Practice Management Q&As

When a patient falls off the exam table

Q. A patient passed out after receiving a PPD test and fell off the exam table, fracturing her jaw and breaking several teeth. Our malpractice insurer says that her hospital and dental bills should be submitted to our general office insurance company. Is that correct?

A. The answer depends on the contract language of both policies. But it's likely your general office insurer will say your patient fell off the table as a result of malpractice or professional negligence.

How to get paid for house calls

Q. Under what conditions am I allowed to charge for house calls to Medicare patients? What codes should I use?

A. Your Medicare patient must be at home (not in an assisted-living facility), and you must document medical necessity for the visit and for why the patient can't come to your office. The reason can't be convenience-for example, the patient has no transportation.

The codes for house calls are 99341-00345 for new patients; 99347-99350 for established patients.

HIPAA and computer passwords

Q. I want one of my staffers to know everyone's computer password in case we need to use an absent employee's machine or if someone suddenly quits. Does HIPAA define who can assume this responsibility?

A. No, the choice is up to you. Your idea is a good one, though, because HIPAA regulations do require you to be able to access protected health information in an emergency. Appointing a staffer to know everyone's password is one way to accomplish this.

However, under HIPAA, you must track everyone who accesses the protected data. So make sure you have a system in place to record that your password keeper logged into the computer in place of the regular user.

Assigning HMO patients to a hospitalist

Q. I'd like to employ a hospitalist to care for my managed care inpatients, while I continue to care for my hospitalized fee-for-service patients myself. Do you see any legal pitfalls?

A. In this case, there's nothing wrong with treating your private patients one way and your managed care patients another. However, to avoid other problems, contact your managed care plan and ask whether your contract allows you to assign patients to a hospitalist. Also ask how the plan will handle reimbursement. Finally, call your malpractice insurance carrier to make sure you're covered if the hospitalist is sued for negligence, because you'll probably be named in the action.

Recovering A/R after your business crashes

Q. I had $30,000 in accounts receivable when I had to close my practice due to financial trouble. My former biller is gone, and I have no reliable records of whether she sent patients notices of payment due or rebilled carriers for unpaid claims. I need to recover what they owe me. How should I start?

A. First, make a detailed list of all outstanding claims and patient balances. Then arrange for a billing service to take over these accounts. They will contract with you personally, since your business is defunct, and will charge you 8 to 12 percent of what they recover. Set up a 90-day period, after which unpaid balances may be turned over to a collection agency.