Practice Management

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?

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?

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?

A senior partner has announced his plan to retire from our single-specialty group practice. We have a buy-out in place and expect his departure will be amicable. However, we have no experience with managing the details of a doctor's departure. For example, when should he tell his patients and referring doctors that he's leaving? What else do we need to do?

The author built up her practice and became a local celebrity by writing a newspaper column.