Practice Management Q&As

March 16, 2007
Liz O'Brien

Associate Editor

Online consults; employee credit checks; financial records

Is a job applicant trustworthy?

What's the best way to assess the trustworthiness of applicants for jobs that involve handling money? Are credit checks a good idea?

Yes. If the credit check reveals a poor credit rating, it could be a clue to a candidate's level of financial desperation and, possibly, his temptation to cheat you. A criminal background check, however, might give you a better idea of whether the person can be trusted. But even if your applicant comes up clean, bond him and make sure you have procedures in place to discourage attempts at embezzlement.

Our office has posted Saturday hours, but most of the patients we see are walk-ins or people who call an hour or so ahead. Should we use CPT 99050 in addition to the E&M code? What about 99051?

You can't use 99050. That code is for services provided when the office is normally closed. However, you can use 99051, which indicates services provided during regularly scheduled evening, weekend, or holiday hours. No matter which code you use, though, you probably won't get paid any more. Medicare will bundle the code, and most commercial payers will deny it.

If a former employee talks about patients

A nurse who resigned from my practice a few months ago has been gossiping about some of our patients. She's divulging specifics about their health problems. Could I be held liable for an ex-employee's breach of patient confidentiality?

Probably not, because she's no longer your employee. However, as in any situation where the possibility of a lawsuit exists, you should alert your liability insurer to what's going on. Their attorney might advise you to send a letter to the nurse asking her to stop talking about patients and warning her of the consequences of violating confidentiality laws. If any further steps are necessary, he'll let you know.

Hang out a URL as well as a shingle

We'd like to offer online consults on our practice website where patients could ask us questions and we'd charge for the answer. What do your consultants think about this idea?

It's a good one. Online visits give you another way to provide minor-acuity, nonemergency care, and your patients will appreciate the convenience. Your patient satisfaction scores may increase, and when word of your new service gets around, you'll have a competitive advantage over other practices.

Start by contacting your medical malpractice carrier to discuss its policy on online office visits. If they're allowed, limit this service to established patients.

There are several companies (Medem, Medfusion, and RelayHealth, for example) who can provide you with the technology you'll need. If you have an EHR, ask your vendor if it offers a compatible e-mail consult system or if it can provide an interface with the product you choose.

Whether you'll get paid for these consultations is another matter, however. Although more than a dozen carriers in several states have begun reimbursing for online services, many do not. Indeed, many may also forbid charging their insureds separately for any services you provide online.

Your rights to your financial records

Three years ago, I signed on with an emergency room staffing company. It subsequently hired a service bureau to do its billings and collections. Now the staffing company and billing service have denied me access to records of my claims and receivables, saying the information is "proprietary." I can't tell whether I'm being paid the full amounts due me. Is it legal to withhold my billing records?