Q One of the doctors who works for me is taking time off to have a baby. How do I bill Medicare in her absence?
A You may have a locum tenens arrangement for services provided by a substitute doctor to your Medicare patients, provided that you comply with the following:
- The substitute doctor must be paid on a per diem or fee-for-time basis, and the arrangement may not exceed 60 continuous days.
- The modifier Q6 must be listed on Item 24d of the HCFA-1500 claim form.
- The substitute doctor’s unique physician identification number (UPIN) must be listed on Item 23 of the HCFA-1500 claim form; the regular doctor’s name must continue to be reported in Item 24k.
- You may identify the substitute doctor by entering the substitute doctor’s number on the HCFA form and cross-referring the entry to the appropriate service line item(s) by number. Make sure you keep a record of each service provided by the substitute doctor, which is associated with the substitute doctor’s UPIN. Such records should be available for review by the carrier at the carrier’s request.
- If your practice furnishes items and services “incident to,” such items and services will still be covered if furnished under the substitute doctor’s supervision.
Q I’ve heard about the HIPAA privacy regulations but I’m not sure what they are or how they relate to me. I have a very small practice; is this something I need to worry about?
A On April 14, 2001, the government issued its final regulations for maintaining the privacy of medical information. These regulations will go into effect on April 14, 2003. They are part of the rights and responsibilities created under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
These regulations apply to various types of health-related entities, including, but not limited to, doctors and their business associates that electronically maintain or transmit health information.
Patients have five new rights regarding the use and disclosure of their protected health information:
- Notice: Patients have a right to notice of the uses and disclosures of their protected health information by you; their individual rights; and your legal duties.
- Access: Patients have the right to access, inspect and copy their records.
- Amendment: Patients have the right to request that you amend their protected health information.
- Additional Restrictions: Patients may request additional restriction of your use and disclosure of their protected health information, although you need not agree.
- Accounting: Patients have the right to receive an accounting of a specific class of disclosures of their protected health information made by you during the preceding six years.
Additionally, the regulations require the patient’s written consent before his or her protected health information may be disclosed for purposes of treatment, payment or health-care operations. Even after obtaining this authorization, only the minimum amount of information necessary may be disclosed.
These are the minimum requirements established by the government. If your state’s laws are less strict than these HIPAA regulations, the HIPAA regulations will apply. If your state’s laws are stricter than HIPAA, then your state’s laws will prevail.
If you fail to comply with these privacy regulations, the patient may file a complaint against you with U.S. Department of Health and Human Services, which may result in criminal or civil penalties filed against you by HHS. Failure to comply with a single standard may result in a $100 fine per violation, up to $25,000 per year. Criminal penalties of a $50,000 fine and jail time up to one year may be imposed if you knowingly obtain or disclose individually identifiable health information.
If the offense is committed “under false pretenses,” the fine may be up to $100,000, and a three-year jail term may apply. If the offense was committed with the expectation of commercial advantage, personal gain or malicious harm, the fine may be raised to $250,000, and potential jail time may be up to 10 years. Additionally, the patient could sue for for mental distress and anguish in addition to any actual damages sustained by the patient as a result of the violation.
Make sure that you implement a compliance plan before April 14, 2003, that can protect you from potential HIPAA liability.
Ms. Green has been a practicing attorney since 1977. She is admitted to the practice of law in New York and Florida.
LEGAL DISCLAIMER
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.
