RE: Re: various issues: learning billing, EOB grooming, and income

April 24, 2006

Yes, I do all of those generally all at once. Technically, what is it that

makes a visit a " preventive visit " ? When the pt calks it that or when the

doctor decides that's what it is? If you discuss, say, a colonoscopy does

that make it a preventive visit? Maybe more of my visits should actually be

preventive codes.

Re: various issues: learning

> > billing, EOB grooming, and income

> >

> > From Dr Joanne in Drain, Oregon,

> >

> > The reason you haven't heard much from me recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may be

> > rejected for payment: however; if so, one can rebill straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled to

> > Medicare.

> >

> > No, I didn't fire the part time worker. I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> > Thinking about a second way increase income. I have been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here, these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

> > Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

April 24, 2006

I don't have Alteer - I just make sure in the areas that are appropriate that I have separate paragraphs or info for the two parts of the visit.Example is pap on a woman with HTN, hyperlipidemia and hypothyroidism. First part of entry includes pap info, LMP, etc, etc,. Second part has HPI pertaining to all her disease states. My plan is separated out also. But I've been reimbursed many times on both without having notes that are so rigid. I think there's articles on this in FPM. I don't bill both if the extra matters are trivial or relate somehow to the preventive visit (how to work on weight, menopausal symptoms during a pap). Everything you listed in your message looks like preventive except the "medication refills for all problems." If I'm reviewing those problems, analyzing if they are being effectively treated and perhaps changing that treatment, that's a separate code for disease management. N What things do you cover in the two different notes in the preventative care versus the problem oriented. How do you separate. It seems like I will deal with complete exam , medication refills for all problems, get preventative services going like immunizations ,mammograms, colonoscopy etc. What more are you guys doing. How easy is it to do this in Alteer. Brent > > > Hi Annie, > > > > > > > > I've had poor experience with getting the preventative and chronic > > dz OV covered, even with 25 modifier. Most insurances in my area > > just flat out won't cover them on the same day. I have had good > > reimbursement for the prolonged services codes, however. > > > > > > > > A. Eads, M.D. > > > > Pinnacle Family Medicine, PLLC > > > > phone fax > > > > P.O. Box 7275 > > > > Woodland Park, CO 80863 > > > > From: > > [mailto: ] On Behalf Of Annie > > Skaggs > > Sent: Sunday, April 23, 2006 6:29 AM > > To: > > Subject: RE: various issues: learning > > billing, EOB grooming, and income > > > > > > > > HI Joanne in Drain, > > > > > > > > Congrats on your expanding skills. It really is eye-opening to dig > > into "working the claims" > > > > > > > > One thing that stood out to me, however, was your statement that WC > > "pays like a trooper". I hope that continues to be true for you, > > but for me, WC is a nightmare. About half the time they never pay > > at all, and take a year or more to ever actually deny, so by then > > it's too late to try the regular health insurance. When they do > > pay, (after 90 days usually), they pay thru subcontracts to really > > rotten payers like FirstHealth or BeechStreet, and pay about 60% of > > what I would get from most private insurances. Two or three times > > over the past 4 years I have gotten 100% of charges, and I guess > > that is what has kept me trying, but not anymore. I have just put > > in place a policy requiring pay up front from the patients if they > > want me to see them for WC or auto insurance related problems. > > Auto insurance also has occasionally paid 100%, but much more > > often, by the time they go to the ER, that uses up all the > > available benefit, so when I see them for the f/u, I get nothing. > > > > > > > > On a cheerier note, I learned from the practicmgt listserv some > > tricks like billing preventive plus OV on the same DOS with -25 on > > the OV for chronic disease mgt, and that has almost doubled my > > reimbursement for visits where I was giving "one-stop-shopping" and > > providing complete preventive service PLUS all their chronic med > > refills and disease follow up testing, etc. The only thing I don't > > like about it is that I have to write two completely different > > notes for the one visit, but good thing I do because a couple times > > they requested the records before they would pay. I also am > > getting some payments for 99050, 99058 and now 99051. Next I am > > going to try the prolonged service codes. > > > > > > > > Good luck with your business adventures! > > > > Annie > > > > > > > > Re: various issues: learning > > billing, EOB grooming, and income > > > > > > > > From Dr Joanne in Drain, Oregon, > > > > > > > > The reason you haven't heard much from me recently is that I am > > now starting to do my own billing. I had a billing expert who came > > in 10 hours a week to bill for me, but I was seeing more patients, > > documenting the way she told me to, and not getting more money. So > > I decided to bite the bullet and learn Lytec well enough to bill > > for myself and find out why. > > > > As of two weeks ago, I have been billing the day's patients > > the end of every day, and am starting to cream through my old EOBs > > and do all the challanges, rebills, charging to secondary billing, > > etc,etc that one must do to actually collect what you are allowed > > to get from these folks. It is irritating and time consuming, but > > it certainly is making me a better coder as well as collecting a > > reasonable amount of money. > > > > What was happening with my (everyone says including the MD she > > is working full time for) skilled billing person, is that she was > > skipping the tough ones: For example, Blue Cross Blue Shield 65 > > Plus is supposed to have a primary care provider that they have to > > access first. Some of them can come here for very acute problems > > if they can't get into their primary provider. They may be > > rejected for payment: however; if so, one can rebill straight to > > Medicare and get them (mostly) covered, except for 15 or 16 > > dollars. I found 25 or 30 of those that never got rebilled to > > Medicare. > > > > No, I didn't fire the part time worker. I have a rule that > > "you can never hire anyone to do anything you don't all ready know > > how to do yourself, better." I think it was my fault for not > > learning the system myself first. And the worker is doing a much > > better job now, too. > > > > I think the business was just getting too busy for one part > > timer, and I am not willing to hire someone full time for this; I > > refuse to become anything but a low overhead practice. > > > > > > > > Thinking about a second way increase income. I have been here in > > Drain long enough that I seem reliable to the local businesses for > > on-the-job injuries. Workman's comp pays like a trooper, if you > > keep good documentation. I am starting to become the one they send > > these folks to, and I have started to visit the local factories/ > > businesses to offer my services. Businesses tend to have habits of > > behavior for injuries, and if you are their first choice, you can > > get some good cases, with great followup coverage. Here, these > > businesses are mills and machinist shops, with some logging > > companies, which have rather specific types of injury. > > > > > > > > Joanne > > > > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries for > > just 2¢/min with Yahoo! Messenger with Voice. > > > > > > > >

April 24, 2006

Generally, if they called to schedule “my

physical” or “my annual” and I do a head to toe exam and

review age appropriate screening and immunizations, I bill that with a

preventive code (unless they are Medicare). If the patient is a completely healthy 22 yo girl whose only prescription is for OCPs,

that is all I bill. But if she is 45 and

on meds for HTN, hyperlipidemia and allergies too, then I

add the 99214-25. I can’t say how

it works in Alteer; I use Healthmatics

from A4. Since the patient wants to take

her prescriptions with her I document the 99214 services first, recording the

HPI as follow up for those diagnoses and only the portions of the ROS, PMH

and exam that are pertinent and then the A & P that includes the pertinent

diagnoses, prescriptions and labs if needed. I sign off that note then and pull the chart

again (having put her on the schedule twice, I pull her from whichever one I

didn’t use already.) This time the

CC/HPI is “Pleasant adult female here for preventive screening.” This

time I use a full multisystem ROS, include

the entire PMH, and record the complete exam including reentering the same

vitals (I change the time on those to show they are the same readings as the

previous note) The

A & P lists V70.0 as the primary diagnosis, followed by V72.31 for the pap,

V76.1 for the mam, and then whatever else I need if

they are due for other stuff (colonoscopy, Td, whatever). With

a little thought about what I am doing, I can usually keep duplication of

effort to a minimum. Sometimes I put the

mammogram in the 99214 A & P so I can print the order for the patient to take

with her, then delete it and put it in again in the second note, but if the

patient is hanging around for a colonoscopy referral or something, I usually can

avoid that.

Hope that helps,

Annie

Re: various issues: learning

> > billing, EOB grooming, and income

> >

> > From Dr Joanne in Drain, Oregon,

> >

> > The reason you haven't heard much from me

recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been

billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says

including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may

be

> > rejected for payment: however; if so, one can rebill

straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled

to

> > Medicare.

> >

> > No, I didn't fire the part time worker.

I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for

not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too

busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> > Thinking about a second way increase income. I have

been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here,

these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

>

Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

April 24, 2006

Generally, if they called to schedule “my

physical” or “my annual” and I do a head to toe exam and

review age appropriate screening and immunizations, I bill that with a

preventive code (unless they are Medicare). If the patient is a completely healthy 22 yo girl whose only prescription is for OCPs,

that is all I bill. But if she is 45 and

on meds for HTN, hyperlipidemia and allergies too, then I

add the 99214-25. I can’t say how

it works in Alteer; I use Healthmatics

from A4. Since the patient wants to take

her prescriptions with her I document the 99214 services first, recording the

HPI as follow up for those diagnoses and only the portions of the ROS, PMH

and exam that are pertinent and then the A & P that includes the pertinent

diagnoses, prescriptions and labs if needed. I sign off that note then and pull the chart

again (having put her on the schedule twice, I pull her from whichever one I

didn’t use already.) This time the

CC/HPI is “Pleasant adult female here for preventive screening.” This

time I use a full multisystem ROS, include

the entire PMH, and record the complete exam including reentering the same

vitals (I change the time on those to show they are the same readings as the

previous note) The

A & P lists V70.0 as the primary diagnosis, followed by V72.31 for the pap,

V76.1 for the mam, and then whatever else I need if

they are due for other stuff (colonoscopy, Td, whatever). With

a little thought about what I am doing, I can usually keep duplication of

effort to a minimum. Sometimes I put the

mammogram in the 99214 A & P so I can print the order for the patient to take

with her, then delete it and put it in again in the second note, but if the

patient is hanging around for a colonoscopy referral or something, I usually can

avoid that.

Hope that helps,

Annie

Re: various issues: learning

> > billing, EOB grooming, and income

> >

> > From Dr Joanne in Drain, Oregon,

> >

> > The reason you haven't heard much from me

recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been

billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says

including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may

be

> > rejected for payment: however; if so, one can rebill

straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled

to

> > Medicare.

> >

> > No, I didn't fire the part time worker.

I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for

not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too

busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> > Thinking about a second way increase income. I have

been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here,

these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

>

Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

April 24, 2006

Not always as easy as I’d like. Say they didn’t schedule a “physical”. They called with some sort of acute “sick”

problem. When I look at the chart, I see

that they are overdue for screening. If

my schedule allows and they aren’t too sick, I might offer to just do the

physical right then. But if they are coughing all over me, and my schedule is

packed, I remind them of the need for a preventive visit and put them on my “chase

her down” list. UNLESS I have

reason to believe this will be my only shot at it, in which

case I plough ahead….Sometimes you just gotta

do what you gotta do.

See my previous post about what I consider

“a preventive visit”

Annie

Re: various issues: learning

> > billing, EOB grooming, and income

> >

> > From Dr Joanne in Drain, Oregon,

> >

> > The reason you haven't heard much from me

recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been

billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says

including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may

be

> > rejected for payment: however; if so, one can rebill

straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled

to

> > Medicare.

> >

> > No, I didn't fire the part time worker.

I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for

not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too

busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> > Thinking about a second way increase income. I have

been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here,

these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

>

Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

April 24, 2006

So, your entire HPI is just “Pleasant

adult female here for preventive screening”? Is that enough to qualify

for a preventive code? And for HTN you just say “patient is here for FUP

on HTN” and nothing else? Wow, maybe I’m charting way too much if

that’s the case. I generally do a small paragraph of ~ 6-8

sentences/problem.

Re: various issues: learning

> > billing, EOB grooming, and income

> >

> > From Dr Joanne in Drain, Oregon,

> >

> > The reason you haven't heard much from me

recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been

billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says

including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may

be

> > rejected for payment: however; if so, one can rebill

straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled

to

> > Medicare.

> >

> > No, I didn't fire the part time worker.

I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for

not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too

busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> > Thinking about a second way increase income. I have

been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here,

these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

>

Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

April 24, 2006

CPT guidelines for use of preventive codes requires a “comprehensive

history (past medical/social) and ROS”,

but does not require a CC or HPI at all.

Typically for a physical, my HPI includes the “here for screening”

statement, plus whatever the patient says to me that seems pertinent, eg “I have had a really good year. I haven’t been sick once, and I joined a

gym in January and lost 7 lbs already”

For the multi problem f/u I “point and drag” the

pertinent diagnoses from the problem list and if there are 3 or more, that by

itself gets me all the “bullets” I need for a -14, but usually I

add some free text descriptions anyway: under Hypertension, I might say, “Brings

her records of readings at home, showing SBP ranging

from 114-148, most readings in the 120s.”

Stuff like that. I try to freetext what I really need, and not much more. If they have a complaint (symptom) related

(or not) to the diagnoses, I will pull that in and use the point and click system

in A4 to describe that because it is faster than freetext.

Hope that helps,

Annie

Re: various issues: learning

> > billing, EOB grooming, and income

> >

> > From Dr Joanne in Drain, Oregon,

> >

> > The reason you haven't heard much from me

recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been

billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says

including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may

be

> > rejected for payment: however; if so, one can rebill

straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled

to

> > Medicare.

> >

> > No, I didn't fire the part time worker.

I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for

not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too

busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> > Thinking about a second way increase income. I have

been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here,

these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

>

Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

April 24, 2006

The problem with not doing much HPI is

that you then have to rely on medical decision making as one of your 2 CPT criteria

to get a 99214 level & that can be much more difficult to ascertain. Also,

the HPI section may be your best legal defense. How do you document what was

said otherwise (ie, was the chest pain substernal or not doctor, etc)? There

are other (non-reimbursement) reasons for charting & I’d hate to

leave off too much of the history. I would skimp on the exam section before

the history. Also, my understanding of CPT is that simply having ‘all

the bullets” for a 99214 by history/physical does not matter if the

medical necessity is not there. Yes, most of the time 3 separate problems will

easily equal a 99214 but it is never automatic. Also, does cutting &

pasting old dx’s or history count towards the new visit’s coding?

I did not think you could do that for coding purposes.

Re: various issues: learning

> > billing, EOB grooming, and income

> >

> > From Dr Joanne in Drain, Oregon,

> >

> > The reason you haven't heard much from me

recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been

billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says

including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may

be

> > rejected for payment: however; if so, one can rebill

straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled

to

> > Medicare.

> >

> > No, I didn't fire the part time worker.

I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for

not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too

busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> > Thinking about a second way increase income. I have

been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here,

these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

>

Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

April 24, 2006