Physicians Practice - October 2008 - (Page 53)

ASK THE EXPERTS YOUR TOP QUESTIONS ANSWERED TRANSPORTING LAB SAMPLES; BOOSTING NET COLLECTIONS; TREATING EMPLOYEES WHEN WORKERS COMP PATIENTS SETTLE Q Our practice treats workers compensation patients, who often end up settling their case for a lump sum of money rather than opting for ongoing medical treatment. Once we have been notified that the patient’s case has been settled and the patient is seeing us on a cash basis, do we charge the patient what the workers compensation insurance has been paying all along for the patient’s visits? Some of us think that because the settlement figures are based on what has been paid by workers comp rates, then I’d charge comp fees. If the practice provided its regular fee schedule — which may be different from what they charge self-pay patients — it should use that as the basis for charging the patient.” Consult an attorney to be sure. BILLING FOR CARRYING LAB SAMPLES Q I’m an ENT. We do many nasal and ear swab cultures when purulent drainage is noted. As far as I know, there are no codes to bill for these procedures. A LabCorp employee picks up the specimens each day. Can we bill if we deliver these ourselves? The lab is just down the street. HARD TO SAY Is a blocked tube routine? Every payer will have a different answer. A If you actually convey the specimen to the lab, you could bill CPT 99000, but Medicare doesn’t actually have a fee attached to that code. You’d need to see if your commercial payers do this, and then judge whether it would be worth losing a staff person even brieﬂy to convey the specimens. (I’m guessing not.) Keep in mind that you are getting paid for analysis of the results and dependent medical decision making. IMPROVING NET COLLECTION in the past, we should continue to charge the patient what workers comp has allowed all along. Others see the individual as being a self-pay patient and think we should charge her the same amount (much less than workers comp allowables) as the rest of our selfpay patients. Should we charge this patient what his workers compensation has paid in the past or is this seen as discriminatory by charging self-pay patients different amounts? A Net collections is meant to measure how much you have collected of the amount you are owed (not the amount you charge, but what payers and patients actually owe you). What it indicates is that you need to do more to collect. And what does that mean? Well, I’d start to sleuth that out by using that number as a benchmark for all your payers and by contrasting all payers to patient receivables. In other words, who owes you the money? If it’s mostly patients, you can tighten time-of-service collections on past balances, copays, and coinsurances. If it’s mostly payers, start to look at your write-offs and denials. Why isn’t the money coming in? What can you do on your end to improve it? For example, if you are getting timely ﬁling denials, you can obviously ﬁle faster. There are lots of other tips, but hopefully this gives you a sense of how to proceed to pinpoint exactly where the problem is — and ﬁx it. GLOBALS AND CLOGGED DRAINS Q During the 90-day global period, if we need to irrigate or replace a clogged drainage or feeding tube during an office visit, is this a billable procedure? A The correct answer is “maybe.” The surgical package, according to CPT, includes “typical” follow-up care. It does not include “postoperative complications, exacerbations, and recurrences.” So is a blocked tube routine? Every payer will have a different answer. You definitely need to look at Medicare’s NCCI edits with the speciﬁc codes you’d like to use in hand. From there, it’s payer-speciﬁc. OCTOBER 2008 | PHYSICIANS PRACTICE | A We checked in with management expert Karen Zupko, of Chicagobased Zupko and Associates, who offered this opinion: “I think a lawyer needs to rule. If the patient settled based on comp WWW.PHYSICIANSPRACTICE.COM Q Our net collection ratio is lower than it supposedly should be — currently 83 percent. Could you please explain exactly what this ratio indicates and what we need to do to improve our percentage? 53 http://WWW.PHYSICIANSPRACTICE.COM

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

Physicians Practice - October 2008 Contents Another Reason to Go Cash-Only? Letters How ’Bout Them Gas Prices? Second Opinion: Oh, Canada! Noteworthy Cover Story: Fixing the Leaks: How to Tighten Your Money Spigot Navigating a Lawsuit Ask the Experts The Administrators Desk: What’s Your Mission? EMR: Help or Hindrance? Dealing with Dr. Dangerous E-Mail Abuse Primer The Road to EMR Interoperability Don’t Let Staff Costs Stifle Profits Coding Classifieds Advertiser Index

Physicians Practice - October 2008

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.