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Practice Management Q&As


A reference for a worker you fired

Q. A colleague wants to hire my former receptionist, whom I had to fire for excessive tardiness. If he calls for a reference, should I warn him that this job candidate is bad news?

A. Any negative reference about a former employee could put you at risk for a defamation suit, unless there's legal evidence of a crime or harm. Stick with the basic fact that the person didn't "fit in" with your office and was terminated. Don't give any more details.

Spelling out your billing policy

Q. All new patients receive a copy of our practice's billing policy, which explains the types of payment we accept, how we handle delinquent accounts, our charges for after-hours visits, etc. We ask them to sign a form, indicating they've read the policy and agree to its provisions. Should we require established patients to re-sign the form every so often?

A. Yes. You should have your patients sign a new form whenever your rules change, their insurance plan changes, or you become aware that collections or insurance laws have changed. To make sure your provisions are enforceable and in compliance with your state's law, have them reviewed by an attorney.

Should you offer professional courtesy?

Q. If I treat a fellow physician, may I accept his insurance reimbursement as payment in full and write off the rest of the charge as "professional courtesy"?

A. It's risky. Doing so could not only violate your insurance company contract, but could also run afoul of Internal Revenue Service rules as well as Stark antireferral rules. The safest answer is not to offer a professional courtesy discount unless you're sure of all the consequences.

Using preventive medicine codes

Q. I'm confused about coding for preventive medicine services. When is it appropriate to use codes 99381-99397, and when should I use 99401-99429?

A. Use 99381-99397 to report a preventive comprehensive physical examination performed on a patient with no symptoms or active illness. The exam must include healthy lifestyle counseling, and may include screening diagnostic tests.

Report 99401-99429 when you provide counseling services only, but no physical exam. So you'd use these codes for counseling sessions in such areas as substance abuse, sexual behavior, family problems, or diet and exercise. Realize, however, that Medicare and many private insurers will not pay for these counseling visits or for preventive physical exams.

You shouldn't use these codes when your counseling is related to the patient's illness. For example, you wouldn't use 99401-99429 when you're counseling a newly diagnosed diabetic on diet and medicine. In that case-when counseling takes up more than 50 percent of the visit-use the appropriate E&M code based on time spent with the patient. To properly document the service, be sure to include the amount of time you spent and the topics you discussed.

Whether to use a physician recruiter

Q. I'd like to hire an associate. Do you recommend using a physician recruiter or placing ads in journals? If you think a recruiter is the way to go, how do they charge for their services?

A. Don't start with a recruiter unless you're pressed for time or anticipate having trouble hiring someone (because you're in an undesirable area, say). Recruiters typically charge a percentage of the new physician's compensation, and that can be very steep (although sometimes a hospital will help with these costs as the law allows).

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health