Apr 2002 Table of Contents

ASK FPM



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Fam Pract Manag. 2002 Apr;9(4):60.

Discounts for uninsured patients

Q

How can we provide adequate medical care to our uninsured patients without going broke?

A

Our practice offers our uninsured patients a 30-percent discount on all office visits. The discount applies only to the office visit charge; we charge our regular price for medicines and tests associated with the evaluation and management (E/M) service because our profit margin on these items is so small. We simply charge the uninsured patient according to our regular fee schedule and then write off the 30-percent discount.

We notify uninsured patients of the discount policy when they make appointments and require that they pay in full at the time of the visit. Ninety-five percent of them are grateful for the discount and readily pay for their visits at the time of service. This not only enables our uninsured patients to obtain cost-efficient medical care, it also increases our practice’s cash flow. Thirty-five dollars in our cash drawer is much more valuable to our practice than $50 sitting in accounts receivable for three months or more. The 30-percent discount is comparable to the discounts that our managed care contracts obligate us to provide to our insured patients, but we don’t have to wait 15, 30 or even 90 days to collect it.

Covering call for ob/gyns

Q

A solo obstetrician/gynecologist has asked me, a family physician who provides obstetric care, to provide call coverage for her when she’s out of town. What should I do? Are there any liability issues involved?

A

First, you should check with your malpractice carrier to be sure that your insurance coverage is sufficient for such an undertaking. Then, think about what you would do if an ob/gyn patient presented with something beyond your comfort level or abilities, and set up a game plan to deal with those situations. Even after taking these steps, your liability may increase since you are stepping in to cover specialty-level care. For this reason, you might consider limiting your call coverage to normal anticipated births or other services within your current scope of practice.

Billing for patients seen in your absence

Q

As a solo doc, I’ve found several physicians who would be willing to see my patients when I’m gone for a week or so, but it seems like a huge burden for their office to have to register the patients just to get $36.20 from Medicare for a level-II visit. I’d like to contract with one of these physicians to see my patients, provide the physician with a laptop that has the patients’ charts on it, keep any notes or labs generated during that visit in my system and then bill myself based on the other physician’s documentation. Can this be done?

A

Yes. Medicare allows for “reciprocal billing” arrangements that permit you to bill under your provider number for the services of the physician seeing patients in your absence, assuming certain conditions are met. For example, the arrangement can’t continue over a continuous period of more than 60 days, and you will need to attach modifier –Q5 to the service codes on the claims. Your state Medicaid agency and some of your commercial insurers might have similar provisions, but you should check with them to be sure.

For more information about reciprocal billing arrangements, see “How to Get Reimbursed When a Colleague Treats Your Patients,” FPM, June 2000, page 14, or contact the provider relations staff of your Medicare carrier.

Buying into a practice

Q

I’m considering buying into a small group practice with a buy-in arrangement that will cause my income to be reduced substantially for several years. Why would a practice do this?

A

Some practices tie the new partner’s up-front, out-of-pocket purchase to the practice’s tangible assets (equipment, furniture, supplies) only, allowing the physician to “pay for” the receivables and goodwill through a salary reduction over a number of years. They do this to make the deal less onerous for the doctor buying in. Because the buy-in is structured this way, the new partner’s taxable income and up-front, out-of-pocket cost are reduced. To determine the amount of the salary reduction, practices may assign a specific value to the receivables and the goodwill (typically a percentage of gross collections) or just reduce the new partners’ share of net income by an arbitrary percentage (e.g., 30 percent in year one, 20 percent in year two, 10 percent in year three).


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Copyright © 2002 by the American Academy of Family Physicians.
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