Cash Payment From Medi-Cal Patients • Refund Request Time Limits • Pamphlet Translation Requirements

SDCMS Member Office Managers: Did you know you have someone on staff at SDCMS to turn to with your questions and concerns? Lauren Wendler, your SDCMS office manager advocate, is here to help you find the answers to your questions, whether they be on OSHA, HIPAA, billing, coding, or what have you! And if she doesn't know the answer when you call, she'll track it down. Lauren also coordinates SDCMS' rich schedule of seminars and webinars and is always looking for new topics and ideas. Contact Lauren at any time if you have any questions or suggestions, and if you'd like to sign up to be included in our new San Diego County Medical Office Manager email listserve, whereby you can communicate instantly your questions and suggestions to all the other office managers on the listserve, let Lauren know at (858) 300-2782 or at LWendler@SDCMS.org. We're here to help!

QUESTION: We have a Medi-Cal patient who wants to pay cash for the doctor's services instead of billing Medi-Cal. Is it okay if we form an agreement with the patient?
ANSWER: Once a physician knows that a patient is a Medi-Cal patient, the physician cannot allow the patient to pay cash for any services that the physician may provide. Private payment agreements have a significant potential for abuse. Providers must submit a claim for reimbursement according to the rules and regulations of the Medi-Cal program and not attempt to obtain payment from the recipients. For further information, consult CMA's ON-CALL document #0150, "Side Agreements With Medi-Cal Patients" - available free to SDCMS-CMA members at www.cmanet.org.

QUESTION: Medicare is requesting a refund for a payment they made three years ago. What is the time limit that third-party payors and Medicare have to request a refund from payments that we received?
ANSWER: Private health plans, Blue Cross, Blue Shield, etc., can only go back 365 days from the date of the last action of the plan. The federal government (Medicare) can go back as far as they want, particularly if they suspect fraud; thus, there is no time limit for Medicare to request a refund. For further information, consult CMA's ON-CALL document #0135, "Plan Requests for Refunds From Physicians" - available free to SDCMS-CMA members at www.cmanet.org.

QUESTION: Is there a regulation that requires physician practices to provide all medical forms and pamphlets in Spanish?
ANSWER: Physicians need to provide written translations of pamphlets depending on the number of patients with limited English proficiency (LEP) that the physician treats. Federal Department of Health and Human Services' Policy Guidance on Foreign Language Interpreters provides a "safe harbor" with respect to written translations. The safe harbor applies to protect physicians who provide (1) written translations of "vital documents" with respect to each LEP patient group that comprises 5 percent of the practice or 1,000 patients, whichever is less or, if there are fewer than 50 persons in a large group that reaches the 5 percent trigger, and (2) written notice in the primary language of the group of the right to receive competent oral interpretation of those materials, free of cost. Examples of vital documents include consent and complaint forms, intake forms with the potential for important consequences, etc. For more information, consult CMA's ON-CALL document #0813, "Language Interpreters" - available free to SDCMS-CMA members at www.cmanet.org.