Ban cell phones in your office? Dealing with a stubborn third-party payer; Can spouses refer to each other? Hiring: Can appearance play a role? A patient's religion vs your duty to care.
Q: Many of our staffers carry mobile phones. Should we require them to turn off these phones while they're at work?
A: Yes. They need to be focused on your patients when they're on duty. Tell them to return nonemergency calls only during breaks, but assure them that they can take emergency calls on your office line.
Q: An insurer that had promised payment for services I provided to a tourist reneged on its word, claiming that it wasn't obligated to honor an oral agreement because I'm not a contracted provider. Would it help to call this patient's primary care physician for a retroactive referral? Could I then rebill the insurer?
A: There's no harm in trying. But if that doesn't pan out, you'll need to bill the patient directly. In the future, bill such patients at the time of service and let them collect from their insurer later.
Q: I'm an internist and my husband is a gastroenterologist. We've just moved to a new city and started separate practices. We would like to refer to each other because we trust each other's work. Do Stark laws prohibit this?
A: As long as neither of you has a direct financial stake in the other's practice, you should be fine. That means you can't have any office- or cost-sharing arrangements. You also can't refer a patient for a "designated health service," such as lab tests, physical therapy, or X-rays. You should also inform patients that you're married to the physician you're referring them to.
Q: The most qualified and likable person who applied for our vacant receptionist's position has a small nose-piercing. We'd like to hire her, but we're worried that her appearance will put patients off, and perhaps call into question our credentials. Is this a legitimate concern?
A: Yes, but it's not insurmountable. When you offer this candidate the job, explain that she'll have to honor certain dress-code policies and that nose-piercing falls outside your guidelines.
Q: Many residents in my community belong to a church that prohibits certain medical treatments. May I refuse patients whose religious beliefs would prevent me from providing appropriate care? If so, may my receptionist ask first-time callers about their religious affiliation?
A: Don't ask prospective patients about their religion. It could be perceived as discrimination. Plus, many health plans contain nondiscrimination provisions. Finally, categorical refusal to treat based on religion may get you in trouble with your state's medical board.
So instead of asking callers about religious affiliation, your receptionist should make it clear that your practice can't accept patients who reject transfusions or other commonly accepted treatments. This will put the refusal on a professional basis.
Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to firstname.lastname@example.org (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management Q&As. Medical Economics Jun. 6, 2003;80:110.