Podiatry Management Online


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Query: Dealing with a Patient who Makes Physical Overtures Toward Staff?


One of my male patients made some physical overtures (tried to touch) my office manager. She was quite offended and after he left, she came to me to complain. How should such an event be handled in the future?


Name Withheld

Other messages in this thread:



Query: HIPAA and Death


How long after a patient's death does the privacy protection continue? I'm afraid to even admit someone was a patient.


Larry Aronberg, DPM, Lake Worth, FL


Editor's comment: PM News does not provide legal advice. "The HIPAA Privacy Rule protects the individually identifiable health information about a decedent for 50 years following the date of death of the individual. This period of protection for decedent health information balances the privacy interests of surviving relatives and other individuals with a relationship to the decedent, with the need for archivists, biographers, historians, and others to access old or ancient records on deceased individuals for historical purposes. During the 50-year period of protection, the personal representative of the decedent (i.e., the person under applicable law with authority to act on behalf of the decedent or the decedent’s estate) has the ability to exercise the rights under the Privacy Rule with regard to the decedent’s health information, such as authorizing certain uses and disclosures of, and gaining access to, the information. 


With respect to family members or other persons involved in the individual’s health care or payment for care prior to the individual’s death, but who are not personal representatives, the Privacy Rule permits a covered entity to disclose the relevant protected health information of the decedent to such persons, unless doing so is inconsistent with any prior expressed preference of the deceased individual that is known to the covered entity."





Query: HIPAA-Compliant App?   


I’ve attended lectures discussing being HIPAA-compliant with patient photos being stored on physicians' smart phones. A close friend has a client who is a world renowned surgeon and uses an app called “Secret Calculator Photo Album” to store his patient photos in his phone. He states this app is HIPAA-compliant. I cannot confirm the validity of being compliant with HIPAA regulations but it would be worth looking into. If anyone can verify this, it would be helpful to many. 


Jack Ressler, DPM, Delray Beach, FL



Query: Purging Patient Charts


I am having a company come out to shred old patient charts, EOBs, and other various insurance information. I understand you are required to keep charts for seven years. I would like to be able to shred  charts and patient information from the year 2012 and before. Can all of the charts from 2012 be disposed of since technically it won't be seven years from 2012 charts dated April 2012 forward? Does it go by calendar year or actual time?


Name Withheld


Editor's comment: PM News does not provide legal advice. The seven year time period for retaining charts is not a legal requirement; it is a widely espoused recommedation of practice management experts. Medicare, for example, has a five-year lookback period, and state requirements fo retaining records vary.



Query: Must Patients Supply Social Security Numbers  


I just had a patient refuse to give an entire ss#, and only gave the last 4 digits. Am I breaking any law if I accept that for my records? 


Larry Aronberg, DPM, Lake Worth, FL


Editor's comment: PM News does provide legal advice. Given the rise of identity theft, Medicare and most (if not all) insurance companies no longer use a patient's Social Security number on their insurance card. Therefore, unless there is a legitimate need for the number, such as using a company to finance a medical bill, a patient is not required to provide a Social Security number. On the flip side, if the patient refuses to provide identifying information and you feel s(he) is at risk of not paying your bill, you are under no obligation to accept the patient. 



Query: Termination Letters from UnitedHealthcare


Recently, some of my patients that have UnitedHealthcare are presenting us with letters they have received from UnitedHealthcare stating "RE: Notice of Termination-Physician will no longer be in UnitedHealthcare network beginning 3/31/19." The letter further states that I "will no longer participate in the UnitedHealthcare network" and "you should choose another physician within the UnitedHealthcare network." 


Our office checked with UnitedHealthcare and we have NOT been terminated and can offer no explanation why these letters were generated. Before I move forward with resolving this disturbing and damaging situation to my practice, I would like to know if anyone else has experienced a similar problem with UnitedHealthcare.


Ron Freireich, DPM, Cleveland, OH 



Query: Is a DEA Number Always Necessary? 


I just received notice that my DEA number is up for renewal. I have done research and have even asked some pharmacists about the need for having a DEA number. The short answer is that if you do not prescribe narcotics, a DEA number is not necessary. My NPI number is all that is really needed. I am semi-retired and do not have the need to prescribe pain medication. I do not do surgery anymore and only use NSAIDs or other non-narcotic medications for pain. What is the general consensus as to the need for having a DEA number? Is there anyone else who still practices and prescribes medications without a DEA number?


Jack Ressler, DPM, Delray Beach, FL 



Query: Expert Witness Fees for Personal Injury Cases


What are the typical charges for a deposition (hourly), expert witness in court, full or half day, and records review?


David Kahan, DPM, Sacramento, CA


Editor's comment: PM News does not provide legal advice. Expert witness fees vary by location and the qualifications of the expert. It's important to note that expert witnesses are not paid for their testimony, but rather for the loss of income that they would earn if they practiced during the time they were in court. According to the SEAK Expert Witness Directory, the median  hourly fee for file review/preparation for all medical expert witnesses is $350.



Query: Access to Records After Leaving a Practice


Are there any HIPAA violations if a doctor leaves a practice but has read-only access to the software that contains both his and the other doctors' patients? I assume if the doctor does not share any information he sees with other patients, then it is not an issue?


Peter J. Bregman, DPM, Las Vegas, NV


Editor's note: PM News does not provide legal advice. If a podiatrist leaves a practice, he loses all access to patient records except for those patients whom he has previously treated.



Query: VA Parity by Title Only?


With the passing of the VA Provider Equity Act, which made podiatrists in the VA system equal with other physicians, parity in pay as well should have followed. This did not happen at my VA hospital. We were informed via email, without any explanation as to why, or even who, made the decision for no parity pay for podiatrists at my VA. My understanding is that VA podiatrists at other VA hospitals did, indeed, get parity pay increases. Can anyone shed light on this disparity?


Estelle Albright, DPM, Indianapolis, IN



Query: Universal Format for Radiographic Evaluation?


After reading x-rays, I list the findings in a paragraph titled “radiographic evaluation” which is in the patient's note. I have been doing this for years. In another area titled "plan," I list the views and location where the x-rays were taken.


I just had to refund monies for an x-ray evaluation because my information didn't meet the standards set forth by the AAOS Bulletin dated Jan/Feb 2007, which listed that the interpretation must include views, anatomic location, diagnosis, reason for the x-ray, and interpretation. This information is to be listed in a separate document.


Does anyone have experience with this situation? Is there a universal format which meets this criteria?


Frank DiPalma, DPM, Athens, GA



Query: Plantar Fasciitis and Workers Compensation


I have been requested by a Workers Comp attorney to comment on plantar fasciitis and job requirements. The patient is a 33 year old, obese but healthy woman who worked at the post office where she stands and walks daily on hard floors.There was no history of trauma. I saw her two years ago but conservative care failed, and she declined surgery or other modalities, and left work. I haven’t seen her in two years, but get the impression from the attorney’s letter that she is still suffering from plantar fasciitis. The contention is that the onset of this condition was work-related, even if work contributed even minimally. The attorney states it is established Federal law that if work contributed even “minutely” to a condition, it may be stated to be a case of Workers Compensation.


There are so many things contributory to plantar fasciitis such as equinus, pronation, lack of shock absorption, body weight, and walking surface. This is not a place for “opinion” as much as fact. Does anyone know of any recent literature, or perhaps other rulings or studies? Is there anything besides opinion, since we see overweight people with PF as well as thin people, sedentary people as well as active ones, runners, and non-runners.



Query: Requests to Trim Fingernails


I have recently been receiving an increase in requests from family members of my homebound geriatric house call patients to "trim" their fingernails. Have any of my colleagues been presented with these requests as of late? If so, would they share their thoughts or experience with this?  


Maryann Trivlis, DPM  Belle Harbor, NY


Editor's comment: PM News does not provide legal advice. In New York (as well as other states), a podiatrist is limited in scope which does not include the trimming of fingernails. Medical malpractice does not cover treatments which are out of scope. Additionally, cutting fingernails could subject one to professional discipline.



RE: Undoing Damage from Dismissed Allegations

From: Name Withheld


I had a board complaint [against me] during the time that the Texas Podiatric Medical Board (TPMB) was moved to the Texas Department of Licensing (TDLR). I was notified of the complaint but advised I could not have any further information and the 'prosecutor' would evaluate the case. I asked for the information, stating they could remove the complainant’s name, but the TDLR claimed that under the statue, I was not entitled to that information. Several weeks later, I received a letter that stated "the complaint was resolved and it was found to be without merit – dismissed." 


Later in the year, however, when applying to a hospital the 'allegation of complaint' showed up in the hospital's search of the data bank and other entities. My question is this: if an allegation is made against you and it is dismissed as unfounded, why should the allegation be reported to entities where you are trying to apply for hospital staff membership and to insurance companies? It seems very unlawful to me, but I'm not a lawyer. Any help or advice appreciated.


Name Withheld


Editor's comment: PM News does not provide legal advice. According to the National Practitioner Data Bank (NPDB), "If you are the subject of an NPDB report, you may add or edit a statement at any time to provide any additional information you would like included with the report. However, you may not modify, correct, or void the report - only the reporting entity listed in Section A of the report is permitted to do so.


Your Subject Statement becomes part of the report and remains with the report unless you (the subject of the report) edits or removes it. The statement is sent to the reporting entity listed in section A of the report, all queriers who received a copy of the report within the past three years, and is included in future query responses." 



Query: "Permanent and Stationary" Under Workers Comp 


I have been an employee for an HMO for over 30 years that banned nail grinders due to lung health risks. I have been debriding toenails with nail clippers exclusively for the past 4 years, at about 18-24 patients per day, 5 days a week. During the past 4 years, my right hand became so painful that I could no longer bend my thumb and developed a trigger index finger. I just had surgery about 9 weeks ago to release the tendon sheaths and I am supposed to go back to work in late March; however, my hand still swells and is stiff. 


I was told by the Work Comp doctor that at the next visit in late March if I am not better by then that I would be considered "permanent and stationary"--which means I will be...


Editor's note: Name Withheld's extended-length query can be read here.



Query: Destruction of X-Ray Films


I have many old x-ray films that I need to dispose. What is the best way?


David Chung, DPM, Aloha, OR



Query: Patient with Bed Bugs


I recently had a new patient come to the office for a non-limb threatening problem. After he left and we went to clean the treatment room, several large bedbugs were found on the chair. I have since had hours of worry, cleaning, and missed productivity time, not to mention the $1,000 I had to pay a pest control company to ensure eradication of the bugs.


My question is, how do I deal with this patient in the future? Am I allowed to refuse to see him unless he can prove to me that he has been “exterminated”? Can I discharge him due to the great expense of time and money his visit caused? We contacted the patient after the incident, and he had “no idea” of any bug problem. He has Medicare/Medicaid. 


Name Withheld 



Query: Responsibility for Interpreter When a Hearing Impaired Patient Cancels 


I have a situation where a deaf patient was unable to attend his appointment due to bad weather that morning. An interpreter was scheduled for the appointment and arrived at the office. Am I required to pay her services (2 hour minimum plus mileage) when her services were not actually used? He recently rescheduled an appointment with 24 hours notice and she is billing me for this visit also. Can I legally refuse to pay these charges or reverse them to the patient in this situation? 


Michaele A. Crawford, DPM, Butler, PA


Editor's Response: PM News does not provide legal advice. Unfortunately, under the ADA, physicians are required to pay for an intepreter even if the patient cancels. We have discussed this situation many times in PM News. The consensus solutuion is to schedule the patient at a hospital where you have privileges.



Query: Request from Attorney


I have a heel pain patient’s workers' comp attorney pressuring me to write a letter stating that her plantar fasciitis was caused by long hours working on concrete. What is today's podiatric opinion as to if this can be stated.


Name Withheld, OH



Query: PC vs. LLC vs. PLLC


I'm a new practitioner starting out. My residency is over and I am finding difficulty navigating the business aspects of our profession. I need direction as far as establishing a PC vs. LLC vs. PLLC. Can my fellow colleagues help? 


Marianna Blokh, DPM, NY, NY



Query: Locum Tenens


I am planning to cover for a podiatrist who will be out of the office for a temporary (6 weeks) period of time. I think this would fall under the category of locum tenens. What are the laws associated with this - i.e. insurance billing, writing prescriptions, etc? Do you know whom I can speak to or where I can get information about this?


Name Withheld 


Editor's comment: PM News does not provide legal advice. Under Medicare, "Locum tenens physicians may not bill Medicare; they should be paid on a per diem or similar fee-for-time basis. Claims payment is made under the name and billing number of the physician or the practice (in the event the physician has left the practice) that hired the locum tenens physician. If the physician has left the practice, every claim still must have a rendering provider, so the practice would still use his or her name and NPI with modifier Q6 Services furnished by a locum tenens physician appended to the procedure code to indicate the service was furnished by a locum tenens physician. The practice must keep on file a record of each service furnished by the locum tenens physician, with his or her NPI or Unique Provider Identification Number (UPIN)." Source: AAPC  The rules of non-Mediare insurances may vary.


Because the rules and regulations regarding the writing of prescriptions as a locum tenens vary by state, it is recommneded that you contact a healthcare attorney in your state to make sure you are following state law.



Query: Source for Background Check Companies


I am hiring a podiatric assistant and want to run a background check. Does anyone have any suggestions on a reliable company to do this? When I did a Google search, I found many companies but their ratings are generally poor. Also, what are the legal responsibilities of the hiring physician to conduct a background check on potential employees?


Name Withheld



Query: Effect of MIPS on Buy-in Price 


I have been an associate for the last 12 months. I am now offered a buy-in, but I have also found out that the group TIN for billing did not meet MIPS criteria. This means a reduction in payments. With buying out a physician, my Medicare patients will also increase significantly. Do I have any options at this point in time? Also, should this reflect on the purchase price of the practice? 


Name Withheld



Query: Podiatrists as Physicians Under Tricare?


I have been prescribing physical therapy services to Tricare recipients for years, but recently ran into an issue in which our Tricare Service Center asserted that podiatrists cannot prescribe physical therapy to Tricare Prime recipients. According to a recent note from Tricare, "The Tricare Policy Manual Ch.7, Sec. 18.2 for physical therapy states: 3.2 Physical therapy services must be prescribed by a physician, certified physician assistant (PA working under the supervision of a physician), or Certified Nurse Practitioner (NP). Since this request is being ordered by a podiatrist, the beneficiary will need an order from the PCM to begin therapy."


I am aware that podiatrists are regarded as physicians under Medicare, but not under Medicaid. What is our status under Tricare?


Ed Davis, DPM, San Antonio, TX



Query: Legalities of Doing a Type of Pro Bono Work.


I am looking into providing podiatry services consisting mostly of routine foot care within an upscale spa. Payment by clients would be on a cash basis only to the spa. I would not receive any remuneration with the exception of discounts on dues/services of that facility. I carry malpractice insurance as I am still a part-time practitioner. I would like to know if anyone has any input as far as the legalities of this type of situation in reference to malpractice, taxation, or any other characteristics dealing with podiatry.


Name Withheld



Query: Payment for Submitting Charts to Medicare Advantage Plans


I have gotten requests in the past for a high number of charts and asked them in writing for $30 per chart for chart retrieval, preparation, copying, and submitting, stating charts would be sent immediately upon receipt of payment. Each time they called to see if charts were sent, I referred them to the letter requesting payment. On one occasion, the supervisor told me they have many requests from doctors for payments.


The end result is that I never received payment and the package containing the charts they requested is still in my possession. It seems like we are being burdened with the time-consuming task of submitting charts so the Medicare Advantage (MA) programs can charge more to Medicare. I would appreciate any input from podiatrists as to the legality of not submitting charts to these MA plans until requested payment is received.


Name Withheld

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