RE: Report for Insurance Approval

[Guest guest]

Message text written by

INTERNET:

>Sara: My goal is always to see the patients 2x and I am successful about

half the time. Unfortunately, the surgeons I work with only require one

visit, and generally the insurance company will only pay for one visit. I

try to convince the patient of the value of seeing me more than once, and

many times they will, but sometimes they won't. And, although it is a lot

to cover, I feel from an ethical standpoint, if I at least give them a

handout with the information they need on it, at least they have access to

the postop eating instructions. I am going to try to meet with these

surgeons soon and hope to convince them to require a three visit combo, and

I'll let you know how that goes.

Randee.

<

Hi Randee and Colleagues -

I just have to jump in here on your comment. Please, Randee, know that I

am not jumping on you - I am jumping on US, us dietitans as professionals.

I make my living (sometimes well, sometimes not so well - as the business

goes up and down!) in private practice. Even though I know where every

dollar comes and goes, I STILL fall into the same old patterns of giving

too much information away for free. Every time each of us does this, we

shoot ourselves - no matter where employed - in the foot. We shoot our own

selves, and we keep our profession oppressed.

What I'm reacting to....your comment about giving post-op info away for

free, just so the patient has it. Think about the value they miss by

skipping an appointment with you. Yes, I know they have to pay cash but if

the doctors value your services, the patients will value them more, and the

cash out will make more sense to them and hurt less. Think of the value

you give them in their handouts. It's a parallel to a surgeon saying,

here's a handout on post-op complications...call if you need us - rather

than requiring (I hope they do...) the patients to return for a post-op

check-up. The patients have to pay for those deductibles and

co-pays....but it's an expected part of the package and they willing pay

the money (relatively speaking).

I have no idea what your presentation plans or needs are (depends on where

the perspective of the surgeons)...but, my unsolicited advice is, give them

facts (can anyone help - are there any on post-op complications based on RD

input or lack thereof?!!?). Try also to compare the post-op progress of

several of your own clients - those that received your full services and

those that didn't. You can definitely pull from the weight management

world on behavior change and the need for accountability and support in the

effectiveness of any behavior change.

Best of luck, Randee - based on your comments I've read on this list, you

know your stuff and you'll do well....Just wanted to pump you up as to your

worth as, hopefully, a way to strengthen your stance!

Trevethan, MS, RD, LD

Private Practice: Consultations, Speaking Engagements, Technical and

Consumer Writing

Nutrition Advantage, LLC

580 Lincoln Park Blvd., Suite 266

Dayton, Ohio 45429

trevethan@...

937.294.3228

Adjunct Instructor: University of Dayton

[Guest guest]

:

Thanks for your comments. You most definitely are right on, I tend to give away a lot for "free". As I said, I am working on changing the situation. I too am in private practice, and see the minimal value put on our services. We do all have an obligation to work on changing these attitudes. thanks for the help.

Randee

Re: Report for Insurance Approval

Message text written byINTERNET: >Sara: My goal is always to see the patients 2x and I am successful abouthalf the time. Unfortunately, the surgeons I work with only require onevisit, and generally the insurance company will only pay for one visit. Itry to convince the patient of the value of seeing me more than once, andmany times they will, but sometimes they won't. And, although it is a lotto cover, I feel from an ethical standpoint, if I at least give them ahandout with the information they need on it, at least they have access tothe postop eating instructions. I am going to try to meet with thesesurgeons soon and hope to convince them to require a three visit combo, andI'll let you know how that goes. Randee.<Hi Randee and Colleagues -I just have to jump in here on your comment. Please, Randee, know that Iam not jumping on you - I am jumping on US, us dietitans as professionals. I make my living (sometimes well, sometimes not so well - as the businessgoes up and down!) in private practice. Even though I know where everydollar comes and goes, I STILL fall into the same old patterns of givingtoo much information away for free. Every time each of us does this, weshoot ourselves - no matter where employed - in the foot. We shoot our ownselves, and we keep our profession oppressed.What I'm reacting to....your comment about giving post-op info away forfree, just so the patient has it. Think about the value they miss byskipping an appointment with you. Yes, I know they have to pay cash but ifthe doctors value your services, the patients will value them more, and thecash out will make more sense to them and hurt less. Think of the valueyou give them in their handouts. It's a parallel to a surgeon saying,here's a handout on post-op complications...call if you need us - ratherthan requiring (I hope they do...) the patients to return for a post-opcheck-up. The patients have to pay for those deductibles andco-pays....but it's an expected part of the package and they willing paythe money (relatively speaking).I have no idea what your presentation plans or needs are (depends on wherethe perspective of the surgeons)...but, my unsolicited advice is, give themfacts (can anyone help - are there any on post-op complications based on RDinput or lack thereof?!!?). Try also to compare the post-op progress ofseveral of your own clients - those that received your full services andthose that didn't. You can definitely pull from the weight managementworld on behavior change and the need for accountability and support in theeffectiveness of any behavior change.Best of luck, Randee - based on your comments I've read on this list, youknow your stuff and you'll do well....Just wanted to pump you up as to yourworth as, hopefully, a way to strengthen your stance! Trevethan, MS, RD, LDPrivate Practice: Consultations, Speaking Engagements, Technical andConsumer WritingNutrition Advantage, LLC580 Lincoln Park Blvd., Suite 266Dayton, Ohio 45429trevethan@...937.294.3228Adjunct Instructor: University of Dayton

[Guest guest]

Message text written by

INTERNET:

>

I am employed by a Medical Center. We charge up front for my services, as a

" package " . They are not optional in our program. So far, I have had only 1

patient who has not followed through with all her post-op visits, but our

program is new since Aug 03. ( I see pts twice prior to surgery, and at 2

weeks, 4 weeks, 3 mo, 6 mo, 9 mo, and 1 yr post-op.)

Strathdee, RD, LD, LMHC, CEDS

Genesis Medical Center

<

-

What an excellent set up ....you have the support within the structure of

the program to value your services. To charge up-front means the entire

program includes your

value...then it's up to the individual to decide their own journey and how

much effort they want to place in the success of their short-term and

long-term outcomes. This up-front payment removes the question in the

patient's mind about how much they want to invest (money and also personal

effort) at different stages of their preparation and recovery - and that

heightens the probability that they will succeed...it makes the

appointments more " pure " in terms of behavioral and educational input

versus monetary output and reacting to the " loss " of that money.

Trevethan, MS, RD, LD

Private Practice: Consultations, Speaking Engagements, Technical and

Consumer Writing

Nutrition Advantage, LLC

580 Lincoln Park Blvd., Suite 266

Dayton, Ohio 45429

trevethan@...

937.294.3228

Adjunct Instructor: University of Dayton

[Guest guest]

I am a new member, from Mt. Pleasant, MI and work primarily with

gastric bypass, having done so on and off since 2000. Thank you for

all your input on insurance reimbursement. This is a daily struggle

for me(i think the director of billing has a dartboard with my pic).

The 1 surgeon who does surgery has an undergrad degree in nutrition

so I feel privilaged to work with him!

RE: insurance reimbursement....it's chaotic using the dx: 278.01 for

Morbid obesity and Procedure code: S9470 some cover, some don't. I

have pt's call, but that is not always helpful.

What I have been doing is charging for first pre-op appt. but then

also see them during hospital stay, 2weeks post-op, 3months post-op

and 6 months post-op.

I find that I spend tons of time on the phone with them as well...so

I am leaning to a program fee that is mandatory. Anyone have anything

similar and what do you charge? I am trying to get a proposal to my

boss. It would be much appreciated!

Thanks!

Stacey Frost, RD

Central Michigan Community Hospital

Mt. Pleasant, MI 48858