Averting common operational & legal pitfalls at your medical practice

Medical practice and legal issues have long been inseparable. History is full of examples wherein practices have run into legal hassles, and eventually been penalized with criminal as well civil charges. Barring some strange cases that have been intentional, physicians have had to pay for what is known as negligence or reluctance to avail medico-legal services. While legal issues surrounding negligent medical services may have severe repercussion on the mere existence of one’s medical practice, issues surrounding medical fees and other operational things may well impede one’s Revenue Cycle Management and the prime source of income besides inviting penalties from the governing authorities. And, it is the latter that we are going emphasize since practices are likely to be more vulnerable to revenue crunch emanating from negligent handling of some of the operational things.

As we try to ponder over some of the routine operational errors to which medical practices are prone, we invariably come across the following ones:

  • Physicians refusing to release medical records on grounds of unrealized fees from patients: While physicians are fully entitled to their fees for medical services, they are not authorized to withhold medical records as long as patients bear the copying or handling charges for medical records. Therefore, it would be legally unwise to withhold patient-pertinent records simply on grounds of non-payment for medical services. Moreover, there are always legal course to redeem your fees from patients in case they are found defaulting.
  • Failure to collect co-pays and deductibles from patients insured under unique insurance schemes: Certain patients’ insurance schemes are attached with co-pays and deductible from patients. Therefore, it is prerogative of the physicians to collect these payments directly from patients. Otherwise, insurance payers are not obliged to make good any loss emanating from physicians’ negligence to exercise right on co-pays and deductibles.
  • Lack of a written agreement in case of physicians’ soliciting external services on their premises: Although, it is common for physicians to enter into an understanding with an external service provider for clinical investigation services, it is always wise to be bound by a contractual agreement for services involving either receipt or payment of monetary value. Such fore-sight would not only save you from the wrath of governing authorities but also safe-guard your revenue flow.
  • Failure to distinguish and credit physicians with certain ancillary or non-ancillary services for federal patients: Often most of the practices make no distinction between certain ancillary and non-ancillary services for which physicians may be credited with. As such injudicious approach may well rob physicians’ off their dues; it could lead to serious repercussion later when found.
  • Falling bait to fancy offers from pharmaceutical representatives, durable medical equipment (DME) companies, or physicians to whom your practice refers: As such tendency is deemed serious violation of healthcare norms, practices would do well to promptly refuse such offers in the first place.
  • Not having valid endorsement for licensed practitioners from the respective state laws: While your practice can employ certain licensed practitioners as medical service providers, yet it is imperative that you obtain a valid endorsement for having complied with supervision agreement from the authority concerned. Such prior approval would go a long way in mitigating any billing issues later on.

While these are commonly observed operational errors with serious legal implications for physicians, they could also be vulnerable to other factors beyond the list highlighted here. Therefore, physicians would do well to stay clear of such erroneous operational practices, which would adversely impact their RCM and revenue generation from medical bill reimbursements. But, in view of physicians finding it difficult anticipate legal implication emanating from these elusive factors, medical billers and coders – having the first-hand knowledge of medico-legal subject – would invariably be physicians’ best bet for the requisite advice. Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S – comes across as a preferred name in outsourced clinical and operational solutions for diverse medical practices.

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