* Can we bill for services if a patient complains about them?
* Do we need to send our NPP to patients who can't read it?
* Medical necessity: Tips for auditing your facility's claims denials

In these examples, the patient may have been informed of the side effects, but he or she may have misunderstood the physician. Investigate this complaint promptly and share the results with the patient.

Therapeutic complaints focus on serious problems. You must investigate these claims immediately. These complaints stem from the following physician or staff errors:

Examples of this include giving a patient an overdose of medication or allowing the patient to drive soon after receiving anesthesia, resulting in a traffic accident. In these scenarios, the medical group may not be able to waive or hold charges to the patient because it has already billed the patient's insurance company for the services. However, the group can flag the account or put it on hold until it investigates the case. This should be done within 30 days.

Once you investigate the initial patient complaint and make a resolution, decide whether to reinstate or inactivate the patient account. The most important aspect for handling complaints is to ensure that the medical group pays attention to the patient's complaint. Medical groups and independent physicians must put a strong process in place for handling patient complaints of injury, including handling patient charges and bills. This process should pay for itself in reduced legal action.

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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Here are the answers to the last survey:

Are you concerned that the new outliers rule will have a negative impact on your organization's reimbursement?

• Yes: 41%
• No: 38%
• I'm not sure what impact the rule will have on our reimbursement: 21%

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