Q I manage a multi-specialty practice, and I am very concerned that all billing be done properly. In order to be sure services are being billed correctly, I have instructed the billing staff to under-bill or not bill at all when there is doubt concerning the proper code. Do you think this is a good idea?
A I understand your rationale, but this type of coding, done on a regular basis, could be construed as an inappropriate discount. For instance, assume a patient is required to pay a 20% co-pay. If you bill $80 for a service that should be billed at $100, the patient is required to pay only a $16 co-pay instead of a $20 co-pay. Therefore, this $4 differential may be viewed as a discount, and you may be violating the anti-kickback laws. Your best bet is to talk to a coding expert and bill for the appropriate amounts. With the proper advice, you will get reimbursed and you will not be violating any laws.
Q I have a difficult time collecting co-payment from my patients. They claim they have forgotten their checkbooks, don’t have enough cash on them, or they tell my staff they should not have to pay the co-pay because I am being paid by the insurance company. What do you recommend?
A Have your front office staff explain to patients when they call to arrange an appointment that the co-pay is due at the time of treatment. Collect the co-payment before you see the patients. Some of your patients will complain, but they are probably the ones who are not paying you anyhow.
Q I’m starting a new practice and will be hiring a chiropractor to work for me. I need advice concerning the patients’ records. How do I deal with them?
A You should: • Find out what the record retention statutes are in your state. Medicare requires you to keep records for seven years, but different states require retention from two to 30 years. Before disposing of any records, you should advise the patient that you have the records, and upon payment of a reasonable copying and postage fee, you will forward the records to the patient.
- Never alter records, especially if you have been sued.
- Document everything, even minor issues. Make sure not to use pencil, since it can fade over time. If you do not document at the time you are rendering the service, your records will not be complete, because it is impossible to remember everything that transpired between you and your patient. Your professional employees must also document everything. If a professional employee quits, you must be able to determine what services were performed for patients by the employee.
- Sign everything, and have your professional employees sign for the services they have performed. There is no way to prove a service was performed if the documents have not been signed.
- If you store your records off-site, make certain the storage area is clean, dry and accessible.
- Scan your records or convert them to microfilm if that is permitted in your state.
Q A lot or my patients are automobile accident victims and are covered by “no-fault.” Although my documentation is complete and submitted in a timely manner, the insurance carriers are frequently late paying my bills or they arbitrarily deny certain claims. What can I do?
A Unfortunately, you are not alone. These types of delaying tactics by insurance companies are widespread. If you belong to a chiropractic association, I suggest you speak to other members to determine if there are certain insurance companies that are more notorious for this type of practice than others. If so, I suggest you all get together and have your association bring a complaint on your collective behalf to either the insurance department in your state or the attorney general, whichever is appropriate. Also, many states impose stiff penalties, including the payment of interest and attorneys’ fees, against insurance companies when they do not pay claims on a timely basis. Look into the regulations in your state and proceed accordingly. As long as the insurance companies find it profitable to engage in delaying tactics, it’s likely they will continue to do so. s
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 and acts as counsel to a number of multi-discipline practice consulting firms.
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.