Practice Management Q&As

February 18, 2005

Billing errors; free equipment; appointment reminders

When patients don't want to see your partnersQ. Our receptionist promised a new managed care patient that she'd always see the doctor she selected from her provider list. But my partners and I often treat each other's patients. Should we honor our receptionist's promise or explain to the new patient that sometimes she'll have to see a different doctor?

A. Tell the patient your practice will make every effort to give her appointments with her designated doctor, but that medical emergencies and other scheduling conflicts might make it necessary for her to see someone else at times. Point out that one advantage of choosing a doctor who's a member of a group is that she'll be able to get an appointment even if her regular doctor isn't available.

Put this information in your brochure, and remind your receptionist to convey the policy to patients.

A. Return the money: It's not yours to keep. Send a letter of explanation along with the refund. Only if the patient has an appointment soon can you ask if he wants the refund applied to his upcoming office visit.

Accept free equipment from your hospital?Q. I'm a rural family physician who practices obstetrics. My local hospital wants to give me an ultrasound machine it no longer uses. Is there any reason not to accept this gift?

A. You could run into trouble with the Stark antireferral rules if the machine's fair market value is greater than $300. So get a written valuation from the hospital or an appraiser. If the value of the machine is $300 or less, make sure the hospital doesn't require you to make any referrals as a condition of accepting the gift.

Hire a part-timer for appointment reminders?Q. Our busy two-doctor practice used to call patients a day ahead to remind them of appointments, but our staff just doesn't have time anymore. As a result, the number of no-shows and last-minute cancellations has increased. Our office manager has suggested we hire a part-timer to resume making the reminder calls. Good idea?

A. Only if you can keep her busy for the few hours she'd come in. It shouldn't take more than two hours to call 50 patients. You'll be hard pressed to find someone other than a student who'd be willing to work such short shifts. Do you have other clerical work you could give the part-timer to stretch out the shift to at least four hours? If you can't line up a part-timer, consider paying overtime to a full-timer who wants to work extra hours. Another option: Pay your answering service to make these calls.

Or invest in a computerized telephone appointment reminder system. This type of software uses your prerecorded voice along with information from your main computer system, to deliver interactive, personalized messages to patients.

Insurance audits: How far back can they go?Q. How far back can insurers go when looking for what they claim are overbillings?

A. The answer varies by plan and by state: In some cases, there may even be no time limit. Read your contract and check with your state's insurance commissioner.