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* Can we create an increased pricing structure for on-call services?
* How can we secure radiology films under HIPAA?
* Pay-per-view article: Evaluate your coding and documentation of E/M services

Compliance Monitor, January 3, 2003

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Can we create an increased pricing structure for on-call services?

Q: Is it permissible to have an increased pricing structure for off-hours or on-call surgeries, including evening and weekend procedures? Medicare states that there should be no separate charges for "on call" or "stat" services. The pricing format, according to Medicare, must be the same for all patients, and priced at what it costs to do the service. However, it usually costs us more to do the surgeries during off hours, due to higher pay for call-in staff. Direct reference for this topic is difficult to find.

A: According to the Medicare Carriers Manual (section 15511.3): "Do not pay for physician standby services. They are covered as inpatient hospital services, not as physician's services, since standing by is not a service to a patient. Physicians may not bill Medicare or beneficiaries for [these services] since payment is included in the payment made to the hospital for other general services necessary to provide quality care."

Georgia Medicare, as an example, considers STAT fees or on-call fees non-covered or non-billable charges; it says that billing for these services as covered services may constitute fraud.

However, in some cases it may be permissible to charge these types of fees to other insurance carriers, if they allow additional reimbursement under these circumstances. I recommend reviewing your payer contracts and even contacting each payer if necessary to determine if these charges are allowed.

This question was answered by Stacie Buck, founder of Himassociates.net.

Go to "Evaluate your coding and documentation of E/M services" for the rest of this article. The cost is $10. Health Care Auditing Strategies subscribers have free access via their online subscriptions. Subscribers to the print edition can find this article in their December issues.

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Q: What kinds of measures are appropriate for securing radiology films under HIPAA? Can we keep them in a locked room, accessible to medical personnel only, or should we lock them in file cabinets in a locked room?

A: The method you use to secure radiology films should be the same as for other medical records.

Radiology films contain several pieces of data that are considered protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). The data includes the patient's name, date of service, and other identifiers. However, the government designed HIPAA to work within your organization's size and budget. The government recognizes that large hospitals and small practices have different financial limits.

First, evaluate your practice. It may be proper to secure films in a locked file cabinet, use a locked file room, or try some other method to secure the films; it all depends on your needs and resources. Remember: Your method must be based on documented risk analysis. So, control your risks and access to the degree that is most prudent for your practice.

When deciding how to secure your films, use the following process:

1. Evaluate your current process and storage practice
2. Identify those risks to the information you control
3. Design prudent steps that you can reasonably take to overcome those risks

Risks include the disclosure of PHI to unauthorized persons outside your practice, as well as disclosure to your own employees who don't "need to know" the information. HIPAA requires you to control access to the minimum necessary within your group or hospital.

In addition to HIPAA, various state laws may have more stringent requirements. Check with your state medical society on state laws. Some states have lists of attorneys who have compared HIPAA requirements to your state confidentiality laws.

This question was answered by Larry Balmer, compliance officer for Radiology Incorporated in South Bend, IN. Balmer is chairman of the Radiology Compliance Officer's Association.

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