RE: Membership Fees, billed Phone Consults While Still PAR?

[Guest guest]

You can charge the fee if you are very

careful it is for ‘non-covered services’. I have charged my pts

since I went solo (2003) for the email access, virtual visits, etc. Now some

of these services are being ‘covered’ so you need to check with the

insurance contracts you have. I make it clear to the pt that these are not

covered by their insurance, and they are responsible for paying it. Some insurances

haven’t liked their pts being charged this fee, and have rewritten their

contracts because of it, to specifically exclude it. Be careful. Fortunately,

I was able to work with the local medical directors of the few insurances I was

contracted with and come to an amicable agreement to do it.

Same thing for phone and virtual/online

visits – if they are considered ‘covered’ services, then you

have to follow the rules of your contracts, collect the copays, etc. Now there

are codes for these online visits (99444) and phone consults (99441-3, based on

time), so use them, but that doesn’t mean they are covered by your

insurance plans. It seems different plans in different regions are covering

these, at different payment rates. Minn

is the best for amt reimbursed from what I hear ~$55 per online visit, while

most others are ~$20-35.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ]

On Behalf Of Bleiweiss

Sent: Tuesday, July 29, 2008 9:03

AM

To:

Subject:

Membership Fees, billed Phone Consults While Still PAR?

Folks,

This sort of came up at Camp a while back but I

never felt like I got a firm and confident answer on this. Can we start

charging a membership fee of our choice while still has contracts and PAR's with some

carriers? Furthermore some of her contracts are Managed Medicare & Medicaid

(managed not straight up), S-CHIPS so NYS's versions called Family and Child

Health Plus, so how does all that play out seeing that we are supposed to not

be allowed to bill these folks anything for services? Who if anyone has

actually contacted the lawyers on any of this and if so what have they said.

Same idea with same restrictions, can we charge for

phone consults while still under these conditions and who has done the hard

research to be sure about all this? Thanks much...

[Guest guest]

What is the easiest way to find out if

these “new” services (phone and online consults) are covered or not

by an individual’s health plan. For instance under CIGNA, we have

one contract but a myriad of plans are available under that carrier. How

is one to know if a particular patient’s plan covers or does not?

We called and e-mailed CIGNA and put the

(new) codes into their website and could not get a “straight”

answer!

For now, we only will do/bill these

services for our out of network patients and cash patients. One medical

assistance product does pay for the online visits and we are awaiting answer

from them on the phone consults.

Thanks

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

410 349-2250

polis, MD

From: [mailto: ] On Behalf Of Eads

Sent: Tuesday, July 29, 2008 1:08

PM

To:

Subject: RE:

Membership Fees, billed Phone Consults While Still PAR?

You can charge the fee if you are very careful it is for

‘non-covered services’. I have charged my pts since I went

solo (2003) for the email access, virtual visits, etc. Now some of these

services are being ‘covered’ so you need to check with the

insurance contracts you have. I make it clear to the pt that these are

not covered by their insurance, and they are responsible for paying it.

Some insurances haven’t liked their pts being charged this fee, and have

rewritten their contracts because of it, to specifically exclude it. Be

careful. Fortunately, I was able to work with the local medical directors

of the few insurances I was contracted with and come to an amicable agreement

to do it.

Same thing for phone and virtual/online visits – if they are

considered ‘covered’ services, then you have to follow the rules of

your contracts, collect the copays, etc. Now there are codes for these

online visits (99444) and phone consults (99441-3, based on time), so use them,

but that doesn’t mean they are covered by your insurance plans. It

seems different plans in different regions are covering these, at different

payment rates. Minn

is the best for amt reimbursed from what I hear ~$55 per online visit, while

most others are ~$20-35.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO

80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ]

On Behalf Of Bleiweiss

Sent: Tuesday, July 29, 2008 9:03

AM

To:

Subject:

Membership Fees, billed Phone Consults While Still PAR?

Folks,

This sort of came up at Camp a while back but I never felt like I got a firm

and confident answer on this. Can we start charging a membership fee of our

choice while

still has contracts and PAR's with some carriers? Furthermore some of her

contracts are Managed Medicare & Medicaid (managed not straight up),

S-CHIPS so NYS's versions called Family and Child Health Plus, so how does all

that play out seeing that we are supposed to not be allowed to bill these folks

anything for services? Who if anyone has actually contacted the lawyers on any

of this and if so what have they said.

Same idea with same restrictions, can we charge for phone consults while still

under these conditions and who has done the hard research to be sure about all

this? Thanks much...

[Guest guest]

Ramona,

You need to bill/charge all patients the same. The only

way to know if it’s covered an billable is to bill it to the insurance

and see what they say. you can have the patient sign an ABN that if it is

not covered they are responsible, for security, but to me that is a lot of

extra paperwork and my policy is clearly posted and they get a copy and sign

every year that they are responsible for all noncovered services.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of RGMS

Sent: Tuesday, July 29, 2008 7:10 PM

To:

Subject: RE: Membership Fees, billed Phone

Consults While Still PAR?

What is

the easiest way to find out if these “new” services (phone and

online consults) are covered or not by an individual’s health plan.

For instance under CIGNA, we have one contract but a myriad of plans are

available under that carrier. How is one to know if a particular

patient’s plan covers or does not?

We called

and e-mailed CIGNA and put the (new) codes into their website and could not get

a “straight” answer!

For now,

we only will do/bill these services for our out of network patients and cash

patients. One medical assistance product does pay for the online visits

and we are awaiting answer from them on the phone consults.

Thanks

Ramona

Ramona G.

Seidel, MD

www.baycrossingfamilymedicine.com

Your

Bridge to Health

410

349-2250

polis,

MD

From:

[mailto: ] On Behalf Of Eads

Sent: Tuesday, July 29, 2008 1:08 PM

To:

Subject: RE: Membership Fees, billed Phone

Consults While Still PAR?

You can

charge the fee if you are very careful it is for ‘non-covered

services’. I have charged my pts since I went solo (2003) for the

email access, virtual visits, etc. Now some of these services are being

‘covered’ so you need to check with the insurance contracts you

have. I make it clear to the pt that these are not covered by their

insurance, and they are responsible for paying it. Some insurances

haven’t liked their pts being charged this fee, and have rewritten their

contracts because of it, to specifically exclude it. Be careful.

Fortunately, I was able to work with the local medical directors of the few

insurances I was contracted with and come to an amicable agreement to do it.

Same thing

for phone and virtual/online visits – if they are considered

‘covered’ services, then you have to follow the rules of your

contracts, collect the copays, etc. Now there are codes for these online

visits (99444) and phone consults (99441-3, based on time), so use them, but

that doesn’t mean they are covered by your insurance plans. It

seems different plans in different regions are covering these, at different

payment rates. Minn is the best for amt reimbursed from what I hear ~$55

per online visit, while most others are ~$20-35.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Bleiweiss

Sent: Tuesday, July 29, 2008 9:03 AM

To:

Subject: Membership Fees, billed Phone Consults

While Still PAR?

Folks,

This sort of came up at Camp a while back but I never felt like I got a firm

and confident answer on this. Can we start charging a membership fee of our

choice while still has contracts and PAR's with some carriers?

Furthermore some of her contracts are Managed Medicare & Medicaid (managed

not straight up), S-CHIPS so NYS's versions called Family and Child Health

Plus, so how does all that play out seeing that we are supposed to not be

allowed to bill these folks anything for services? Who if anyone has actually

contacted the lawyers on any of this and if so what have they said.

Same idea with same restrictions, can we charge for phone consults while still

under these conditions and who has done the hard research to be sure about all

this? Thanks much...

[Guest guest]

So, the annual payment policy is good

enough then, no need to build in an ABN of sorts directly into the virtual

office visit algorithm for each visit? I do not have people sign ABN

every LIVE office visit, but for some reason it seemed like the “right”

thing to do for the virtual office visit.

Along these same lines, is anyone charging

for telephone consultations under 3rd party and getting re-imbursed

with the new codes? If so, what kind of charges are folks assigning to

these codes? These new codes have strict criteria and time criteria (5-10

minutes; 11-20 mintues etc). I have not yet tried to bill for

any such services, but was thinking of giving it a shot, and wondered what

experience is out there already.

Thanks

Ramona

From: [mailto: ] On Behalf Of Kathy Saradarian

Sent: Tuesday, July 29, 2008 7:17

PM

To:

Subject: RE:

Membership Fees, billed Phone Consults While Still PAR?

Ramona,

You need to bill/charge all patients the same. The only

way to know if it’s covered an billable is to bill it to the insurance

and see what they say. you can have the patient sign an ABN that if it is

not covered they are responsible, for security, but to me that is a lot of

extra paperwork and my policy is clearly posted and they get a copy and sign

every year that they are responsible for all noncovered services.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ]

On Behalf Of RGMS

Sent: Tuesday, July 29, 2008 7:10

PM

To:

Subject: RE:

Membership Fees, billed Phone Consults While Still PAR?

What is the easiest way to find out if these “new”

services (phone and online consults) are covered or not by an

individual’s health plan. For instance under CIGNA, we have one

contract but a myriad of plans are available under that carrier. How is

one to know if a particular patient’s plan covers or does not?

We called and e-mailed CIGNA and put the (new) codes into their

website and could not get a “straight” answer!

For now, we only will do/bill these services for our out of network

patients and cash patients. One medical assistance product does pay for

the online visits and we are awaiting answer from them on the phone consults.

Thanks

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

410 349-2250

polis, MD

From:

[mailto: ]

On Behalf Of Eads

Sent: Tuesday, July 29, 2008 1:08

PM

To:

Subject: RE:

Membership Fees, billed Phone Consults While Still PAR?

You can charge the fee if you are very careful it is for

‘non-covered services’. I have charged my pts since I went

solo (2003) for the email access, virtual visits, etc. Now some of these

services are being ‘covered’ so you need to check with the

insurance contracts you have. I make it clear to the pt that these are

not covered by their insurance, and they are responsible for paying it.

Some insurances haven’t liked their pts being charged this fee, and have

rewritten their contracts because of it, to specifically exclude it. Be

careful. Fortunately, I was able to work with the local medical directors

of the few insurances I was contracted with and come to an amicable agreement

to do it.

Same thing for phone and virtual/online visits – if they are

considered ‘covered’ services, then you have to follow the rules of

your contracts, collect the copays, etc. Now there are codes for these

online visits (99444) and phone consults (99441-3, based on time), so use them,

but that doesn’t mean they are covered by your insurance plans. It

seems different plans in different regions are covering these, at different

payment rates. Minn

is the best for amt reimbursed from what I hear ~$55 per online visit, while

most others are ~$20-35.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ]

On Behalf Of Bleiweiss

Sent: Tuesday, July 29, 2008 9:03

AM

To:

Subject:

Membership Fees, billed Phone Consults While Still PAR?

Folks,

This sort of came up at Camp a while back but I never felt like I got a firm

and confident answer on this. Can we start charging a membership fee of our

choice while

still has contracts and PAR's with some carriers? Furthermore some of her

contracts are Managed Medicare & Medicaid (managed not straight up),

S-CHIPS so NYS's versions called Family and Child Health Plus, so how does all

that play out seeing that we are supposed to not be allowed to bill these folks

anything for services? Who if anyone has actually contacted the lawyers on any

of this and if so what have they said.

Same idea with same restrictions, can we charge for phone consults while still

under these conditions and who has done the hard research to be sure about all

this? Thanks much...

[Guest guest]

Yes we too would like to know who has had what experiences with the Cartels in terms of this stuff. I know that at least in our area Atena is offering to pay for "E" visits, but they want them thru their portal. The "con job" that they use is that they will get your copays or what have you pre-paid so you know that you are getting paid...

But here's the rub in our area they are offering to pay a whole whopping $30 bucks or so and today most people's copays are around $20-$30 bucks so now they get a free visit out of you and the patient instead of paying you let's say about $65 for a level 3 in office sick visit. But what really makes me avoid them on this is, because it goes thru their portal, now it is a "Chart Review" to watch your notation, OV style, and billing verses charting. It is allowing them to grab and save a copy of your private interactions between you and your patient. They are SPYING on the two of you. That is just garbage, or as we would say at the AC user board, BullCCHIT. We love CCHIT can't ya tell??? So it is our humble opionion to avoid these carrier portals for such things at all costs. I'm not too sure if they would still pay for such a thing if we did it thru our own

So yes please we would love to hear from other folks on this... Thanks much,

[Practiceimprovemen t1] Membership Fees, billed Phone Consults While Still PAR?

Folks,

This sort of came up at Camp a while back but I never felt like I got a firm and confident answer on this. Can we start charging a membership fee of our choice while still has contracts and PAR's with some carriers? Furthermore some of her contracts are Managed Medicare & Medicaid (managed not straight up), S-CHIPS so NYS's versions called Family and Child Health Plus, so how does all that play out seeing that we are supposed to not be allowed to bill these folks anything for services? Who if anyone has actually contacted the lawyers on any of this and if so what have they said.

Same idea with same restrictions, can we charge for phone consults while still under these conditions and who has done the hard research to be sure about all this? Thanks much...

[Guest guest]

so paul now take a breath..if you do e visits on aetna patients and aetna has a policy to pay for such visits can you just have the patient submit fo rreimbursement , though they pay you?

Or , are you saying aetna will only cover e vists through their portal?And why does Aetna get the copay then I missed something?They reimburse you 30.00 for an e vist if you do it through their portal?So good you get paid. yes?

I only charge 25.00 for evisits.... does the portal cost?I agree it is pain one more scattered place for info but it mightbe possilbe to do if you are hurting and this could keep you afloat t a bit

if you cut and paste from the chart becasue you do that anymway for a n e vists or save it to the desktop folder where you put such things yes? I understand, part of this as usual is there is no some simple emr as one cohesive system but it seems possibly doable?(I do not take aetna I got them to offer me 15%more when I argueduse of HYH but then I turned them down becasue others tell me their hassle factor is huge)

Yes we too would like to know who has had what experiences with the Cartels in terms of this stuff. I know that at least in our area Atena is offering to pay for " E " visits, but they want them thru their portal. The " con job " that they use is that they will get your copays or what have you pre-paid so you know that you are getting paid...

But here's the rub in our area they are offering to pay a whole whopping $30 bucks or so and today most people's copays are around $20-$30 bucks so now they get a free visit out of you and the patient instead of paying you let's say about $65 for a level 3 in office sick visit. But what really makes me avoid them on this is, because it goes thru their portal, now it is a " Chart Review " to watch your notation, OV style, and billing verses charting. It is allowing them to grab and save a copy of your private interactions between you and your patient. They are SPYING on the two of you. That is just garbage, or as we would say at the AC user board, BullCCHIT. We love CCHIT can't ya tell??? So it is our humble opionion to avoid these carrier portals for such things at all costs. I'm not too sure if they would still pay for such a thing if we did it thru our own

So yes please we would love to hear from other folks on this... Thanks much,

[Practiceimprovemen t1] Membership Fees, billed Phone Consults While Still PAR?

Folks,

This sort of came up at Camp a while back but I never felt like I got a firm and confident answer on this. Can we start charging a membership fee of our choice while still has contracts and PAR's with some carriers? Furthermore some of her contracts are Managed Medicare & Medicaid (managed not straight up), S-CHIPS so NYS's versions called Family and Child Health Plus, so how does all that play out seeing that we are supposed to not be allowed to bill these folks anything for services? Who if anyone has actually contacted the lawyers on any of this and if so what have they said.

Same idea with same restrictions, can we charge for phone consults while still under these conditions and who has done the hard research to be sure about all this? Thanks much...

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

so paul now take a breath..if you do e visits on aetna patients and aetna has a policy to pay for such visits can you just have the patient submit fo rreimbursement , though they pay you?

Or , are you saying aetna will only cover e vists through their portal?And why does Aetna get the copay then I missed something?They reimburse you 30.00 for an e vist if you do it through their portal?So good you get paid. yes?

I only charge 25.00 for evisits.... does the portal cost?I agree it is pain one more scattered place for info but it mightbe possilbe to do if you are hurting and this could keep you afloat t a bit

if you cut and paste from the chart becasue you do that anymway for a n e vists or save it to the desktop folder where you put such things yes? I understand, part of this as usual is there is no some simple emr as one cohesive system but it seems possibly doable?(I do not take aetna I got them to offer me 15%more when I argueduse of HYH but then I turned them down becasue others tell me their hassle factor is huge)

Yes we too would like to know who has had what experiences with the Cartels in terms of this stuff. I know that at least in our area Atena is offering to pay for " E " visits, but they want them thru their portal. The " con job " that they use is that they will get your copays or what have you pre-paid so you know that you are getting paid...

But here's the rub in our area they are offering to pay a whole whopping $30 bucks or so and today most people's copays are around $20-$30 bucks so now they get a free visit out of you and the patient instead of paying you let's say about $65 for a level 3 in office sick visit. But what really makes me avoid them on this is, because it goes thru their portal, now it is a " Chart Review " to watch your notation, OV style, and billing verses charting. It is allowing them to grab and save a copy of your private interactions between you and your patient. They are SPYING on the two of you. That is just garbage, or as we would say at the AC user board, BullCCHIT. We love CCHIT can't ya tell??? So it is our humble opionion to avoid these carrier portals for such things at all costs. I'm not too sure if they would still pay for such a thing if we did it thru our own

So yes please we would love to hear from other folks on this... Thanks much,

[Practiceimprovemen t1] Membership Fees, billed Phone Consults While Still PAR?

Folks,

This sort of came up at Camp a while back but I never felt like I got a firm and confident answer on this. Can we start charging a membership fee of our choice while still has contracts and PAR's with some carriers? Furthermore some of her contracts are Managed Medicare & Medicaid (managed not straight up), S-CHIPS so NYS's versions called Family and Child Health Plus, so how does all that play out seeing that we are supposed to not be allowed to bill these folks anything for services? Who if anyone has actually contacted the lawyers on any of this and if so what have they said.

Same idea with same restrictions, can we charge for phone consults while still under these conditions and who has done the hard research to be sure about all this? Thanks much...

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

We’ve actually billed insurance for

2 phone visits. One was paid (HMO), one was not. “Non-covered

services” are part of our financial agreement, and phone visits are

specifically included as a non-covered service in our financial agreement, so

the patient’s responsible if insurance doesn’t pay. We also

have web visits, forms completion, overdraft charges, late fees, and chart “copies”

specifically included in the financial agreement as non-covered services.

If you go to our website, there is a copy of the Financial Agreement on the New

Patient page and you can see the fees that we charge. www.prattmd.info

Pratt

Office Manager

Oak Tree Internal Medicine P.C.

From: [mailto: ] On Behalf Of RGMS

Sent: Thursday, July 31, 2008 8:55

PM

To:

Subject: RE:

Membership Fees, billed Phone Consults While Still PAR?

So, the annual payment policy is good enough then, no need to build

in an ABN of sorts directly into the virtual office visit algorithm for each

visit? I do not have people sign ABN every LIVE office visit, but for

some reason it seemed like the “right” thing to do for the virtual

office visit.

Along these same lines, is anyone charging for telephone

consultations under 3rd party and getting re-imbursed with the new

codes? If so, what kind of charges are folks assigning to these

codes? These new codes have strict criteria and time criteria (5-10

minutes; 11-20 mintues etc). I have not yet tried to bill for

any such services, but was thinking of giving it a shot, and wondered what

experience is out there already.

Thanks

Ramona

From:

[mailto: ]

On Behalf Of Kathy Saradarian

Sent: Tuesday, July 29, 2008 7:17

PM

To:

Subject: RE:

Membership Fees, billed Phone Consults While Still PAR?

Ramona,

You need to bill/charge all patients the same. The only

way to know if it’s covered an billable is to bill it to the insurance

and see what they say. you can have the patient sign an ABN that if it is

not covered they are responsible, for security, but to me that is a lot of

extra paperwork and my policy is clearly posted and they get a copy and sign

every year that they are responsible for all noncovered services.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ]

On Behalf Of RGMS

Sent: Tuesday, July 29, 2008 7:10

PM

To:

Subject: RE:

Membership Fees, billed Phone Consults While Still PAR?

What is the easiest way to find out if these “new”

services (phone and online consults) are covered or not by an

individual’s health plan. For instance under CIGNA, we have one

contract but a myriad of plans are available under that carrier. How is

one to know if a particular patient’s plan covers or does not?

We called and e-mailed CIGNA and put the (new) codes into their

website and could not get a “straight” answer!

For now, we only will do/bill these services for our out of network

patients and cash patients. One medical assistance product does pay for

the online visits and we are awaiting answer from them on the phone consults.

Thanks

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

410 349-2250

polis, MD

From:

[mailto: ]

On Behalf Of Eads

Sent: Tuesday, July 29, 2008 1:08

PM

To:

Subject: RE:

Membership Fees, billed Phone Consults While Still PAR?

You can charge the fee if you are very careful it is for

‘non-covered services’. I have charged my pts since I went

solo (2003) for the email access, virtual visits, etc. Now some of these

services are being ‘covered’ so you need to check with the

insurance contracts you have. I make it clear to the pt that these are

not covered by their insurance, and they are responsible for paying it.

Some insurances haven’t liked their pts being charged this fee, and have

rewritten their contracts because of it, to specifically exclude it. Be

careful. Fortunately, I was able to work with the local medical directors

of the few insurances I was contracted with and come to an amicable agreement

to do it.

Same thing for phone and virtual/online visits – if they are

considered ‘covered’ services, then you have to follow the rules of

your contracts, collect the copays, etc. Now there are codes for these

online visits (99444) and phone consults (99441-3, based on time), so use them,

but that doesn’t mean they are covered by your insurance plans. It

seems different plans in different regions are covering these, at different

payment rates. Minn

is the best for amt reimbursed from what I hear ~$55 per online visit, while

most others are ~$20-35.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO

80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ]

On Behalf Of Bleiweiss

Sent: Tuesday, July 29, 2008 9:03

AM

To:

Subject:

Membership Fees, billed Phone Consults While Still PAR?

Folks,

This sort of came up at Camp a while back but I never felt like I got a firm

and confident answer on this. Can we start charging a membership fee of our

choice while

still has contracts and PAR's with some carriers? Furthermore some of her

contracts are Managed Medicare & Medicaid (managed not straight up),

S-CHIPS so NYS's versions called Family and Child Health Plus, so how does all

that play out seeing that we are supposed to not be allowed to bill these folks

anything for services? Who if anyone has actually contacted the lawyers on any

of this and if so what have they said.

Same idea with same restrictions, can we charge for phone consults while still

under these conditions and who has done the hard research to be sure about all

this? Thanks much...

[Guest guest]

I have not been paid either, but bill the patients and they pay seem to

understand that the world has changed this is sort of like eecummings or jean

________________________________

From: on behalf of Pratt

Sent: Tue 8/5/2008 10:00 AM

To:

Subject: RE: Membership Fees, billed Phone Consults While

Still PAR?

We've actually billed insurance for 2 phone visits. One was paid (HMO), one was

not. " Non-covered services " are part of our financial agreement, and phone

visits are specifically included as a non-covered service in our financial

agreement, so the patient's responsible if insurance doesn't pay. We also have

web visits, forms completion, overdraft charges, late fees, and chart " copies "

specifically included in the financial agreement as non-covered services. If

you go to our website, there is a copy of the Financial Agreement on the New

Patient page and you can see the fees that we charge. www.prattmd.info

<http://www.prattmd.info/>

Pratt

Office Manager

Oak Tree Internal Medicine P.C.

________________________________

From:

[mailto: ] On Behalf Of RGMS

Sent: Thursday, July 31, 2008 8:55 PM

To:

Subject: RE: Membership Fees, billed Phone Consults While

Still PAR?

So, the annual payment policy is good enough then, no need to build in an ABN of

sorts directly into the virtual office visit algorithm for each visit? I do not

have people sign ABN every LIVE office visit, but for some reason it seemed like

the " right " thing to do for the virtual office visit.

Along these same lines, is anyone charging for telephone consultations under 3rd

party and getting re-imbursed with the new codes? If so, what kind of charges

are folks assigning to these codes? These new codes have strict criteria and

time criteria (5-10 minutes; 11-20 mintues etc). I have not yet tried to bill

for any such services, but was thinking of giving it a shot, and wondered what

experience is out there already.

Thanks

Ramona

________________________________

From:

[mailto: ] On Behalf Of Kathy Saradarian

Sent: Tuesday, July 29, 2008 7:17 PM

To:

Subject: RE: Membership Fees, billed Phone Consults While

Still PAR?

Ramona,

You need to bill/charge all patients the same. The only way to know if it's

covered an billable is to bill it to the insurance and see what they say. you

can have the patient sign an ABN that if it is not covered they are responsible,

for security, but to me that is a lot of extra paperwork and my policy is

clearly posted and they get a copy and sign every year that they are responsible

for all noncovered services.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of RGMS

Sent: Tuesday, July 29, 2008 7:10 PM

To:

Subject: RE: Membership Fees, billed Phone Consults While

Still PAR?

What is the easiest way to find out if these " new " services (phone and online

consults) are covered or not by an individual's health plan. For instance under

CIGNA, we have one contract but a myriad of plans are available under that

carrier. How is one to know if a particular patient's plan covers or does not?

We called and e-mailed CIGNA and put the (new) codes into their website and

could not get a " straight " answer!

For now, we only will do/bill these services for our out of network patients and

cash patients. One medical assistance product does pay for the online visits

and we are awaiting answer from them on the phone consults.

Thanks

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com <http://www.baycrossingfamilymedicine.com/>

Your Bridge to Health

410 349-2250

polis, MD

________________________________

From:

[mailto: ] On Behalf Of Eads

Sent: Tuesday, July 29, 2008 1:08 PM

To:

Subject: RE: Membership Fees, billed Phone Consults While

Still PAR?

You can charge the fee if you are very careful it is for 'non-covered services'.

I have charged my pts since I went solo (2003) for the email access, virtual

visits, etc. Now some of these services are being 'covered' so you need to

check with the insurance contracts you have. I make it clear to the pt that

these are not covered by their insurance, and they are responsible for paying

it. Some insurances haven't liked their pts being charged this fee, and have

rewritten their contracts because of it, to specifically exclude it. Be

careful. Fortunately, I was able to work with the local medical directors of

the few insurances I was contracted with and come to an amicable agreement to do

it.

Same thing for phone and virtual/online visits - if they are considered

'covered' services, then you have to follow the rules of your contracts, collect

the copays, etc. Now there are codes for these online visits (99444) and phone

consults (99441-3, based on time), so use them, but that doesn't mean they are

covered by your insurance plans. It seems different plans in different regions

are covering these, at different payment rates. Minn is the best for amt

reimbursed from what I hear ~$55 per online visit, while most others are

~$20-35.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

________________________________

From:

[mailto: ] On Behalf Of Bleiweiss

Sent: Tuesday, July 29, 2008 9:03 AM

To:

Subject: Membership Fees, billed Phone Consults While

Still PAR?

Folks,

This sort of came up at Camp a while back but I never felt like I got a firm

and confident answer on this. Can we start charging a membership fee of our

choice while still has contracts and PAR's with some carriers? Furthermore

some of her contracts are Managed Medicare & Medicaid (managed not straight up),

S-CHIPS so NYS's versions called Family and Child Health Plus, so how does all

that play out seeing that we are supposed to not be allowed to bill these folks

anything for services? Who if anyone has actually contacted the lawyers on any

of this and if so what have they said.

Same idea with same restrictions, can we charge for phone consults while

still under these conditions and who has done the hard research to be sure about

all this? Thanks much...