From Physicians Practice, Inc. Q. One of our big payers recently told us that it will be requiring additional group coverage information on claims that may not be available on the patient's insurance card. We will have to call the plan administrator prior to filing the claim to get this information. Of course, there are no plans to send beneficiaries new cards that would include the needed data points. What can I do? I can't afford to have staff on the phone all day.
A. One suggestion is to track the time you spend on this and bring it up when you renegotiate, saying you'll need more pay to recover the hassle factor — not a great solution, but it's something. You certainly can contact other practices in your area and circulate a petition requesting a change in policy, new beneficiary cards, or at least easy Web access to the information. You also could try to make it a nuisance for them by calling to request all numbers for all patients coming in all of next week in one sitting. Or call your rep and ask her for the info every time you need it, just to get the point across. Consider a letter to your state insurance commissioner and state medical society with formal complaints copied to your rep and whoever is in charge of provider relations at the corporate level. In other words, be the squeaky wheel. Q. What has been your experience with practices offering discounts to self-pay patients? They are the only ones paying full price and the ones who can least afford it. How do practices manage this? A. Most practices seem to offer an across-the-board discount to self-pay patients if payment is in full at the time of service. The discounts range from 10 percent to 30 percent. You certainly could write a policy that says the discount applies if people pay at least half up front and take with them an envelope and invoice for the other half due in 30 days. Your billing costs are low and it makes sense. Many also have a discount policy or sliding scale for poor patients. You can base this on poverty levels in your region. See www.ocpp.org/poverty. You are allowed to offer discounts, but because you don't want payers to see this as your "usual and customary" fee, you should not go below your lowest discounted rate or below Medicare. You also should have a written policy on any discounts, and follow it to the letter. You can't have patients claiming that you treat some preferentially. Q. Our physicians are extremely busy and often spend a great deal of time at the hospital during office hours. The partners and a nurse practitioner see each other's patients. Who should bill for the services rendered, the primary doctor or the one who provides the service? Can reciprocal billing arrangements between the partners apply to this situation? A. For most payers, the norm is that whoever provides the service bills it and that reciprocal billing only applies to call sharing. Q. How many surgeries should the average surgical schedulers be able to schedule per year? A. We don't have any data on this one, and don't know anyone who does. If you are concerned about productivity, I'd go step by step through the process with your scheduler — from consent to authorization all the way through to the day of surgery — and look for ways to improve the process. Measure how many surgeries she schedules now and set a timeline and expectation for improvement. Of course, much of her success will depend on the flexibility and responsiveness of the hospital scheduler. And remember, she can only schedule surgeries that the physicians in your practice plan to perform. Be careful not to hold her accountable for things she can't control. Copyright © 2005 Physicians Practice Inc. http://www.physicianspractice.com/ All rights reserved. Republication or redistribution of Physicians Practice content, including by framing, is prohibited without prior written consent. Physicians Practice shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. | 
