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Fam Pract Manag. 2005 Jan;12(1):58.

Breaking up with Medicare

Q

I want to disenroll from Medicare, but I have been unable to find answers to some basic questions. Can you direct me to some sources that will explain this process?

Several resources provide information about disenrolling as a physician under traditional Medicare and privately contracting with Medicare beneficiaries. First, the Medicare rules related to private contracting are spelled out in some detail in section 3044 of Part 3 of the Medicare Carriers Manual. You can find section 3044 online at http://www.cms.hhs.gov/manuals/14_car/3b3026.asp#r1639_1. Second, FPM has published some articles that discuss private contracting (see “How to Opt Out of Medicare,” November/December 2003, page 15; and “The Truth and Consequences of Private Contracting,” March 1998, page 25). Third, American Medical News has published two articles on the particulars of private contracting with Medicare beneficiaries. Those articles may be found online at http://www.ama-assn.org/amed-news/2002/12/09/bica1209.htm and http://www.ama-assn.org/amed-news/2003/01/06/bica0106.htm.

Protecting patients’ info over the phone

Q

My practice is reviewing our privacy policies and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA). Do we need to be able to definitively identify a patient over the phone before discussing protected health information (PHI)? If so, can you recommend a reasonable process?

The HIPAA privacy rule does not specifically require a process for verifying the identity of a patient when discussing his or her PHI over the telephone. However, it does require the practice to take “appropriate and reasonable” actions to protect the use and disclosure of patient PHI. Therefore, it would seem prudent to establish and use some type of process for verifying patients’ identities.

A number of processes could be used to verify a patient’s identification over the telephone. Each involves the use of a unique identifier. The chosen identifier should be prominently displayed on the patient file, whether electronic or paper, for easy reference by the practice staff. The level of control that should be applied to patient identifiers should be “reasonable,” meaning they should not be easy for an unauthorized person to acquire and use.

Examples of unique identifiers include birth date, the last four digits of the Social Security number, child’s birth date, date of last visit, last four numbers of the driver’s license number and mother’s maiden name.

The policy and procedure to establish and guide the use of the identifier should be simple and designed to easily assist the staff in responding appropriately to a telephone call from a patient. Remember, the patient has a right to get the information. The process should not offend, but rather assure the patient that the practice does not give out confidential information to just anyone.

Coupons come with consequences

Q

I am planning to market my dermatology capabilities, particularly cryosurgery. I would like to either offer patients a coupon for discounted skin treatment procedures or a coupon for a discount at a third-party business, such as a local restaurant, to those who use this service. I have heard that offering coupons like these could be considered fraud by the Centers for Medicare & Medicaid Services. Is that true?

Unfortunately, offering items of value to your patients for less than fair market value is a complex area fraught with trouble. Several standards apply. First, under the federal anti-kickback statute, it could be a felony to provide any item with the intent to induce an individual to obtain services from your practice or to refer individuals to your practice. Second, if you offer a Medicare beneficiary an item that is likely to induce him or her to come or return to your practice, the federal civil monetary penalties law could be applied against you, resulting in serious fines.

The government has stated that gifts with a value of less than $10 individually, and less than $50 annual aggregate, are acceptable. Other than such gifts, the only allowable benefits are waivers of cost-sharing amounts based upon financial need or reasonable collection efforts and certain incentives to promote preventive care services. Many states have standards that apply as well.

Whether the item was for services at your practice or from a restaurant or other third party would not be a significant factor (except in the case of preventive services). You should contact your local attorney for more information and advice prior to implementing your ideas.

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

 

 

Copyright © 2005 by the American Academy of Family Physicians.
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