Q I have been contacted by a billing, collection and audit company that has offered to audit all the personal injury claims my practice has submitted during the last two years. The company claims to have two or three patient management codes that it can use to bill retroactively on my behalf. One code they mentioned is 99211, which they say is a daily SOAP note code. We did not bill for these services when we did the billing. Can I bill retroactively?
A Unless you want to provoke an investigation, I would not recommend doing this type of retroactive billing. You should not rebill for old files unless you can substantiate that the work was done (and documented at the time of service), and the omission of the appropriate billing was accidental. The code (99211) you provided as an example is not a daily SOAP note code. It is a “re-evaluation” code.This code should not be overused, since a patient does not necessarily need to be re-evaluated at each visit.
Bear in mind that even if you rely on an outside company to do your billing, collection work, etc., you are still ultimately liable for any mistakes the billing company might make. Before entering into any agreements with a billing company, you should find out if the company has a compliance program in place, and if so, you should ask to see a copy. Also, find out if the company has liability insurance and whether they are willing to indemnify you if they are in error.
Q My partner and I have been approached by a company that performs diagnostic testing — specifically, the company performs nerve conduction tests. The testing company would perform the required test on our patients then sell us the test at a flat fee. We would then bill Medicare as if we had personally performed the test and charge any amount that we considered reasonable. The testing company says this billing approach is perfectly legal. My partner and I are concerned that this may not be quite as easy as the testing company is making it sound. What do you think?
A You are not permitted to bill for the test as if you and your partner had performed the service. Section 4051 of the Omnibus Reconciliation Act of 1987 (OBRA ‘87), more commonly referred to as the “purchased diagnostic test” rule, prohibits a physician who has purchased a diagnostic test from “marking up” the price of that test when billing Medicare Part B. Some, but not all, the tests covered by this rule include ultrasound, cardiac monitoring, EKGs and X-ray testing. You must also identify the supplier of the test to Medicare.
Q I am a chiropractor who does not want to form a multi-discipline practice. Is it possible to merely rent/lease space to a medical doctor? I would then have the option of referring to this medical doctor when my patients require it.
AYou may rent space to a medical doctor. You should have a written lease for a period of no less than one year. The rental value needs to be at fair market value and may not be based on either the amount or volume of referrals generated. The lease needs to specify the days and times the space will be used by the medical doctor. When the medical doctor is using the premises, no one else may use the same premises at the same time.
Ms. Green has been a practicing attorney since 1977. She is admitted to the practice of law in New York and Florida. She has formed numerous integrated practices throughout the country.
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Because this column is being presented to you by an attorney, it would not be complete without a legal disclaimer. This column is provided subject to and governed expressly by the terms of this disclaimer. This column is provided for educational purposes only. The accuracy or timeliness of the information presented herein is not warranted. The information presented herein is not intended to be advice as to a specific fact pattern with which you may be presented. Accordingly, please note that the information contained herein is not being presented as legal advice with respect to any matter and that no attorney-client relationship is hereby established.
