Pediatric Coding Alert

The professional-courtesy visit, in which children of other physicians are treated for free, is gradually disappearing from the world of pediatricsand from the rest of the medical world as well. However, these visits still exist, particularly when the children of employees are treated. Providing courtesy visits poses special challenges for pediatric practices.

We are still doing some professional-courtesy visits for physician patients, writes Lois Cunningham, office manager for Carola Fleener, MD of Sarasota, FL. Also, in the professional-courtesy category of billings, we have had (to code for) a few families who barter services, as well as care given to the children of the office staff. Our physician wishes to continue seeing the children of our office staff without having to collect a co-pay from them. Should we attempt to collect the co-pays from these particular patients? If so, this would increase our receivables figure throughout the year, making it difficult to use the accounts receivables totals for tracking collections.

Although most practice management experts recommend against performing professional courtesy visits, in many areas it is impossible to maintain a successful practice without it. Here are some tips for handling the billing aspects of professional courtesy from practices who have been making it work.

1. Charge the visit fully. Its essential to keep track of what is done during the appointment, even if you dont collect a co-pay, advises David Rider, practice administrator for Wineland, Wilmot, and May, MDs, Ltd., a three-pediatrician, five-nurse practitioner practice based in Alexandria, VA. In order to keep the records straight, we generate a bill, explains Rider. We go ahead and submit a claim to the insurance company for everything they would cover. And when it comes back, we write everything off that they dont cover. That usually means a co-pay.

2. Cover your bases. Remember that the child you see for free one day is a patient who may need to be hospitalized in the futureand its unlikely that the hospital will be able to have the same arrangement that you have. For example, if there is insurance, the hospital will definitely bill the carrier. What are you going to tell the insurance company if the child is hospitalized for what is a chronic condition, and they want to know if you have been following the child all along? asks Rider. Would you say, Umm, weve been seeing the child, but behind closed doors? Its much better to have everything on the record, Rider notes.

3. Use a specific transaction code. Instead of using the same write-off code you would use for insurance companies (when they do not pay the full amount), set an internal transaction code and put it into your computer, advises Jane Post, insurance manager for Western Michigan Pediatrics, a four-pediatrician, three-nurse practitioner practice in Grand Rapids, MI. We use a special transaction code instead of an insurance write-off code for professional-courtesy visits, says Post. Its important to do that because its the pediatrician whos writing it off, not the insurance company.

4. Track your losses. Its also a good idea to put everything you do into your computer as a bill so you can track exactly how many of those professional-courtesy co-pays youve given away, says Post. Youll want to know if it adds up to $1,000 (or more) at the end of the year, she notes.

5. Changing times. Dabbs & Hyland, MDs of Jasper, AL, used to do quite a few professional-courtesy visits, reports insurance clerk Dana Kimbrell. However, two years ago, the practice merged with a medical management company, Medisphere Healthcare Network, which instituted a policy prohibiting professional courtesy visits. An exception is made for employees children, however. Rider agrees that times are changing. We still see a lot of physicians kids, but so many are covered by managed care, he says. Also, theres not so much of the old-boy network any more. Rider says there just arent as many physicians requesting professional-courtesy visits as there used to be.

6. Employees children. When it comes to seeing employees children, it is easy to handle insurance issues, says Kimbrell. We all have Blue Cross/Blue Shield, she says. The co-pays are written off, and the pediatricians know the 14 employees children, with little extra paperwork needed.

7. Writing off co-pays. We know everyone we talked to is doing it for professional-courtesy visits, but its important to note that this is not a recommended procedure. You have a contractual commitment to collect the co-pay. Technically, the health plan could terminate your contract if they discover that you are writing off co-pays. If you feel you must provide professional courtesy, the best method would be not to bill the insurance company at all. Its better to write off the whole charge. That way, the insurance company cant demand a refund later.

8. Change your office procedure manual. Compliance experts would recommend that you get rid of the phrase professional courtesy altogether, and use the phrase too costly to collect instead. Then, add this paragraph to your office procedure manual: This office depends on the physicians in the community to provide patient referrals. Due to the local business traditions we feel it would jeopardize our referral base to charge physicians for medical care delivered to their family. Therefore, it is too costly to collect these charges. This gives you a legitimate business rationale for providing professional courtesy.