Practice Management

Providing nursing home care that passes government muster

Q A cardiology group has asked our family practice to provide care to the nursing home patients those doctors have been following. The group has offered us a signing bonus and fixed monthly fee for our primary care services. Although we're under no obligation to the cardiologists, we'd probably refer patients from our practice to them because of our familiarity with their practice. Would Medicare consider this an above-board arrangement?

A No. Medicare would call it a kickback.

If you want to care for these patients, forgo the cardiology group's proposal. Instead, explore the possibility of caring for these patients independently of the specialty practice. This will leave you free to refer patients to whomever you'd like. You may bill Medicare for the services you provide to nursing home residents, utilizing codes 99301, 99302, 99303, 99311, 99312, and 99313.

Why you need a payroll paper trail

QAn assistant has asked to be paid in cash so she doesn't have to endure the crowds at the bank on paydays. Is there harm in indulging this request?

A Yes. The IRS would have a field day with you. You'd have no proof that you'd truly paid the employee or that the payroll taxes you withheld on her salary matched what you'd paid to the state and federal government.

A solution: Give your employees the option of direct deposit, and politely suggest that if they need cash, they can avoid long lines at the bank by using an ATM.

Call in a lawyer before firing a staffer?

QMy partner and I agree that a billing clerk is underperforming and should be dismissed. Should we get a lawyer's decision before we take action?

A Not if you've routinely documented the clerk's performance problems and she's employed "at will"—meaning without a contract.

But if you're worried that the employee may file a claim for harassment or discrimination, or that she may steal, vandalize, or sabotage records, seek an attorney's advice.

You're particularly vulnerable to a wrongful dismissal lawsuit if, in the past, the employee filed a workers' compensation claim, took time off under the Family and Medical Leave Act, or requested accommodation for a disability. She may try to claim that the dismissal is retaliation.

Other reasons you may want legal counsel: for help in designing a severance package, arranging for COBRA coverage, or paying out pension or profit-sharing funds.

How to staff an expanding practice

QMy partner and I plan to open the office two evenings a week plus Saturday mornings—a total of eight additional hours a week. Should we hire a whole new staff to work the extra time? Or should we pay our staff overtime to cover these hours?

A Have current employees cover the extra hours until you're sure you'll continue with the schedule. If you retain the new hours, hire part-timers to keep the office staffed. Put one or two full-timers on flex hours so they can be there to help you train the new people. Even though you may have to sweeten these full-timers' paychecks, this may eliminate the need to pay overtime routinely.

Edited by Kristie Perry,
Contributing Writer

Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to mepractice@medec.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.

 

Carol Pincus. Practice Management. Medical Economics Dec. 3, 2001;78:86.