Practice Management

October 25, 1999

Practice Management Q&A

Practice Management

Business tax deductions for employed doctors

Q As a salaried physician, I've been incurring expenses for suppliesthat I need but that the group's office manager says aren't in the budget.The items include some clinical supplies, including a pulse oximeter, aswell as furniture for my office and dry-cleaning bills. If these expensesexceed 2 percent of my income, can I write them off on my tax return?

A Not the first 2 percent, but you can deduct everything above that.Make sure you get documentation from your employer to support these deductions.

Is there such a thing as too many medical licenses?

Q I want to practice within a particular tri-state region, but I haven'tlanded a job yet. With the long waiting period for medical licenses, wouldit make sense to apply for licenses from all three states now? Once I geta job, I'd let two of the licenses expire. Or would that look bad down theroad?

A Our consultants couldn't agree on an answer. Although it's common forphysicians along state borders to hold more than one license, customs varyby region. Some states may raise their brows at multiple applications; otherswon't blink. So check with each state's medical society and your specialtysociety for advice.

Whether to warn colleagues about problem patients

Q Is there any way to warn other physi- cians about disruptive patientsI've discharged, without risking accusations of violating confidentiality?

A Not really. Even if you avoid a lawsuit for invasion of privacy, youmight find yourself on the wrong end of a defamation suit. If the patient'snext doctor asks, simply confirm that you discharged the patient. Your colleaguewill probably pick up on the implication that he was a troublemaker.

When Medicare doesn't follow its own billing guidelines

Q Because I was unsure of how to code for a neurological procedureused to treat chronic pain, I asked my Medicare carrier for advice. I submittedthe claims with the Medicare-recommended codes and appropriate documentation,only to be denied payment three months later. The unpaid claims amount toabout $5,000. Should I resort to charging patients for this care, or shouldI hound Medicare for reimbursement?

A Go after Medicare. But if your appeal is denied, you'll have to writeoff the $5,000.

In the future, you can bill the patient, but only if you have him signa statement, acknowledging that he may be responsible for payment, beforeyou perform the procedure.

Is this no-show policy effective--or harsh?

Q I'm a salaried FP who recently joined a small practice. The officeconfirms all patient appointments. Nonetheless, both new and establishedpatients sometimes fail to show. Is it appropriate to charge these patients?If Yes, how and when should we tell patients about this policy? How muchshould I charge?

A No-shows are a fact of life, no matter how good your staff is aboutconfirming appointments. Charging these patients will only lead to poorpatient relations. Plus, it would be difficult to collect the money, andit might violate the terms of your managed care contracts. Instead, warnpatients who habitually skip appointments that they will be discharged ifthey miss another one.

How to find a buyer for your practice

Q How do I go about advertising the sale of my practice?

A You can turn over the entire matter to a practice broker, who'll handlethe details of advertising and determining a price. Or if you'd like todo the advertising yourself, run announcements in specialty and local journals,and send notices to hospitals, medical schools, and doctors in your community.

Indicators of a successful merger

Q What factors should my partner and I consider in calculating whethera potential merger with two other practices will be profitable?

A The three most important questions when considering a merger are: (1)Do the doctors share the same practice philosophy? (2) Will the merger createsavings in such areas as staff costs, rent, or supplies? (3) Will you beable to win more managed care contracts and attract more patients by offeringmore services or more convenient hours?

Other things to think about: Who will control management, staffing, andoperational issues? How will the board of directors be structured? How willincome and expenses be shared?

When an insurer tightens its drug-prescribing rules

Q A managed care plan I contract with now requires that I submit myDEA number with every prescription I write. Although I pointed out thatsuch information isn't required by law for noncontrolled substances, theplan refuses to cover the drugs without it. What's the plan trying to accomplish,and is the practice legal?

A No law says a health plan can't have such a requirement. Whether youcan refuse depends on the terms of your contract with the company.

The policy may be intended to relieve the plan from responsibility fordistinguish- ing between controlled and noncontrolled medications.

Should small talk be part of performance reviews?

Q Is chitchat before or after an employee's performance evaluationinappropriate?

A It's a good way to break the tension. Just don't get carried away.The best way to put employees at ease is to start the evaluation with positivecomments.

How to bill for a relative with high-volume health care needs

My father-in-law, who is covered by Medicare, has been living withme for three months. During this time, I've done twice-weekly CBCs on himin my office. I also examine him often at home.

Should I code the office visits as a 99212 plus lab work? Can I codethe home visits as house calls? Or should I write off the charges as professionalcourtesy?

Write them off. You're not permitted to bill Medicare for services providedto an immediate family member. HCFA includes in-laws in that category.

Edited by Kristie Perry, Senior Associate Editor

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

Carol Pincus. Practice Management. Medical Economics Oct. 25, 1999;76:198.