Physicians Practice - February 2008 - (Page 51)

ASK THE EXPERTS YOUR TOP QUESTIONS ANSWERED ANTIKICKBACK RULES; REFUND REQUESTS; SELF-PAY PATIENTS SHARING SURGICAL LOAD Q A solo practitioner wishes to share his surgical load with another physician outside his practice. Is there a way he can do this and still be compensated as the referring physician? A You would still bill for and be compensated for the care you did provide the patient, such as an E&M to establish the need for surgery. But, short of making the other physician a partner in or employee patient was no longer covered by the employer. I performed the procedure because it was authorized; I have been unable to contact the patient to pay. Do I have a right to refuse the refund to the carrier? What should I do? preauthorizations, or at least limiting the length of time they have to request a refund or take-back. DOES REIMBURSEMENT DIFFER BY SPECIALTY? A I would pursue the issue with the payer. Show that you got preauthorization. Review your contract with the payer to see the exact terms of what you are obliged to refund and what security it provides for its Q Is reimbursement for an infectious disease specialist and an internal medicine physician the same if both physicians are coding the same? A For commercial payers, the rates the physicians are paid depend entirely on their individual contracts with each payer. Medicare pays the same for the same code regardless of specialty. HOSPICE MODIFIERS I would think twice before closing your office to new patients. You don't want all the referrals to stop; it's hard to get them started again when you do need more patients. REFERRAL OVERLOAD: of your practice, I can’t see any way for you to share in the surgery revenue or get a fee for referrals. Generally, antikickback rules prevent physicians from getting paid per referral (quite rightly, really, since it can encourage physicians to over-refer). On the other hand, you’ll have a lighter workload. FAULTY AUTHORIZATIONS AND TAKE-BACKS Q When and how do we use the GV and GW modifiers in hospice work? A The GV modiﬁer is placed in ﬁeld 24D on the CMS 1500 claim form. This is the modiﬁer used when a physician is the attending physician for a hospice patient and not associated with the hospice in any way (employed, contracted, or volunteering), but who is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice. The GW modiﬁer, on the other hand, is used when a physician is the attending physician for a hospice patient and not associated with the hospice in any way (employed, contracted, or volunteering) who is providing a services that is not related to the diagnosis for which a patient has been enrolled onto hospice. My source for this information was NHPCO NewsBriefs, Volume 6, Issue 41 (October 14, 2004). The old link, which may still work, is www.nhpco.org/ﬁles/public/ NB_101404.htm. FEBRUARY 2008 | PHYSICIANS PRACTICE | Q Being a general surgeon, I usually obtain preauthorization for procedures. An insurer paid me after a recent surgery, but a few weeks later, it requested a refund, claiming the WWW.PHYSICIANSPRACTICE.COM preauthorization services. Is there a more up-to-date preauthorization process it can suggest? Play it out. Paying you and then pursuing a refund isn’t in the payer’s best interest either, so it may be motivated to help you ﬁnd a better way. You may end up having to pay it back. Many payers do not promise that their preauthorizations are iron-clad. Capture as much information as you can when you get the preauthorization: a number, a person’s name, the date and time. You can also try to change terms in payer contracts when renewing, insisting that payers stand by their 51 http://www.nhpco.org/?les/public/NB_101404.htm http://www.nhpco.org/?les/public/NB_101404.htm http://WWW.PHYSICIANSPRACTICE.COM

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Physicians Practice - February 2008 Contents The Bigger Picture: Your Future is in Your Hands Letters Physicians Practice Pearls: Creating an A+ Practice Noteworthy Cover Story: Conquering Time: 5 Keys to a More Efficient Practice In Balance: A Family Affair Technology: Making EMRs Work in the Exam Room In Practice: "I've Got Some Bad News" The Tech Doctor - The EMR: Savior or Poseur? Ask the Experts NEW! Healthonomics: How to Handle Health Savings Accounts The Administrator's Desk: Finishing School for New Managers Human Resources: Is Your Partner Impaired The Great Practice Makeover: Too Well-Liked for His Own Good? Coding Idealab: 'Why I Blog' Classifieds Advertiser Index

Physicians Practice - February 2008

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