Practice Management Q&As

April 22, 2005

Deadbeats; Medicare statute of limitations; employment contract

When a deadbeat wants another appointment Q. Sometimes a patient will ask for an appointment after his account has been turned over to a collection agency. It's our policy to require such a patient to pay at least half of the outstanding balance in addition to the current visit's full fee before we'll see him. Is there anything wrong with this policy?

A. There would be if you applied the policy to any patient in a continuing course of care. Refusing to see a patient under these circumstances is abandonment. But you can ask your patient to pay half the outstanding balance. If he agrees, make sure to report the payment to the collection agency. And check your agreement with the agency to see whether you'll still have to pay its commission on an account your office collected.

You should have a system in place that helps your receptionist distinguish true "deadbeats" from patients with serious, expensive medical problems who are having trouble keeping up with their bills.

A. Yes. The statute of limitations on look-backs for overpayments is as long as four years. However, there is no limitation if fraud or abuse is suspected.

Do you really need a headhunter? Q.Is there any advantage to using an employment agency to find qualified clinical or administrative staff?

A. The advantage is small. Although an agency will narrow the field of applicants, you still have to interview candidates and check their references. Are you and your office manager so busy that you can't do the preliminary screening yourselves?

Can an employer change your contract? Q. After I had a disagreement with my employer of six months, he retroactively added a nine-month probationary period to my contract. Can he make such changes without my consent? Should I try to fight this?

A. Whether your employer can alter your contract retroactively depends on the terms of your original agreement and on your state's laws. But more to the point, instead of fighting this move, you should be thinking about whether it's indicative of other problems. It may be a signal to move on.

If you decide to leave, first consult with your attorney about the consequences of terminating your contract, especially if there's an enforceable noncompete clause. And consider nonlegal repercussions, such as negative references.

Billing for an independent contractor Q. I'm not sure how to handle billing for the independent contractor I recently brought on board as a part-time associate. I'd like to have my incorporated solo practice do the billing and then issue him a check for his services. Does this system conflict with his independent contractor tax status?

A. No. Medicare permits your independent contractor to give you the right to bill and collect payments for the services he performs. He should file a CMS 855R form for this purpose. For non-Medicare patients, check your managed care contracts to see what they say about using your corporation's identification number. Some plans may want to give the doctor his own PIN.

You may charge the contractor for your billing services and overhead expenses.

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 mepractice@advanstar.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.