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12/04/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Daniel Chaskin, DPM
"There should be some form of alternate pathway for everyone! The fact is that there isn't, and that there won't be is shameful. An alternative path could exist " - Kass
Regarding the above, I believe an alternative pathway should exist in every state. Such equivalency criteria can consist of a certain number of years in practice in a sister state for all those who do not meet the residency and or board certification requirements for a basic podiatry license. I feel the first step should be to have every state accept a certain number of years in successful practice as a podiatrist as meeting any residency equivalency criteria in every state.
Furthermore, if an unmatched podiatrist is able to become licensed and currently competent as a podiatrist, he/she should be enabled to move from state to state without restriction due to residency criteria.
Other messages in this thread:
07/05/2024
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Name Withheld (FL)
Name Withheld, I commend you for the way you will be handling a difficult situation. This was an honest mistake on your part, and you are trying to remedy the situation. The most important advice I would give you is to contact a medical consultant to guide you along this process. Hopefully, you are with a malpractice company that provides you with legal defense. If so, they will talk you through the process of reporting these errors to insurance companies. Several years ago, I had a circumstance where I misinterpreted the regulation of taking x-rays in my office. I thought the rules stated that as long as the practicing podiatrist is in the office the assistant can take an x-ray without being certified. I unfortunately found out this wasn’t the case.
Although we did not take many x-rays in our office, enough were taken through the years that would have put me in a difficult situation had that not been reported. I did have legal defense through PICA and they put me in contact with a healthcare consultant. It turned out to be an expensive mistake. Working with the healthcare consultant, they contacted Medicare to explain my circumstance. Medicare appreciated our transparency, but still asked for a refund of $10,000 dollars. This amount was based on three years' worth of billing. Obviously, this was not a slap on the wrist, but if they would have discovered this error themselves via a whistle blower or disgruntled employee, they could have gone back, I believe, seven years or more if fraud was suspected.
You are doing the right thing by reporting this unfortunate situation but you must go about it the right way.
Name Withheld (FL)
07/05/2024
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Alan Bass, DPM
This is very troublesome to hear. This is why it is so important to review your collections report, as well as your accounts receivables monthly with your billing company. At this time, I suggest the following steps be taken:
1. Contact your malpractice carrier and alert them to this and ask if your policy with them contains administrative defense coverage (ADC) and if it will cover any audits that may arise from this. Hearing that this was for skin substitute claims leads me to believe that these were for Medicare recipients and that can be very problematic.
2. Contact the billing company and alert them to their inappropriate billing practices. You should ask them to return any monies to you that they were paid on the inappropriate claims, since the monies reimbursed by the insurance carrier should be refunded to them.
3. Contact the insurance companies for these claims and inform them that you are aware that you were reimbursed inappropriately for certain claims and discuss reimbursing them for the inaccurate claims.
4. Contact your accountant regarding any tax implications this may have.
5. Consider switching your billing company. I would review the last several months of billing to see if this happened previously.
Disclosure: I am the owner of my own podiatric-specific billing company.
Alan Bass, DPM, JARALL Medical Management Consulting
02/01/2024
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Jeff Pinsky, DPM
Yes, this happens all the time. It’s just accounting to them, debits and credits. They owe you $200 for patient X, and according to them, you owe them $70 back on patient Y. Net $130, that’s what they send you and from their point over view, you’re happy. All the arguing in the world isn’t going to get them to budge. You can put in for a review for patient Y, but don’t get your hopes up. Since you’re non-participating, bill the patient for the recovered payment.
Wait until more claims are AI evaluated vs. the current hard algorithms; I predict scenarios like this will be more frequent.
Jeff Pinsky, DPM, Petersburg, VA
10/16/2019
RESPONSES/COMMENTS (MEDICAL/LEGAL)
RE: Re-use of Single-Use Injectables
A podiatrist in a local hospital has been given by the nurses used single-use vials of Marcaine, Xylocaine, Celestone, and Decadron at the conclusion of his cases. He then uses these same single-use vials and re-draws from them to give injections to his patients. The illegality here is two-fold: First, this is fraud due to double billing, because the patient is charged for the full 50cc vial in the hospital, and then the patients are charged in the office for the same vial. Second, there are no preservatives in the single-use vial, hence the chance of infection is huge when using on multiple patients, especially when many of the patients are diabetics with infections. This podiatrist has been reported to the OIG as well as to the county health board.
A very similar situation had occurred in Las Vegas, in which a physician was doing the same thing, with the state health department coming in and having to contact all the patients who had been injected to check on their health and well-being. I foresee the same situation here in that the health department will come into his office, and have to contact all the patients who have received injections and place them on notice that they have been injected with a contaminated medication. This is only the beginning of the end, with the hospital now being liable also by allowing him to remove the medications from the hospital.
Name Withheld
03/19/2019
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Elliot Udell, DPM
On the surface it may appear that unless you write prescriptions for narcotics, spending close to a thousand dollars to renew a DEA number seems unnecessary. The problem is that certain states will require a DEA number in order to prescribe other non-narcotic medications. At the SAM meeting, one of the speakers said that in the state of Florida, one must have a DEA number in order to prescribe Lyrica. Double check this if you practice in Florida. In New York, Ketamin trochies require that the prescriber have a valid DEA number. The bottom line is that you should survey what medications you prescribe and then ask the local pharmacy whether you need a DEA number to prescribe them in your particular state.
Elliot Udell, DPM, Hicksville, NY
03/18/2019
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Matthew B. Richins, DPM
I had a patient who liked to hug (never “grabbing” or “touching” my staff). I took it as his being a sweet old man and thought nothing of it. One day, this got brought up in conversation with a lawyer friend. He told me that if he makes them feel uncomfortable, I know it is going on and I do nothing to prevent it, that is sexual harassment. The next day, I asked my staff their opinion on the patient. It turns out, they all thought he was creepy and they tolerated him because he was a patient. Needless to say, he was discharged that day and my staff appreciated knowing that they and their well-being came before patients.
In your case, that patient needs to be discharged at the least and a police report filed, if warranted.
Matthew B. Richins, DPM, Joplin, MO
06/22/2017
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Raymond Posa, MBA
Regarding the post, the IT guy is not correct in suggesting that a lock on the server closet is required in order to be compliant. It is a very good suggestion, but it is not mandated.
One of the things to understand about the HIPAA security standards is that they are purposely written in very open language, so everything is in shades of gray, very little is black and white. The reason for this is that the standards apply to all covered entities from a single provider office to the largest hospitals, so writing very specific requirements that fit both large and small would be impossible. Rather, the regulation...
Editor's note: Ray Posa's extended-length letter appears here.
06/21/2017
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: George Jacobson, DPM
Although I agree with everyone's comments on their method of remediating this problem, one needs to look at their contract with each company. In all likelihood, you agreed to this and are contractually bound to supply these notes. They are abusing this clause for the purpose of achieving greater reimbursement at our expense and their reimbursement to us goes down each year.
George Jacobson, DPM, Hollywood, FL
03/02/2016
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: George Jacobson, DPM
There may be general and or specific requirements by your state or state board. For example, you may be required to publish legal notice of the closure with specific information required by your state. Ask a healthcare attorney in your state. When my oncological surgeon passed away a decade ago, I wanted to secure my records. There was a legal notice in the newspaper instructing patients. His estate had a third-party administrator maintain the records for a said period of time. I paid a fee for the records.
George Jacobson, DPM, Hollywood, FL
09/28/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL))
From: Spencer Dubov, DPM, Robert Scott Steinberg, DPM
The first area to check is the Wyoming Podiatric Practice Act for scope, including H&Ps. With that in hand, you have a substantial basis to rectify your problem.
Spencer Dubov, DPM, Commack, NY
Is rearfoot within the WY scope of practice? What is the rational behind the refusal to grant rearfoot privileges to a DPM? Has the APMA and state society, been contacted?
Robert S. Steinberg, DPM, Schaumburg, IL
09/26/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: William Deutsch, DPM
I have two suggestions for the DPM considering selling his practice and retiring.
1. Do not ratchet down your practice. Instead try increasing your income and patient load.
2. Market your practice to a podiatrist contented to do only forefoot/mid-foot surgery. After all, how many rear foot surgeries come breaking down your door?
As an alternative, market your practice to an enterprising orthopedist specializing in foot and ankle disorders and willing to open a foot treatment/wound clinic. Forget the hospital cutting podiatry a break. You might have to put your retirement off by a decade.
William Deutsch, DPM, Valley Stream, NY
09/26/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: J.C. (Chris) Mahaffey, MS
If the Wyoming podiatrist referred to is an ACFAS member, please have him/her contact me regarding the College’s Credentialing and Privileging Advisors Team. We have a team of members, all of whom have served on a hospital credentialing committee, who can advise you on this matter. The College has other resources I would be happy to discuss with him/her.
J.C. (Chris) Mahaffey, MS, Executive Director, ACFAS
09/25/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: John Chisholm, DPM
This is the type of problem that can be dealt with quickly and effectively by your local APMA/state local component association. Most state associations, in my case the California Podiatric Medical Association, have the knowledge, experience, and, if necessary, legal resources to correct any discriminatory position of your local hospital.
It is also a good example of why every podiatrist, in practice or retired, should belong to APMA and their state component association. In order to do this kind of work for its members, APMA needs everyone to pull their fair share of the load, and this includes the financial support of its dues-paying members. If you are an APMA member, contact your state component association and they will get this matter straightened out quickly. If you are not a member, then join today.
John Chisholm DPM, Chula Vista, CA
06/15/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: William Deutsch, DPM
If the sole function of government were problem-solving, there would only be one voice heard, no need for a legislative or judicial branch. The purpose of government in a democracy is to offer the illusion that citizens also have a voice in decision-making. But it's just an illusion.
There is no reason to assume that solutions offered by government are wise, efficient, or competent. In the realm of healthcare overhaul, the purpose was simply to...
Editor's note: Dr. Deutsch's extended-length letter can be read here.
06/12/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Richard A. Stanley, DPM
I sympathize with Dr. Benjamin’s plight. These policies are pervasive in the EMR industry. I purchased an EMR program 6 years ago, for a rather large sum, which was located on MY server and the data backed up on MY external drive. Unfortunately, that firm filed for bankruptcy and was acquired by a new entity. Due to the reasons mentioned by Dr. Benjamin, I switched vendors as well. I have now been locked out of MY software still located on MY server unless I pay an outrageous sum. I am not sure what I paid for if I cannot access the software or my data. There are three years of medical records present in that software that were entered prior to their acquisition. I do not take being held hostage kindly. It is time for legislation and/or EMR licensing rules that require a read-only file be provided at no additional cost in the event of a termination.
Richard A. Stanley, DPM, Indianapolis, IN
05/26/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Michael L. Brody, DPM
Your Notice of Privacy Practice Form should have been updated after the HIPAA Omnibus Act of 2013. The form should list the name of the privacy officer at your practice.
Any time you change your privacy officer or make a change to your office policies, the Notice of Privacy Practices should be updated to reflect those changes.
Michael L. Brody, DPM, Commack, NY
02/05/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Lisa Merkow, CPC
Since I posted the suggestion to use doctordefender.com to help collect from patients who skip out on high deductibles, Dr. Beaton has been besieged with questions about the service. I wish I could address them all, but here are answers to the most FAQs.
1) HIPAA doesn't apply to collections. doctordefender.com does not share any patient medical information and HIPAA is therefore not applicable. You can't tell which patient saw which doctor. You can only see if a patient was posted by another doctor as a non-payer.
2) You do not need the patient's email address.
3) You can pay the annual fee and just utilize the database to identify patients who don't pay their bills. You do not need to use the notification letter; however, we find it to be very effective and much more affordable than a collection agency.
4) They don't have a phone number that is public. We figure it's because they don't want patients calling. They are very accessible through their email address.
Lisa Merkow, CPC, Office of William Beaton, DPM, St. Petersburg, FL
01/22/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Michael L. Brody, DPM
The incentive is for using certified technology and meeting meaningful use. It is for the provider who met meaningful use. That being said, the money can be assigned to any entity. In order to attest for you, the group must have access to your PECOS username and password. The only way they have this is if you provided the group with this information.
In many cases that I have encountered, there was some sort of agreement between the group and the employed podiatrist. The group has access to all of the documentation necessary to allow you to attest for meaningful use, and you have access to your PECOS credentials. Generally, I would advise against giving out your username and password for any account as important to you as the PECOS, In the situation you present, much depends upon your employment agreement. This situation can get even more complicated when a provider works part time for different groups and the data from each group must be aggregated to allow a provider to attest for meaningful use.
It is possible that some time in the future, you will be audited for that meaningful use attestation. If you do not have all of the necessary documentation to pass the audit, it is YOU who will be responsible for refunding the incentive payment to CMS. It is imperative that you obtain copies of all documents necessary to respond to an audit now, because if you leave that group it can become difficult to get the documentation in the future. You may wish to consult with an attorney to properly protect yourself in case of potential future audits.
Michael L. Brody, DPM, Commack, NY
01/09/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Elliot Udell, DPM
The relationship between podiatric physicians and narcotic-seeking patients is far from being a black and white situation. Not every patient is a faker. There are many patients suffering with chronic painful conditions who will probably be on morphine-based drugs all of their lives. On the other hand, in my state, authorities are not happy with us writing for these drugs. A friend of mine who is a hematologist wrote a script for an opioid for a patient suffering with sickle cell anemia pain. Authorities swooped down on him. He was exonerated, but only after he paid 50K+ in legal fees and a year of aggravation.
In our practice, I do not write for these drugs even if a patient comes in sucking on Fentanyl lollipops justly prescribed by another doctor. I refer these patients to pain management specialists who have carte blanche with prescribing these drugs, and I will restrict my therapies to other aspects of foot and ankle care.
Elliot Udell, DPM, Hicksville, NY
12/22/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 3
From: Tom Zoldowski, DPM
I have gone through this same situation with hospital privileges. I met with the hospital credentialing committee, explained that I don't do a lot of surgery, that I do use the hospital facilities and services for out patient testing, that this hospital is where I do 90% of my surgery, and I am involved in the residency program. The committee then allowed an exception.
Tom Zoldowski, DPM, Toledo, OH
12/22/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Jim DiResta, DPM, MPH
It has been my experience that credentialing committees will accept activity at another facility where you maintain privileges in lieu of not seeing enough patients at their particular facility where you lack the minimum 20 patient encounters over the 2-year period. This is a fairly common occurrence and protects the hospital in recredentialling you for medical staff membership. Often there are two parts to this. One is hospital membership where you need patient contacts, i.e. inpatient consults, out patient treatments, OR procedures, or activity in the hospitals wound care center. The second is surgical privileges. Many surgical departments are now requiring certain volume thresholds of surgical procedure activity to renew providers privilege cards. Satisfying that request is more daunting.
The other issue Dr. Borreggibe raises as to whether you should voluntarily relinquish your privileges or allow the facility to not renew them is a question that I would seek out legal counsel as you will be asked this question on numerous renewals for third-party payer contracts, ACO involvement, healthcare privilege applications and license renewals, etc.. and it would appear taking a proactive course of voluntarily giving up your membership and privileges would be wiser with a reason that you simply no longer need use of that facility for non-renewal rather than allow them to "take your privileges away" and have to continually explain that to other parties in the future.
Jim DiResta, DPM, MPH, Newburyport, MA
12/22/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Elliot Udell, DPM
Many physicians are faced with this same problem. They do not admit too many patients to their local hospitals yet need to verify that they are on staff of a hospital for the purposes of insurance credentialing. What our local hospital system has done was to create an on-staff privilege, which does not allow the doctor to admit patients but allows him or her to read charts and visit but not treat patients. It is a win - win situation for the physician and the hospital. On one hand, the doctor no longer feels impelled to admit more patients than is necessary and on the other hand the hospital still makes their share of dues from each practitioner.
Elliot Udell, DPM, Hicksville, NY
12/20/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL)
From: Michael J. Schneider, DPM
If you think you might work as a podiatrist in some way after retirement, I would advise you to keep every form of license you have. You can never tell what opportunities arise (locum tenens, etc.)...even when you think you are done...done....done. "Been there...done that."
Michael J. Schneider, DPM, Denver, CO
12/18/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Elliot Udell, DPM
A friend of mine called me over the weekend asking me about similar paperwork she had to sign in order to gain admission to a motivational seminar in New York City. I could not imagine anyone suing them over not "being motivated"; however, what they may be concerned with is if she is not happy with the program, leaves early, and wants her six hundred dollars returned.
This would go to arbitration. This might be what is so with the orthopedic group. With high co-payments with the new insurance plans, many patients might run up a bill for a couple of thousand of "out-of-pocket" dollars and look for ways to not pay the bill. Some patients truly believe they are covered for all services, and then refuse to pay even though the visits went toward a four thousand dollar deductible. In other cases, the patients might claim they do not owe money because their knees or shoulders did not feel better. I cannot see a court allowing a patient to sign his or her rights to sue for professional negligence.
Elliot Udell, DPM, Hicksville, NY
12/18/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Donald R Blum, DPM, JD
"....When I received the new patient paperwork, an arbitration document was included in the packet for me to sign. It basically stated that if I felt dissatisfied in the care I received and I was considering a medical liability claim, I could arbitrate the matter with the institution where the care was provided instead of a seeking legal counsel."
I think the key word in the notice is "could". To me, this is giving you the option to arbitrate versus making it the only option. Please do not construe this to be legal advice. I also suggest asking them the meaning of the notice.
Donald R Blum, DPM, JD, Dallas, TX
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