Practice Management

I've decided not to renew credentialing with one of the two hospitals in my town. If one of my patients is admitted to that hospital and the attending physician there calls me for a consult, do I have an obligation (professional or legal) to go? I'd like to just say that I don't go to that hospital, the attending physician should get another specialist for the consult, and I will take over the patient's care when he or she is discharged. Is there anything wrong with that?

I've been called to appear before my state's Board of Medical Examiners regarding a patient I treated for depression. The board stated no specific reason. Should I bring an attorney with me?

Parents going through divorce and custody battles have been requesting immunization records and letters about treatment of their kids' health conditions, primarily to prove that they're adequate caregivers. What are the legal implications for me? What are my obligations? To whom may I give this information?

I'm frustrated with patients who refuse to pay their outstanding bills. I'd like to report their overdue balances to the three major credit bureaus as bad debts. What do you think of this idea?

How long is a HIPAA-compliant, signed medical release valid?

Until I get an EHR, I've been typing my care notes into a Microsoft Word template. Then I print them out, sign them, and store them in the patient's chart. I save the electronic copy in read-only format on a network server that's password protected. Do you see any weaknesses in this system that, in a malpractice trial, might give a plaintiffs' attorney the opportunity to suggest that I could have altered records?

I accept Medicare patients, but I don't participate in any private health plans. When I'm called to the ED to perform surgery on a patient covered by a Medicare HMO, who's responsible for paying me?

The author's extra effort to get low-cost drugs for her patients works to her detriment under P4P.

Help ease your patients' money problems, and you may improve their health, says the author.

Don't stew in anger over your annoying call coverage schedule. Here's how to improve the situation.

We're about to take on nursing home patients and have the following billing questions: Is billing different for patients in a nursing home versus a skilled nursing home, and what's the difference between the two? Do we bill the nursing home or the insurer?

Our large cardiology group encompasses numerous subspecialties, invasive and noninvasive cardiology and cardiac electrophysiology among them. When one of our general cardiologists refers a patient to our cardiac EP, who sees the patient on the same day, our claims are often rejected. Both the generalist's visit and the EP consult are typically paid on appeal, but we'd like to avoid having to file an appeal. What's happening, and what do you suggest?

Our pathology group is a private practice, not part of the hospital where we perform our services. Our new biller maintains that since we're an independent entity, it's not necessary to use any modifiers when billing our services. But we've experienced massive claims rejections recently. Could this be due to the lack of modifier use? If so, should our new biller have anticipated this?

Hospitals known as "safety net" facilities for the poor and uninsured are working with these patients in an attempt to prevent them from clogging busy EDs with their nonurgent needs, finds a new study from the Center for Studying Health System Change.

Do you have space in your medical building that you'd like to rent to another doctor?

Georgia's $350,000 cap on noneconomic damages in malpractice cases gives doctors special protections that other professions don't enjoy, and is therefore unconstitutional.

Amoxicillin, lovastatin, propranolol, or tetracycline for 11 cents a day? That's roughly how much patients will pay for any of up to 350 generic drugs under Wal-Mart's new $10, 90-day prescription-drug program.

Coding modifiers are often underused, misused, or submitted without supporting documentation. Here's how to end these costly mistakes.

When I serve on the ED call roster, I frequently see elderly patients. Recently, I've received several requests to fill out FMLA forms from adult children who accompanied their parents to the ED and then took time off from work to care for them after they left the hospital. I only cared for these patients in the ED. Do I have any obligation to fill out these forms?

One of our receptionists shows absolutely no initiative. She makes no effort to promptly answer the phone, doesn't file unless she's asked, and never offers to help the co-workers who frequently assist her. On the other hand, she has a wonderful personality and has been with us for seven years, with perfect attendance. Is there any way to rehabilitate her?

How do I handle a patient's demand for a refund for an outcome that was less than perfect?

The author realized his minor, commonplace errors were hampering patient care. See if any of them ring a bell for you.

Physicians must put patients first, but you also need to be profitable. Here's how doctors tackle the wrenching decisions about money and ethics.

Posting an ad for an associate is not enough. You need to convince job candidates that your practice is desirable.

Our practice has never billed for extended visits, but we often spend a great deal of time counseling patients. How do we go about reporting extended visit codes? What else needs to be documented besides the history, exam, and medical decision-making?

One of our physicians was called to active duty earlier this year. We've hired a substitute doctor and plan to bill his services as a locum tenens physician. Our concern is that we can only do this for 60 days. Do we need to find another replacement after that time has elapsed or can we ask for an extension?or discharge and rehire the same locum tenens doctor?

Our family practice routinely sees patients after they've been treated in the ED for lacerations, fractures, and similar injuries. We've recently seen an increase in claim denials for such services because the ED physicians are billing for complete care for procedures, even though we're doing the follow-up. What can we do?

Twenty-eight percent of medical practices still don't accept credit card payments, according to a survey by SK&A Information Services.

The number of disciplinary actions taken against doctors has dropped during the past two years, according to the Federation of State Medical Boards.

Angie's List, a website where visitors can read--and write--reviews about service providers, is adding healthcare practitioners to the mix of businesses it holds up to scrutiny.