Physicians Practice - February 2008 - (Page 52)

ASK THE EXPERTS Thanks to Daniel Maison, MD, of Treasure Coast Hospice for his help with this question. DISCOUNTING FEES FOR SELF-PAY PATIENTS that doesn’t stand up to scrutiny. I’d love to see Medicare publicly defend a policy that says uninsured patients should pay four times as much as Medicare does. IN-OFFICE REQUIREMENT FOR INCIDENT-TO Q Recently, you had a question about discounting fees for private-pay patients, and you stated you could do that. I just talked to a Medicare consultant who used to work for Medicare, and he stated what we had always been told: If Medicare or any other insurance company found out, they would state that the discounted fee would actually be your “usual and customary” fee, and you could face fines from Medicare for doing so. Could you clarify your answer? Q I have searched and searched for a rule that states that the “physician must be in the ofﬁce suite while the nonphysician provider is practicing.” Is this a guideline from Medicare and only for Medicare patients or is this speciﬁed elsewhere and applies to all NP services regardless of insurance carrier? Often we hear the rhetoric that we don’t have to accommodate these guidelines when it is for commercial carriers only. I’d really appreciate clariﬁca- lead, others may not. Many don’t have any real policy on incident-to. The only way to know what they expect is to ask each carrier. Of course, states and regulatory boards will have their own supervision requirements, separate from the incident-to billing issues. Check with these as well. PACEMAKER CODING Q A surgeon performed a battery change of a pacemaker. I have looked for the CPT code, and from what I understand from the CPT book, I would bill for the insertion and removal of the batteries. Are codes 33212 and 33233 OK? The doctor removed the old batteries and replaced them with new ones. A You are correct. The replacement of a battery or pulse generator requires two codes, one for the removal and another for the insertion. You’d pick 33212 or 33213, depending on whether it’s a single or dual chamber, and 33233. CLOSING A PRACTICE A TREND TOWARD FLEXIBILITY I'd say that many practices are becoming more accepting of part-time physicians, largely thanks to an influx of female physicians who insist on it while they need to mother. tion on the statement and the supporting documentation for it. Q I am a solo physician. I need to leave the practice — and the country — to care for my ill parents. How can I disengage from this practice? A If you can safely assume your trip abroad will end at a certain date, you can look into hiring a locum tenens to run the place while you are gone. If you expect a very long stay, you might also want someone else to back you up on the business side of things. The other alternative, of course, is to close the practice. To do that, you need to consider all the logistics based on your practice situation. For example, what will you do with your building? Do you rent or own? If you rent, you’ll need to notify your landlord of your intentions. If you own, do you plan to sell? Find a real estate agent and start your preparations. Also, determine what you need to do to move your equipment, ﬁles, and furniture — and where you will put them. If you lease your equipment, notify your lessor. If you want to sell the equipment you own, ﬁnd WWW.PHYSICIANSPRACTICE.COM A Sure. For one thing, you need not drop your price below Medicare’s price (or that of commercial payers) but you can still offer a discount from your fee schedule. In that case, if Medicare wanted to pay what your uninsured patients pay, great. For another, you set a very detailed, written guideline for when the discount can be offered — if the patient is uninsured and pays in full at the time of service, for example. This might be, what, 20 percent of your patients? That’s not usual and customary. You have legitimate cost savings when you don’t have to bill and get more for your money when it arrives on the day of service. Certainly, there is some gray here. But there is also a lot of hocus pocus 52 | PHYSICIANS PRACTICE | FEBRUARY 2008 A This language is from the Medicare Carrier’s Manual: “Direct supervision in the ofﬁce setting does not mean that the physician must be present in the same room with his or her aide. However, the physician must be present in the ofﬁce suite and immediately available to provide assistance and direction throughout the time the aide is performing services.” See Section 2050 of the carrier’s manual or follow this link to access it online: www.cms.hhs.gov/transmittals/ downloads/R1764B3.pdf Note that “incident-to” billing is a Medicare-only concept. While some commercial payers may follow its http://www.cms.hhs.gov/transmittals/downloads/R1764B3.pdf http://www.cms.hhs.gov/transmittals/downloads/R1764B3.pdf http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - February 2008

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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