Practice Management

Setting up a low-cost Medicare compliance plan

Q I've been advised to set up a voluntary plan to help me comply with Mediplan antifraud regulations. I agree that would be in my best interest, but I'm just getting started in solo practice and my patient volume is still small. Several of my colleagues have hired a local attorney to act as their compliance manager, but the cost seems prohibitive at this time. Should I try to do the job myself, postpone the idea until I can afford to hire a knowledgeable professional, or gulp and hire one now?

A Although the final guidance issued by the HHS Office of Inspector General makes clear that the programs are voluntary, you'd be wise to set up internal controls and procedures for preventing fraud and abuse in government health programs. A qualified coding expert can help you develop policies and procedures. You needn't hire an attorney to act as your compliance manager; your office manager can fill the role.

A way to make your patients feel more at home

Q Our office manager thinks patients will be more comfortable approaching staff members if they know who each of them is and what she does. The manager has suggested putting a photo of each employee, along with her name and job description, on a bulletin board in our reception area. Is it a good idea?

A Our consultants think it's a great idea! Not only will it help put patients at ease, it will make your staff feel good about the jobs they're doing. You might want to include a heading over the pictures, such as "We are proud of our staff and want you to know them." If staffers agree, you can add personal descriptions—mother of three, graduate of XYZ School of Nursing—and give the employees a say in what appears there. Also consider providing a name tag for each staffer.

When you're asked to embellish a medical record

QA patient I've been treating for wrist pain has asked me to embellish her discomfort in hopes of prodding her HMO into appropriate extra diagnostic tests and, possibly, surgery. I agree that the patient needs more aggressive care than the HMO has allowed. Plus, I fear that a missed diagnosis or delayed treatment may lead to a more serious problem later. Should I honor the patient's request?

A No. If the HMO catches on, your contract and reputation with other managed care plans will be jeopardized.

You need to balance your responsibility to your patient with your legal obligations to follow the plan's policies and procedures. Do that by going through the proper channels. Appeal the denials for care straight up to the insurer's medical director, if necessary.

If that fails, you and your patient can complain to the state's department of insurance or appropriate regulatory agency. Your patient should also ask her employer's benefits administrator for help.

As a last resort, your patient could hire a lawyer to force the plan's hand. More HMOs are being sued successfully for failure to provide appropriate care, so the threat of a lawsuit could carry considerable weight.

Help for patients who can't afford medicine

QA number of my patients have no health insurance and can't afford the drugs they need. Can I do anything to help?

A Yes. Many pharmaceutical companies offer free medicine for indigent patients. To find out what programs are available, talk to your drug reps or check out the Directory of Prescription Drug Patient Assistance Programs (www.phrma.org/patients ).

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.

 

Kristie Perry. Practice Management. Medical Economics 2001;18:104.