Doctors Q & A
Q. I have been working with a broker to find a new office location and expect to receive a lease shortly. What legal issues should I consider while I am reviewing the lease?
A.
As a physician and business owner, selecting the right office location is one of the most important business decisions you will make. Many good physicians are prevented from developing or retaining their optimal patient base due to an inconvenient location, inadequate parking, unattractive or unkempt common areas, signage limitations, etc. After you have narrowed the playing field and selected a good location, it is critical that you understand some of the key terms of the lease you will be asked to consider and sign. |more...|
Q. I received a document called “fee negotiation agreement” from MultiPlan. MultiPlan states that it is working for a payer and is asking me to accept a reduced fee for services rendered. What are my options?
A. MultiPlan, Meridian Resource Company, LLC, Global Claim Services and the like are referred to as “cost containment” or “fee negotiation” companies. The payers pay these companies a fee if a provider agrees to accept a reduced payment for services rendered. Therefore, these companies are often quite assertive and have an incentive to minimize your payment. |more...|
Q. While I submitted a claim to a payer more than 3 months ago, I still have not received payment. My office staff has called the payer and it has confirmed that it has all the information it needs to pay the claim, yet explains (in not so many words) that there is a backlog. This is not the first time I’ve experienced this problem with this payer and it seems to happen more often when the charge amount is high. What can I do?
A. Payers make mistakes, ‘misplace’ submitted claims and sometimes intentionally delay reimbursement. This loss of claims and intentional payment delays is most prevalent with smaller regional payers. The law empowers you to demand timely payment and you should not hesitate to assert your rights. Most states have a statute or administrative regulation that requires health insurance payers to pay claims within a specified period of time. These statutes are often referred to as the “prompt payment” statutes. |more...|
Q. I am a new pediatrician struggling to grow my practice. I recently retained a local marketing firm and they have encouraged me to promote my practice by: (1) Sending thank you letters containing small tokens of my appreciation (e.g., gift certificates to a local restaurant) to physicians who refer patients to my practice; (2) Giving new patients a free subscription to Highlights® magazine; (3) Sending existing patients a birthday card containing a two dollar bill or silver dollar; and (4) Obtaining a patient mailing list from a colleague who is nearing retirement. I love these ideas, but are there any legal issues I should consider?
A. Yes, as you are selecting the optimal marketing strategy, there are important legal issues you should consider. In this increasingly competitive health care environment, it is crucial to think ‘outside the box,’ however, you want to make certain that this thinking is not also ‘outside the law.’ |more...|
Q. I keep hearing about “NPI.” What is it and do I really need to obtain one?
A. Section 1173(b) of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires the Secretary of Health and Human Services to develop a system whereby each health care provider and practice could be identified by a unique health identifier. This requirement is based upon the belief that such a national identifier will improve the efficiency and security of claims submission and data exchange. In response to this congressional mandate, the Secretary created the National Provider Identifier, which is also known as the “NPI.” |more...|
Q. I am a New Jersey family physician. One of my nurses recently discovered that a patient of our practice is a registered sex offender. This patient has an appointment for next week and my office staff is very concerned. I am deciding how to respond. Is there anything that prevents me from terminating my relationship with this patient? If I decide not to terminate my relationship with this patient, what are my legal responsibilities concerning my staff?
A. There are more than 500,000 registered sex offenders in the United States and every state has a law requiring some form of sex offender registration. New Jersey is the birthplace of “Megan’s Law” and it has been in the forefront of protecting the public from sex offenders. New Jersey’s statute requires high risk sex offenders to register with the appropriate governmental authorities. In turn, the State directly notifies local residents regarding new registrants and also posts such information on a publicly accessible website. As such, the information is certainly in the public domain, but the question becomes what can and/or should you do with this information. |more...|
Q. I regularly waive my clients' Medicare Part B co-insurance and deductible payments. However, a colleague recently told me that waiving Medicare co-insurance and deductible payments may violate the law. Is it really against the law to waive such payments?
A. Yes. The Anti-kickback Statute, 42 U.S.C. Sec. 1320a-7b(b), states that a physician may not knowingly solicit, receive, offer or pay any remuneration (directly or indirectly), in cash or in kind, with respect to the referral of a patient or the furnishing of any service to a patient for which payment may be made under a federal health care program. The violation of this federal law is a felony offense and can result in significant monetary penalties and imprisonment. |more...|
Q. I received an invoice from my malpractice insurance carrier. According to the invoice, my insurance premium has increased by almost $3,500. I am a good doctor and have never been sued. I can’t understand how the insurance company can charge me this much money for coverage. Is there anything I can do to reduce my malpractice insurance costs?
A. While I don’t know the specifics of your situation, the answer could well be “yes.” It is important to put your increase in perspective. According to data compiled by a recent congressional advisory commission, medical malpractice premiums have increased by an average of 11.6% per year since 1975. If these numbers hold true for 2005, that would place your anticipated increase this year at $2,320 (assuming a 2004 premium of $20,000). Moreover, increases vary widely from specialty-to-specialty; therefore, your increase may be, more-or-less, in line with the average increase. |more...|
Stephen A. Snyder, Esq.
Vice President/General Counsel
Disclaimer: The information contained within the MTBC® Legal Corner is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Legal Corner does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances