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Fam Pract Manag. 2001 Apr;8(4):52.

Part-time malpractice premiums

Q

Can physicians who work part time get lower malpractice premium rates?

It depends on your malpractice carrier's terms and policy requirements. Some carriers may offer reduced rates based on the number of hours the physician works (e.g., a physician working 25 to 29 hours a week gets a 10 percent discount, one who works 18 to 24 hours a week gets a 20 percent discount, and so on). Other carriers may not specifically offer a discounted rate but, upon request, will perform a review to determine whether a reduction can be offered. And some carriers won't offer discounted rates at all because accurately tracking the status of the physician's actual hours is too difficult for them.

Contact your insurance carrier, agent or broker to find out how they define “part-time” employment and what types of discounted rate schedules they offer, if any.

Defining repricing

Q

Can you explain what “repricing” means?

Repricing, or discounting, occurs when the physician signs a participation agreement with an intermediary (typically a PPO). The intermediary then sells access to the participating physicians (the network) to multiple payers at a per-member, per-month rate that allows the payers to receive discounted services from the physicians. Profits for the intermediary and savings for the payer are high; the physician gets lower reimbursement.

Some agreements call for the physician to send claims to the intermediary, who marks out the physician's fee and writes in the discounted amount per the physician's participation agreement before sending the claim on to the payer. But the more prevalent repricing method is for the intermediary to simply provide each payer with the repricing allowables electronically.

Workers' comp claims

Q

Who is responsible for determining whether a patient's problem qualifies for workers' compensation? If I submit to a private insurer a claim for services that are due to a work-related injury, have I broken the law?

Although most private insurance companies do perform limited routine screens for workers' comp claims, the process involves little more than evaluating the HCFA-1500 claim form. Therefore, they do depend on physicians accurately filling out the HCFA-1500 form, which specifically asks whether the patient's injury is related to employment. Although you're not in a position to determine whether workers' comp benefits are available, you should be able to determine whether an injury is work-related after obtaining the history of the present illness.

The law prohibits knowingly filing a false claim (see the fine print on the HCFA-1500 claim form). Most private insurer contracts exclude workers' comp services. If you're reimbursed for services you determine after the fact to have been due to work-related injuries, you must refund the payments to the insurer.

Routinely asking patients about workers' comp and other secondary payers contributes to efficient, accurate claims filing, which results in benefits beyond reimbursement for an individual claim and may protect the practice from investigation, fines and penalties.

Practice administrator vs. office manager

Q

What distinguishes a practice administrator from an office manager?

A practice administrator usually works in a larger practice, has higher-level skills and responsibilities and earns more than an office manager.

Typically, practices need a practice administrator when they grow to somewhere between six and 10 physicians. The complexity of organizations this size makes them best run by either a higher-qualified administrator or a physician willing to trade some patient-care hours for administrative duties.

A practice administrator should handle liaison duties with other entities, verify profit-and-loss statements and suggest and carry out strategic plans when needed. He or she should have some administrative authority over physicians and nearly full administrative authority over support staff. Administrators often have a college degree plus advanced education or experience.

Office managers typically earn $35,000 to $45,000 per year, while administrators can earn up to as much as a physician.


* Denotes member of FP Assist, the AAFP's online clearinghouse for consultants and attorneys.


 

Copyright © 2001 by the American Academy of Family Physicians.
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