Re: wake up call- Retainer & Vacation...

[Guest guest]

, et.al;

In your retainer model (reasonable it seems) how are you proposing

to have

VACATION coverage (will your patients resent your inavailability or

will you take on the expense of hiring coverage for your practice?)

HOSPITAL coverage (will you do inpatient work as well?) 24/7? How

about family time as a priority?

Also, by my calculations, if you have 1000 pts, and each get a

preventive med visit every year, that would be 500 hrs given the 30

min minimum that a patient would feel as an 'entitilement' for the

extra $200. That is nearly 13 weeks (hopefull 40 hr weeks) out of

the year on this activity (as opposed to working it into the current

visit for which the patient presents... which may be an additional

win-win 'convenience' to the patient on slow days)

Will you take Medicare, and if so how will you make such a charge

legal?

I applaud your honesty re: this situation. It is so important to

have integrity towards the greater callings on one's short life in

this world. I took a walk in the woods today with my 6 yr old

son..... we had not done so in over a year!!! The urgency of

changing was rarely so acute or powerful for me.

H. Haase MD

> Group,

> In light of my recent difficulties. I decided to

> take my ideas to the people. Today, I went to my

> prospective practice site(also my hometown) and looked

> up two people. One a prominent business person who is

> well respected and I trust. The other was my former

[Guest guest]

Greetings,

As far as Medicare covered or not, I am not sure, I don't have access to my book at this moment. However, here are the codes.

CPT-4 Code

Category

CPT-4 Description

Benchmark

99371

Evaluation & Managment

Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals (eg, nurses, therapists, social workers, nutritionists, physicians, pharmacists); simple or brie.

$7.40

99372

Evaluation & Managment

Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals (eg, nurses, therapists, social workers, nutritionists, physicians, pharmacists); intermediate (.

$14.80

99373

Evaluation & Managment

Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals (eg, nurses, therapists, social workers, nutritionists, physicians, pharmacists); complex or len.

$21.87

Re: Re: wake up call- Retainer & Vacation...

ARE PHONE CALLS A NON COVERED SERVICE? I COULDNT FIND A CODE OR AREIMBURSEMENT DOES ANYONE CHARGE THESE TO MEDICARE?

[Guest guest]

THANKS DO YOU KNOW IF THERE IS A CODE FOR PATIENT CALLS??

> Greetings,

>

> As far as Medicare covered or not, I am not sure, I don't have access to

> my book at this moment. However, here are the codes.

>

> CPT-4 Code Category CPT-4 Description Benchmark

> 99371 Evaluation & Managment Telephone call by a physician to

> patient or for consultation or medical management or for

> coordinating medical management with other health care

> professionals (eg, nurses, therapists, social workers,

> nutritionists, physicians, pharmacists); simple or brie. $7.40

> 99372 Evaluation & Managment Telephone call by a physician to

> patient or for consultation or medical management or for

> coordinating medical management with other health care

> professionals (eg, nurses, therapists, social workers,

> nutritionists, physicians, pharmacists); intermediate (. $14.80

> 99373 Evaluation & Managment Telephone call by a physician to

> patient or for consultation or medical management or for

> coordinating medical management with other health care

> professionals (eg, nurses, therapists, social workers,

> nutritionists, physicians, pharmacists); complex or len. $21.87

>

> Re: Re: wake up call- Retainer &

> Vacation...

>

>

> ARE PHONE CALLS A NON COVERED SERVICE? I COULDNT FIND A CODE OR A

> REIMBURSEMENT DOES ANYONE CHARGE THESE TO MEDICARE?

[Guest guest]

Greetings,

Sorry for the formatting, will have to figure out how to do a table in this listserv. These are the only codes, I have found thus far. I also do have access to my CPT code book. But in the book, the first few pages describe these codes.

I am not sure if I understand your question about PATIENT CALLS. If you mean phone calls where the physician talks to the patient, these are the codes.

TAS

Re: Re: wake up call- Retainer & > Vacation...>>> ARE PHONE CALLS A NON COVERED SERVICE? I COULDNT FIND A CODE OR A> REIMBURSEMENT DOES ANYONE CHARGE THESE TO MEDICARE?

[Guest guest]

in our area (one hour drive north of Boston, MA) many internists (including

myself) do annual Complete physicals on medicare patients. Patients typically

sign a waiver acknowledging that medicare will not pay for a preventative visit.

typically a patient pays about 80- 100 dollars out of pocket for this annual

visit. we usually can code a 99213 or 99214, plus

a -25 modifier for gyn or prostate exam and bill that 45-80 dollar charge to

medicare.... and the patient pays the remainder of our customary fee for a CPE

which has recently gone up to 165 dollars

in a sense this Fee greatly subsidizes the years unreimbursed phone calls, low

reimbursements. although quite a few patients get cranky about the

waiver...less than 3% of patients actually refuse.

I average about 400 medicare physicals/year which represents about $35,000 in

income.

I understand that medicare in 2006 will pay for physicals (who knows how much)

.. if that's the case then it will be harder to earn income as I expect medicare

will reimburse poorly for that as well.

miguel

[Guest guest]

thanks this is a help

> Greetings,

>

> Sorry for the formatting, will have to figure out how to do a table in

> this listserv. These are the only codes, I have found thus far. I also

> do have access to my CPT code book. But in the book, the first few

> pages describe these codes.

>

> I am not sure if I understand your question about PATIENT CALLS. If you

> mean phone calls where the physician talks to the patient, these are the

> codes.

>

> TAS

> Re: Re: wake up call- Retainer &

> > Vacation...

> >

> >

> > ARE PHONE CALLS A NON COVERED SERVICE? I COULDNT FIND A CODE OR

> A

> > REIMBURSEMENT DOES ANYONE CHARGE THESE TO MEDICARE?

>

>

>

>

>

[Guest guest]

medicare also expects a certain number physicals so you cannot bill these

visits as 99215.. they audited 1 group in our area who had to pay a huge

fine for billing 99215 for preventive physicals

> in our area (one hour drive north of Boston, MA) many internists

> (including myself) do annual Complete physicals on medicare patients.

> Patients typically sign a waiver acknowledging that medicare will not

> pay for a preventative visit. typically a patient pays about 80- 100

> dollars out of pocket for this annual visit. we usually can code a

> 99213 or 99214, plus a -25 modifier for gyn or prostate exam and bill

> that 45-80 dollar charge to medicare.... and the patient pays the

> remainder of our customary fee for a CPE which has recently gone up to

> 165 dollars

>

> in a sense this Fee greatly subsidizes the years unreimbursed phone

> calls, low reimbursements. although quite a few patients get cranky

> about the waiver...less than 3% of patients actually refuse. I average

> about 400 medicare physicals/year which represents about $35,000 in

> income.

> I understand that medicare in 2006 will pay for physicals (who knows how

> much) . if that's the case then it will be harder to earn income as I

> expect medicare will reimburse poorly for that as well. miguel

>

>

>

>

>

[Guest guest]

Tim, that sounds good, except the $200 hour visits still add up to

alot of hours that you are NOT billing something else. I love the

plan, but it does seem to take alot of income generating time out of

the picture.

H. Haase, MD

> Thanks for your reply. First, the way I am going

> to facilitate my plan is to offer one hour yearly

> exams for patients who elect for me to be their

> primary MD. This will cost the patient 200 dollars. I

> will do preventive care, lifestyle modification

> counseling, medication reveiw. So, technically it is

> not a retainer practice. This is allowed by medicare.

> Vacation will be one week every two months. This

> will be clearly stated in the initial pt-physician

> agreement. During that time I will advise patients to

> call if they need help and I will have designated call

> back times during that period. Secondly, I will have

> patients use the ER for any urgent care matters that

> arise during that time. That is all the have at this

> time, anyway.

> I will do my own hospital coverage. I am IM. I

> will be sharing call with the over physicians in town.

> q6wks x 1week. They actually get a better deal sharing

> call with me since I hopefully will be able to handle

> my own patient load on average. It WILL get crazy

> sometimes. That's medicine! However, I am keeping my

> patient load to 1000 patients total.

> I will see scheduled patients during the morning

> hours. I will facilitate a disease oriented visit into

> the plan when appropriate. The afternoon will be for

> open access(even for people who call who are not my

> patient as long as it doesn't interfere with my care

> of the people that are part of that 1000), urgent

> matters and scheduled follow-ups(15-25 minutes).

> Hopefully, decreased patient load and open access

> will lead to a better lifestyle. I may have to titer

> the patient load to fit a reasonable work schedule. If

> I am working my butt off at 800 then I may stop there.

>

> Beck, M.D.

>