Practice Management Q&As

Getting paid for new patient visits

Q. I'm an internist who has just joined a large, multispecialty health system with more than 100 providers. Many of the patients who come to me for the first time were seen by some of the other doctors in the past. I've been told that if a patient was ever under the care of any physician in our system, I can't bill for a new patient visit. Is that right?

A. No. The AMA's CPT guidelines state that a patient is "new" if he hasn't received professional services from you or another physician in the same specialty and group within the last three years.

Answering service or answering machine?

Q. As a solo practitioner, must I employ an answering service to take calls when the office is closed? Would an answering machine that directs calls to my pager or cell phone be sufficient?

A. Yes. The important thing is to provide reliable access for patients who need care. Most doctors have elected to eliminate their answering service and adopt voice mail and pagers. However, if you decide to go with an answering machine, be prepared for more interruptions of your time without a service to screen incoming calls.

Will renting an office attract antikickback scrutiny?

Q. Our small group practice plans to rent office space to a physiatrist. If we refer Medicare patients to him, will we violate federal antikickback statutes?

A. Not necessarily. You can fit this rental into a "safe harbor" (where the antikickback rules don't apply) if (1) your arrangement is in writing, (2) the term of the lease is for at least one year, and (3) the lease rate is equal to fair market value and the rent the physiatrist is scheduled to pay isn't affected by the number of patients you refer to him.

Can you fire a staffer on disability leave?

Q. My office manager has been on disability for three months. During that time, my other four employees have taken over her tasks, and we're doing quite well without her. Can I eliminate her position?

A. If her disability is the result of a work-related accident or injury, covered by workers' compensation, you may be required to reinstate her, depending on the laws of your state. Check with your state's workers' compensation board.

You also might be obliged to hold her position open for her if your state has a law similar to the federal Americans with Disabilities Act. The ADA applies to businesses with at least 15 employees, but some states have enacted laws that apply to smaller employers.

Likewise, although your practice is too small to be covered by the federal Family and Medical Leave Act, your state may have a similar law that may apply to you. The FMLA requires businesses with at least 50 employees to give a worker with a qualified serious health condition 12 weeks of unpaid leave per year, with the right of reinstatement to the job.