Ask the Experts: Your Top Questions Answered<

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Charging for Education; Practices Billing as ASCs; Need for Employee Contracts; Fee Schedule Changes; Setting Up a Waiting Room; Nonphysician Partnerships; Manager Boot Camp; Physician Manager Salaries

CHARGING FOR EDUCATION
Q: Are there any articles out there about the usual and customary fees charged for tobacco-use counseling and asthma education?

A: For tobacco-use counseling, bill based on a percentage of Medicare or commercial payments. Read this AAFP article at http://www.aafp.org/fpm/20060500/75anup.html for background on coding and Medicare. Since even fewer payers reimburse for asthma education, tending to bundle it into the E&M, I'd look at what your costs actually are, especially if you have a trained and dedicated educator on staff.

PRACTICES BILLING AS ASCs
Q: We've realized that ambulatory surgical centers (ASCs) get paid more than physician offices for some of the procedures we do. Our billers say we can just start billing as an ASC. I'm not so sure.

A: Well, the definition of the ambulatory surgical center place-of-service code for CMS is "a freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis." So it seems a little fishy to me.

Now, I've not had this issue come up before, so the billing team may truly have found some legitimate work-around, but I think it's sure worth asking for proof.

My suggestion: Ask staff to justify their position. "Gosh, you know I really want to understand how this works. I see the definition is this. Please explain to me how we aren't impacted by that. I'm really trying to expand my knowledge."

See what you get and check it out.

NEED FOR EMPLOYEE CONTRACTS
Q: Our clinical nurse specialist is changing from working as a contractor to an employee. Do I need to use a written agreement or is our verbal agreement enough?

A: I suggest you use a written contract. If things go south, everyone will remember his own version of the verbal agreement. Download a sample physician employment agreement from the AMA Web site at:
http://www.ama-assn.org/ama/upload/mm/46/model_physician_aug.pdf
You can adapt the language to suit your particular needs. Be sure to cover these key issues:

compensation
schedule
call schedule
dissolving the relationship

FEE SCHEDULE CHANGES
Q: One of our local insurance companies reduced our fee schedule and is paying at or below Medicare rates. In addition, it did not notify us in a timely manner that our fee schedule would change. Do we have any recourse besides terminating our contract?

A: Our fee schedule surveys suggest that many commercial payers are reimbursing below Medicare. Consider what your full payment is, including copays and other patient portions, before determining that it is actually lower than Medicare, however. Allowables are dropping but other revenue is getting pushed to patients. You certainly can try to renegotiate the contract for a different fee schedule, especially if the terms are much lower than your other payers. If they don't want to negotiate, why keep them?

SETTING UP A WAITING ROOM
Q: I need articles or other information on setting up my waiting room in such a way as to make my patients more comfortable, to alleviate the anxieties of the office visit, and to assure privacy as much as possible.

A: You'll find lots of articles and resources by typing "waiting room" in our Search Articles box on our Web site PhysiciansPractice.com. In general, consider a calming, sophisticated color scheme. In internal medicine, you'll want a variety of chair styles and heights - chairs with arms for those who need to press with their arms to stand up, wider love seats for obese patients, seating groupings that allow an elderl<

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