As physicians, we're all faced with making decisions about the purchase of new electronic technology that promises to streamline the efficiency of the practice and significantly reduce our overhead expenses. Vendors ply their products and promise us the sun and the moon, yet few office managers and even fewer physicians know how to evaluate these products.
Amgen has gotten Medicare to pay for limited amounts of Enbrel, the $1,000-a-month rheumatoid-arthritis drug. The coverage, tucked in the new Medicare law that covers drugs for seniors, includes some expensive biotech drugs that patients can inject themselves, such as Enbrel and a rival, Abbott Laboratories' Humira.
Dr. B, with an active dermatology practice, sought to increase revenues in his office. After considering a variety of practice enhancement options, he hired a Web master who designed his new highly interactive Web site.
We get many faxes regarding issues that don't warrant that I dedicate an entire column to their responses. Many of these questions can answered with simple "yes' and "no" answers. I have collected the questions and will dedicate the next few months to answering them. I refer to them as "Dermatology Potpourri." Enjoy!
National Report - For most professionals, accepting another job or retiring involves little more than giving notice and enduring a farewell party or two. Not so for physicians. You have to notify patients, colleagues, employees, insurers, hospitals, and medical boards. You must make appropriate referrals, see that patient records remain accessible, collect accounts receivable, and arrange for continued liability coverage. If you're a solo office-based practitioner, you'll need to find a buyer, hire an associate who will eventually take over, affiliate with another practice, or shut down the business.
In the beginning of Internet marketing, the most important aspect of the strategy was the practice website. Today, in order to capture Internet traffic and manage it, there are five necessary components, including: 1) an effective website; 2) a directory listing; 3) search engine optimization; 4) a commercial e-mail program; and 5) integration and implementation. Without these five components, a practice is missing out on the complete equation.
You have an employee who makes a salary of $480 per week. Your practice has been busy and the employee stays 60 minutes late for a few days to catch up on paper work. You tell the employee to take off a few hours next week to compensate for staying late a few hours. You believe you are being a good employer or office manager by balancing the situation with fewer hours worked the following week.
We've seen sweeping changes in treatments, how medical care is delivered, and how it is paid in 25 years of publishing Dermatology Times.
Q: I have known for quite a while that there are site-specific codes for biopsies. I don't know why I never used them but perhaps I was a little afraid to try something new (new to me, that is).
San Diego - Electronic medical records are more efficient than paper charts, but dermatology practices have been slow to catch on because of its costs, said Lawrence Martinelli, M.D. He said EMRs can actually save time and money for physicians who learn to adapt their office systems and buy only what they need. He spoke at the 41st Infectious Disease Society of America annual meeting here.
It's no big news to anyone doing medical billing that getting paid gets more and more time consuming. It seems that each month carriers devise new schemes not to pay us. The latest one is that CPT code 17000 is denied when billed with another service, but 17003 is paid. When asked why the 17000 code was not paid, carriers state it is bundled into the other surgical service billed, such as 11100. They state they are following CPT guidelines. Where is that written?
Does this sound familiar? Every year at Christmas time, you make a decision to provide a bonus to your employees. You check with your accountant or office manager to see what you gave last year, and you increase the amount from 5 percent to 15 percent, depending on the profitability of the practice.
Dermatologists who administer chemotherapy and other drugs in their offices could see significant reductions in reimbursement levels as a result of an effort by the federal government to curtail Medicare's costs for drugs used to treat cancer.
Las Vegas - Though Medicare reform is the hostage of legislative gridlock, and tort reform is the victim of pre-election year inertia, American Academy of Dermatology President Raymond L. Cornelison Jr., M.D., has at least one piece of positive news for dermatologists. According to Dr. Cornelison, the AAD's recently formed Ad Hoc Task Force on Skin Care for Developing Countries, in conjunction with the Centers for Disease Control (CDC), in Haiti has begun an initiative providing for volunteer dermatologists to train primary care givers to treat filoriasis.
Despite the trend over the past decade for the formation of larger and larger group medical practices, more than 70 percent of dermatologists still practice in one- or two-doctor offices. For a time, young physicians shied away from becoming solo practitioners, but once again, more are considering the possibility of starting or taking over solo dermatology practitioners.
Q: Is there a way for me to charge for dressing changes in my office?
Physicians, including dermatologists, would face a 4.2 percent cut in Medicare reimbursement levels if a proposed payment update published in August by the Centers for Medicare & Medicaid Services (CMS) takes effect.
Q: I recently saw a minor patient's mother in our office. The minor patient is under my ongoing care for acne. I spent approximately 15 minutes reviewing the patient's condition, prognosis, and various options for treatment including Accutane therapy. I also provided the mother with several new prescriptions for her son. Should I bill this to the insurance company under the mother's name or under the patient's name?
The January FDA clearance of Biogen Inc.'s Amevive (alefacept) for thetreatment of moderate-to-severe chronic plaque psoriasis officially usheredin the era of biologic treatments for dermatologists. Amgen Inc.'s biologic,Enbrel (etanercept), FDA-cleared for treating psoriatic arthritis, has alsobeen prescribed (off-label) for psoriasis. Amevive, administered by IM injectionor IV infusion in the physician's office, is purchased directly from Biogenby the physician or institution while self-injected Enbrel is purchasedby the patient at the pharmacy.
The January FDA clearance of Biogen Inc.'s Amevive (alefacept) for the treatment of moderate-to-severe chronic plaque psoriasis officially ushered in the era of biologic treatments for dermatologists.
Q: As HIPAA moves ahead at full speed, it has brought my attention to many other issues in our practice ?? among them chart audits. We have four physicians and two physician assistants in our practice. I plan to perform chart audits personally but don't know where to start. How do I get started?
As Congress moves toward possible approval of a new prescription drug program for Medicare recipients later this summer, how payments for cancer drugs and therapeutic services are determined may well hang in the balance.
Q: Recently it seems I am getting a significant number of patients whose appointments are very time-consuming. Although I can quickly ascertain their chief complaints, do the examination, and determine the treatments, it takes a long time to go over the various diagnoses, the treatment options, and risks. Frequently, I go over the information two or three times before I can leave the exam room. I'm unclear about billing visits based on time. Must I meet the regular documentation criteria in addition to charting the time I spent? How is time documented? Do I count the time spent with the patient during the entire encounter or do I separate out the time I spent discussing diagnoses, treatment options, etc.?
Q: I am aware that there are several "site specific" biopsy codes that can be used by dermatologists, such as biopsy of the ear (69100), penis (54100), eyelid (67810) and lip. My question regards the CPT code 40490 (biopsy of the lip).
There are signs that House Republicans and the Bush Administration may be preparing to pull out the stops to pass malpractice reform legislation this year as a way to placate physicians who face another projected reduction in Medicare reimbursement levels next year.
