Re: Well care, problems, administrivia...

May 15, 2006

Matt,I think you were the one to coin the term "administrivia" which I really like. In my practice the patients deal with most of their own administrivia when it comes to insurance benefits and understanding their various plans. I do not see it as my job to do that for them. On a rare occasion if they can not penetrate the layers of beauracracy after multiple attempts I *may* intervene to quickly get the answer from the provider reps who I know on a first name basis by company.This is the benefit of getting the community involved in the practice (designing, marketing etc...)These people WANT me to stay in business so they do their best to take care of their own minutiae so I do not have to bother with it.I think this could work anywhere in the country where a caring doctor is valued by the community (everywhere). Giving patients a feeling of ownership in the practice gets them activated to figure out whether well care is covered, for example.Complaining back and forth about covered/not covered, eligible/not eligible, EOBs, FREEOBs, them ,us, etc.. is counterproductive. Win the hearts and minds of the community and they will be activated in making your practice a success.As usual manipulative, dishonest patients can go to the Wal Mart clinics and argue with the nurse practitioner about how to get more of their wife's immitrex while they are picking up their dog food. These people do not want a relationship with you. Open the cage and let them go....PamelaP.S. I totally agree about handling problems first and when the dust settles and the relationship has developed then I schedule the physical. RE Well care is NOT for problem care 1) Yep, have had a couple of these-- these folks actually had a certain dollar amount for "well care" in a year without deductible. Then, when I found some problem, they went ballistic when I charged for the acute problem and the well care. 2) Got worse-- person when they came to office "didn't know" if physical was "covered" so I was sure to identify a medical problem to be sure they got coverage at all. 3) Finally, pt had history of migraines, was taking wife's immitrex. So pt calls me up to complain about his deductible for the acute (I did get paid, I think, for the well care-- was working for hospital at that time and they NEVER showed me EOBs), and didn't want to pay. Told him he had to come in for the immitrex-- was trying to save him some care time. My take-home from this problem-- 1) My policy for first time pt is TAKE CARE OF ANY PROBLEMS FIRST 2) Bring back for follow up with old records, usually in about 4 weeks (time for prior docs to get records copied and out the door), BUT in meantime, check to see if pt has well care coverage. This often requires a phone call, but best to do this with ANY pt to see what their well-care/insurance really covers. Remember that pt is often feels as trapped as you do, but best to be ready with this information. You want return pts, not dissatisfied ones, OR high accounts receivables. 3) When pt then back in for follow up, you can address appropriately and honestly about follow up well-care issues, coverage and chronic care issues. My thoughts... Dr Matt Levin Solo FP since Dec 2004 In practice since 1988 Pittsburgh eastern suburbs, PA Re: code for "form physical" I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of the insurance companies).

May 15, 2006

Matt,I think you were the one to coin the term "administrivia" which I really like. In my practice the patients deal with most of their own administrivia when it comes to insurance benefits and understanding their various plans. I do not see it as my job to do that for them. On a rare occasion if they can not penetrate the layers of beauracracy after multiple attempts I *may* intervene to quickly get the answer from the provider reps who I know on a first name basis by company.This is the benefit of getting the community involved in the practice (designing, marketing etc...)These people WANT me to stay in business so they do their best to take care of their own minutiae so I do not have to bother with it.I think this could work anywhere in the country where a caring doctor is valued by the community (everywhere). Giving patients a feeling of ownership in the practice gets them activated to figure out whether well care is covered, for example.Complaining back and forth about covered/not covered, eligible/not eligible, EOBs, FREEOBs, them ,us, etc.. is counterproductive. Win the hearts and minds of the community and they will be activated in making your practice a success.As usual manipulative, dishonest patients can go to the Wal Mart clinics and argue with the nurse practitioner about how to get more of their wife's immitrex while they are picking up their dog food. These people do not want a relationship with you. Open the cage and let them go....PamelaP.S. I totally agree about handling problems first and when the dust settles and the relationship has developed then I schedule the physical. RE Well care is NOT for problem care 1) Yep, have had a couple of these-- these folks actually had a certain dollar amount for "well care" in a year without deductible. Then, when I found some problem, they went ballistic when I charged for the acute problem and the well care. 2) Got worse-- person when they came to office "didn't know" if physical was "covered" so I was sure to identify a medical problem to be sure they got coverage at all. 3) Finally, pt had history of migraines, was taking wife's immitrex. So pt calls me up to complain about his deductible for the acute (I did get paid, I think, for the well care-- was working for hospital at that time and they NEVER showed me EOBs), and didn't want to pay. Told him he had to come in for the immitrex-- was trying to save him some care time. My take-home from this problem-- 1) My policy for first time pt is TAKE CARE OF ANY PROBLEMS FIRST 2) Bring back for follow up with old records, usually in about 4 weeks (time for prior docs to get records copied and out the door), BUT in meantime, check to see if pt has well care coverage. This often requires a phone call, but best to do this with ANY pt to see what their well-care/insurance really covers. Remember that pt is often feels as trapped as you do, but best to be ready with this information. You want return pts, not dissatisfied ones, OR high accounts receivables. 3) When pt then back in for follow up, you can address appropriately and honestly about follow up well-care issues, coverage and chronic care issues. My thoughts... Dr Matt Levin Solo FP since Dec 2004 In practice since 1988 Pittsburgh eastern suburbs, PA Re: code for "form physical" I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of the insurance companies).

May 15, 2006

RE proactive coverage confirmation

Sorry, pts do NOT want a bill for well care, but if covered, are willing to pay the copay, and then I can get the compensation.

It would certainly be nice if the "community" would check to be sure they have the coverage, but just doesn't work that way. Besides, can check with 2 of my major insurers on-line and works well, as well care coverage is $95-115 and also they pay with acute care with -25 modifier.

I could argue with the pts, but they have the coverage, I provide the service and get compensated for it. If pt doesn't have the insurance, then I need to discuss it with them.

Just the world I live in... perhaps your world is different? How so? Would you bill the pt for well care and acute care and when pt ends up NOT being covered for the well care, you'd "eat it" OR aggravate them by telling them later they didn't have the coverage?

I want happy, returning pts, with chronic care issues I can take care of, pts that see me as a resource. The pts as well have little choice what type of insurance they can get through a company plan, and I DO see part of my role as an "insurance mediator." Hate it, but, then, I outsource that for my billing company to do (as I don't do enough inhouse to warrant my investment in such hardware, software and billing issues.

What's your take?

Dr Matt Levin

Pittsburgh, PA

Solo, since Dec 2004

EMR SOAPware

Re: code for "form physical"

I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of the insurance companies).

May 15, 2006

RE proactive coverage confirmation

Sorry, pts do NOT want a bill for well care, but if covered, are willing to pay the copay, and then I can get the compensation.

It would certainly be nice if the "community" would check to be sure they have the coverage, but just doesn't work that way. Besides, can check with 2 of my major insurers on-line and works well, as well care coverage is $95-115 and also they pay with acute care with -25 modifier.

I could argue with the pts, but they have the coverage, I provide the service and get compensated for it. If pt doesn't have the insurance, then I need to discuss it with them.

Just the world I live in... perhaps your world is different? How so? Would you bill the pt for well care and acute care and when pt ends up NOT being covered for the well care, you'd "eat it" OR aggravate them by telling them later they didn't have the coverage?

I want happy, returning pts, with chronic care issues I can take care of, pts that see me as a resource. The pts as well have little choice what type of insurance they can get through a company plan, and I DO see part of my role as an "insurance mediator." Hate it, but, then, I outsource that for my billing company to do (as I don't do enough inhouse to warrant my investment in such hardware, software and billing issues.

What's your take?

Dr Matt Levin

Pittsburgh, PA

Solo, since Dec 2004

EMR SOAPware

Re: code for "form physical"

I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of the insurance companies).

May 15, 2006

I mostly do acute care separate from preventative/CPX visits (which I schedule for an hour). We may touch on various chronic issues a bit during the CPX but I do not often bill for both concurrently.I keep my patients happy. They keep me happy by paying their bills and keeping me in practice.It all works out generally.Pamela RE proactive coverage confirmation Sorry, pts do NOT want a bill for well care, but if covered, are willing to pay the copay, and then I can get the compensation. It would certainly be nice if the "community" would check to be sure they have the coverage, but just doesn't work that way. Besides, can check with 2 of my major insurers on-line and works well, as well care coverage is $95-115 and also they pay with acute care with -25 modifier. I could argue with the pts, but they have the coverage, I provide the service and get compensated for it. If pt doesn't have the insurance, then I need to discuss it with them. Just the world I live in... perhaps your world is different? How so? Would you bill the pt for well care and acute care and when pt ends up NOT being covered for the well care, you'd "eat it" OR aggravate them by telling them later they didn't have the coverage? I want happy, returning pts, with chronic care issues I can take care of, pts that see me as a resource. The pts as well have little choice what type of insurance they can get through a company plan, and I DO see part of my role as an "insurance mediator." Hate it, but, then, I outsource that for my billing company to do (as I don't do enough inhouse to warrant my investment in such hardware, software and billing issues. What's your take? Dr Matt Levin Pittsburgh, PA Solo, since Dec 2004 EMR SOAPware Re: code for "form physical" I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of the insurance companies).

May 15, 2006

I mostly do acute care separate from preventative/CPX visits (which I schedule for an hour). We may touch on various chronic issues a bit during the CPX but I do not often bill for both concurrently.I keep my patients happy. They keep me happy by paying their bills and keeping me in practice.It all works out generally.Pamela RE proactive coverage confirmation Sorry, pts do NOT want a bill for well care, but if covered, are willing to pay the copay, and then I can get the compensation. It would certainly be nice if the "community" would check to be sure they have the coverage, but just doesn't work that way. Besides, can check with 2 of my major insurers on-line and works well, as well care coverage is $95-115 and also they pay with acute care with -25 modifier. I could argue with the pts, but they have the coverage, I provide the service and get compensated for it. If pt doesn't have the insurance, then I need to discuss it with them. Just the world I live in... perhaps your world is different? How so? Would you bill the pt for well care and acute care and when pt ends up NOT being covered for the well care, you'd "eat it" OR aggravate them by telling them later they didn't have the coverage? I want happy, returning pts, with chronic care issues I can take care of, pts that see me as a resource. The pts as well have little choice what type of insurance they can get through a company plan, and I DO see part of my role as an "insurance mediator." Hate it, but, then, I outsource that for my billing company to do (as I don't do enough inhouse to warrant my investment in such hardware, software and billing issues. What's your take? Dr Matt Levin Pittsburgh, PA Solo, since Dec 2004 EMR SOAPware Re: code for "form physical" I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of the insurance companies).

May 15, 2006

One question though: how do you handle

someone that was scheduled for an hour slot & then is a no call-no show?

That is the potential pitfall to seeing so few total patients & giving

patients these long marathon-like visits. If someone did not call or show

up, and was without a bullet proof reason, I would think you would almost have

to dismiss them on the spot for just one infraction. Otherwise, your

entire schedule goes down the tubes. Hopefully, your patients don’t

do that and so it is a moot issue for you but I just wonder. Our style of

practice seems much more vulnerable to the harmful effects of no call-no

shows.

Re:

Well care, problems, administrivia...

I mostly do acute care separate from preventative/CPX

visits (which I schedule for an hour). We may touch on various chronic issues a

bit during the CPX but I do not often bill for both concurrently.

I keep my patients happy. They keep me happy by

paying their bills and keeping me in practice.

It all works out generally.

Pamela

RE proactive coverage confirmation

Sorry, pts do NOT want a bill for

well care, but if covered, are willing to pay the copay, and then I can get the

compensation.

It would certainly be nice if the

" community " would check to be sure they have the coverage, but just

doesn't work that way. Besides, can check with 2 of my major insurers

on-line and works well, as well care coverage is $95-115 and also they pay with

acute care with -25 modifier.

I could argue with the pts, but they

have the coverage, I provide the service and get compensated for it. If

pt doesn't have the insurance, then I need to discuss it with them.

Just the world I live in... perhaps

your world is different? How so? Would you bill the pt for well

care and acute care and when pt ends up NOT being covered for the well care,

you'd " eat it " OR aggravate them by telling them later they didn't

have the coverage?

I want happy, returning pts, with

chronic care issues I can take care of, pts that see me as a resource.

The pts as well have little choice what type of insurance they can get through

a company plan, and I DO see part of my role as an " insurance

mediator. " Hate it, but, then, I outsource that for my billing

company to do (as I don't do enough inhouse to warrant my investment in such

hardware, software and billing issues.

What's your take?

Dr Matt Levin

Pittsburgh, PA

Solo, since Dec 2004

EMR SOAPware

Re:

code for " form physical "

I usually code these as a well visit cpt and the pe for admin

purposes also. Lately I have had a rash of patients who have a new health plan

from UHC or Anthem that is the HSA and high deductible major medical.

These folks have been told they have no copay for a well visit, so now they

schedule everything as a well visit and don't want to pay their copay.

None of them could even come close to being a well visit. These people

were in their late 20's or early 30's and had significant complaints for their

visit. All three of them had already had their PAP this year. I

have been telling them that I am sure a copay is needed. One of them has

been really difficult about it. Anyway, my point is that there

always seems to be some new thing between us and the patients that ends up

being a point of contention (usually because of the insurance companies).

May 15, 2006

Once I have my core group of activated respectful patients it is not an issue (NO Showing). I think I have had 6 or 7 NO shows in 13 months working part time. I only had one guy who No Showed for 2 separate CPX visits and then was terminated. He ended up being a drug seeker. the weird thing is (I was sooo pissed) he paid me in full for both missed physicals. I find that really bizarre. I have not seen him since and he never signed for my certified term letter.The other folks were a smattering of people who No Showed on 15 or 30 min visits (probably all 30 min FUs) and 90% paid the $50 No show fee. I let one woman who has no money slide without paying the fee. She has been OK since.I think when we set high expectations we can be pleasantly surprised.Pamela One question though: how do you handle someone that was scheduled for an hour slot & then is a no call-no show? That is the potential pitfall to seeing so few total patients & giving patients these long marathon-like visits. If someone did not call or show up, and was without a bullet proof reason, I would think you would almost have to dismiss them on the spot for just one infraction. Otherwise, your entire schedule goes down the tubes. Hopefully, your patients don’t do that and so it is a moot issue for you but I just wonder. Our style of practice seems much more vulnerable to the harmful effects of no call-no shows. Re: Well care, problems, administrivia... I mostly do acute care separate from preventative/CPX visits (which I schedule for an hour). We may touch on various chronic issues a bit during the CPX but I do not often bill for both concurrently. I keep my patients happy. They keep me happy by paying their bills and keeping me in practice. It all works out generally. Pamela RE proactive coverage confirmation Sorry, pts do NOT want a bill for well care, but if covered, are willing to pay the copay, and then I can get the compensation. It would certainly be nice if the "community" would check to be sure they have the coverage, but just doesn't work that way. Besides, can check with 2 of my major insurers on-line and works well, as well care coverage is $95-115 and also they pay with acute care with -25 modifier. I could argue with the pts, but they have the coverage, I provide the service and get compensated for it. If pt doesn't have the insurance, then I need to discuss it with them. Just the world I live in... perhaps your world is different? How so? Would you bill the pt for well care and acute care and when pt ends up NOT being covered for the well care, you'd "eat it" OR aggravate them by telling them later they didn't have the coverage? I want happy, returning pts, with chronic care issues I can take care of, pts that see me as a resource. The pts as well have little choice what type of insurance they can get through a company plan, and I DO see part of my role as an "insurance mediator." Hate it, but, then, I outsource that for my billing company to do (as I don't do enough inhouse to warrant my investment in such hardware, software and billing issues. What's your take? Dr Matt Levin Pittsburgh, PA Solo, since Dec 2004 EMR SOAPware Re: code for "form physical" I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of the insurance companies).

May 16, 2006

Pamela, do you call pts day before with reminder of their apts?

--------- Re: code for "form physical"

I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of th

e insurance companies).

May 16, 2006

I agree with you, Matt. I want happy returning patient who see me as a resource, and I do also feel that I must help them with the complexities of insurance.I take a number of HMOs/insurance plans in my practice, something that's essential for my patients, as their benefits change yearly with many employers.(Watch out, short repetitive rant coming). I think it is difficult to honestly champion this type of practice if it can't be accessed by every day working people.Any way, I've sort of internalized about 90 % of the billing questions/reimbursement hassles in terms of acute care/well care for these plans (just based on looking at EOBs for a couple of years). I warn people when I see them what the likely outcome will be for them (and me) depending on what we do. There's a discussion about how deductibles work or how medicare doesn't pay for check ups, so we're rarely surprised. I charge very reasonably for not covered services. This seems to be part of the "social work" that all people need to get through their daily insurance life here: what's a formulary drug, the difference in copays between name brand and generic, how mail order pharmacy works. I used to do this also in the busy community clinic I worked in, so it's a relief to have a minimum of a half hour now. RE proactive coverage confirmation Sorry, pts do NOT want a bill for well care, but if covered, are willing to pay the copay, and then I can get the compensation. It would certainly be nice if the "community" would check to be sure they have the coverage, but just doesn't work that way. Besides, can check with 2 of my major insurers on-line and works well, as well care coverage is $95-115 and also they pay with acute care with -25 modifier. I could argue with the pts, but they have the coverage, I provide the service and get compensated for it. If pt doesn't have the insurance, then I need to discuss it with them. Just the world I live in... perhaps your world is different? How so? Would you bill the pt for well care and acute care and when pt ends up NOT being covered for the well care, you'd "eat it" OR aggravate them by telling them later they didn't have the coverage? I want happy, returning pts, with chronic care issues I can take care of, pts that see me as a resource. The pts as well have little choice what type of insurance they can get through a company plan, and I DO see part of my role as an "insurance mediator." Hate it, but, then, I outsource that for my billing company to do (as I don't do enough inhouse to warrant my investment in such hardware, software and billing issues. What's your take? Dr Matt LevinPittsburgh, PASolo, since Dec 2004EMR SOAPware Re: code for "form physical"I usually code these as a well visit cpt and the pe for admin purposes also. Lately I have had a rash of patients who have a new health plan from UHC or Anthem that is the HSA and high deductible major medical. These folks have been told they have no copay for a well visit, so now they schedule everything as a well visit and don't want to pay their copay. None of them could even come close to being a well visit. These people were in their late 20's or early 30's and had significant complaints for their visit. All three of them had already had their PAP this year. I have been telling them that I am sure a copay is needed. One of them has been really difficult about it. Anyway, my point is that there always seems to be some new thing between us and the patients that ends up being a point of contention (usually because of the insurance companies).

May 16, 2006

Wow, once again it sounds like your little

niche in Oregon is the place to be. A $50 no show fee? I might get

0.9% of the people to pay that here but certainly not 90%! Life/people

are just different in small Midwestern towns. I’m starting to

wonder more & more if a geographic move might be in my future in the next 2

– 3 years. I get tired of hearing these things other docs are doing

& then thinking “ yeah, but unfortunately that would never work here.”

I know, I’m a broken record.