When a contract gives your employer too much leeway, If nonpatients e-mail you for advice, How to keep rejected claims from falling through the cracks, Does urgent care justify higher fees?
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Q I'm about to sign my first employment contract as a physician. It includes a list of specific actions that give the employer authority to terminate me for cause. But it also provides that "behavior that reflects negatively on the practice" is grounds for termination. Isn't this too vague? Should I object to its inclusion, or are such clauses the norm in employment contracts?
A Our consultants agree that the contract is too open-ended, and that signing it wouldn't be in your best interest. Ask the employer to spell out the specific types of behavior it has in mind, such as dishonesty, moral turpitude, or professional incompetence.
Q Our practice occasionally receives e-mail messages from people we've never seen, some of whom have serious conditions. We don't want to ignore these requests for help, but neither do we want to open ourselves to a malpractice suit. What's the best way of handling such messages?
A Respond that you'd be happy to accept the person into your practice, but that you're unable to provide specific advice without examining the patient and familiarizing yourself with her history. If the patient's message indicates an urgent problem, advise her to seek treatment immediatelyeither from you, another physician, or the ER. Save a copy of your response.
Q My solo practice seems to have more than its fair share of denied claims. As hard as my staff tries to stay on top of them, many end up going unchallenged. Is there a simple way to track rejections and ensure that corrected claims are resubmitted for payment?
A Resolving the problem may be as simple as upgrading your computer billing system to track claim denials. Then, when you receive each EOB, enter whether the claim has been paid or denied and the reason for the denial. This will enable you to track rejections by type and volume. Once you determine where the errors are coming from, you can correct the problem.
Resubmit the corrected claim and file a copy in a folder with 12 dividersone for each month. When the claim is paid, remove the copy. At the end of the month, pull all delinquent claims from previous months, follow up with a letter, and put a copy of the letter and the claim in the current month's file.
However, if you find that clean claims are repeatedly being denied, meet with the insurer to discuss the problem. If it isn't resolved to your satisfaction, contact your state insurance department. As a last resort, consider dropping the health plan.
QWe're opening a second urgent care facility in a nearby location and plan to see patients of higher acuity than we do now. Currently, we bill every patient for a regular office visit (depending on the level of care) and add a facility fee of $25. Since our new facility will be designed, equipped and staffed like an emergency room, can we bill at ER rates even though we won't be part of a hospital?
A No. An urgent care center is considered a "walk-in" office, not an ER. Although fee schedules are generally higher than for physicians' offices, you're not permitted by Medicare or Medicaid to charge a "facility fee." Check your contracts with commercial insurers to see if they reimburse for this fee.
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;12:113.