Practice Management Q&A

October 5, 2007

Health fair tests results; returning overpayments; leasing employees; managing claims denials; leasing employees; long-distance prescription requests

Different fees for different patients?

I was confused by your answer to the doctor who asked about charging privately-insured patients different fees for the same service, depending on what health plan they have. Is it legal to do this or not?

While there's no law that says you can't charge different fees for the same service, the contracts you've signed with the health plans probably prohibit it. They all likely require you to charge their insureds your standard or "usual and customary" fee for a particular service.

A way to manage claims denials

I've just started a solo practice and employ one biller. We need help recovering thousands of dollars in denied or unpaid claims. Is there an inexpensive solution?

Find an experienced billing/collections specialist from another medical office who would like to moonlight. Although she wouldn't be available during the day to contact carriers for you, after hours she could review your denials, organize a plan of attack, and coach you and your biller on how to proceed. As she works with you both to reduce your outstanding claims, you'll learn how to improve claims filing and appeals efficiency.

Test results from a long-lost patient

A patient I hadn't seen in years had some screening tests done at a local health fair. He must have listed me as his doctor, because I received the results in the mail. What should I do with them?

Contact the patient, and follow up as you would for one of your regular patients. Give him the test results and, if necessary, advise him to make an appointment. If he tells you he now sees another physician, explain that you'll need his authorization to forward these results and the rest of his chart.

Try to help him find the right path. If he went to a health fair, he may be concerned about his health, and perhaps he'd like to re-establish his relationship with you.

Acquiring a practice-and Medicare trouble

A physician whose practice I'm buying tells me Medicare is on his tail for the return of alleged overpayments. Could they force me to return the money he owes?

It's unlikely. Make sure your purchase agreement has a "no assumption of liability" provision. It lists the types of liabilities that you, the buyer, will not be responsible for. Among them should be liability to third party payers for overpayments.

There's a possibility, however, that Medicare could come after you if your situation meets the following conditions: (1) you were employed by the seller in the business before you bought it or, as the new owner, you hired other providers or contractors previously employed by the seller, and (2) the overcharges involve services billed under the seller's provider number that were performed either by you, or those providers and contractors.

You could also be liable if you're buying stock in the seller's corporation.

A "Meet our staff" bulletin board

Our office manager thinks patients will be more comfortable approaching staff members if they know who each of them is and what she does. She's 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?