Practice Management

Dealing with drug reps

QHow often should our group's doctors meet with pharmaceutical reps? Should we delegate a point-person for this? We're feeling overwhelmed by the large number of requests for meetings.

A Many practices designate a specific time of the week for physicians to meet with drug reps. Ask your receptionist to communicate this policy to reps who call for appointments, and have her make clear that the doctors in your group won't meet outside this regularly scheduled time.

Could helping poor patients hurt your practice?

QI sometimes waive coinsurance for patients struggling to make ends meet. I tell them that I have to send them a bill and a series of collection letters, but that they can disregard these notices because I intend to write off their unpaid bills as bad debt. Is there anything wrong with this strategy?

A Although you have your patients' best interests at heart, your strategy still amounts to insurance fraud. Most plans require you to make a good-faith effort to collect coinsurance. If an insurer's audit reveals that you don't, you could face financial penalties or be kicked out of the plan. Medicare is especially unforgiving.

Some of your patients may be taking advantage of your generosity. In the future, ask patients for proof of indigence, like their tax return, and consider caring for the genuinely needy ones for free. It's perfectly legal not to bill the insurance company in the first place.

Whether to give raises at the same time as performance reviews

QShould yearly performance reviews and raises coincide or occur separately?

A Each method has its fans and detractors.

Giving raises at the same time you do reviews clearly connects wage increases with performance. On the other hand, employees may focus on the money and ignore the feedback received in reviews.

Conducting reviews two weeks before announcing raises is a good compromise.

An office setup that raises malpractice red flags

QI share office space, expenses, call, and letterhead with one other sole proprietor. We're not a partnership or professional corporation, but we do business under the same name. What's my risk if that physician is sued? If there's none, what's the best way to tell patients that we don't share liability? Through signs in our waiting room or disclaimers on our stationery?

A Since your arrangement looks like a single practice, it could be viewed as an "ostensible partnership," and the courts could hold you liable for the other doctor's actions.

A sign in the waiting room won't sufficiently clarify your relationship. Instead, you should incorporate separately and each use your own letterhead, telephone lines, and billing forms. While you can still share office space and staff, it's a good idea to have a separate front-desk window for each doctor.

When you're drowning in uncompensated paperwork

QMore and more patients are asking me to fill out forms that range from medical excuses for jury duty, work, or school to applications for handicapped parking passes or discounted drug supplies. None of their health plans cover the cost of these time-consuming services. May I charge patients a per-page fee for completing these forms?

A Not if your contracts with these insurers consider the paperwork a covered service.

Even if a plan's contract doesn't bar you from such billing, our consultants advise against it. The practice will alienate patients. However, if you haven't seen the patient for some time, it's reasonable to ask him to come in for an exam, so that you can complete the form more accurately.

A better way to divide prepaid income

QOur five-member group has decided it can't share prepaid income based on the number of patients assigned to each physician for three reasons:

(1) Our managing partner now devotes 15 hours a week to administrative functions, so he's assigned fewer new patients.

(2) Our senior partner treats a greater portion of elderly patients, who require more time per visit.

(3) In preparation for retirement, our founding partner has shortened his work week by 10 hours, so the rest of us treat the patients he can't fit into his abbreviated schedule.

While all three doctors contribute as much to the practice as the rest of us, they're losing out on capitation revenue. What compensation formula would allow us to reward everyone fairly?

A You could share revenue equally or divide it according to the number of hours each physician works.

For example, if the five of you work a total of 260 hours a week, and you put in 50, you'd be entitled to a 50/260 share, or 19 percent of the revenue. If the managing partner works 55 hours a week on patient care and administrative duties, he'd be entitled to 21 percent.

Getting Medicare to pay for coordinating patient treatment

QI understand that Medicare is now paying for "health care plan oversight." How should my practice code for telephone order reviews for skilled nursing facilities or hospice care, or for ordering diabetic supplies or durable medical equipment?

A Use code G0181 for reviewing nursing home care or home health aid care, and G0182 for reviewing hospice care. (These are new codes that replace 99375 and 99378, respectively.)

In order to receive reimbursement, you must document that you've spent at least 30 minutes within the calendar month coordinating the patient's care. (The 30-minute requirement excludes time spent in consultation with nonmedical personnel, such as family members.) Although you must have had a face-to-face encounter with the patient within the past six months, you probably can't bill for care plan oversight if you're seeing the patient in your office on a regular basis.

You should also be aware of two additional codes: G0180 and G0179. If you need to "certify" a patient who hasn't received Medicare-covered home health services for 60 days, use G0180. Use G0179 to report recertification every 60 days thereafter.

Don't let an employer take advantage of you

QI'm about to enter into a partnership with the doctor I've been working with for two years. He sees patients three days a week, and devotes the rest of his time to two other businesses. Meanwhile, I see patients seven days a week. Yet my employer insists that the partnership agreement should have us split revenues equally. Wouldn't it be fairer to share revenues and expenses according to productivity?

A Absolutely. It sounds as if this doctor hasn't acknowledged that he's moved into semiretirement. You may need to hire an attorney to help with the negotiations. If the doctor still won't budge, walk away from the deal.

Edited by Kristie Perry,
Contributing Writer

Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to mepractice@medec.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.

Kristie Perry. Practice Management.

Medical Economics

2002;7:154.