol, or tetracycline for 11 cents a day? That's roughly how much patients will pay for any of up to 350 generic drugs under Wal-Mart's new $10, 90-day prescription-drug program.

Coding modifiers are often underused, misused, or submitted without supporting documentation. Here's how to end these costly mistakes.

When I serve on the ED call roster, I frequently see elderly patients. Recently, I've received several requests to fill out FMLA forms from adult children who accompanied their parents to the ED and then took time off from work to care for them after they left the hospital. I only cared for these patients in the ED. Do I have any obligation to fill out these forms?

One of our receptionists shows absolutely no initiative. She makes no effort to promptly answer the phone, doesn't file unless she's asked, and never offers to help the co-workers who frequently assist her. On the other hand, she has a wonderful personality and has been with us for seven years, with perfect attendance. Is there any way to rehabilitate her?

How do I handle a patient's demand for a refund for an outcome that was less than perfect?