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What are the penalties for violating the privacy regulations of the Health Insurance Portability and Accountability Act (HIPAA)? Section 1176 of the Act sets limits for penalties. Specifically, it says penalties may not exceed $100 per person per violation and $25,000 per person per year for violations of a single standard. Section 1177 establishes penalties for any person that "knowingly uses a unique health identifier, or obtains or discloses individually identifiable health information." Those penalties include: (1) A fine of not more than $50,000 and/or imprisonment of not more than 1 year; and (2) if the offense is ``under false pretenses,'' a fine of not more than $100,000 and/or imprisonment of not more than five years. If the offense is with intent to sell, transfer, or use individually identifiable health information, the Office for Civil Rights is responsible for enforcement.
Should I use a coding "cheat sheet" or summary form to help physicians document correctly--or at least to document in a way that supports the codes they bill for?
Summary forms are a good way to educate physicians about the level of documentation needed to support coding levels, but they should not take the place of full, independent, patient-specific documentation. In fact, the Center for Medicare and Medicaid Services, formerly the Health Care Financing Administration, has suggested that Medicare peer review organizations stop accepting "boilerplate coding summary forms as a substitute for physician documentation in the medical record." Their concerns apparently stem from the fear that such forms steer physicians toward high-paying codes. Of course, boilerplate documentation also can negatively impact patient care. If, for example, a physician is merely expected to check a box to signify that he checked a patient's major systems, he is discouraged from writing a full report on what he found. On such forms there often literally isn't any room to provide patient-specific notes. In short, you should avoid "checkbox" forms at all times. Use of more loose guidelines is fine, especially as an educational starting point. Eventually, though, physicians should understand coding and documentation well enough to be able to produce records without such aids.
We are thinking about providing billing services to other physician offices. Is it legal to base your rates on a percentage of collections?
It's not only legal to price billing service based on a percent of collections--it's standard. Still, there are important issues to consider before moving ahead with this plan. According to expert attorney Alice Gosfield of Philadelphia-based Gosfield & Associates, almost all billing companies charge clients based on a a percentage of collections, and the 1980 preface to the billing agent regulations explicitly acknowledges that approach. However, the regulations do add that if the billing agent negotiates--in other words, can cash the checks--then the payment cannot be based in any way on a rate that reflects volume of collections. "Cashing" the checks means cashing the payments yourself that you would receive on behalf of the practice. A lockbox directly into the client practice's account would allow you to avoid "cashing" them. Keep in mind, too, that one physician group doing billing for another raises issues that a plain old billing company would not have to face. For example, if the customer physicians get referrals from the billing company physicians then a percentage is really no good. There may be some antitrust issues as well. In short, we suggest you discuss this with an attorney if you move forward.
Our clinic is next to the hospital lab. We often ask that patients needing blood work walk next door after their appointment. Many times, they never go. What can we do to make sure patients comply?
Implement some checkpoints to remind and encourage patients to have lab work done: Hand the patient a bright-colored card with bold writing: "Please have your blood drawn before checking out." Have the checkout staff look for lab orders and remind patients to have their blood drawn. Do a survey or study to see if patients are leaving just because the wait was too long or they can't find the lab. If the draw station sees scheduled patients, consider a chair used solely for patients who have just been seen by a physician. That individual deserves some courtesy; she probably is spending more time and money in the practice than someone just having blood drawn. Consider a phlebotomist floater who draws specimens in the exam rooms before the patient leaves. A signal or sign at the exam door could indicate a blood draw is necessary. However, be careful that patients don't end up using exam space that could otherwise be more productive. Also, make sure you do not bill for services that were not rendered. If the physician orders tests on a superbill or requisition that is, in turn, used as a charge ticket, the practice can end up charging for services although no results will ever appear in the medical record. This is a definite danger zone.
In order to measure physician productivity at our teaching institution, we convert their actual work RVUs to a clinical FTE of one. To determine clinical FTE percentage, we take the number of hours spent in clinical activities and divide by the total hours worked. But what do we do about
For clinical full-time equivalency, time on call spent in actual patient care counts toward productive time. Time on the phone and time in the hospital counts, but time spent sleeping while the beeper is sitting on the bureau doesn't. Accounting for trauma call is tough. Physicians should get some credit for their efforts because they are giving up something (time at home) to be on call even though they're not doing direct--or indirect--patient care. For example, you might count time on trauma call, but not spent on patient care at 50 percent. So, if the physician is on trauma call for 12 hours and spends six of that in direct or indirect patient care and the other six sitting around in the lounge, he could be credited with nine work hours. For more background, according to the American Academy of Medical Colleges, a clinical full-time equivalent is: "Aggregate percentage of time spent in direct patient care activities for all full-time and part-time compensated faculty members; activities include time devoted to capitated contracts, indigent and professional care, supervisory attending, and clinical or ancillary services, in addition to direct patient care and consultation where a patient bill is generated or a fee-for-service equivalent charge is recorded".
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