Fam Pract Manag. 1999 Jan;6(1):55.

Medicaid and “teaching physician” rules


Our hospital attorneys told us that we must use the Medicare “teaching rules” for all the Medicaid patients seen by our family physician residents. What is your take on that?


State Medicaid programs often adopt Medicare rules and regulations, since both programs operate as government entitlements with at least some federal funding. Thus, it is possible the Medicaid program in your state has adopted the Medicare teaching physician rules for its own purposes. To confirm whether this is required under Medicaid in your state, contact the state office responsible for the Medicaid program.

PCPs and Stark II


Recently, a group of surgeons, internists, other specialists and I, a family physician, got together to create an ambulatory surgical center (ASC) for our community. However, our consultant told us that primary care physicians cannot participate with surgeons according to the Stark II law. Can you explain this?


Nothing in Stark II prevents primary care physicians from participating with surgeons in ASCs, but this doesn't mean that they should not be concerned with Stark II at all. Remember that Stark II prohibitions concern referrals.

The law does not prohibit joint ownership arrangements. In order for Stark II to apply, three factors must be present: You must have a Medicare or Medicaid patient referral, it must be to an entity with which you (the referring physician) or an immediate family member has a financial relationship, and it must be for a designated health service. Even if all three elements are met, Stark II is not violated if a specific exception applies.

The concern for the primary care physician who is a co-owner of an ASC with surgeons is that this co-ownership will create a financial relationship between the physician and the ASC and may create one between the physician and the surgeon based on the broad definition of “financial relationship” under Stark II.

While joint venturing among various medical specialties in ASCs may create concerns about Stark II compliance that will need to be examined, Stark II does not flatly prohibit such arrangements.

Who can sign your prescriptions?


If a physician has prescribed medication for a patient, can a nurse or medical assistant who works in the physician's office sign the prescription form with the physician's name?


No. Nobody should sign a physician's name on a prescription form except the physician. Written prescriptions must be signed by the authorized practitioner.

Practitioners who sign a physician's name to a prescription when they are not authorized to prescribe medication may be charged under state law with the unauthorized practice of medicine. They may also be violating the federal Controlled Substances Act, which states that the prescribing practitioner must “manually sign” prescriptions. Licensed practitioners, such as nurses, may also be disciplined for performing an act that exceeds the scope of their professional practice.

In some states, physicians who enable this practice may be subject to disciplinary action by the state licensing board for aiding a person in the unauthorized practice of medicine. Moreover, state law in many jurisdictions makes it a crime to forge or alter a prescription.

Tracking ED use


How can I find out how many of my patients went to an emergency room last year? Many of them are covered by different insurance companies and go to different hospitals. I don't see how my staff could identify the numbers. Any ideas?


It may be prohibitively difficult to get a complete list, but a few phone calls can get you a long way. You can contact the insurance companies that cover your patients and ask them for the information for a specific period. You can also contact the medical records departments at the hospitals where you have privileges, and ask them to print a list of your patients who have used the emergency department (ED). The list should show you the specific dates of ED use as well as the reasons for the visits.

In the future, you can track your patients' ED use as the paperwork from the ED arrives in your office. Establish a system of entering the information on a tracking form (or in a computer database) as well as in the patients' charts.

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Copyright © 1999 by the American Academy of Family Physicians.
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