A paper trail that protects your practice, Can you accept new patients without accepting their health plans? What to do if a bankrupt insurer leaves you bare, How to get reimbursed for an hour of phone time
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Q A patient recently complained about my group's use of a sign-in sheet, saying it violates privacy. Traditionally, we've used these sign-in sheets to verify visits. The signature comes in handy when a patient forgets he has come in for an appointment or challenges a bill.
What can we use in place of the sign-in sheet to prove we've provided a service to a patient?
A Ask patients to sign the encounter form.
Q Occasionally, I ask employees to run personal errands, such as picking up dry cleaning. If one were to get into an auto accident on such a trip, would my practice or I be liable for damages?
A Yes, even though the employee isn't acting in her professional capacity. Extra auto insurance or a personal umbrella liability policy might cover you if a staffer gets into an accident. Consult your insurance agent and ask for written confirmation that you'll be covered if any staffer has an accident while running an errand on your behalf.
Q My contract with the clinic I used to work for included a provision for three years of malpractice tail insurance. I left the clinic after nine months, to go into private practice. Now both the clinic and the carrier have gone out of business, and I'm left with no coverage. What should I do?
A Whether the clinic failed financially or voluntarily discontinued its services, the obligation assumed under the contract passes to its owners personally. Your only recourse is to hire an attorney to try to force them to provide coverage and, perhaps, pay you damages for any legal costs you may have incurred during the hiatus created by the clinic's failure. However, that could be an exercise in futility if they have no assets.
Q One of my PAs was recently working up a 9-year-old for possible ADHD and found herself spending almost an hour on the phone talking with two counselors and a teacher about the boy's problems, behavior, and academic performance. Is there a code that would reimburse us for this time?
A Yes: 99358. This covers medical services (lasting 30 to 60 minutes) that don't occur face to face. However, most health plans don't pay for this care.
Insurers would, however, pay for an appointment in your office with the child, his parents, and his teachers.
QMy solo ob/gyn practice is so close to capacity that I think it's time to limit the number of new patients I see. I'd start by telling patients from low-paying plans that I'd be happy to accept them as long as they're willing to pay my regular fees. Is this a good way to go?
A Not unless you're willing to risk losing all the patients from those plans. It's unlikely that many patients would agree to pay your full fee. Moreover, the policy is sure to violate your provider contracts with those patients' plans.
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 firstname.lastname@example.org (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management. Medical Economics 2001;16:106.