Practice Management

It's still possible-with a solid banking relationship, a sharp business plan, and ample collateral.

Important as it is to find the right people, keeping them happy and productive is key to a successful practice.

Our multispecialty group recently added a nephrologist, and our staff members are unsure of how to bill for her services. Can you provide some guidance on how to handle capitated and partial month end-stage-renal disease (ESRD)?

We're confused by the time requirements to establish the AHI (Apnea-Hypopnea Index) for coverage of Continuous Positive Airway Pressure (CPAP) therapy. Is it two recorded hours or two hours of actual sleep time?

Our internal medicine practice gives yearly physicals to anyone who requests them, arranging for those whose insurance doesn't cover annual exams to self-pay. Recently, several older patients told us that Medicare now covers this preventive service?a change we're not aware of. Are they right?

To help reduce conflicting incentives and better coordinate care, hospitals and physicians participating in CMS' Acute Care Episode (ACE) demonstration will receive a single bundled payment for Part A and Part B Medicare services provided during an inpatient stay.

For women who call the shots on matters of health for themselves or their families, the healthcare system can be tough to navigate.

Clearinghouses play a key role, too, in determining when?and in some cases, whether?you get paid.

In a third annual ranking of health insurers, Aetna came out on top of 137 national, regional, and government payers in terms of its business dealings with doctors.

It's never been easy to recruit physicians to practice in the nation's smallest communities, and the challenge is likely to escalate in coming years.

Medicare and reimbursement cuts affect doctors

How can I find out whether medical assistants are allowed to give injections in my state, and if they are, what restrictions apply?

I received a request for a deceased patient's chart from someone claiming to be a representative of the patient's estate. Don't I need to verify that she's telling the truth before I release the chart?

We recently found several two-year-old insurance reimbursement checks?one for more than $5,000. The checks are marked "void after 90 days" and the patient is now insured by a different carrier. What should we do?

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'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?

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?

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