Ask the Experts: Your Top Questions Answered<

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Paying for Templated Transcription; Shift in Intake; Watch Out for Web Fraud; Thanks for the Referral; Making Staff Pay for Mistakes; What to Cover; Getting DEXA to Pay; Billing for Wasted Injections

PAYING FOR TEMPLATED TRANSCRIPTION
Q: The transcriptionist charges us for each line even though there is a template on her computer that automatically creates whole sections of the note by punching one key. If they only have to type one key to print a template, is it appropriate for them to charge us for 11 lines of print?

A: Well, it sure doesn't seem fair, but it's up to you to negotiate the contract. Most transcriptionists do still charge by the line. Shop around. If you can find someone with a different policy, then confront your transcriptionist and ask for a change to the contract.

If you can't find anyone willing to do it differently, you can still ask her, but you'll know not to press too hard.

Consider what she might want that would make it easier for her to accept the change. More work? More lenient deadlines?

SHIFT IN INTAKE
Q: I recently read that CMS will soon adopt rule changes regarding the new patient intake history/interview process. I thought I read that physicians have to take the entire history themselves and can no longer rely on what a medical assistant or other ancillary staff member writes down. Can you help? Have you heard of this?

A: Physicians Practice covered this in our e-mail newsletter, "Pearls on Coding." (To sign up, visit our online E-Newsletter Signup Page at www.physicianspractice.com.) In the newsletter, coding expert Bill Dacey writes:

CMS has given more substance to the documentation requirements for the history of present illness (HPI) portion of a physician's E&M history. This latest addition to a long line of CMS "clarifications" is neither welcome nor practical in the provider community.

Coming in the form of a much-copied e-mail, the guidance says that a physician or nonphysician practitioner must write the HPI, not just sign an HPI that has been taken in part or entirely by ancillary staff.

Anyone who has worked in a practice for any measurable time knows that whether a nurse or a provider actually records the HPI, the substance of it - the actual medical information being communicated - is clearly used by the provider and is, in reality, part of the provider's work. If physicians didn't check the HPI data, and the review of systems for that matter, they wouldn't know what to examine and how to arrive at their decision - the assessment and plan portion of the note. The HPI is integral to the encounter.

It is absurd to imply that because an element of the work isn't written by the provider then it isn't part of the "physician work."

In the past two years, the majority of "guidance" that CMS has given in relation to E&M has consisted of leaked memos, comments, and unattributed statements. It's time for CMS to issue formal direction.

WATCH OUT FOR WEB FRAUD
Q: A Web-based company has offered me a loan. I'm required to send $2,500 to the company's account via wire transfer before the company sends the loan amount of $50,000. Is that right?

A: The scenario you describe is classic fraud. Never extend cash to get a loan, especially to an online company via wire transfer. You are very unlikely to get your loan money back. I would definitely not proceed. Visit a reputable brick-and-mortar bank in your area instead.

THANKS FOR THE REFERRAL
Q: We would like to reward patients who send their family and friends to our practice. What are the ethical and legal implications of sending them, for example, a gift certificate to a local restaurant?

A: We put this question to Lonnie Hirsch, a marketing guru with Healthcare Success Strategies. He recommends two relatively conservative approaches:

1. Simply thank<

For Healthcare Professionals