Question MA’s performing suppressed menses visits no charge ?!?

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shelocta, PA
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Our OB/gyn practice has had two MD resignations within a 5 month period and we are experiencing access issues for the volume of patients we see.
Admin suggested the suppressed menses visits be seen by Medical Assistants and not bill for the visit verses the suppressed menses visit having a full exam by a mid level.
I am not onboard with the model they are proposing due to 1) revenue loss 2) patient satisfaction 3) MA’s not trained for this scope of practice.
Being an MA myself and the Practice Manager, am I being too sensitive to this issue? Tell me your thoughts because I don’t feel listened to!!
 

thomas7331

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You're not being too sensitive, especially if you're the practice manager - that is part of your job!

#3 is the most serious issue here - if the MAs are not trained or are potentially practicing outside the scope of their license, the physicians are potentially putting the practice at great risk and could be in violation of their malpractice insurance requirements, not to mention that they could be putting their patients health at risk. Ensuring that your patients are safe and that your MAs are properly supervised and not putting their licenses at risk should be your priority issue.

I think #3 probably contributes to your issue #2 - if the patients are being treated by non-physicians, this almost certainly will negatively impact patient satisfaction. But I guess this would need to be weighed against the access issue - is it more likely that your patients will seek care elsewhere due to being seen by MAs, or due to not being able to get timely appointments with the physicians? It sounds like you're sort of between a rock and a hard place here, so it's hard to say what the best solution is.

As for revenue loss, #1, of course that's never a good thing but the practice owners are entitled to make that decision if they feel that lost revenue in the short run is a worthwhile investment to tide things over until they can get it back on track. Any business decision involves a risk that may or may not pay off in the end. At the same time, why would these visits not be billed? If the 'incident to' requirements are met (and they should be if your MAs are acting within their scope), then you should be able to bill these as 'nurse visits'.
 

csperoni

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I agree with all of Thomas' advice.
Exactly what the MAs are performing is the key of whether or not it's scope of practice. Particularly, MAs cannot order testing or interpret results. They may perform testing ordered by a clinician. They may implement a clinician's plan of care.
I am assuming "suppressed menses visit" means a late/missed period with a possible pregnancy. If the clinician orders a pregnancy test, MA performs pregnancy test, and clinician has a plan for positive or negative result, then that all seems reasonable. Those services are also billable (99211 level plus pregnancy test, but billable if incident to is met). From a patient satisfaction issue, it is less than ideal if the patient needs to return for another visit with clinician, but again reasonable.
If this is what will be done, I would make sure your front desk and MAs are trained and communicating this with patients prior to them coming in. The patient shouldn't think they will be seeing the doctor. Managing expectations and communicating especially when situations are less than ideal can make a huge difference.
Perhaps televideo (or telephone) visits with the clinician can be of assistance in this scenario. One of my clinicians does televideo with a scribe, and often performs a level 3 visit in just a few minutes of his time. If your clinicians are sometimes waiting on a laboring patient, they can even do televideo while at the hospital. Maybe a clinician who does not typically work on an evening or weekend might be willing to do a couple of telehealth on their "day off."
Good luck!
 
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