Query: Inappropriate Billing Practices
I am going through a billing company transition and have uncovered inappropriate billing practices. I do not believe they intentionally committed fraud but their mistakes are fraudulent. For example- they submitted the same claims two and sometimes even three times. Another example - they separated E&Ms from CPT codes for the same date of service. Luckily, they only did this 10 or so times.
Now, I am having to submit recoupments to the insurance companies. I am concerned this will trigger an audit. I also paid the billing company their commission on payments received for these double billed claims. Some of these double billed claims were for skin substitution products, which reimbursed well. That increased my overall collection last year, which I paid taxes on. What recourse do I have?
Name Withheld
01/31/2024
QUERIES (MEDICAL/LEGAL)
Query: Insurance Carrier Withholding
In the case of a non-participating provider, can a carrier withhold reimbursement which it claims represents an overpayment from one patient from the reimbursement that it legitimately owes for another patient?
Todd Rotwein, DPM, Hempstead, NY
07/03/2018
QUERIES (MEDICAL/LEGAL)
From: Paul Kesselman, DPM
A simple phone call to the requesting party is usually all that is required to get things started. This is totally a business matter and it should not become anything more. Express your willingness to comply and provide your expectations; that is, you expect upfront payment and your per chart fee. Let them know you are not interested in their paper, ink, or any other supplies, nor having their employees viewing records on your EHR (even with direct supervision of one of your employees).
If need be, speak with a supervisor, and if you have a previous good track record with the carrier, they will either comply or not comply with your request. The third-party requestor often will contact your local rep to do some further inquiries. As with any contact with any carrier, obtain the name of the person you spoke with, and their employee ID and/or a log number for the call.
Paul Kesselman, DPM, Woodside, NY
06/28/2018
QUERIES (MEDICAL/LEGAL)
Query: Charging Insurance Companies for Medical Records
There was recent dialogue about charging insurance companies for medical records. Is there any clarification as to whether we can or can’t charge for our time? With EHR, there is no printing of records, so any copying fee is out. Is this a state to state issue? I have searched but found no information specific to charging insurance companies.
David L. Kahan, DPM, Sacramento, CA
Editor's Response: PM News does not supply legal advice. You are correct in assuming that how much you can charge varies from state to state. Click here to check on the rules in your state. Unfortunately, there are no independent provisions to compensate for the labor involved in copying records. These statutory fees generally incorporate all aspects of copying records.
06/18/2018
QUERIES (MEDICAL/LEGAL)
Query: Locum Tenens
Can a podiatrist who has opted out of all insurances work as a locum tenens in a practice on the days that the owner is gone. The owner of the practice will still work one day a week. If so, can the locum tenens bill under the podiatrist who owns the practice.
Name Withheld
Editor's comment: PM News does not provide legal advice. Your question has two parts 1) does the locum tenens physician need to accept insurances? and 2) can the hiring doctor still work in the practice? Since the policies of insurance companies vary, this response will only be in reference to Medicare. 1) Under Medicare, a locum tenens physician can work up to 60 days in place of a physician. While the locum tenens doctor must be registered with Medicare, there is no rule requiring the locum tenens to accept insurance. It is irrelevant, since billing is done under the owner's Medicare number and the locum is paid a negotiated salary by the owner.
2) The owner of the practice cannot work at the practice while employing a locum tenens and a locum tenens physician cannot be used to cover expansion or growth in a practice.
06/13/2018
QUERIES (MEDICAL/LEGAL)
Query: Emailing Non-NPI Under HIPAA
Can we use regular email to communicate not sensitive info to patients as long as they initiate the email? Is this HIPAA-compliant?
Peter Bregman, Las Vegas, NV
Editor's comment: PM News does not provide legal advice. The simple answer is if you do so, you should obtain the patient's consent and keep a record of it. On the Department of Health and Human Services (HHS) HIPAA FAQs page, it is stated that the Privacy Rule “allows covered healthcare providers to communicate electronically, such as through e-mail, with their patients, provided they apply reasonable safeguards when doing so.”
The tricky part is determining what exactly is personal health information (PHI) and if PHI is involved, is there encryption? Being over-cautious prevents future problems. In addition, HIPAA is only the minimal privacy standard. State law, if stricter, supercedes HIPAA.
06/05/2018
QUERIES (MEDICAL/LEGAL)
Query: Switching Practice, Manners, and Ethics
I’m planning to leave a group practice to join another group in the same city. What are my obligations or good practice to notify my boss and my patients? Is it bad manners to tell my current patients where I am going? What is the proper ethics and manners in this situation?
Name Withheld
05/31/2018
QUERIES (MEDICAL/LEGAL)
Query: Potential Kickback Scheme
A rep came to my office asking me to start prescribing her company's compression devices after surgery for DVT prevention. She says the company will pay me $$$ for each prescribed device delivered to the patient. They even have a “legal contract.” But...it strikes me as a possible kickback violation (not to mention paying doctors for prescriptions seems like a huge conflict of interest for the doctor). I am sure you can’t do that with Medicare or Medicaid (as it is a Stark Law violation), but I can’t find definitive answers for private carriers. I could be wrong, but it smells a bit fishy. Is this kind of thing legal? I am sure I am not the only podiatrist that has come across this kind of situation.
Name Withheld
05/17/2018
QUERIES (MEDICAL/LEGAL)
Query: Billing Company Negligence
8 months ago, I hired a new billing company highly recommended by other physicians in my area. My income dropped, which I did not notice immediately. I did a random audit of my accounts consisting of a small sample of 17 accounts and found that 4 of the accounts were not paid or followed up in the period of 8 months. I fear that this small sample represents what has been happening for the entire 8 months. I am sure some of the claims with insurance companies will not be paid due to the 3 or 6 month statute of limitations. Does the billing company have any responsibility to pay me my lost income due to their negligence? The contract with the billing company mentions nothing regarding this issue. Has anyone had a similar experience?
Name Withheld
06/21/2017
QUERIES (MEDICAL/LEGAL)
Query: HIPAA Security Regulations
Our office server is in a storage room. My IT person just told me that in order to be HIPAA compliant, I will need to get a lock on the door to that room and to keep it locked when the office is closed. We've had the door to this room unlocked for years. Is this a new HIPAA regulation or have I been non-compliant all along? After the office was broken into years ago, we had a special lock put on the main entry door to prevent any future break-ins. Would this be enough for compliance?
We recently got an attachment to the computer monitor at the front desk so patients can't see the screen at an angle. Monitors in treatment rooms go blank after a few minutes so the schedule doesn't show. Our IT person has also taken care of many other HIPAA compliance issues for us. We're doing many of the required HIPAA compliance requirements currently, but are there any other or new HIPPA compliance issues that I might need to be aware of? I've looked at HIPAA compliance lists online, but they don't seem to give specifics on things like door locks, etc.
Name Withheld
09/05/2015
QUERIES (MEDICAL/LEGAL)
Query: Nerve Conduction Studies
Kindly comment on the use of nerve conduction studies (NVC) in podiatric practice. l feel the utilization of NCV studies could be very useful diagnostically and prognostically for patients who experience symptoms associated with symptomatic peripheral nerve disorders (diabetes, numbness, parasthesias, tarsal tunnel, nerve entrapment disorders, etc.). However, I recently read an article from the National Gov't Service (Medicare) that this test is considered a "screening" and should NOT be considered a complete study by any doctor unless this doctor performs an EMG concurrently and possesses "specific credentialing requirements to perform the test."
Howard Dinowitz, DPM, Brooklyn, NY
12/19/2014
QUERIES (MEDICAL/LEGAL)
Query: Retirement Questions
As of March 31, I will be retiring from my hospital position. I would like to keep my license active in case I want to pick up some work later on. Should I keep my DEA? Can I get malpractice insurance as needed. What about CAQH and NPI numbers? What about my DMERC license?
12/19/2014
QUERIES (MEDICAL/LEGAL)
Query: Patients' Right to Paper Prescriptions
Do patients lose any rights under federal law to request paper prescriptions, so they can take them to different pharmacies to price compare?
Dan Chaskin,DPM, Ridgewood, NY
Editor's comment: PM News does not provide legal advice. Most prescriptions are covered by state law, which varies. Under most state laws, patients have the right to request paper prescriptions. Controlled substances are governed by federal law. Effective October 6th, 2014, the DEA stiffened the regulations regarding Schedule II drugs, which now require paper prescriptions. As noted in the pharmaceutical news article in today's issue, the FDA is seeking regulations to totally eliminate paper prescriptions.
08/30/2014
QUERIES (MEDICAL/LEGAL)
Query: Patient Request for Compensation
My associate gave a woman an injection and she developed a cellulitis/allergic reaction. She was treated successfully, but still has slight edema. She asked to be financially compensated for what she claims was two weeks of work lost. It now turns out her health insurance was inactive at the time of her visit. How would you handle this?
Name Withheld
Editor's comment: PM News does not provide legal advice. One of the reasons to carry professional liability insurance is to cover cases such as this. Contact them ASAP. A post- injection reaction may well be a simple complication, but these types of situations should always be handled by attorneys.
08/22/2014
QUERIES (MEDICAL/LEGAL)
Query: Value of Patient Charts
A colleague is asking me what the value of his charts are as he has left his practice and a podiatrist wants to buy his charts. He has 50 active Medicare charts, 400 total medicare charts, and several hundred PPO charts.
Name Withheld
08/18/2014
QUERIES (MEDICAL/LEGAL)
Query: Charge for Meeting With Attorney
My front office person set up a meeting, without my knowledge or approval, with one of my patient's Workers Comp lawyer. He told her he needs 20-25 minutes of my time. How much should I charge him for my time?
Name Withheld
Editor's comment: PM News does not provide legal advice. We hope you instructed your front office person not to schedule such consultations without your knowledge and consent. The fee you charge should be commensurate with the income you would earn seeing patients for the same period of time and should include your preliminary review of the chart, x-rays,and other tests. This should be a minimum of one hour. If you divide your gross income by the number of hours worked, you will come up with an hourly fee. For most podiatrists, this should be in the $250-350 per hour range.
07/25/2014
QUERIES (MEDICAL/LEGAL)
RE: G0179, G0180, G0181 and RICO
I used to get paid for these codes. I would save up 6 months of HHC forms and send them in, giving me a nice little “bonus.” Then the rules changed, and now in my area, only NPs and MDs can get paid for them. RICO anyone?
Joseph G. Smith, DPM, Tidewater, VA
07/21/2014
QUERIES (MEDICAL/LEGAL)
Query: Proximate Cause of Tarsal Tunnel
I have a patient who stepped out of her truck onto a gravel surface. She states she lost her balance, slid on the gravel but did not fall. I picture slipping on ice and flailing to catch oneself. Since then, she has demonstrated global bilateral nerve injury. She also has EMG evidence of tarsal tunnel. The indepedent medical examiner (IME) thinks it is unlikely that she would have this much pain with the mechanism of injury. I would tend to agree with him, except she states she had no pain prior to the incident. Her Workers Compensation claim is being challenged and I have a conference next week. Does anyone think this is a reasonable story? Did she have latent tarsal tunnel that “woke up” with the tripping incident? There is no evidence of CRPS.
07/04/2014
QUERIES (MEDICAL/LEGAL)
Query: Journal Articles and Legal Issues
Are there malpractice or other legal issues in writing reviews of journal articles? The reviews are solicited by the publisher.
Phil Organ, DPM, Naples, FL
Editor's comment: PM News does not provide legal advice. Since no doctor/patient relationship is established, there are insufficient grounds for a malpractice action. More common issues are plagiarism and copyright infringement.
07/03/2014
QUERIES (MEDICAL/LEGAL)
Query: Legal Consequences for Giving Medical Advice to Acquaintances
What are the legal issues when I give medical advice to acquaintances. There has been no doctor-patient relationship established. Also, I am retired and no longer carry malpractice insurance?
Phil Organ, DPM, Naples, FL
Editor's Comment: PM News does not provide legal advice. While you may assume that no doctor-patient relations is established, a court of law could differ. The issue will hinge on whether the acquaintance "reasonably believed" that a doctor-patient relation had been established and whether he or she relied on this advice. Therefore, it's safest to say, "I'm now retired. I recommend that you get a complete examination by a podiatrist."
06/28/2014
QUERIES (MEDICAL/LEGAL)
Query: Legality of Pharmacy-Based Study
Out here in Las Vegas, there is a pharmacy offering our preventive foot care network a relationship in which the company would place paid newspaper ads for a study of the use of their topical products, particularly for peripheral neuropathies. Half the patients get the product, half get a placebo for two weeks. If there is no improvement, and they have been given a placebo, they then get the actual medication.
The ads announce the study, and tell patients they can call the podiatrist for an appointment. The medication is provided to the patients free for the two-week study duration, but after that, if they are improved, and have been using the actual product rather than a placebo cream, they receive it at a discounted price or their insurance is billed. This brings new patients to an office, but the question is whether it is problematic. I suppose a healthcare attorney is the one to ask, but maybe there are comments.
Lawrence M. Rubin, DPM, Las Vegas, NV
06/09/2014
QUERIES (MEDICAL/LEGAL)
Query: Legality of Advertising on Groupon
What are the legalities with selling services on Groupon? I see podiatry-related services often. I was under the assumption that giving away free services or reduced fee services was illegal. I also thought a disclaimer had to be put on all advertising like this that insurance was not going to be billed for "free or reduced fee services."
Eugene A. Batelli, DPM, Clifton, NJ
Editor's comment: PM News does not provide legal advice. The legality of advertising on Groupon varies from state to state. States such as New York and New Jersey do not allow fee-splitting, and thus advertising on Groupon would subject the provider to professional misconduct charges. Whether or not a disclaimer is required also varies from state to state. Thus, one should contact his/her state podiatry society or a healthcare attorney for more specifics.
05/10/2014
QUERIES (MEDICAL/LEGAL)
Query: E-mailing PHI to Patients and HIPAA
Does the HIPAA Privacy Rule permit healthcare providers to use e-mail to discuss health issues and treatment with their patients?
Steven J. Kaniadakis, DPM St. Petersburg, FL
Editor's comment: PM News does not provide legal advice. Yes. According to HHS. "the Privacy Rule allows covered healthcare providers to communicate electronically, such as through e-mail, with their patients, provided they apply reasonable safeguards when doing so. See 45 C.F.R. § 164.530(c). For example, certain precautions may need to be taken when using e-mail to avoid unintentional disclosures, such as checking the e-mail address for accuracy before sending, or sending an e-mail alert to the patient for address confirmation prior to sending the message.
Further, while the Privacy Rule does not prohibit the use of unencrypted e-mail for treatment-related communications between healthcare providers and patients, other safeguards should be applied to reasonably protect privacy, such as limiting the amount or type of information disclosed through the unencrypted e-mail. In addition, covered entities will want to ensure that any transmission of electronic protected health information is in compliance with the HIPAA Security Rule requirements at 45 C.F.R. Part 164, Subpart C."
03/31/2014
QUERIES (MEDICAL/LEGAL)
Query: Liability for Telemedicine
I found the article and topic on interstate licensure interesting and wondered if the obvious follow-up question was going to be asked: what sort of legal liability do you face by fielding inquires from patients seeking medical advice via email, social networking/media, office web page response link, phone, or the like when the patient is from a state where you don't hold a license to practice? If the patient follows your informed opinion and faces the sequelae of an untoward outcome, would you face liability and possibly not have malpractice coverage because you practiced without a license? If not, why not?
David Secord, DPM, Corpus Christi, TX
Editor's comment: PM News does not provide legal advice. Since the laws of each state vary, this question is best answered by your professional liability carrier. In the event you were to be sued, it would be your insurer whom you ask to defend you. Therefore, it seems logical to get an answer in writing before engaging in diagnosing or treating out-of-state patients.
03/13/2014
QUERIES (MEDICAL/LEGAL)
Query: Laws and Rules CME for Florida License
I have more than 70 hours of CME credits towards this biannual renewal, but I somehow managed to miss the one-hour of Laws and Rules CME required for Florida licensure. I have been searching for online courses to no avail. Does anyone know of a source to obtain this one-hour credit?
Name Withheld
