09/05/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Moving and Insurance Companies
From: Carol Cribbs
Billing staff can create a form letter showing old and new location, effective date of move, EIN, NPI. Mail or fax to all commercial insurance companies' provider contracting departments and include a W9 form with the new info. (W9 PDF form available on line) Some insurance companies allow you to update on their website, but you may still need to mail or fax a W9.
Make sure the post office has your new location and effective forwarding date. Medicare has to be changed through PECOS or an 855 needs to be submitted to your carrier. Medicaid has similar requirements. Have billing staff check with your carriers.
If you're changing banks for e-deposits, required paperwork needs to completed for each company with which you have an e-deposit agreement. It would seem that if you're not changing bank accounts, there should be little, if any, delay for e-deposits--except Medicare/Medicaid, of course!
Carol Cribbs, Visalia, CA, h_r_advocate@hotmail.com
09/04/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Moving and Insurance Companies
From: Jeff Kittay, DPM
Start with Medicare, assuming that you participate with them. Nearly all other insurers will respond to a letter on your letterhead informing them of the change in location. Medicare has a 30+ page written document that you must download, complete, and mail in, and it takes them several months to actually make the change. Despite all their improvements, they have yet to come in to the 21st century in this area and will not accept a simple letter.
Jeff Kittay, DPM, Boston, MA, twindragons2@verizon.net
09/03/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 1A
RE: Moving and Insurance Companies
From: Howard R. Fox, DPM
Every insurance company has its own policy regarding documentation needed to update your new address, but they will all want a new W-9 with your new address. Stay very organized about this by creating a file for each company. Even companies you have no participation agreement with will need to be notified, since they will either be involved with Medicare crossover claims or reimbursement to your patient, which will be delayed if they do not have an accurate address for you.
Start by calling the professional relations representatives for each company to find out what their procedure is. Be forewarned; I have found...
Editor's note: Dr. Fox's extended-length letter can be read here.
08/26/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Compensation for Deposition (Mario Dickens, DPM)
From: David T. Taylor, DPM
I charge $500 an hour with a minimum of 2 hours, money up-front, and a 72 hour cancellation policy. That way if the parties decide to settle, you don't have an empty 2 hours in your patient schedule.
David T. Taylor, DPM, Flint, MI, dttaylor_19@yahoo.com
08/09/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Treating Homeless Patients (Elliot Udell, DPM)
From: Daniel Chaskin, DPM
Why not have homeless patients sign a statement that you are giving them treatment for free, and in return, they must promise not to sue for any substandard care or substandard record-keeping? I understand that courts, in general, do not allow patients to waive their right to sue, but if a monetary consideration is given for this, such as free care, then this agreement can be shown to a jury.
The bottom line is if the judge even tells the jury to disregard such a contract, the contract is still in the subconscious minds of the jurors. Perhaps most jurors will see a podiatrist who made such a contract to treat for free as a caring person and tend not to grant a large settlement, even if found negligent.
Daniel Chaskin, DPM, Ridgewood, NY, <podiatrist12@gmail.com
08/06/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 2
RE: Documenting Radiological Findings
From: Robert Christman, DPM
Daniel Evans and I, representing the ACFAOM Podiatric Imaging Council, have developed a Standardized Radiology Report Template (available as Microsoft Word or Adobe PDF documents; there is also a PDF version, including examples). They can be accessed by visiting ACFAOM.org, hovering the cursor over the "Healthcare Professionals" tab along the top-right of the page, then clicking "Standardized Radiology Report."
Robert Christman, DPM, Pomona, CA, rchristman@westernu.edu
08/06/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 1
RE: Treating Homeless Patients (Elliot Udell, DPM)
From: David S. Wolf, DPM
I am one of the 15 plus Houston podiatrists who volunteer every Saturday morning at a downtown homeless medical clinic. My advice is to treat the homeless patient as only we DPMs know how to do and not be concerned as to the possible medical/legal issues and follow-up appointments.
The homeless and the other uninsured are already going to overcrowded ERs and county clinics. We can, as podiatrists, make a real difference in helping those less fortunate to ambulate and get back on their road to recovery. Most homeless people today are not just psychiatric/alcoholic types, but people (and entire families) who lost their housing and employment due to the recent economic downturn.
David S. Wolf, DPM, Houston, TX, rebdovid@aol.com
06/18/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Medicare Enrollment Revocation for Providers Occurring for Reasons You May Not Suspect - Be Proactive!
From: Name Withheld (FL)
Revocation of Medicare enrollments are occurring for physicians and other providers not only in jurisdictions where they previously practiced; but, as a result of those enrollments in prior Medicare jurisdictions, revocations are now occurring for their Medicare enrollments where they currently practice. Revocation is a serious problem resulting not only in termination of revenue, but re-enrollment in the Medicare program in these cases is barred for ONE YEAR.
How is this happening? Here is an example, and you will agree that it happens all the time, thus being an issue that EVERY practice will need to pay attention to and be proactive in preventing!
Dr. Jones was doing his fellowship in...
Editor's note: Name Withheld's extended-length letter can be read here.
05/29/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Documenting Radiological Findings (Michael G. Warshaw, DPM)
From: Marc Katz, DPM
I think the solution is very simple. Just pick up a report from a radiologist and that's all you need. And yes, you can template some of it. Radiologists use templates daily for views and common findings. An example would be, "No fractures or dislocations were identified."
I make a report as a Dragon template that easily allows me to quickly choose views, locate the interpreting physician, etc. The rest is common sense.
Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com
05/03/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 2
RE: Wireless Printers and HIPAA (Elliot Udell, DPM)
From: Raymond Posa, MBA
When I advise and/or consult with my HIPAA clients, I always advise against using wireless networking. While encryption protocols are much stronger than in the past, it is still a weak link in your network security. To turn on wireless network just to support a printer would be a totally unacceptable risk. There are so many business class printers that offer hardwire networking built in (i.e., HP 2000 series laser printers are an excellent choice for the office). Also, with wireless come other wireless issues like slower speed than hardwired (one tenth the speed of wired) and the nagging issues of dropped or weak signals to the printer. My advice is to stay wired, stay safe, and stay productive.
Raymond F. Posa, MBA – Farmingdale, NJ, rposa@themantagroup.com
05/02/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 3
RE: Patients' Requests for X-Rays (Joseph Borreggine, DPM)
From: Raymond Posa, MBA
E-mailing patient information or any ePHI can be done as long as the email service you are using is secure. There are secure email services such as Zix Corp (zixcorp.com) that grab your outgoing email and re-route it to their secure email servers, and then send a secure link to the recipient. It is all done seamlessly and is transparent to the recipient. Email is one of the most efficient modes of communications available to us today. I encourage all busy professionals to take advantage of it; just do so safely.
Disclosure: I have no financial ties to Zix Corp.
Raymond F. Posa, MBA, Farmingdale, NJ, rposa@themantagroup.com
04/30/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 2
RE: Podiatry's Secret Problem (Michael J. Schneider, DPM)
From: David L. Kahan, DPM
Dr. Schneider, why are you turning this into a finger-pointing match? You have correctly stated the facts... "There are those who would dishonor themselves and their profession, but I believe that they are few and far between. Personally, I do not know nor have I ever known a colleague who intentionally billed for services not performed. The only instance where I see that is in the reporting done in this forum where someone was caught."
"Few and far between" is not the point. The problem is that...
Editor's note: Dr. Kahan's extended-length letter can be read here.
04/30/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 1
RE: Patients' Requests for X-Rays (Joseph Borreggine, DPM)
From: Don R. Blum, DPM, JD
Purchase duplicating x-ray film. Place the original on top of the duplicating film with the serrated edge of the duplicating film to the upper right. Expose to "fluorescent" light (overhead lighting in most offices) for about 7 seconds. Shut the light off and then develop. If too dark or light, adjust your exposure time. You can also purchase a developing box from a vendor which basically does what I described above. For patients, I offer to email a copy of x-rays for free or a hard copy for $25 per plate.
Don R. Blum, DPM, JD, Dallas, TX, donrblum@sbcglobal.net
04/29/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 2
RE: Billing for Missed Appointments (Olga Luepschen, DPM)
From: Hartley Miltchin, DPM
Where I practice in Toronto, Canada, all fees are cash payment at time of service. We do not deal with coding, insurance billing, etc. I became very stressed with the number of inconsiderate new patients who failed to show up for their appointments or canceled at the last minute. I implemented a credit card appointment requirement.
When a new patient books an appointment, they must provide us with a credit card. They are advised that if they do not cancel their appointment within 48 hours of their scheduled time or do not show up, their credit card will be billed for 50% of the consultation fee. If they refuse to provide a credit card (we do not keep this information on our computers), we don't book the appointment (never happens). In the past 2 years, my new patient no-shows, etc. have dropped by over 99%. I have only billed new patients twice in this 2-year period. I believe this protocol is a wise deterrent.
Hartley Miltchin, DPM, Toronto, Canada, ilovebunions@aol.com
04/27/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 2
RE: Billing for Missed Appointments (Olga Luepschen, DPM)
From: Bill Deutsch, DPM
Dr. Luepschen wants to know if she can bill for missed appointments. My suggestion is not to embark on this course. I don't know if it's legal or not, but I think it's not the way to go. My suggestion is to have staff call patients a day or two before the appointment to reconfirm. If you have patients who make a habit of not showing up, I suggest calling that day to reconfirm. There are all sorts of reasons a patient may not show: inclement weather, feeling ill, work demands, family problems, being given a follow-up appointment when the patient may feel no need for one, etc. It's part of having a controlled practice and establishing a rapport with patients. And then, of course, there are some patients you could easily do without.
Bill Deutsch, DPM, Valley Stream, NY, woollfy1@yahoo.com
04/26/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Legit or Kickback? (Adnan Shariff, DPM)
From: Michael Forman, DPM
Dr. Shariff is treading on thin ice with this deal. A kickback occurs when you are paying or receiving value for referring patients. The company that is offering neurological testing ON YOUR PATIENTS is paying you for the referral. If they use a whole day in your office, what would be a "fair market value?" I don't know what your office lease is, or how much space they are going to use, but it seems to me that $150 for a one-day lease might not be a fair market value.
What will you do to earn the $150 per hour they offer. You are not doing the testing nor are you interpreting the results of the test. It appears that they are paying you $150 per hour for you to refer a patient to them. It is my feeling that this smacks of a clear violation of the Anti-kickback legislation.
By the way, I seem to remember a colleague of ours who ran afoul of the government for just such a scheme. I believe he lost his license and did jail time. If you wish to proceed, you must contact a healthcare attorney.
Michael Forman, DPM, Cleveland, OH, im4man@aol.com
04/19/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Accommodating Disabled Patients (Name Withheld NJ)
From: Richard A. Simmons, DPM
A great resource to look at is at the ADA website. It is here that you read: “In some instances, especially in older buildings, it may not be readily achievable to remove some architectural barriers. For example, a restaurant with several steps leading to its entrance may determine that it cannot afford to install a ramp or a lift. In this situation, the restaurant must provide its services in another way if that is readily achievable, such as providing takeout service. Businesses should train staff on these alternatives and publicize them so customers with disabilities will know of their availability and how to access them.”
Richard A. Simmons, DPM, Rockledge, FL, RASDPM32955@gmail.com
04/11/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) PART 1B
RE: HBOT Supervision (Stan Gorgol, DPM)
From: Joe Agostinelli, DPM
In 1986, I was fortunate enough to be the first non-MD/DO or nurse hyperbaric oxygen therapy healthcare provider to take the Air Force HBO course. At my base at the time, we had the largest HBO chamber, with the ability to even operate in this chamber. The reasoning I gave to be a must attendee to the course was that 90 percent of the patients in that chamber were referred by me because of diabetic and or dysvascular non-healing ulcerations.
I do not know what courses certify you to be an HBO treatment provider now, but are they at least 7 full days with certification after successfully completing the course? The reason to attend and become certified for HBO therapy should not be a billing issue but...
Editor's note: Dr. Agostinelli's extended-length note can be read here.
04/11/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) - PART 1A
RE: HBOT Supervision (Stan Gorgol, DPM)
From: Ira Weiner, DPM
I was instrumental in changing the law in Nevada allowing podiatrists to supervise treatments. Recently, the law was challenged and was upheld in our favor. Our law currently states, and has always stated, that we can monitor dives for diagnoses in our scope of practice only. In addition, we have gone further to state that all dives need to be performed in a facility located in an acute care campus. Based upon Nevada law, osteoradionecrosis of the jaw would not qualify a podiatrist to monitor the dive.
Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com
04/10/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: HBOT Supervision (Stan Gorgol, DPM)
From: Frank Lattarulo, DPM
I have been supervising HBO treatments at our hospital for over 6 years. We have a 12-person multi-place chamber, and we treat all appropriate diagnoses, both podiatric and non-podiatric. For the first 4 years, I was billing for all patients in the chamber, regardless of diagnosis. I had tried for almost 2 years to get accurate information from the state board of podiatry examiners, the NYSPMA and the APMA, about being able to bill for diagnoses other than those that involved the foot and ankle. All to no avail.
I was never given a definitive answer because, in our state, there is (or was) no hard and fast law on that particular subject. However, the next thing I know, in 2011, our director states the hospital attorneys now have a problem with a podiatrist supervising treatments for "other than podiatric diagnoses." That also coincided with the director taking on a new associate. So, in our hospital (as in many other states), we do not bill for non-podiatric diagnoses. I still feel fortunate, however, because in many states, it is not allowed - period, because as you said, it's a systemic treatment and reimbursement rates are pretty good.
Frank Lattarulo, DPM, NY, NY, doclatt@aol.com
04/09/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: HBOT Supervision (Stan Gorgol, DPM)
From: Wm. Barry Turner, BSN, DPM
Supervision and billing for the service of full body hyperbaric oxygen therapy by podiatrists is an interesting question. I practice podiatry in Georgia. I bill for full body HBO therapy when I am treating a lower limb pathology. It would be outside my scope of practice to supervise and treat pathology that is not in the " foot and legs".
When I owned my own HBO chambers, I billed and was paid by Medicare for the service, but it was a battle; a battle that every year or two, is thrown back in my face. Luckily, I saved the letters signed by my local Medicare Medical Director acknowledging that I am legally allowed to bill and be paid for supervising HBO when treating lower limb pathology in the State of Georgia.
Read your state practice act!
Wm. Barry Turner, BSN, DPM, Royston, GA, claret32853@ymail.com
03/30/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Podiatric Certification of Nail Techs (Jeanine Jones Moss, DPM)
From: Janet McCormick, MS
The certification Dr. Moss was mentioning is probably from the Medical Nail Technician Program written by Robert Spalding, DPM, and Janet McCormick, MS of Medinail Learning Center. Its purpose is to train nail technicians to work appropriately for podiatrists. As we all know, nail techs are not properly trained, and if they are to perform well in podiatry offices, they must be appropriately trained.
The podiatrist does not certify the technician, though Medinail Learning Center (medinails.com) does seek podiatrists who are willing to offer the internship the students must take before being certified as an MNT. The graduates of this program will also be eligible for the new Clinical Podiatric Medical Assistant Program from the ACFAOM. Many podiatrists are employing nail technicians to perform aseptic pedicures on their patients.
Janet McCormick, MS, Frostproof, FL, janet.mccormick.info@gmail.com
03/23/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL) PART 1B
RE: Drug-Seeking Patients (Bruce Lebowitz, DPM)
From: Peter Smith, DPM, Brian Kashan, DPM
If I think that a patient has legit pain, I give them a pain killer. What is wrong with that? We are supposed to be here to help! Once I think that pain is improved, I stop. If I don’t think the pain is legit, I say "no" right from the beginning. It is really not that complicated. I have probably been duped once or twice in my 20+ years, but I’ll get over it!
Peter Smith, DPM, Stony Brook, NY, Ps84@bc.edu
I have a policy for patients who ask for pain meds for conditions that I don’t feel warrant it. I just tell them I do not treat this condition with pain meds. I explain to them that pain is a sign from your body that something is wrong. Masking those signs can be dangerous, encourage more activity, and result in more severe pain when the meds wear off. This adds to increased use of drugs and not resolution of the cause of the pain. My pain med regimen basically is for surgical patients in the first week, and post-traumatic injury patients.
Patients learn very quickly which doctors in a community prescribe or over-prescribe narcotics, who are easy targets, and who won’t give them at all. Stick to your guns and don’t say, “I’ll give you a few now but not any more,” as you will be giving more again and again.
Brian Kashan, DPM, Baltimore, MD, drbkas@att.net
02/18/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Patient Non-Responsive to Insurance Company Request (Joseph Borreggine, DPM)
From: Misty McNeill, DPM
At our office, once we receive the letter from the insurance company stating they are waiting on information from the patient, we send a letter to the patient. This letter states that to ensure they receive their maximum insurance benefits, they need to contact their insurance with the information or, should they choose not to contact their insurance, we expect payment in full in 14 days from them. We also include a complete statement. It never fails; patients always call the office and say that they have taken care of it.
Misty McNeill, DPM, Elmhurst, IL, mistydpm@yahoo.com
01/02/2013
RESPONSES / COMMENTS (MEDICAL/LEGAL)
RE: Requirement of Signed Orders in Nursing Homes (Stanford Rosen, DPM)
From: Richard Rettig, DPM
Dr. Rosen wants to know if it is necessary to get a new order for subsequent visits in a nursing home. No, it is not. Once you see a patient, you have developed a direct relationship with the patient and can see the patient as often as is medically necessary without further orders.
Richard Rettig, DPM, Philadelphia, PA, rettigdpm@gmail.com
Editor's note: Dr. Rettig is correct. What a physician at a nursing home can't do is write a standing order that says, "patient to be seen by a podiatrist every 61 days for routine care."
