Practice Management Q&As

January 5, 2007

Fee schedules; group visits; practice valuations

Billing with multiple fee schedules?

My new billing service offered to create multiple fee schedules, allowing me to tailor charges to match different insurance companies' reimbursements. For example, for a 99213 visit, I could bill a lower-paying insurer $80 and a higher-paying one $100. What do your experts think of this idea?

Not much. They recommend that you bill all private insurers and fee-for-service patients the same fee for the same CPT code. Not only will this make bookkeeping simpler, but typical managed care contracts require you to charge your "standard" fee. If you have multiple fee schedules, it will be impossible to know what that fee is.

HIPAA and group visits

I'd like to offer group visits for patients with Parkinson's disease. How would this work under HIPAA?

There's nothing in HIPAA that precludes group visits, provided the patients are willing and competent to participate. Make sure patients understand that their personal medical issues will be discussed in front of others and vice versa. And stress the importance of not revealing the identity of fellow group members or discussing their concerns with others outside the group. Some physicians have their patients sign a confidentiality release prior to the meetings, but, practically speaking, such agreements are very difficult to enforce.

Otherwise, the same HIPAA rules apply as in one-on-one visits. A physician can't reveal protected health information without the patient's consent; nor can he use any protected information obtained during these sessions for reasons other than treatment, payment, or healthcare operations.

Practice valuations: What do they cost?

How much should I expect to spend for a practice valuation?

In most situations, a standard practice valuation-involving a practice sale, partner buy-in terms, or a practice transition plan-should cost about $6,000. When the valuation requires full forensic services (as you'd need, say, for the sale of a large, multisite group with complicated financial problems), the cost can climb to over $50,000.

In this issue, the answers to our readers' questions were provided by: Margaret Davino, JD, Kaufman Borgeest & Ryan, New York City; Barry S. Pillow, CHBC, Healthcare Consulting Inc., Greensboro, NC; Maryann (Ricardo) Wolf, MBA, The Ricardo Group, Las Vegas.

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.