Policies and Procedures

We are a Private Multi-Specialty Practice
- We lease our EMR from Martin Health Systems therefore
  - We do not have access to all the features in EPIC (like the hospital)
  - We do not utilize all the features in EPIC (like the hospital)
  - We do not manage "My Chart" access
- Our office has different policies and procedures when it comes to day to day operations including but not limited to:
  - Scheduling
  - Confirmation of Appointments
  - Cancelations/Rescheduling of Appointments
- We use a separate billing system than the hospital
  - We have a separate patient portal through eClinicalWorks (eCW) which is used for billing and payment purposes.
  - We do manage eCW patient portal access
Healthcare Professionals
- A term used to group both our Physician's and our Physician Extenders (aka ARNP's and PA's) together.
Medical Supplies
- We now carry on hand, a few medical supply items.
- Our Medical Supplies are not covered by a patient's insurance.
  - If a patient desires their insurance company to cover these items the patient must have their Healthcare Professionals order them from a DME company of the patient's choice.
  - Placing an order does not guarantee insurance coverage. We are only assisting our patient with their request.
- Patient's may find a list with prices of our medical supplies on our main web page under services and then Medical Supplies.
  - Prices are subject to change without notice, depending upon the distributor.
Medical Scribes (aka Efficiency Experts)
- Our office has adopted a growing field known as Medical Scribes (aka Efficiency Experts).
- What are Medical Scribes?
  - Medical Scribes are physician collaborators who fulfill the primary secretarial functions of the busy Healthcare Professional. Scribes specialize in medical data entry into a paper or electronic medical record system and in instituting efficient workflow process, thus increasing the Healthcare Professional's capacity to provide direct patient care like seeing the next waiting patient, performing medical procedures and communicating with nursing staff.
- What do Medical Scribes do?
  - Medical scribes are essentially a personal assistant to the Healthcare Professional; performing documentation in the EHR, gathering information for the patient's visit, and partnering with the physician to deliver the pinnacle of efficient patient care. The Scribe actively participants in the plan of care (as it is made real time thus discussion between the scribe and the Healthcare Professional should take place throughout the visit), monitors the duration of medical testing results such as blood and urine tests, x-ray, and CT reports in order to prevent unnecessary delays and expedite patient dispositioning.
Telephone Calls
- All calls into our office are recorded for quality assurance purposes.
- Phone Calls to a Healthcare Professional must be returned within 24 business hours, this includes calls made to Medical Assistants.
- Billing Inquiry phone calls are returned as quickly as possible. We understand that patients are waiting patiently for an answer however, each billing inquiry is reviewed personally. It often takes a considerable amount of time to view a patient's account and provide accurate information. Please understand:
  - If finance charges occur while a patient is waiting for a response to the recorded telephone encounter, we will ensure those charges are adjusted to reflect a 0.00 balance.
  - The Business Office has an operator that accepts, records, and distributes all telephone encounters to the appropriate person for handling. Patients will receive a call back when the account review process has been completed.
- Scheduling calls should be returned the same day and no less than 24 business hours after receipt.
- Patients must leave a message, calls where no message is left cannot be identified thus not returned.
Zero Tolerance against Verbal Abuse
- We understand that situations can become frustrating both internally and externally when situations are not being handled as quickly as we want them to be or think they should be.
- Patients shall treat each PIMA employee with the utmost respect.
- PIMA employees shall treat each PIMA patient with the utmost respect.
- PIMA employees shall treat each colleague with the utmost respect.
Pharmaceutical Representatives
- Due to the overwhelming number of Pharmaceutical Representatives, a Pharmaceutical Representative must schedule their visit to our office on the website and check in at the front desk.
- You may visit our Pharmaceutical Representative tab on our Home page to guide you in this process.
  - Keep in mind, the Pulmonologists are not normally in the office during morning hours (there are exceptions).
- Pharmaceutical Representatives are required to book luncheons online.
- Pharmaceutical Representatives may call our Front Office to inquire about a specific Healthcare Professional they need to see.
DME Companies
- We understand signatures are needed and patients value your business as much as we value what your company does for our patients daily. In addition, we understand this may turn into several trips a day and consideration has always been taken to not disrupt operations.
- DME companies must check in with the front desk and are not permitted in the back-office area unless it has been approved by the person requesting to be seen.
- Texting an employee for approval is inappropriate and will not be tolerated as means of avoiding the Front Office.
- DME companies are no longer permitted to just walk into the Back Office.
- It is against company policy for a PIMA employee to give a DME company approval to just walk in, DME companies must check in at the Front Office. The Front Office will retrieve the approval from the requested party to let the representative back.
- Unless approved in advance, DME companies must come in, obtain what they need, and then exit. Lingering is not permitted!
Onsite Billing Questions
- We discourage making a special trip to the office for a billing inquiry and encourage calling the Business Office, extension 1422, and having a telephone encounter recorded with in-depth information.
Feedback
- Due to stringent HIPAA guidelines on internet conversation and breach of patient confidentiality, it is against company policy for a PIMA employee to comment on the internet regardless of content.
- We encourage our patients to share their feedback with us through our anonymous surveys listed on the home page of our website, under patient surveys.
  - Chronic Care Management Survey
  - In Person Visit Survey
  - Phone Etiquette Survey
- We also encourage our patients to share their feedback with our Practice Administrator.
Post Hospital Discharge
- We encourage our patients who have been hospitalized to contact our office, once discharged, to schedule a Hospital Follow-up with our Healthcare Professionals.
Coding for Annual Visits
- We understand that certain insurance companies cover a patient's "annual" visit with their Healthcare Professional however, we adhere to strict regulatory guidelines when it comes to these visits. We want to inform our patients:
  - There is no actual CPT code for an annual appointment.
  - Annual codes referenced by a patient's insurance, by definition, is a "Preventative Maintenance Visit" thus not a Problem Management Visit.
  - Our Healthcare Professionals are educated on when these services can be billed and when they cannot.
  - If a patient feels that a service should have been coded as a Preventative Maintenance Visit, they should call our Business Office, extension 1422.
    - Our Certified Professional Coder will review each request individually. This review involves specifically looking at the Physicians documentation to see what was performed during the visit and if the services provided meet the guidelines (criteria) to bill for that service (code).
    - Seeing a Healthcare Professional once a year does not automatically qualify a patient for that service (code).

Telephone Calls
- Phone Calls to a Healthcare Professional must be returned within 24 business hours, including calls to Medical Assistants.
- If a patient has left a message and has not received a call within 24 hours, please contact our Front Office at Ext. 1406 and request a telephone encounter be entered on the patient's behalf.
Authorizations
- It may take hours to request and days, weeks, and even months to receive an approval.
- We understand that patients want to follow the plan of care implemented by their Healthcare Professional; however, we are unable to speed up the process.
- If a denial is received, we can and will dispute it to the best of our ability. However, it is imperative that each patient understands that we are not in control of the outcome or the decision the insurance company makes.
- If we are out of network with an insurance plan, we will not be able to obtain an authorization.
Patient Forms
- We understand that patients may have dropped off forms, and they are important; however, it takes time to complete these forms. Thus, we charge the following fees for filling out forms on the patient's behalf:
  - $15.00 for up to 5 pages
  - $30.00 for 6 to 10 pages
  - $45.00 for 10 to 15 pages
  - $60.00 for 16 or more pages
Prescriptions (New or Dosage Changes)
- We understand that office visits can sometimes be burdensome; however, the patient's well-being is paramount to our Healthcare Professionals.
Medical Scribes (aka Efficiency Experts)
- Our office has adopted a growing field known as Medical Scribes (aka Efficiency Experts).
- What are Medical Scribes?
  - Medical Scribes are physician collaborators who fulfill the primary secretarial functions of the busy Healthcare Professional. Scribes specialize in medical data entry into a paper or electronic medical record system and in instituting efficient workflow processes, thus increasing the Healthcare Professional's capacity to provide direct patient care like seeing the next waiting patient, performing medical procedures, and communicating with nursing staff.
- What do Medical Scribes do?
  - Medical Scribes are essentially personal assistants to Healthcare Professionals, performing documentation in the EHR, gathering information for the patient's visit, and partnering with the physician to deliver efficient patient care. The Scribe actively participates in the plan of care (as it is made real-time, discussion between the scribe and the Healthcare Professional should take place throughout the visit), monitors the duration of medical testing results such as blood and urine tests, x-ray, and CT reports in order to prevent unnecessary delays and expedite patient dispositioning.

Billing/Medical Records/Written Consent
- According to the Federal HIPAA laws, a written signature to obtain and/or release patient’s protected health information (PHI) must be acquired, therefore, a patient will need to sign a release.
- If a patient wants us to print billing and/or medical records and give them directly to them, our fees are as follows (Billing/Medical Record Fees are customary as per Florida Statute 64B8-10.003):
  - $1.00 per page up to the first 25 pages
  - $0.25 per page thereafter
- There are no charges to patients who request their medical records be sent or obtained to or from another Healthcare Professional.
Supervising Physician for Physician Extenders (ARNP’s / PA’s)
- They Physician (within our group practice) listed on a patient’s EOB may or may not be the patient’s normal physician, and the patient may or may not have seen them before.
- A billing error did not occur, the Physician listed on the patient’s EOB was the Supervising Physician. Therefore, we billed the services provided to the patient by our Physician Extender in accordance with the guidelines defined by the Medicare Claims Processing Manual Pub. 100-04, Chapter 12 § 30.6.4 and MLN Matters Number: SE0441, which states “if you are in a group, any Physician member of the group may be present in the office to supervise”.
Statements and Finance Charges
- Statements are generated for each claim after the insurance(s), on file, has been processed.
- Each claim will automatically generate a finance charge of $15.00, 30 days after the statement has been sent, if the claim has not been paid by the patient.
  - We understand snail mail, and it is possible the finance charge calculated a day or two before a payment was posted. In this case, call our Business Office so there is a record of a telephone encounter. We will review each financial dispute individually for reconciliation consideration.
  - We also encourage the patient to pay their bill online through our patient portal, which is located on the Home page of our website.
Onsite and Mailed Billing Inquiries
- We understand that each patient needs and wants their billing issues resolved as soon as possible. However, it is impossible to take care of each walk-in and adequately perform the rest of the tasks necessary.
  - Our Business Office employees do not have access to computers downstairs to review a patient’s account and provide accurate information.
  - Patients who insist on coming into the office will be asked to fill out a sheet listing their billing inquiry, which will be converted into a telephone encounter.
- Billing inquiries sent through My Chart to the Healthcare Professional and/or Medical Assistant are forwarded to the Business Office for handling.
  - We record these as telephone encounters and process them in the order in which they are received.
- Billing inquiries sent in letters and on statements are recorded as telephone encounters and processed in the order in which they are received. This method costs money for the patient and delays our response as they are entered as time permits.
  - We recommend calling the business office, extension 1422, and having a telephone encounter entered on the patient’s behalf.
Collections
- After three months (90 days) of nonpayment, the claim will automatically:
  - Go to Collections
  - Incur a collection charge of $20.00
- Patients who are in collections must pay their balance in full before scheduling another appointment with a Healthcare Professional in our practice.
Payment Plans
- We do offer interest-free payment plans in increments of:
  - 3 months
  - 6 months
  - 9 months
  - 12 months
  - Customized – must be approved by the Practice Administrator
- To stop finance charges from accruing, the patient must set up a payment plan with our office.
- We understand how a medical bill, especially an unexpected one, can be a burden to our patients.
  - We recommend the patient contact the Business Office as soon as it is identified that payment cannot be made in full. This will avoid recurring finance charges and collection fees (if applicable).
Telephone Calls
- Billing inquiry phone calls are returned as quickly as possible. We understand that patients are waiting patiently for an answer. However, each question and concern is reviewed personally and often takes a considerable amount of time to view a patient's account and provide accurate information. Please understand:
  - If finance charges occur while a patient is awaiting a response, to the recorded telephone encounter, we will ensure those charges are adjusted to reflect a 0.00 balance.
  - The Business Office has an operator that accepts, records, and distributes all telephone encounters to the appropriate person for handling. The patient will receive a call back when the account review process has been completed.

Distinct Department
- Our Chronic Care Management Office is a distinct department, with day-to-day operations separate and distinct from other day-to-day operations.
- Our Chronic Care Management team only handles situations surrounding the patient's chronic care management program, including annual wellness visits and advance care planning.
Scheduling and Rescheduling Appointments
- Our Chronic Care Management team handles scheduling for Annual Wellness Visits only. They will reach out to each patient directly to schedule this appointment.
  - If a patient is wanting to reschedule their appointment and it is related to an annual wellness visit, please follow the main prompts for the Chronic Care Management Team.
  - If a patient is wanting to reschedule their appointment for any other visit, please follow the main prompts for Scheduling or dial one 1405 directly.
  - The CCM team will need to transfer all patients or their messages to centralized scheduling should they receive a call for any visits other than the Annual Wellness Visit.
Chronic Care Management Services
- Please visit our Chronic Care Management link on our Home page to view the value of our CCM program.
  - If you have two or more chronic conditions, then you are eligible for the program.
  - Our Healthcare Professionals' statistics revealed:
    - Every pulmonary patient should be enrolled.
    - The majority of the internal medicine patients should be enrolled.
- There will not be any out-of-pocket cost to our patients for CCM. This valuable service is paramount for you in our practice.
Annual Wellness Visit (AWV) Services and Advance Care Planning (ACP)
- AWVs are performed annually for everyone who is identified by Medicare as needing one.
  - AWVs are not limited to PCP's, and we perform them as part of the Chronic Care Management program.
  - A Health Risk Assessment (HRA) must be completed at each AWV to meet the guidelines for billing this service (code).
  - There is no cost to Traditional Medicare recipients.
  - All patients are enrolled in CCM services when AWV is performed/provided.
  - Patients who have a Medicare Advantage/Replacement plan will need to contact their insurance plan to check coverage.
Telephone Calls
- Varies depending upon the circumstance and the patient, this is an individualized service.
- Messages should be returned the same day or no more than 24 business hours later.
Billing Inquiries
- Should be directed to the Business Office, option 5.

To Cancel and Reschedule a Patient's Appointment
- All cancellations and/or rescheduled appointments for all appointments other than annual wellness visits must go through our main scheduling.
  - Messages left on other lines are not given prompt attention, causing patients to be billed no-show fees.
  - To reach a scheduler, follow the prompts on the main line or the patient may dial one of two extensions, 1405 or 1406.
- We discourage our patients from utilizing "My Chart" to try and schedule or reschedule an appointment.
  - Until recently, we were unaware this feature was active.
  - We have requested the feature to be deactivated for our group.
  - We are not responding to any scheduling requests sent through "My Chart".
- We recommend all patients to call our office and follow the prompts for scheduling or dial extension 1405 or 1406 directly.
No Show and Appointments Canceled less than 24 hours
- As a courtesy to other patients in the practice, we charge patients when they do not show up for their appointment or cancel less than 24 hours before. Our fees are as follows:
  - $35.00 for Office Visits
  - $50.00 for Pulmonary Function Tests
- If there are extenuating circumstances, please contact our Business Office as the Practice Administrator will review each circumstance on a case-by-case basis.
- We discourage our patients from utilizing "My Chart" to try and schedule or reschedule an appointment.
  - Until recently, we were unaware this feature was active.
  - We have requested this feature to be deactivated for our group.
  - We are not responding to any scheduling requests sent through "My Chart".
- We recommend all patients to call our office and follow the prompts for scheduling or dial extension 1405 or 1406 directly.
Insurance Information
- It is the responsibility of the patient to know if we are in-network with a specific insurance plan.
  - Though we can provide a patient with information on whether we accept a specific insurance company, there are far too many plans and new plans emerging every day to be able to accurately advise.
  - We are not guaranteeing participation with any specific insurance plan by accepting a copay.
  - We encourage all patients to contact their insurance and verify before their appointment. We will bill the patient for charges not covered under their insurance plan.
  - We encourage patients to ask their insurance companies to reach out to us for credentialing. We want to accept all our patients' plans; however, the ultimate choice is up to the insurance company.
- At every appointment, we should be asking each patient if their insurance has changed. We understand this can be overwhelming with how busy our practice is; however, this process ensures the timely filing of patients' claims. To speed up this process:
  - Have new insurance cards out and ready upon check-in.
- Traditional Medicare Beneficiaries
  - When new insurance cards are received, please ensure we receive a copy of it.
  - There is only a certain amount of time until we will no longer be able to bill under the current (old) beneficiary number.
- Medicare Advantage Plans (aka Medicare Replacement Plans)
  - If a patient has elected a Medicare Advantage plan, the patient is still Medicare eligible.
  - Traditional Medicare Benefits are overridden by the benefits of the Medicare Advantage plan.
  - Unlike Traditional Medicare, patients are not able to go to any Physician or Hospital – these Healthcare Professionals/Providers must be in the network.
  - Tests and other services often need authorization, which means the insurance decides if the patient can have the test, not the Healthcare Professional.

Supervising Physician for Physician Extenders (ARNP’s / PA’s)
- We understand the patient’s confusion when it comes to their Explanation of Benefits (EOB) and the guidelines we are required to adhere to for our Physician Extenders. The Physician listed on the patient’s EOB may or may not be their normal physician, and the patient may or may not have seen them before.
  - A billing error did not occur; the Physician listed on the patient’s EOB was the Supervising Physician. Therefore, we billed the services provided to the patient by our Physician Extender in accordance with the guidelines defined by the Medicare Claims Processing Manual, Pub. 100-04, Chapter 12 § 30.6.4 and MLN Matters Number: SE0441, which states "If you are in a group, any Physician member of the group may be present in the office to supervise."
Utilization of Physician Extenders
- Our Physicians utilize Physician Extenders for continuity and increased quality of care.
  - We understand that patients want to see their Physician, and we make every effort to deliver upon that request; however, at times it is not possible.
- We want our patients to know that even though a Physician Extender is seen, the Physician is still active in the patient's plan of care, review of test results, and provides the expert advice patients seek.
- Requests to see only the Physician (when rescheduling) will not be honored as of October 01, 2018. This does not mean patients cannot see their Physician. This means:
  - We will make every effort to schedule each patient with the Physician without passing the indicated follow-up date.
  - If we do need to reschedule a patient with one of our Physician Extenders, the patient may ask, at check-out, to have their next appointment scheduled with the Physician.

We will not tolerate callous comments or behavior toward our Physician Extenders, in person or over the telephone. Physician Extenders are Healthcare Professionals and should be respected as such.

We take pride in our Physician Extenders as they are carefully chosen.
They would not be part of our team if they could not provide the quality of care each Physician desires for their patients.

Medical Scribes (aka Efficiency Experts)
- Our office has adopted a growing field known as Medical Scribes (aka Efficiency Experts).
- What are Medical Scribes?
  - Medical Scribes are physician collaborators who fulfill the primary secretarial functions of the busy Healthcare Professional. Scribes specialize in medical data entry into a paper or electronic medical record system and in instituting efficient workflow processes, thus increasing the Healthcare Professional’s capacity to provide direct patient care like seeing the next waiting patient, performing medical procedures, and communicating with nursing staff.
- What do Medical Scribes do?
  - Medical scribes are essentially personal assistants to the Healthcare Professional, performing documentation in the EHR, gathering information for the patient's visit, and partnering with the physician to deliver the pinnacle of efficient patient care. The Scribe actively participates in the plan of care (as it is made real-time, thus discussion between the scribe and the Healthcare Professional should take place throughout the visit), monitors the duration of medical testing results such as blood and urine tests, x-ray, and CT reports in order to prevent unnecessary delays and expedite patient dispositioning.
Patient Forms
- We understand patients may have dropped off their forms, and they are important; however, it takes time to fill out these forms. Thus, we do charge the following fees for filling out forms on the patient’s behalf:
  - $15.00 for up to 5 pages
  - $30.00 for 6 to 10 pages
  - $45.00 for 10 to 15 pages
  - $60.00 for 16 or more pages
Telephone Calls
- Phone calls to a Healthcare Professional must be returned within 24 business hours, including calls to Medical Assistants.
- If a patient has left a message and has not received a call within 24 hours, please contact our Front Office at Ext. 1406 and have a telephone encounter entered on the patient’s behalf.
  - Patients, be sure to leave a message when calling. Calls with no messages cannot be identified and thus not returned.
Prescriptions (New or Dosage Changes)
- We understand office visits can sometimes be burdensome; however, the patient’s well-being is paramount to our Healthcare Professionals.

Policies And Procedures

Billing/Medical Records

Forms

No Shows and Appointments Canceled Less than 24 Hours

Physician Extender (ARNPs and PAs) Visits

Policies And Procedures By Department