In this issue I’ll address some miscellaneous questions that I’m frequently asked on my fax hotline. These queries are not necessarily coding questions, but they certainly do pertain to front-office functions.
Q: Are we allowed to discuss account balance information with a parent if the patient is over the age of 18 years, as long as no clinical information is released?
A: For a person who is over the age of 18, regardless of who pays for the health care (for example, the patient pays for health himself or parents pay for the health care), account balance information may only be discussed with a parent if the practice’s Privacy Practices Notice states that information regarding treatment, payment or healthcare operations may be discussed with the parent.
Q: Can we discuss account balance information with a patient’s spouse, as long as no clinical information is released?
A: Generally, the Health Insurance Portability and Accountability Act (HIPAA) prohibits the disclosure of information that would indicate that a person is even a patient in your practice — much less discussing specifics about the care or costs. Unless your Privacy Practices Notice indicates that a patient’s spouse may be informed about the patient’s Protected Health Information (PHI), including account balance
information, any such discussions are prohibited.
Q:Can you discuss financial information with third parties as long as no clinical information is released?
A: If the financial information relates to carrying out treatment, payment or healthcare operations, then the information may be disclosed pursuant to a disclosure in the Privacy Practices Notice. The Privacy Practices Notice should state that certain financial information regarding the treatment, payment and healthcare operations may be disclosed to third parties. However, make sure you have such disclosure permission before any information is disclosed.In all three questions above, disclosure on the phone is risky because you cannot verify the identity of the person with whom you are speaking versus having the patient appear in person. In-office disclosure (although not practical) is recommended because you can ask the patient in person for identification to substantiate his or her true identity. Disclosure over the phone is especially risky with third parties. Individuals could identify themselves as insurance carriers, but may really be attorneys or other entities not entitled to have access to the PHI.
In summary, a practice may disclose financial information with respect to payment, treatment or healthcare
operations to parents, spouses or third parties as long as notice of such specific disclosures is provided by the patient in a Privacy Practices Notice (45 C.F.R. 164.502).
If the account balance information relates to treatment information, payment or healthcare operations, it may be disclosed in accordance with the practice’s Privacy Practice Notice. If the practice wishes to disclose financial information other than for carrying out payment, treatment or healthcare operations, it may be disclosed provided that the patient signs an authorization that specifies the type of disclosure and to whom it will be made (45 C.F.R. 164.508).
Q: We have two buildings that are separated by a driveway. The medical practice owns both buildings, although they have different postal addresses. In one of the buildings, we perform Mohs surgery and complex reconstructions after skin cancer surgery. In the other building, we see clinical patients.
If the Mohs surgeon is doing surgery in Building A and we have nurses and PAs seeing patients in Building B, can we bill the services rendered by the nurses and PAs as incident-to the services of the Mohs surgery in Building A? (There would be no other doctors onsite supervising the staff except for the Mohs surgeon.) Would this qualify and meet the definition of direct supervision?
A: Medicare regulations require that services provided “incident to” the physicians’ services by auxiliary personnel, such as a nurse, may only be billed if they are “directly supervised”. “Direct supervision” means that a physician is “present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.”
(42 C.F. R § 410.32(b)(3)(ii)). Direct supervision requires that the service be provided in a building with the same postal address. (42 C.F.R. §411.352; 66 F.R. 856, 889.)
Since the scenario in your question indicates that the physician is in one building with one postal address and the auxiliary staff is in a building with another postal address, it is impossible for the physician to be in the same “office suite” and meet the “direct supervision” requirement. Common ownership of the buildings does not affect the analysis. However, if another physician or provider from the same group practice is “present in the same office suite,” then that group practice physician may “directly supervise” the auxiliary staff.
One interesting note to make regarding your question, however, is your inclusion of a PA as rendering services “incident to.” Since it is evident by the aforementioned regulations that you must have a physician at each postal address in order to meet the direct supervision criteria, you could use your physician assistant to fulfill that role. If your PA is credentialed with the various plans and has his/her own Medicare provider number, then the PA can bill under his or her own provider number and act as the supervising provider for your auxiliary staff.
In short, the services would be billed out under the PA’s name and number. Be sure that you have carefully investigated the scope of services allowed by a PA in your state and for those plans with which you are contracted.
In this issue I’ll address some miscellaneous questions that I’m frequently asked on my fax hotline. These queries are not necessarily coding questions, but they certainly do pertain to front-office functions.
Q: Are we allowed to discuss account balance information with a parent if the patient is over the age of 18 years, as long as no clinical information is released?
A: For a person who is over the age of 18, regardless of who pays for the health care (for example, the patient pays for health himself or parents pay for the health care), account balance information may only be discussed with a parent if the practice’s Privacy Practices Notice states that information regarding treatment, payment or healthcare operations may be discussed with the parent.
Q: Can we discuss account balance information with a patient’s spouse, as long as no clinical information is released?
A: Generally, the Health Insurance Portability and Accountability Act (HIPAA) prohibits the disclosure of information that would indicate that a person is even a patient in your practice — much less discussing specifics about the care or costs. Unless your Privacy Practices Notice indicates that a patient’s spouse may be informed about the patient’s Protected Health Information (PHI), including account balance
information, any such discussions are prohibited.
Q:Can you discuss financial information with third parties as long as no clinical information is released?
A: If the financial information relates to carrying out treatment, payment or healthcare operations, then the information may be disclosed pursuant to a disclosure in the Privacy Practices Notice. The Privacy Practices Notice should state that certain financial information regarding the treatment, payment and healthcare operations may be disclosed to third parties. However, make sure you have such disclosure permission before any information is disclosed.In all three questions above, disclosure on the phone is risky because you cannot verify the identity of the person with whom you are speaking versus having the patient appear in person. In-office disclosure (although not practical) is recommended because you can ask the patient in person for identification to substantiate his or her true identity. Disclosure over the phone is especially risky with third parties. Individuals could identify themselves as insurance carriers, but may really be attorneys or other entities not entitled to have access to the PHI.
In summary, a practice may disclose financial information with respect to payment, treatment or healthcare
operations to parents, spouses or third parties as long as notice of such specific disclosures is provided by the patient in a Privacy Practices Notice (45 C.F.R. 164.502).
If the account balance information relates to treatment information, payment or healthcare operations, it may be disclosed in accordance with the practice’s Privacy Practice Notice. If the practice wishes to disclose financial information other than for carrying out payment, treatment or healthcare operations, it may be disclosed provided that the patient signs an authorization that specifies the type of disclosure and to whom it will be made (45 C.F.R. 164.508).
Q: We have two buildings that are separated by a driveway. The medical practice owns both buildings, although they have different postal addresses. In one of the buildings, we perform Mohs surgery and complex reconstructions after skin cancer surgery. In the other building, we see clinical patients.
If the Mohs surgeon is doing surgery in Building A and we have nurses and PAs seeing patients in Building B, can we bill the services rendered by the nurses and PAs as incident-to the services of the Mohs surgery in Building A? (There would be no other doctors onsite supervising the staff except for the Mohs surgeon.) Would this qualify and meet the definition of direct supervision?
A: Medicare regulations require that services provided “incident to” the physicians’ services by auxiliary personnel, such as a nurse, may only be billed if they are “directly supervised”. “Direct supervision” means that a physician is “present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.”
(42 C.F. R § 410.32(b)(3)(ii)). Direct supervision requires that the service be provided in a building with the same postal address. (42 C.F.R. §411.352; 66 F.R. 856, 889.)
Since the scenario in your question indicates that the physician is in one building with one postal address and the auxiliary staff is in a building with another postal address, it is impossible for the physician to be in the same “office suite” and meet the “direct supervision” requirement. Common ownership of the buildings does not affect the analysis. However, if another physician or provider from the same group practice is “present in the same office suite,” then that group practice physician may “directly supervise” the auxiliary staff.
One interesting note to make regarding your question, however, is your inclusion of a PA as rendering services “incident to.” Since it is evident by the aforementioned regulations that you must have a physician at each postal address in order to meet the direct supervision criteria, you could use your physician assistant to fulfill that role. If your PA is credentialed with the various plans and has his/her own Medicare provider number, then the PA can bill under his or her own provider number and act as the supervising provider for your auxiliary staff.
In short, the services would be billed out under the PA’s name and number. Be sure that you have carefully investigated the scope of services allowed by a PA in your state and for those plans with which you are contracted.
In this issue I’ll address some miscellaneous questions that I’m frequently asked on my fax hotline. These queries are not necessarily coding questions, but they certainly do pertain to front-office functions.
Q: Are we allowed to discuss account balance information with a parent if the patient is over the age of 18 years, as long as no clinical information is released?
A: For a person who is over the age of 18, regardless of who pays for the health care (for example, the patient pays for health himself or parents pay for the health care), account balance information may only be discussed with a parent if the practice’s Privacy Practices Notice states that information regarding treatment, payment or healthcare operations may be discussed with the parent.
Q: Can we discuss account balance information with a patient’s spouse, as long as no clinical information is released?
A: Generally, the Health Insurance Portability and Accountability Act (HIPAA) prohibits the disclosure of information that would indicate that a person is even a patient in your practice — much less discussing specifics about the care or costs. Unless your Privacy Practices Notice indicates that a patient’s spouse may be informed about the patient’s Protected Health Information (PHI), including account balance
information, any such discussions are prohibited.
Q:Can you discuss financial information with third parties as long as no clinical information is released?
A: If the financial information relates to carrying out treatment, payment or healthcare operations, then the information may be disclosed pursuant to a disclosure in the Privacy Practices Notice. The Privacy Practices Notice should state that certain financial information regarding the treatment, payment and healthcare operations may be disclosed to third parties. However, make sure you have such disclosure permission before any information is disclosed.In all three questions above, disclosure on the phone is risky because you cannot verify the identity of the person with whom you are speaking versus having the patient appear in person. In-office disclosure (although not practical) is recommended because you can ask the patient in person for identification to substantiate his or her true identity. Disclosure over the phone is especially risky with third parties. Individuals could identify themselves as insurance carriers, but may really be attorneys or other entities not entitled to have access to the PHI.
In summary, a practice may disclose financial information with respect to payment, treatment or healthcare
operations to parents, spouses or third parties as long as notice of such specific disclosures is provided by the patient in a Privacy Practices Notice (45 C.F.R. 164.502).
If the account balance information relates to treatment information, payment or healthcare operations, it may be disclosed in accordance with the practice’s Privacy Practice Notice. If the practice wishes to disclose financial information other than for carrying out payment, treatment or healthcare operations, it may be disclosed provided that the patient signs an authorization that specifies the type of disclosure and to whom it will be made (45 C.F.R. 164.508).
Q: We have two buildings that are separated by a driveway. The medical practice owns both buildings, although they have different postal addresses. In one of the buildings, we perform Mohs surgery and complex reconstructions after skin cancer surgery. In the other building, we see clinical patients.
If the Mohs surgeon is doing surgery in Building A and we have nurses and PAs seeing patients in Building B, can we bill the services rendered by the nurses and PAs as incident-to the services of the Mohs surgery in Building A? (There would be no other doctors onsite supervising the staff except for the Mohs surgeon.) Would this qualify and meet the definition of direct supervision?
A: Medicare regulations require that services provided “incident to” the physicians’ services by auxiliary personnel, such as a nurse, may only be billed if they are “directly supervised”. “Direct supervision” means that a physician is “present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.”
(42 C.F. R § 410.32(b)(3)(ii)). Direct supervision requires that the service be provided in a building with the same postal address. (42 C.F.R. §411.352; 66 F.R. 856, 889.)
Since the scenario in your question indicates that the physician is in one building with one postal address and the auxiliary staff is in a building with another postal address, it is impossible for the physician to be in the same “office suite” and meet the “direct supervision” requirement. Common ownership of the buildings does not affect the analysis. However, if another physician or provider from the same group practice is “present in the same office suite,” then that group practice physician may “directly supervise” the auxiliary staff.
One interesting note to make regarding your question, however, is your inclusion of a PA as rendering services “incident to.” Since it is evident by the aforementioned regulations that you must have a physician at each postal address in order to meet the direct supervision criteria, you could use your physician assistant to fulfill that role. If your PA is credentialed with the various plans and has his/her own Medicare provider number, then the PA can bill under his or her own provider number and act as the supervising provider for your auxiliary staff.
In short, the services would be billed out under the PA’s name and number. Be sure that you have carefully investigated the scope of services allowed by a PA in your state and for those plans with which you are contracted.
