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Practice Management Q&As


Contracts; strep test; liability risk

Could a contract clause spoil your retirement plans?

Q. My younger associate, whom I assumed would succeed me, told me that he intends to resign. He says our buy-sell agreement obligates me to purchase his shares. I plan to retire next year, and this will upset my plans. What should I do?

A. Consult a healthcare attorney. He will lay out your options, depending on the terms of your agreement. Hopefully, your contract has a provision that allows both of you to liquidate the practice, rather than requiring one to buy the other out. That may be the best solution.

When an MA administers strep tests

Q. As a way of increasing my productivity, I'd like to have my medical assistant administer strep tests. What rules do I need to know to avoid problems getting paid?

A. First contact your state's department of health to make sure regulations permit medical assistants to administer strep tests. Also find out whether you're required to be in the office at the time of the testing. Since you'll be billing for the test under your provider ID number, make sure you understand the rules for "incident to" billing: The patient must have been seen by you previously for this condition, you must document the need for the test in your treatment plan, and you must provide "direct oversight" of the medical assistant (meaning you must be in the same office suite).

Should a fired employee get severance?

Q. My billing clerk gave two weeks' notice of her intention to quit. But by the end of the first week, her attitude was so poor that I terminated her on the spot. I paid her for the week she worked and for the balance of her unused vacation days. Am I obligated to pay her for the second week?

A. You're not required to pay her unless it's your established practice to pay severance to terminated employees. Your practice's written personnel policy should state that severance pay is at the discretion of the employer.

Reprinting chart pages: a liability risk?

Q. Although I don't have an EHR, I keep a Microsoft Word file for each of my patients. I put a printout of the file in their paper chart. However, the last page changes whenever I update the document by adding a new progress note to the end. So I print out a new last page for the chart, and remove the old one, which I shred. If I were ever sued for malpractice, might this look as if I were altering patient records? Would it be better to literally cut the text out of the new printout and actually paste it into the last page of the chart?

A. It's okay to continue the practice you've been using; you don't need to cut and paste. But make sure you have a written protocol that describes your charting procedures. That will help explain your actions if there's ever a question of your altering evidence in a lawsuit.

In this issue, the answers to our readers' questions were provided by: Geoffrey T. Anders, JD, CPA, The Health Care Group, Plymouth Meeting, PA; David Carpenter, Healthcare Management Consultants, Southern Pines, NC; Ellis I. Kahn, JD, Kahn Law Firm, Charleston, SC; Mary Jean Sage, The Sage Associates, Pismo Beach, CA.

Do you have a practice management question that may be stumping other doctors, too? Write PMQA Editor, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to (please include your regular postal address). Sorry, but we're not able to answer readers individually.

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