Physicians Practice's Ask an Expert is a questions and answer forum featuring leading practice management experts who may or may not be employed by Physicians Practice. On average, Physicians Practice receives 250 questions per month from physicians, office managers, office administrators, and others. Have a question about the operation of your practice? Visit www.PhysiciansPractice.com. Your question will be answered within three business days.
Are small group practices exempt from the requirement to provide interpreters for the deaf? Case law may vary in different parts of the country, but generally, small medical practices are not exempt from Americans with Disabilities Act (ADA) rules requiring interpretation services for patients if those services are needed to communicate medical information. You may want to check with an attorney about your specific circumstances. The ADA regulations say that businesses can be exempted from making accommodations that pose an undue burden or a fundamental alteration to the business. However, the Department of Justice (DOJ) describes "fundamental alteration" as "a modification that is so significant that it alters the essential nature of the goods, services, facilities, privileges, advantages, or accommodations offered." It defines "undue burden" as "significant difficulty or expense." It does not appear from recent case settlements that the DOJ considers losing money on an office visit as an undue burden for a small medical practice. In one instance, a surgeon was required to reimburse an assisted living facility $200 for interpreter services, and in another, an oral surgeon agreed to provide an interpreter for a patient who is deaf and blind after she complained to the government. In both cases, these appear to be small practices. You can read more detail in the "ADA Title III Technical Assistance Manual" at www.usdoj.gov/crt/ada/taman3.html.
For more information about possible tax deductions or tax credits for ADA accommodations that small businesses, including small medical practices, might qualify for, go to www.usdoj.gov/crt/ada/taxpack.pdf.
When a CMA, LPN or RN provides a nonbillable service to our patients and documents what she has done, does this note need to be signed by the physician?
Technically, no. There is no requirement that it be signed. That said, attorneys definitely recommend that all actions be signed off on. I would suggest that you check with your malpractice carrier on the specifics.
I would like to use your series of three collections letters (posted in the Tools area of your Website, www.PhysiciansPractice.com) in my office, but I have been told by my collections agency that if I mention collections more than once in my letters, I am harassing the patient. If I use your letters, am I harassing the patient? Your collections agency is mistaken. I'm assuming that the agency is referring to the Fair Debt Collections Practice Act. You can see a summary of it at:
www.acainternational.org/images/328/yourrightsfdcpa.pdf. As a practice, you don't have to comply with the Act unless you extend credit (charge patients interest or a finance fee) or otherwise act like a collections agency. Ask your agency where they got this information and to show you the source.
I would like to create a wellness program through my practice and market Health Risk Appraisals to local industries and individuals. What CPT code would I use to bill these services? Any suggestions on getting started?Most physicians who do this work have direct contracts with the employers. In such cases, there are no coding issues -- physicians simply send the employer an invoice for the services rendered as agreed upon. If you're interested in establishing an occupational medicine service line, the best thing to do is to contact the benefits offices of your top local employers. Ask to meet with them about their healthcare needs: Do they do pre-employment screening? Physicals for their executives? Negotiate the service, the price, the turnaround time, and the billing. Physicians who do this successfully guarantee quick access, quick turnaround, and top-notch service, but also garner good reimbursement and quick payment.
A competing group at another hospital has been seeing Medicaid patients in the ER. When the patients call that group's office for follow-up appointments, they are told that they cannot be seen because that group does not participate in Medicaid. The patients are then being referred to my group. Isn't the first provider responsible for some period of time after initiating treatment? Unfortunately, no, they are not responsible to provide continuing care to patients they meet in the ER. This is a real problem in communities across the country, particularly as more surgeons cut ties with low-paying payers. More than 50 percent of surgeons do not accept all insurances.
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