Physician's Practice - November 2008 - (Page 50)

ASK THE EXPERTS I suggest that you appeal the denials with documentation, conﬁrm the payer’s policy regarding this issue, and provide the families with the CPT information and the payer’s response if you have trouble getting paid. SPACE PLANNING FOR EMR Q We are planning on a new building for five doctors. Included in this plan is a fully operational EMR — no paper charts! But we need some help with the floor plan. What should it look like to reflect an all-EMR practice instead of the current layout we have with big medical records departments for housing paper charts? Any suggestions? A Actually, EMR accommodation is the least of your concerns in a redesign; productivity is paramount. Make sure you focus squarely on that. That said, I have seen some trends for optimal EMR implementation. I’ve been seeing more and more “kiosk”-style work stations in the middle of exam room pods (e.g., three exam rooms clustered around a work station). Physicians stop there to complete charting after every few visits. They can also check messages there instead of returning to an ofﬁce. I’ve also seen small, built-in shelves within exam rooms so that a physician can use his tablet or laptop PC and still face the patient. This is great for staying connected with your patients while treating them. OVERHEAD IN INTERNAL MED MODIFIER -25 Q Please explain how and when we should use modifier -25 when filing insurance for our patients. We are very confused on this issue. A Ah, the dreaded modiﬁer -25, the bane of many an ofﬁce. The basic rule is this: You perform a legitimate, separate procedure during a routine ofﬁce visit. You then indicate to the payer that it is a separate service by adding the -25 modiﬁer to the E&M visit — common sense, and it’s consistent with the American Medical Association’s CPT guidelines. In reality, however, many, many payers routinely deny claims that include the -25 modiﬁer. Part of the problem is that the rules the AMA sets when publishing CPT guidelines don’t always agree with payers’ rules on modiﬁers. It’s obviously easy to disagree about what is both signiﬁcant and separate enough to count. Fight for the correct interpretation of the rules, instead of just writing off the denials or not coding -25 at all. If it is valid for you to get the reimbursement, if you have done that separate service, you should code and bill for it. And if you get denied, you should appeal it. Make sure you also consult the correct coding initiative edits. PATIENT KEEPING CHARTS Q Can you please provide me with a current benchmark for a practice’s overhead expense as a percentage of collected revenue for an internal medicine practice? A For internal medicine, the median total operating cost as a percent of net medical revenue is 54.87 percent, according to the Medical Group Management Association’s Cost Survey for Single-Specialty Practices: 2007 Report Based on 2006 Data. Q We recently had a patient in a treatment room, awaiting a physician (who was late from a surgery). The patient took her chart with her, and left the office without being seen by the physician. When we discovered that she’d left and the chart was missing, we called the patient. She admitted she had taken the chart, claiming it is “her” medical record. We explained that the chart is in fact the doctor’s property, but we offered to make copies for her. We also asked if she wanted to reschedule her appointment. She said “not at this time.” Is there a form letter we can use to notify a patient that medical records belong to the doctor? What should we do to offset any liability? 50 | PHYSICIANS PRACTICE | NOVEMBER 2008 WWW.PHYSICIANSPRACTICE.COM http://www.meditlive.com http://www.meditlive.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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