Practice Management

Societies can help with Medicare matters and with private insurance companies

Pharmaceutical manufacturers have long been under scrutiny for the methodsthey employ in marketing their products to physicians. Now, increasing concernthat drug makers are winning physician favor by deeply discounting chemotherapymedicines is placing those physicians under the microscopes of federal andstate authorities.

Only six states in the union have patient populations, physicians, and health care systems that are not suffering some degree of hardship caused by skyrocketing costs of medical liability insurance, according to the American Medical Association.

New codes established for catheterization and bladder ultrasound forresidual urine

Q How do I charge for a bladder scan for residual urine using thenew 2003 CPT code (51798 ) if I am using an "imaging" ultrasound?

Fee schedule will apply endoscopic reduction rules to cystoscopy andother CPT codes

As most urologists know, new federal standards have been established to ensure the privacy of patients' health information as part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. In my September 2002 article, I presented limited information on HIPAA and its impact on physicians' practices, including the standards for the electronic transmission of health care transactions and the rules associated with implementation.

Denison, TX-A non-existent cap on non-economic medical liabilitydamages and the disproportionate number of high jury awards in the country'slargest state have physicians wondering if relief will ever come, even withlegislation in the works.

Philadelphia-The City of Brotherly Love has what many say is theleast friendly climate for physicians when it comes to medical liabilityinsurance. Insurance and reimbursement problems, however, are statewidephenomena in Pennsylvania. In Scranton, located in the northeastern cornerof the state, a seven-urologist group has said it will decide in Januarywhether to close.

Q. We see a lot of patients who are physicians and do not require themto pay co-pays. There are no enticements involved, but they do not haveany financial difficulties. At a seminar, I heard that you should collectthe co-pays but that you could choose not to collect the co-insurance. Therefore,should we start charging the physicians their co-pays?

But new rate schedule will reduce reimbursement for some drugs, devices,and procedures

With HIPAA compliance for the electronic transmission of health care data still looming, most urologists will have to modernize their practices by changing or significantly modifying their practice management information system (PMIS).

Urologists across the country are reporting an average increase of 39% in their medical liability insurance rates for the most current premium year.

Hicksville, NY-Nuclear Associates offers the Urological Radiation Shield, which has been shown to reduce the exposure of radiation dose from scatter by 70%. After the patient has been positioned on the table, the support rail is attached and the shield is slid onto the rail so it hangs in front of the patient, between the radiation source and the surgeon. This shielding system allows maximum radiation protection to be maintained, according to the company.

An astounding article in this issue of Urology Times details how oneurologist quit all commercial insurance participation, then "optedout" of Medicare-and is not only surviving, but thriving. Mike Harris, MD, a well-trained, board-certified, respected urologistin Traverse City, MI, said "Enough is enough!" and did somethingabout it. He no longer exists in any private insurance carrier databaseand likewise does not appear anywhere on the Medicare radar screen.

Ex-urologists say they wanted to escape reimbursement woes, pursue morefulfilling careersMedicine is a commitment. Pre-med, medical school, internship, residency,and building a reputation in academia or in community practice adds up toa self-imposed promissory note that can take a decade, perhaps two, to payoff. This is why it is unusual when an established physician opts to changecareers.

New Products as presented in the July 1, 2002 issue of Urology Times

What are the benefits of PVP to the urologists?

Technologies are currently available or in development to make use of real-time wireless technology, which can be applied to the office practice of medicine and is affordable to large and small practices. Using wireless technology, physicians can have access to data on their patients anytime and anywhere.

System based on average sales price would reduce overpayments, membersof Congress sayWashington-Convinced that physicians are somehow ripping off Medicareby overcharging for prescription drugs, members of Congress are workingto find a solution. The eventual result could be restrictions on drug charges,combined with improvements in reimbursement levels for some cognitive services.

Q How can I code cysto with double-J stent replacement to receivea higher reimbursement? Medicare states that 52315 is bundled with 52332.I have used ­59 and ­58 and still do not receive reimbursement for52315.

Most urology practices evaluate their staffs' performance at least annually. The physician manager or office manager meets with the employees and evaluates their productivity and achievement of goals.

Patients' rights, regulatory reform, and research funding are still underconsiderationWashington-With a 5.5% decrease in Medicare reimbursement rates now inplace for 2002, urologists and other specialty groups are hoping to convinceCongress to quickly reduce those cuts and act on other issues importantto them, as well.

Make sure vendors have experience with urology practices and are HIPAAcompliantIn the new age of medicine, electronic medical records (EMR) systemswill transform the way you practice. Last month, I discussed the benefitsof EMR and its ability to facilitate many of the goals common to all practices-efficiency,correct coding, Medicare and HIPAA compliance, and improved outcomes. Inthis column, I will discuss how to select an EMR system, including productfeatures, vendor support, and cost.

As of January 4, the final Stark II rules became effective. These federalregulations will have a profound effect on the relationship between urologypractices and the Medicare and Medicaid programs. Their impact extends farbeyond lithotripsy, which has been the primary concern of many urologists,to virtually every aspect of their practices. Practices that have not conformedto the requirements of these new regulations are exposed to financial penaltiesand other severe sanctions.

It's time to add electronic medical records, or EMR, to the list of buzzwordscommon in medical practices today. This new technology, although in itsinfancy, has the opportunity to facilitate many of the goals common to allpractices-efficiency, correct coding, Medicare and HIPAA compliance, andimproved outcomes. We are in a new age of medicine, and EMR technology willtransform the way you practice.

Q Can you please clarify the tax ramifications associated with long-termcare insurance?

Attention to reimbursement, billing/collection, and accounts receivablewill boost cash flow

Oak Park, IL-Cunningham Group has launched a new insurance plan thatoffers complete protection to medical practices, hospitals, clinics, andother health care providers that bill Medicare and Medicaid. The new plan,called MediKey, takes the guesswork out of coding and protects medical earningswith special low-cost billing errors and omissions (E&O) insurance availableto those who enroll in the compliance plan. This combined approach enablesproviders to qualify for the E&O insurance at a favorable rate, thecompany says.

Washington-A sweeping new proposed federal regulation dealing with hospital outpatient compensation would change Medicare payments for specific medical procedures and tighten rules governing new technology payments, a move that could adversely affect urologists. The regulation from the Centers for Medicare & Medicaid Services CMS) would apply to services furnished on or after January 1, 2002.