Physicians Practice - April 2008 - (Page 39)

ASK THE EXPERTS YOUR TOP QUESTIONS ANSWERED CESSATION AGREEMENTS; WEEKEND CALL; BILLER BENCHMARKS; SHOPPING FOR SOFTWARE WHAT YOU OWE A DEPARTING PHYSICIAN Q Our primary practice is working on a cessation agreement to be used when a member retires or relocates. We are using the outstanding total A/R as of the date of termination multiplied by the gross collection percentage over the most recent 12 months. That number, the Collectable A/R, is then multiplied by a percentage to reflect Using 10 percent is very common, but it could go as high as 15 percent. The key here is to talk about it and agree while everyone is working toward what is best for them. Once someone is actually leaving it will be more difﬁcult since personal issues will get in the way. So using the range 10 percent to 15 percent and having the doctors agree to it is ﬁne. and physical. They justify it by saying they’ve done what it takes to qualify for this level of service. What is the current thinking on this practice? Having credit card numbers on file can be a temptation to staff and a theft risk. Some patients won’t want you to do this for these reasons, and they are quite right to be nervous. RISKY BUSINESS the anticipated cost of collection. That number, the Net A/R, is then multiplied by the withdrawing member’s production percentage for his profit share allocation. Searching your previous questions and answers shows that for primary care a fair percentage ranges from 10 percent to 15 percent. Are these numbers still current? You’ll also want to decide on the time frame for payment. This could be over a period as short as three months or as long as quarterly over ﬁve years depending on the circumstances for the departure. The remaining question is whether this is a guaranteed amount of payment (whether collected or not) or if it will be based entirely on collections from the departing doctors’ accounts. It is much easier to have a calculated, guaranteed amount, so the collections and worries then remain with the others in the group. CAN YOU REALLY USE 99215? A If you do a level 5, you code a level 5. Just make sure you know what is required and that it’s all documented. A “complete history and physical” may or may not count. Speciﬁcally, a 99215 requires two of these three components: 1. A comprehensive exam: A general multisystem exam or comprehensive exam of a single organ system 2. A comprehensive history: Chief complaint, extended history of present illness, review of systems related to present illness plus review of additional systems, a complete past, family, and social history 3. Medical decision making of high complexity Highly complex medical decision making might include, per CPT examples, a patient with four or more stable chronic illnesses. That sounds like a lot of Medicare patients. Treatment options might include medications requiring intensive monitoring. Again, typical of many Medicare patients. You might consider having a coding expert come do a prospective audit of your documentation and claims to see if you could accurately bill the level 5 or not. CLINICAL STAFF AND WEEKEND CALL A Here is a response from consultant Owen Dahl: The approach and formula that is being used is fairly consistent: Total A/R x Collectible percentage (historical over the previous 12 months) = Adjusted Total A/R. Departing doctor’s percentage or share of A/R is identiﬁed based upon compensation formula = Total eligible to be received – Cost of collection. WWW.PHYSICIANSPRACTICE.COM Q Some doctors in other practices will code Medicare patients with a level 5, 99215, when they do a complete history Q We are considering using our nurse practitioners (NPs) to take weekend call. What would be the pros and cons? APRIL 2008 | PHYSICIANS PRACTICE | 39 http://WWW.PHYSICIANSPRACTICE.COM

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

Physicians Practice - April 2008 Contents The Bigger Picture: Medicare Decision Time Letters Physicians Practice Pearls: Outsource Your Pain Noteworthy Cover Story: Trial Lawyers Tell All Management: When It’s Time to Change Ask the Experts Technology: Do You Know Where Your Data Is? The Tech Doctor: Are Your Discarded PCs Really Clean? Billing & Collections: Playing Hardball The Administrator's Desk: Recruiting for Patient Satisfaction Start It Up: Finance - Mastering the Numbers Game Coding The Great Practice Makeover: Taking Care of Business Associates Classifieds Advertiser Index

Physicians Practice - April 2008

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