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Query: Are We Mandated to Accept Obamacare Patients?


I just received my Massachusetts renewal and licensure information. The last paragraph states participation in medical assistance programs is a condition of renewing. I found it very interesting that the effective date is October 1, 2013. It also states, "the board will post further details about this requirement on its website within the next few months". Are any other podiatrists in different states getting the same thing? Does this mean we are bound to accept Obamacare patients?


Bryant Tarr, DPM, Sudbury, MA

Other messages in this thread:



Query: EHR Charging for Medical Records


I have been with the same EHR company (Success EHS by Greenway) for over 10 years. They are sunsetting the EHR at the end of the year. They wanted me to stay with their recommended EHR product which I did not like. Now, I switched EMRs with a different company and they want to charge me 14K for all of my patient records. Is this legal? I have paid them a percentage every month for practice management and billing.  


Name Withheld


Editor's Comment: PM News does not provide legal advice. The answer may lie in the contract agreement you signed when you bought the EHR. The lesson to be learned is to always anticipate the possibilty that you may someday switch to a different EHR system and negotiate accordingly. Among the negotiated items are a liquidated damage clause if you end your contract prematurely and a clause that assures that the data provided to you will be in a "useable" format. 



Query: HIPAA Implications of Windows 7 Support Ending


For those using Windows 7, you are likely aware that Microsoft will no longer provide support for that OS early in 2020. Aside from support issues, what are the HIPAA implications?


Mark Aldrich, DPM, Antigo, WI



Query: Recommendation for Malpractice Carrier


I have been in practice for more than 10 years. I have had 5 claims, out of which only one was settled. The rest have been dropped. My insurance company is going to drop me, claiming that I am high risk for them (I have cost them 120K). I want to know what carriers are out there that anyone can recommend.


Name Withheld



Query: Orthotics as Part of Revenue 


I recently was approached by an orthopedic group for employment. We have gotten to the contract negotiation stage, but we have gotten hung up on the fact that they will not use orthotic revenue as part of either the base threshold or bonus compensation. Their reasoning is that it is a Stark violation because it is not a personally-provided service. Their legal team informed them that it would fall into the category of DME. They are a large orthopedic group and I would expect many referrals for orthotics and braces.


Does anyone have an opinion on the calculation of orthotics as part of revenue towards a base threshold or even a bonus structure?


Name Withheld



Query: Sun Setting Medical Records in Pennsylvania


My hospital, that has been maintaining EMR records from my previous EMR system, is retiring the server. What are my obligations as far as length of time maintaining access to those records, for adults and particularly for minors? I practice in Pennsylvania. 


Editor's comment: PM News does not provide legal advice: According to Pennsylvania statute § 563.6 "Medical records whether original, reproductions or microfilm, shall be kept on file for a minimum of 7 years following the discharge of a patient. (b) If the patient is a minor, records shall be kept on file until his majority, and then, for 7 years or as long as the records of adult patients are maintained."



Locum Tenens and Long-term Coverage


A podiatrist in town will be medically disabled for at least six months and needs coverage for his office to try to maintain some income and keep his patient base. I and others are willing to keep some of his hours and his office open for him but do not want to risk running afoul of CMS, etc. We are looking for information regarding locum tenens (is it a total of 60 days per physician or can we have separate physicians for 60 days each?) and also the ability to see patients in HIS office which would be a new place of service for us (does this require a new POS and CMS 850 form?).  


Name Withheld


Editor’s comment: PM News does not provide legal advice. Services provided by an individual locum tenens cannot exceed a continuous period of more than 60 days. Each podiatrist can have a turn as a locum tenens. Claims payment is made under the name and billing number of the physician or the practice that hired the locum tenens physician. Every claim must have a rendering provider, so the practice would still use his or her name and NPI with modifier Q6 -  services furnished by a locum tenens physician appended to the procedure code to indicate the service was furnished by a locum tenens physician.


The practice must keep on file a record of each service furnished by the locum tenens physician, with his or her NPI or Unique Provider Identification Number (UPIN).


Source: LuAnn Jenkins, AAPC



Query: Secondary Office Locations


I have read on numerous sites that if a podiatrist is set up in a medical room, beauty salon, or other location where they are attending to patients specific to that location (for instance, a high rise senior citizen apartment building where the only patients seen would be from that high rise), that the podiatrist must 1) register this address with Medicare as an office location and 2) must pay a reasonable rent. Are these "suggestions" or is this actually a law/rule/regulation? Would the same apply if treating patients at adult daycare facilities? 


Richard A. Simmons, DPM, Rockledge, FL



Query: Posting Surgical Procedure Videos on Social Media 


In this current Dr. Pimple Popper world, I’m seeing an increase on podiatry office Facebook sites of surgical procedures. I’d like to know if posting videos of our procedures could lead to a liability issue.


Olga Luepschen, DPM, Sebring, FL 


Editor's Comment: PM News does not provide legal advice. In order to steer clear of HIPAA and state privacy laws, make sure the patient is not identifiable. In addition, it is recommended that you get a signed release from the patient.



Query: Duty to Inform


I know there are many circumstances in which this is allowable, but when do I have to step in and inform family members (HIPAA) or authorities?


George Jacobson, DPM, Hollywood, FL


Editor's comment: PM News does not provide legal advice. A HIPAA-covered entity may disclose PHI to law  enforcement without the individual’s signed HIPAA authorization in certain incidents, including: "To report PHI to a law enforcement official reasonably able to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public." If you reasonably believe that your patient's driving presents a threat to public safety, It is not a breach of HIPAA regulations. Whether you have a duty to make such a report would vary under state laws. You might also consider having a conversation with your patient about the potential danger posed to him/herself and others.


Source: CMS



Query: HIPAA and Death


How long after a patient's death does the privacy protection continue? I'm afraid to even admit someone was a patient.


Larry Aronberg, DPM, Lake Worth, FL


Editor's comment: PM News does not provide legal advice. "The HIPAA Privacy Rule protects the individually identifiable health information about a decedent for 50 years following the date of death of the individual. This period of protection for decedent health information balances the privacy interests of surviving relatives and other individuals with a relationship to the decedent, with the need for archivists, biographers, historians, and others to access old or ancient records on deceased individuals for historical purposes. During the 50-year period of protection, the personal representative of the decedent (i.e., the person under applicable law with authority to act on behalf of the decedent or the decedent’s estate) has the ability to exercise the rights under the Privacy Rule with regard to the decedent’s health information, such as authorizing certain uses and disclosures of, and gaining access to, the information. 


With respect to family members or other persons involved in the individual’s health care or payment for care prior to the individual’s death, but who are not personal representatives, the Privacy Rule permits a covered entity to disclose the relevant protected health information of the decedent to such persons, unless doing so is inconsistent with any prior expressed preference of the deceased individual that is known to the covered entity."





Query: HIPAA-Compliant App?   


I’ve attended lectures discussing being HIPAA-compliant with patient photos being stored on physicians' smart phones. A close friend has a client who is a world renowned surgeon and uses an app called “Secret Calculator Photo Album” to store his patient photos in his phone. He states this app is HIPAA-compliant. I cannot confirm the validity of being compliant with HIPAA regulations but it would be worth looking into. If anyone can verify this, it would be helpful to many. 


Jack Ressler, DPM, Delray Beach, FL



Query: Purging Patient Charts


I am having a company come out to shred old patient charts, EOBs, and other various insurance information. I understand you are required to keep charts for seven years. I would like to be able to shred  charts and patient information from the year 2012 and before. Can all of the charts from 2012 be disposed of since technically it won't be seven years from 2012 charts dated April 2012 forward? Does it go by calendar year or actual time?


Name Withheld


Editor's comment: PM News does not provide legal advice. The seven year time period for retaining charts is not a legal requirement; it is a widely espoused recommedation of practice management experts. Medicare, for example, has a five-year lookback period, and state requirements fo retaining records vary.



Query: Must Patients Supply Social Security Numbers  


I just had a patient refuse to give an entire ss#, and only gave the last 4 digits. Am I breaking any law if I accept that for my records? 


Larry Aronberg, DPM, Lake Worth, FL


Editor's comment: PM News does provide legal advice. Given the rise of identity theft, Medicare and most (if not all) insurance companies no longer use a patient's Social Security number on their insurance card. Therefore, unless there is a legitimate need for the number, such as using a company to finance a medical bill, a patient is not required to provide a Social Security number. On the flip side, if the patient refuses to provide identifying information and you feel s(he) is at risk of not paying your bill, you are under no obligation to accept the patient. 



Query: Termination Letters from UnitedHealthcare


Recently, some of my patients that have UnitedHealthcare are presenting us with letters they have received from UnitedHealthcare stating "RE: Notice of Termination-Physician will no longer be in UnitedHealthcare network beginning 3/31/19." The letter further states that I "will no longer participate in the UnitedHealthcare network" and "you should choose another physician within the UnitedHealthcare network." 


Our office checked with UnitedHealthcare and we have NOT been terminated and can offer no explanation why these letters were generated. Before I move forward with resolving this disturbing and damaging situation to my practice, I would like to know if anyone else has experienced a similar problem with UnitedHealthcare.


Ron Freireich, DPM, Cleveland, OH 



Query: Is a DEA Number Always Necessary? 


I just received notice that my DEA number is up for renewal. I have done research and have even asked some pharmacists about the need for having a DEA number. The short answer is that if you do not prescribe narcotics, a DEA number is not necessary. My NPI number is all that is really needed. I am semi-retired and do not have the need to prescribe pain medication. I do not do surgery anymore and only use NSAIDs or other non-narcotic medications for pain. What is the general consensus as to the need for having a DEA number? Is there anyone else who still practices and prescribes medications without a DEA number?


Jack Ressler, DPM, Delray Beach, FL 



Query: Dealing with a Patient who Makes Physical Overtures Toward Staff?


One of my male patients made some physical overtures (tried to touch) my office manager. She was quite offended and after he left, she came to me to complain. How should such an event be handled in the future?


Name Withheld



Query: Expert Witness Fees for Personal Injury Cases


What are the typical charges for a deposition (hourly), expert witness in court, full or half day, and records review?


David Kahan, DPM, Sacramento, CA


Editor's comment: PM News does not provide legal advice. Expert witness fees vary by location and the qualifications of the expert. It's important to note that expert witnesses are not paid for their testimony, but rather for the loss of income that they would earn if they practiced during the time they were in court. According to the SEAK Expert Witness Directory, the median  hourly fee for file review/preparation for all medical expert witnesses is $350.



Query: Access to Records After Leaving a Practice


Are there any HIPAA violations if a doctor leaves a practice but has read-only access to the software that contains both his and the other doctors' patients? I assume if the doctor does not share any information he sees with other patients, then it is not an issue?


Peter J. Bregman, DPM, Las Vegas, NV


Editor's note: PM News does not provide legal advice. If a podiatrist leaves a practice, he loses all access to patient records except for those patients whom he has previously treated.



Query: VA Parity by Title Only?


With the passing of the VA Provider Equity Act, which made podiatrists in the VA system equal with other physicians, parity in pay as well should have followed. This did not happen at my VA hospital. We were informed via email, without any explanation as to why, or even who, made the decision for no parity pay for podiatrists at my VA. My understanding is that VA podiatrists at other VA hospitals did, indeed, get parity pay increases. Can anyone shed light on this disparity?


Estelle Albright, DPM, Indianapolis, IN



Query: Universal Format for Radiographic Evaluation?


After reading x-rays, I list the findings in a paragraph titled “radiographic evaluation” which is in the patient's note. I have been doing this for years. In another area titled "plan," I list the views and location where the x-rays were taken.


I just had to refund monies for an x-ray evaluation because my information didn't meet the standards set forth by the AAOS Bulletin dated Jan/Feb 2007, which listed that the interpretation must include views, anatomic location, diagnosis, reason for the x-ray, and interpretation. This information is to be listed in a separate document.


Does anyone have experience with this situation? Is there a universal format which meets this criteria?


Frank DiPalma, DPM, Athens, GA



Query: Plantar Fasciitis and Workers Compensation


I have been requested by a Workers Comp attorney to comment on plantar fasciitis and job requirements. The patient is a 33 year old, obese but healthy woman who worked at the post office where she stands and walks daily on hard floors.There was no history of trauma. I saw her two years ago but conservative care failed, and she declined surgery or other modalities, and left work. I haven’t seen her in two years, but get the impression from the attorney’s letter that she is still suffering from plantar fasciitis. The contention is that the onset of this condition was work-related, even if work contributed even minimally. The attorney states it is established Federal law that if work contributed even “minutely” to a condition, it may be stated to be a case of Workers Compensation.


There are so many things contributory to plantar fasciitis such as equinus, pronation, lack of shock absorption, body weight, and walking surface. This is not a place for “opinion” as much as fact. Does anyone know of any recent literature, or perhaps other rulings or studies? Is there anything besides opinion, since we see overweight people with PF as well as thin people, sedentary people as well as active ones, runners, and non-runners.



Query: Requests to Trim Fingernails


I have recently been receiving an increase in requests from family members of my homebound geriatric house call patients to "trim" their fingernails. Have any of my colleagues been presented with these requests as of late? If so, would they share their thoughts or experience with this?  


Maryann Trivlis, DPM  Belle Harbor, NY


Editor's comment: PM News does not provide legal advice. In New York (as well as other states), a podiatrist is limited in scope which does not include the trimming of fingernails. Medical malpractice does not cover treatments which are out of scope. Additionally, cutting fingernails could subject one to professional discipline.



RE: Undoing Damage from Dismissed Allegations

From: Name Withheld


I had a board complaint [against me] during the time that the Texas Podiatric Medical Board (TPMB) was moved to the Texas Department of Licensing (TDLR). I was notified of the complaint but advised I could not have any further information and the 'prosecutor' would evaluate the case. I asked for the information, stating they could remove the complainant’s name, but the TDLR claimed that under the statue, I was not entitled to that information. Several weeks later, I received a letter that stated "the complaint was resolved and it was found to be without merit – dismissed." 


Later in the year, however, when applying to a hospital the 'allegation of complaint' showed up in the hospital's search of the data bank and other entities. My question is this: if an allegation is made against you and it is dismissed as unfounded, why should the allegation be reported to entities where you are trying to apply for hospital staff membership and to insurance companies? It seems very unlawful to me, but I'm not a lawyer. Any help or advice appreciated.


Name Withheld


Editor's comment: PM News does not provide legal advice. According to the National Practitioner Data Bank (NPDB), "If you are the subject of an NPDB report, you may add or edit a statement at any time to provide any additional information you would like included with the report. However, you may not modify, correct, or void the report - only the reporting entity listed in Section A of the report is permitted to do so.


Your Subject Statement becomes part of the report and remains with the report unless you (the subject of the report) edits or removes it. The statement is sent to the reporting entity listed in section A of the report, all queriers who received a copy of the report within the past three years, and is included in future query responses." 



Query: "Permanent and Stationary" Under Workers Comp 


I have been an employee for an HMO for over 30 years that banned nail grinders due to lung health risks. I have been debriding toenails with nail clippers exclusively for the past 4 years, at about 18-24 patients per day, 5 days a week. During the past 4 years, my right hand became so painful that I could no longer bend my thumb and developed a trigger index finger. I just had surgery about 9 weeks ago to release the tendon sheaths and I am supposed to go back to work in late March; however, my hand still swells and is stiff. 


I was told by the Work Comp doctor that at the next visit in late March if I am not better by then that I would be considered "permanent and stationary"--which means I will be...


Editor's note: Name Withheld's extended-length query can be read here.



Query: Destruction of X-Ray Films


I have many old x-ray films that I need to dispose. What is the best way?


David Chung, DPM, Aloha, OR

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