Part B Insider (Multispecialty) Coding Alert

Published on Sat Feb 23, 2008 PDF

Massachusetts levies fine on physician who didn't keep records, wasn't up-front about certification

If you-re running a concierge practice, you had better save those records.

A Massachusetts physician who owns a concierge practice was hit with a $2,500 fine in January for failing to keep a patient's records for seven years. The patient requested her medical records, but the physician was unable to provide them, prompting a charge from the Massachusetts Board of Registration in Medicine that the physician did not follow board regulations in medical records maintenance. In addition, the physician claimed to be board-certified, even though his certification had expired.

How it works: Concierge phy-sicians charge patients an annual fee, and in exchange, the patients enjoy membership perks. -The fee generally goes toward access,- says Heather Corcoran with CGH Billing. -You have access to the physician wherever you are, no matter what time of day. You can call him, and he-ll talk to you or make you an appointment to come in to see him on short notice.-

But concierge physicians aren't exempt from state and federal rules, as the Massachusetts case demonstrates. In addition, Medicare rules still apply to these practices. -Although you can enroll a patient in your concierge care practice, you cannot bill Medicare for the annual concierge fee,- says Sara Wright, Esq., in Nashville. In addition, you can't bill the patient for services that Medicare covers.  

For example: Suppose your annual concierge fee includes payment for one annual physical. The patient becomes a Medicare beneficiary while a member of the practice, and you perform the physical. If the -Welcome to Medicare- (WTM) exam benefit would cover that physical, you should reimburse the patient for that portion of his or her con-cierge fee and bill the WTM charge to Medicare.

-Basically, if you-re a concierge practice, you just have to remember to follow all of the rules that every other Medicare provider is subject to,- Wright says.

Keep in mind: The government last commented on concierge care in 2005, when the Government Accountability Office (GAO) issued its report, -Concierge Care Characteristics and Considerations for Medicare.- At that point, the GAO found that because relatively few physicians are providing con-cierge care, the issue was unlikely to cause access problems for Medicare beneficiaries. The agency also noted that concierge care was mostly a bicoastal phenomenon, and physicians charge anywhere from $60 to $15,000 per year for the service.

You can read the Massachusetts Board of Registration in Medicine's decision at www.massmedboard.org/public/pdf/goldman_20080220.pdf.