Physicians Practice - September 2008 - (Page 45) ASK THE EXPERTS YOUR TOP QUESTIONS ANSWERED PAYER POLICIES; BREAKING A LEASE; BILLING COMPANY SELECTION; THIRD-PARTY CLAIM REVIEW. FINDING PAYER POLICIES Q I have one payer (UnitedHealthcare) who consistently won’t pay for an office visit and pap on the same date of service. Ladies do not want to have to come back on a different day for me to address their hypertension or allergies or whatever. I’ve not seen a written policy on this from United. Any ideas? A A quick search of United’s Web site brought up its policy, which is not to pay for a problem-focused visit and Pap done during the same visit. So my first advice is, at the very least, to take advantage of the information payers do make available to you so you are clear what is covered. Also, I assume that women don’t come in solely for a pap, but also for a preventive care visit that includes the pap. Look into coding for a full preventive exam, assuming you are doing that, instead of just the pap. NO REQUIREMENT TO OFFER BENEFITS — to manage such issues. A PEO will find, retain, and manage your staff, and because they have lots of employees in addition to yours, they can get good rates on benefits. Of course you have to pay them, but it might be worth it. Just Google “PEO” in your part of the world. Also, note that I recently wrote a Bigger Picture column on some pros and cons of PEOs. Visit www.PhysiciansPractice.com, and type “No More HR Headaches” into the Search Articles box. CLIA BILLING DETAILS done in the office and are placed on the CLIA-waived list. It is important to check the list and make sure that the exact test for glucose that you are performing is on the list, and that you are using the correct CPT code for that test. You don’t want to use the code for strep test done by culture without the -QW modifier (and get paid for that service) when you have performed the quick strep test done by kit (87880), which is on the CLIA-waived list. GETTING OUT OF A LEASE Q I am thinking about opening my own practice. If I have only three or four employees, am I legally required to set up a retirement plan for them? Also, in the same situation, do I need to provide them with a health insurance plan, or could I pay them a higher salary and have them get their own health benefits? A State rules may vary a bit, but generally, no, you are not required to offer health benefits or a retirement plan. Of course, you might have a hard time recruiting if everyone else in your area offers these benefits. Some physicians use a PEO — professional employer organization WWW.PHYSICIANSPRACTICE.COM Q I enjoy your newsletter on coding [Sign up for free at www.PhysiciansPractice.com.] and the article on CLIA was very informative until I got to the last statement. It said that we learn from the mistakes we make. Well, I certainly learned from mine: I added the –QW modifier to a lab test that was CLIA-waived but did not have the –QW listed on the CLIA list. If you doublecheck the CLIA list, some CPT codes have –QW and some do not. Those that do not have the –QW do not require it when filing. We received denials for invalid modifier and I was required to remove the –QW to those codes I had previously added. I thought that if a lab test was waived it required the –QW. A Answer provided by Betsy Nicoletti, certified professional coder: That’s right, generally, but there is a qualification. Many tests, such as measuring a patient’s glucose, have many ways to perform them: quantitative, qualitative, via an assay, via a culture, or via a test kit that changes colors. Tests that may be performed via a test kit (not requiring a lab tech’s clinical skill) can be Q Last year I signed a five-year lease with a laser company. I have been paying about $3,000 a month. I do not have many customers, and the payment is a big burden for me. I have tried to sell to other physicians without success. What can I do to get out of this lease? I am very desperate. A You need to read the contract in very close detail to see if there are exit or other similar clauses. It may cost you something, but that may be less expensive in the long run. You can also look at the other side of the equation. You must have expected to have customers when you leased the laser. What happened? Wrong audience? Too little marketing? If you can identify what went wrong and devise a way to change it, maybe you can begin to recoup your costs. NO EMR REQUIREMENTS Q Is it mandatory for a small practice of one to two physicians to incorporate electronic medical records into their practice, or is it for practices with more than five physicians? SEPTEMBER 2008 | PHYSICIANS PRACTICE | 45 http://WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.