By Alex Tate
The telephone in your office is the critical communications tool of your practice. Yet it can also be a source of danger to your practice. Teach your staff how to protect your telephone from becoming a tool for those who would abuse you and your practice. Teach them well.
Most payers and virtually all outsourced vendors of all the payers have corporate policies that allow employees to call physicians without identifying themselves beyond a first name. The ability to use the apparent authority of their employer, while remaining anonymous has led to some very inappropriate messages, even threats and intimidation attempts being made and inferred. Of course, without a full name, and only central switchboard number provided by the caller, there is little ability to track down the offensive authority person that has overreached their authority. And without a full name, the employee has plausible deniability.
Therefore, to protect yourself and your practice, it is important to teach your staff that they must obtain full and complete identification of callers, be it the health plans, or one of their sub-contractors.
When receiving calls, teach your employees to ask the following:
- May I have your full/last name?
- Please spell it?
- What is your title?
- What is your department?
WARNING: If it is from the Special Investigation Unit (sometimes call Plan Integrity) of the plan, listen carefully and take notes, but continue to listen. They may be soliciting information that will be used against you or trying to start a discussion over some investigation they have open regarding your practice. These are not to be taken lightly. Learn all you can from the call and then consider a conversation with a competent healthcare attorney as to what was said. You should be prepared for a follow up with an issue that will need a careful and considered response.
- Could I have a direct phone number?
- What is the full name of your supervisor?
- What is their direct number?
- How can I help you?
(After they say their piece)
- Thank you; however, it is the policy of this office not to comment/respond/act on phone calls from health plans or their vendors. Please put your request in writing that we can review it with our counsel. End the call.
If at any time the caller decline/refuses to provide requested information, the proper response is;
- I am sorry that we cannot engage in conversation with plan representatives that refuse to fully identify themselves, and their role and authority. We will file a complaint about this call with your employer, good day. And end the call.
There is nothing that changes the tone and substance of a caller than the personal accountability of being identified with the statements that are made. There is nothing that costs a plan more than to end their ability to intimidate, harass, and conduct business using cheap, and undocumented phone calls.
You have done nothing wrong, you have protected yourself and your practice. You are not running around working for a plan based on a phone call. If they want something, let them put it in writing, so you can understand what they are requesting, why, and if necessary, review with your attorney.
Alex Tate has served in various positions at leading health IT organizations for the past thirteen years. Most recently Mr. Tate served as Vice President at a leading EHR for small practices. He currently oversees product management and revenue cycle consulting for a number of organizations. Mr. Tate oversaw the development of many emerging products and held leadership roles across health-tech strategy, operations, service organization development, delivery and optimization. His ongoing collaboration with startups and academic research centers are paving the way for the development and commercialization of groundbreaking technologies like artificial intelligence, augmented reality, HCI and other initiatives for a future that offers the promise of transforming care delivery through cutting-edge technology and progressive methodologies.