Practice Management

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.

One of my associates is treating the father of the senior partner in our corporation and billing Medicare for his services. It's my understanding that CMS doesn't permit a physician to bill for medical services provided to his own family members or those of other doctors in his group, but others in our practice disagree. Who's right?

The author and her partner bet that patients would pay out of pocket for extra service. They were wrong.

You can't ignore a patient's missed appointment. Looking closer can help boost practice income, and prevent litigation.

Some doctors are doing it successfully, but costs and logistics can make it a challenge. Here's what to watch for.

In today's shifting marketplace, becoming a practice partner may no longer be a matter of when, but if.

Patients who come in without appointments can disrupt-or build up-your practice. A solid walk-in policy will make the difference.

Tech Talk

Here's how to find and use these substitute doctors.

Technological advances, and the Americans with Disabilities Act, are enabling people with hearing loss to succeed as physicians.

A management services organization can take some hassles off your back, but there's a price. Make sure you know what you're getting into.