Physician's Practice - November 2008 - (Page 18)

P eARLS HSAy WHAT? BY OWEN DAHL PHYSICIANS ADVISORY BOARD David Albenberg, MD Scott Meyer, MD Access Healthcare, Prairie Glen Family Medicine, Charleston, SC Glenview, IL Michael F. Bonazzola, MD Oregon Health & Science University Medical Group, Portland, OR Lucien W. Roberts III, MHA, FACMPE Cognos LLC Glen Allen, VA William Smits, MD The Allergy & Asthma Center, Fort Wayne, IN A health savings account, or HSA, is a low-premium/high-deductible plan where the patient pays greater out-of-pocket costs than he would under a more traditional plan. Like it or not, they’re becoming more prevalent. Successfully collecting HSA-patient copays prior to the ofﬁce visit and ensuring that these patients comply with recommended follow-ups can be a challenge. Case in point: A patient visits your practice. He pays $73 prior to seeing you for a routine visit. Later, he receives a bill from your ofﬁce for an additional $35. He’s understandably annoyed. Why is he being charged more money? Isn’t $73 enough? The explanation is simple from your viewpoint: The level of service generated by the visit turned out to be greater than initially expected. This scenario usually ends with the patient calling your ofﬁce and refusing to pay the additional $35 because he feels that his visit has already been paid for, and he has a receipt to prove it! Another example: This patient was also scheduled for an MRI as a followup to his ofﬁce visit. Because of his high deductible, the patient says he will have to delay the test until he can afford it. In good conscience, how comfortable are you with your patient’s decision to delay treatment? Ethically, what is your responsibility for ensuring that your patient be tested in a timely manner? To justify the need to be paid additional funds when you initially collected for the visit at check-in: • Refer to the fee schedule for this patient’s insurance carrier. You are writing that full payment is expected upfront, based on expected insurance reimbursement, but that occasionally they may be charged subsequent fees, depending on the ultimate level of service and any additional procedures performed. As for the second issue of the delayed lab tests, since you already have an established physician-patient relationship with this person, I do think you are under legal obligation to make a reasonable effort at follow up. That said, “You can lead a horse to water….” Therefore, document, document, document! Keep a log of patient referrals — electronically or the old-fashioned way — and review them on a routine basis. Assuming that the patient has already been scheduled for a follow-up appointment, then ideally you would like to have the testing complete and the report back prior to the next visit. It is much more efﬁcient to review test results and draw up a detailed treatment plan ahead of time. Follow up by phone or mail on tests that were not completed. Make sure that all efforts at follow-up are also documented in the patient chart. There’s another reason for following up, too: What kind of lost revenue will your practice suffer if the patient is not encouraged to keep his follow-up appointment and comply with required testing or referral? Reviewing your collection and care policies periodically is always a best practice, and essential to ensuring that your staff is prepared to deal with the patient who presents with an HSA plan. Juliet Breeze, MD Richmond Bone and Joint Clinic P Richmond, TX .A., Robert C. Goldszer, MD, MBA Mount Sinai Medical Center Miami Beach, FL BUSINESS ADVISORY BOARD Rebecca A.H. Anwar, PhD The Sage Group, Philadelphia, PA John Barrasso, MD Wyoming Medical Center, Casper, WY V. Alin Botoman, MD Holy Cross Hospital, Fort Lauderdale, FL Barry Brennan Miami Children’s Hospital, Miami, FL Greg Bruce UMC Health System, Lubbock, TX Patrick Cawley, MD Medical University of South Carolina, Charleston, SC Lee M. Duke II, MD Lancaster General Lancaster, PA Wanda English Shands at the University of Florida, Gainesville, FL Richard Gangemi, MD Rochester General Hospital, Rochester, NY Hewitt Goodpasture, MD Via Christi Regional Medical Center, Wichita, KS Diane Haines Oregon Health & Science University, Portland, OR Darren R. Haskell, MD St. Luke’s Hospital, Chesterﬁeld, MO Larry Hopperstead, MD Central Maine Medical Center, Lewiston, ME Allen B. Hornell, MD ETMC Regional Healthcare System,Tyler, TX Timothy Huffcutt Saint Joseph’s Hospital, Marshﬁeld, WI Peter J. Jacoby, MD, FACEP St. Mary’s Hospital, Waterbury, CT Cynthia Johnson Washington Hospital Center, Washington, DC Jean Kostelansky Northwestern Memorial Hospital, Chicago, IL Michael Kryda, MD Ministry Healthcare, Saint Joseph’s Hospital, Milwaukee, WI Leonard Lichtenfeld, MD American Cancer Society, Atlanta, GA Jim Lindsey, MD SETON Family of Hospitals Austin, TX John Mackel, MD Saint Francis Medical Center, Cape Girardeau, MO Phillip J. Manno, M.D., F .A.C.P . Nevada Cancer Institute, Las Vegas, NV Lorraine L. Manzella SUNY Upstate Medical University, Syracuse, NY Hagop Mekhjian, MD OSU Medical Center, Columbus, OH Daniel M. Navin, MD Munson Healthcare, Traverse City, MI Harold Pillsbury, III, MD UNC Hospitals, Chapel Hill, NC Thomas Pow, MD Lakeland Regional Health System, St. Josephs, MI Brian Reardon St. John’s Hospital Springﬁeld, IL Kevin Ruggles, MD Rockford Health System Rockford, IL Ronald W. Swinfard, MD Lehigh Valley Hospital, Bethlehem, PA R. Stephen Taylor, MD Piedmont Hospital, Atlanta, GA Donald Thomas, MD Kingman Regional Medical Center Kingman, AZ Jerome Thompson, MD UT Medical Group, Memphis, TN J. Stephen Wikle, MD, MPH Hoag Memorial Hospital Presbyterian, Newport Beach, CA Michael Wong, MD Roswell Park Cancer Institute, Buffalo, NY Sally Wright, MD Swedish Medical Center, Seattle, WA John M. Zerwas, MD Memorial Hermann, Houston, TX Nathan J. Zuckerman, MD Lourdes Medical Center of Burlington County, Willingboro, NJ contractually authorized to collect a payer’s allowable amount. • Use calm, polite reasoning. Politely explain to your patient about the increased level of service. • Communicate your HSA payment policies. Inform your HSA patients in 18 | PHYSICIANS PRACTICE | NOVEMBER 2008 • Owen Dahl, FACHE, CHBC, is a nationally recognized medical practice management consultant with more than 24 years of experience in healthcare consulting. He can be reached at odahl@comcast.net. WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physician's Practice - November 2008

Physician's Practice - November 2008 Contents Death of Solo Practice Just a Myth Letters HSAy What? Noteworthy Finding Lost Revenue: The Search for Billing and Coding Gold Getting More: Our Annual Physician Compensation Survey ’Tis the Season to be Neutral Ask the Experts Evaluating Paperless Labs HR in a Box? The Guide Coding Third-Party Audits on the Rise Branding the Cash-Only Practice Intra-Office Tug-of-Wars Stickin‘ Up For Yourself Classifieds Advertiser Index

Physician's Practice - November 2008

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