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Ask the Experts: Your Top Questions Answered<
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Patient discounts Q. I have a sleep lab, and I want to charge patients different prices depending on whether they are self-paying or if they don’t want to pay coinsurance or a high deductible. Can I do this? A. If patients are strictly self-pay, you can offer a discount. What you’ll want to do is create a written policy for staff to follow and that you can distribute to patients. It might say, for example, that anyone who is self-pay (that is, has no insurance) and who pays at the time of service can have a 20 percent discount based on your standard fee schedule. Make sure the policy is used consistently. You don’t want to offer the discount to one patient, but not another. You should not reduce your prices any lower than your lowest allowable, lest this new price be perceived as your reasonable and customary fee. It’s a totally different story for patients who are insured but have a high copay or deductible. You must collect all of the money they owe you — that is, all of their copay or deductible, according to the contracts both you and the patient have with the insurance company. If the patients don’t like to pay the high deductible or copay, they should find a new plan with a lower deductible or copay. Getting paid for phone calls Q. Are there any payers that will cover telephone calls by either the physician or the nursing staff? Our nurses can spend up to 20 minutes on the phone with patients, giving them results, instructions, and so on. The physicians do the same, changing medications and offering other services. A. It’s worth a call to your major payers — or a claim to them — to see if they will pay, but in general, the answer is no. Most consider this “management” time as part of your service/treatment code. Some physicians are charging patients directly for phone calls and other “extra” services on an a la carte basis. You’ll need to be careful, however. Most payers do consider phone calls “bundled,” and thus not something you can charge their beneficiaries for. Some will instead tell you that phone calls are uncovered. Then you are free to charge. The only way to know is to call each payer. While you’re at it, ask if they pay for secure email communications. Some will, even if they don't pay for phone-based communication. Call it technophilia. Of course, the other, quite reasonable, option is to bring these patients into the office for a visit or to look for other ways to get them the information they need. For example, try a secure phone or Web-based service to deliver test results. Use time during the office visit or at scheduling to offer instructions, post them to a Web site, or even mail them out. The cost of a stamp is less than 20 minutes of a nurse’s time. Pre-op physicals Q. As a primary-care physician, how do I code a preoperative routine physical exam? A. Medicare officially stated several years ago that a physician could report a consultation code for a preoperative clearance if all the requirements of a consult were met — that is, the consult was requested by another provider and a written report is supplied to the referring physician. The consultation code can be reported even for an encounter with an established patient. The American Academy of Family Physicians (AAFP) published an informative article on the subject once Medicare clarified its rules: www.aafp.org/fpm/20010900/16medi.html. In September 2002, the AAFP clarified: “Family physicians do most of these services at the request of a surgeon, who is usually seeking the family physician’s opinion on whether the patient is fit for surgery. If you document this request in the patient’s medical record (e.g., “Ms. Jones was seen at the request of Dr. Smith, who is requesting preoperative clear< |
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