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* Can we use the overhead pager?
* Can we charge for set-up when the patient cancels?
* Pay-per-view Article: Draft compliant medical director and administrative services agreements

Compliance Monitor, January 28, 2003

Can we use the overhead pager?

Q: Using an overhead pager, our pharmacy calls patients to pick up their medications. You can hear the pager throughout our facility. Is this is a violation of patient privacy under the Health Insurance Portability & Accountability Act (HIPAA)?

A: It's unlikely that use of the overhead pager is a violation. One could argue that the pharmacy's announcement is an incidental disclosure under HIPAA, and that just the name does not constitute protected health information (PHI). However, there is a counter view: One could argue that calling a person specifically "to the pharmacy" by name is not a reasonable safeguard under HIPAA to protect that person's health information.

You have some options to avoid this problem and comply with HIPAA's "reasonable safeguard" requirement. When patients place their prescription, ask if they will

• wait at the pharmacy for it
• come by the pharmacy to pick it up at a specific time
• want you to use the overhead pager to find them (you might want to use a word like "loudspeaker" so patients clearly understand that others may overhear)

Also, consider hanging a sign outside the pharmacy that asks patients to wait for their prescriptions, unless they want to be paged. If you must use the loudspeaker, try changing the message you use. Instead of saying, "Your prescription is ready," try something like, "Please return for your order" or "Please see Anita." At the time patients place their prescription, Anita could tell them what they should listen for.

So, if you have to use the overhead pager, use it cautiously, and don't make it a surprise.

This question was answered by Marion Neal, President, HIPAASimple.com

Go to "Draft compliant medical director and administrative services agreements " for the rest of this article. The cost is $10. Strategies for Health Care Compliance subscribers have free access via their online subscriptions. Subscribers to the print edition can find this article in their February issues.

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Q: Can we charge a patient for a product used to set-up for a procedure, even though the patient cancelled last minute and did not have the procedure?

A: For contracted payers, including Medicare and Medicaid, a physician may not charge a patient for a product used to set-up for a procedure when the patient cancels and does not have the procedure. A physician may bill only for a rendered service, not for an anticipated service not delivered. If Medicare and Medicaid rules allowed this practice, physicians would be billing for cancelled appointments and no-shows.

Non-contracted payers, however, have different sets of rules and regulations that you would need to address before billing a patient.

For self-pay patients, a physician could feasibly charge them for the product used to set-up for the cancelled procedure, as long as this charge doesn't violate your state laws. However, you also have to consider the legal and public relations issues:

• From a legal perspective, physicians must develop a written policy about their billing practice and have the patient sign-off on it before scheduling surgeries. If you do this, you have given patients appropriate advance warning of your billing practice.
• From a public relations perspective, make sure the patient is aware of the policy. Otherwise, the patient could file a complaint with the Better Business Bureau, which could lead to negative publicity. In this case, you'd likely spend more money on damage control than you would have on the unused product.

And from a strictly pragmatic perspective, even if your patient has agreed to pay by signing your policy , the likelihood of actually collecting the fee is small.

Overall, implementing this billing practice—regardless of the payer—creates more problems than it is worth.

This question was answered by Michael O'Connell, MHA, CMPE, CHE, senior director of the Cleveland Health Network MSO, LLC, in Independence, OH.

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