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Your Top Questions Answered
Introducing a non-physician practitioner; Depo-Provera shots; TB testing; outsourcing
INTRODUCING A NON-PHYSICIAN PRACTITIONER
Q. I am a solo practitioner, but I am expanding into a second office and will be hiring a nurse practitioner (NP) or physician assistant (PA). How do I turn over my established patients to the new person? I have seen over 10,000 people over the last 23 years, and they have become accustomed to seeing only me on their visits. I never had even a nurse in the office.
A. Here are a couple of ways to introduce your new NP or PA:
Have the new hire accompany you on several office visits so you can formally introduce her to your established patients. Say something like, "Amy here has stellar clinical skills and works under my guidance. She'll also be easier for you to get in to see, and she will have more time than I usually do to chat. So I'd like you to make your next follow-up appointment with her. I'll still see you at regular intervals, of course, to make sure all is well."
Encourage your scheduler to direct patients, as appropriate, to your new employee. Give the scheduler guidelines regarding who should be directed where. You could also give the scheduler a script to help guide her with these patient conversations. You may want her to say, "Dr. Jones doesn't have any openings for three weeks, but he is overseeing a new nurse practitioner who is just great. She is a graduate of XYZ University, has been in practice for X number of years, and all her work is supervised by Dr. Jones. Dr. Jones instructed me to tell all of his established patients that they are welcome to make appointments with her. She has an opening tomorrow. Why don't you see her for this visit?"
You also could invite patients to an open house to meet your new NP or PA. Do so by mailing postcards to your patient base with the new practitioner's photo and credentials. Explain when and where the practitioner will start seeing patients, and invite your patients to meet your new colleague informally at a reception.
Keep in mind that while patients may not be used to an NP or PA in your practice, they likely will have seen them in other offices.
Finally, make sure you've thought through all the related billing and supervisory issues that accompany bringing in a new practitioner. Review articles addressing this topic at www.PhysiciansPractice.com for further guidance.
CODING FOR DEPO-PROVERA
Q. What are the CPT and ICD-9 codes for billing Depo-Provera injections for birth control?
A. According to coding expert Emily Hill, report 90772 (therapeutic, prophylactic, or diagnostic injection - specify substance or drug; subcutaneous or intramuscular) for the administration of the medication. Report the medication (Depo-Provera) in addition to the administration code using HCPCS Level II code J1051 or J1055. The specific code depends on the dosage given.
TB SKIN TEST CODING
Q. How can we bill for reading a tuberculosis skin test? We have two references that seem to disagree. One states that when the test is ordered by a physician, we can code 86580/86585 for administering the test, and then code 99211 for the reading by an RN. Another source states that reading the test is included in procedure codes 86580 and 86585.
A. Emily Hill says 86585 is no longer a valid code. Use 86580 instead. The codes in the laboratory section of CPT include reporting test findings. Therefore, reading the test isn't typically reported separately. However, if you spend significant time with a patient reviewing the results or providing instruction, it would be appropriate to report those activities using an E&M code; you would select the level of E&M codes based on the E&M coding requirements.
DRAWBACKS TO OUTSOURCING BILLING
Q. Can you please list the cons of outsourcing billing?
A. Roughly 17 percent of medical practices outsource their billing, but only 5.66 percent of "better-performing practices" do, according to the Medical Group Management Association's "Performance and Practices of Successful Medical Groups." To decide whether you should outsource or not, you must determine how well your current, in-house billing operation is performing and what it is costing you.
Measure your performance by tracking age trial balance, days in accounts receivable, and total accounts receivable over the past three years. Compare these trends to national benchmarks available from the Medical Group Management Association at www.mgma.com.
Measure your billing costs by tallying your expenses related to telecommunications/phone bills, information systems, space allocation, support staff benefits, and billing supplies. Divide your total revenue by these combined costs. Generally, billing costs eat up from 4 percent to 12 percent of your
revenue.
If you have high costs and low performance, you should certainly consider outsourcing. However, if you have low costs and low performance, your needs may be best served by spending more on your staff and support tools. Don't outsource just to boost performance; the cost may be too much.
Remember that if you do outsource billing, you are still responsible for regulatory compliance. Billing services have been known to change codes to boost collections.
Some other drawbacks to outsourcing to keep in mind include:
Less-expensive billing companies may be happy to have inexpensive staff file claims, but they aren't really interested in having high-paid staff appeal denials. On the other hand, your in-house staff may not be appealing denials either. Someone at a billing company may have better contacts than your staff - but they may also not care to use them. Similarly, some physicians feel that a billing company will never care as much about your income as your staff does. Conversely, I do see plenty of in-house billers who don't exactly seem enthusiastic about their work.
Some billing companies won't give you the data and skill set you need to improve your billing processes. Remember that billing starts with pre-verification at the front desk, not when claims get filed. You need a partner who can help you determine why your claims are getting denied and help you establish processes to fix the problems that occur on your end.
Most people seem to feel this is ultimately a wash - you hate to pay a billing company, but otherwise you'd have to pay staff and benefits. You have to do the analysis to determine what works best for you. Remember, you can't just hand the whole thing off. You still need some staff.
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