Practice Management Q&As

November 17, 2006

Treating pregnant patients; overdue balance; reimbursement mix-up

What a collection agency can recover

How much can you reasonably expect a good collection agency to recover?

Only about 15 percent of the debts you submit. And from that you'll have to deduct the agency's contingency fee, which will range from 20 to 50 percent of whatever it collects. So before you turn over delinquent accounts, make sure you've done all you can to collect your bills in house.

Treating an out-of-town patient

Medicare denied my claim for treating a homebound patient. Although she lived in another state, she was staying in my town with her daughter while she recovered from an operation. On the claim form, I'd described the place of service as "home" (because I'd cared for the patient at her daughter's house and not in my office). Apparently that confused Medicare because the patient's home address that's listed in their records is in one state, yet my office is in another. What should I have used for the POS in this case?

You completed the claim form correctly. You were right to fill in the place of service with a "12" (Home: location, other than a hospital or other facility, where the patient receives care in a private residence). That description fits the place where you saw the patient-her daughter's home. However, it's not surprising that Medicare denied the claim. Its system noticed the discrepancy between your patient's home address in its database and your claim, submitted from another state. The best strategy in this situation is to file an appeal with a letter of explanation, and you'll probably get paid.

Pregnant patients and malpractice liability

Our practice recently hired two family physicians with the understanding that they wouldn't do any OB work. Now, they're refusing to see any patient who's pregnant, even for an unrelated problem like a sore throat. When asked, they explained they don't want to be named in any shotgun birth-defect lawsuits. What should we do?

Call your liability carrier for guidance on the limits of an FP's responsibility when he isn't insured for obstetrics. Then, establish protocols describing the kinds of problems the non-OB doctors should be expected to handle. Generally, the treatment of pregnant women with acute illnesses-with the collaboration of an OB, if necessary-is within the scope of family practice.

New job, old reimbursement?

Two months ago, I started my own practice and joined the same healthcare plan I had belonged to at my former job (I was an employed hospitalist). Now, I notice that I'm still being reimbursed at my old hospitalist rate-20 percent less than the published fee schedule I had discussed with the plan's rep.

I've attempted to straighten this out, but the plan insists that I'm still under contract from last year. Never during the credentialing process did I receive or was I asked to sign a new contract. What can I do?

Take your case to someone higher up in the organization, perhaps the corporate counsel. The healthcare plan should have had you sign a new contract (with a new fee schedule) when your circumstances changed. If the representative still insists it's the plan's policy to keep you under your former contract, contact your state insurance department. What the plan is doing is highly irregular.

Can your receptionist use the EHR?

Our receptionist documents all clinically relevant phone calls in our EHR and then alerts the appropriate doctor or clinical staff member. Our new office manager says this is not acceptable because, according to HIPAA, a receptionist shouldn't have access to the EHR. Is he right? I don't see how our office could function if only doctors or clinical staffers could enter data into the EHR.

No, there's nothing in the law that prohibits an employee from using an EHR when it's necessary for office operations. Just make sure that you have safeguards in place to keep the information confidential (a privacy filter on her monitor, for example) and make sure she understands the security issues involved.

When the ED wants your home phone number

The hospital where I have privileges requires all physicians to leave their home phone numbers with the ED so any of our patients who end up there can call us if necessary. I've refused to comply. Although I've offered to supply my office and beeper numbers, I've been written up as a "disruptive physician." Can they require me to release my home number to anyone who requests it?

Possibly, but this policy sounds very unusual. Find out exactly why the ED is requesting your number. Perhaps they just want to be able to call you at home themselves, if they can't otherwise reach you during an emergency. If they confirm that they plan to share your home phone number with patients, check with your state medical association for a legal opinion of their policy.

Reschedule a patient who owes money?

A patient with an overdue balance called to make a new appointment. He said he couldn't pay what he already owes. Can we reschedule him to a later date when he'll have sufficient funds?

You shouldn't postpone an appointment because a patient owes you money. Try to work out an installment plan that allows him to pay off the balance due. If he makes no effort to cooperate, you may decide to dismiss him from your practice. But until you formally discharge him, you must continue to provide medical care.

Sharing the loss when a partner leaves

One of the partners in our group plans to leave and move to another state. Her departure will be very costly to us in lost revenue and increased overhead, and we'll also have the expense of finding a replacement. She's been with us four years, and we feel she should share part of the financial loss to the practice. Is there a formula to determine this?

Probably not. Your practice's buy-sell agreement sets the value the departing owner should receive. However, it should also require the resigning or retiring doctor to give notice early enough to enable the practice to replace her without adverse financial effects. If she didn't provide the required notice (often six to 12 months), you may be able to reduce the buy-out value, according to a sliding scale over time.

In this issue, the answers to our readers' questions were provided by: Michael Brown, CHBC, Health Care Economics Inc., Indianapolis, IN; David Carpenter, Healthcare Management Consultants, Southern Pines, NC; Alice G. Gosfield, JD, Alice G. Gosfield and Associates, Philadelphia, PA; Ellis I. Kahn, JD, Kahn Law Firm, Charleston, SC; Michael LaPenna, The LaPenna Group, Kentwood, MI; Barbara Pappadakis, Union Pacific Railroad Employes Health Systems, Salt Lake City; Elizabeth A. Pector, MD, Naperville, IL; Mary Jean Sage, The Sage Associates, Pismo Beach, CA; David C. Scroggins, CHBC, Clayton L. Scroggins Associates, Cincinnati; Gray Tuttle Jr., CHBC, The Rehmann Group, Lansing, MI.

Do you have a practice management question that may be stumping other doctors, too? Write PMQA Editor, Medical Economics, 123 Tice Blvd., Suite 300, Woodcliff Lake, NJ 07677-7664, or send an e-mail to mepractice@advanstar.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.