Re: Medicare co-pay & deductible -- Medicaid a joke reimbursement

[Guest guest]

RE Medicaid as a payor???

This insurance is NOT reimbursement, but a downloading from the state system to make docs do charity care.

I take 1 of the 3 "managed care" plans, who all pay ONLY $29.97 for any visit of any type.

Will as I get closer to capacity cut it off.

Annie, I'm glad that the system is getting restricted -- this is the only way for the state to understand Medical assistance does not in any way justify the cost. With this shortage, I'd bet that the hospital will end up setting up "clinics" (like the residency programs have done in past) and insist they take all of these pts. I'm certain that this also is starting to stack up on the hospital "affiliated" practices in my area.

These pts really should reimburse MORE, not less, as they take more time and effort.

Sounds callous, doesn't it? Just like the hospital getting its raise, and I'm not. They'll need to afford it, I can't.

Sadly,

Dr Matt Levin

East of Pittsburgh, PA

FP, solo since Dec 2004

Just paying the office bills now after almost 2 years.

Happy though

Residency completed 1988

Worked for hospital 8 years 1996-2004

RE: Medicare co-pay & deductible

I certainly expect to be paid by the patients for their “patient responsibility” portions, and so far as I can find out, the same is true in all the practices in Lexington. When I hear from patients that they are accustomed to NOT paying, it always turns out that it was “Ole Doc So’n’so” who just retired/died/had a heart attack, so he can’t keep seeing the 80 patients per day he was seeing out in the wilderness somewhere.

Incidentally, today I spoke with a hospital employee who runs the physician finder service and who told me that she has no primary care doctors at all to whom she can send Medicaid patients, and gets 25 to 50 calls per week from Medicare beneficiaries who say they can’t find a doctor who will take new Medicare patients, and she only knows two primary care docs to send them to….scary! ( I told her I would take a few, but not to go crazy)

Annie

-----Original Message-----From: [mailto: ] On Behalf Of Brock DOSent: Tuesday, November 14, 2006 1:52 PMTo: Subject: Medicare co-pay & deductible

For those on the list that still accept Medicare: does anyone write off that 20% or the annual deductible that the patient is responsible for? We still get patients that expect us to just accept the 80% that Medicare pays as payment in full, which blows my mind. They say that there are docs out there that do that. Is that true? That is business suicide, if so. I doubt anyone on this list does this, but I’m just curious how common the practice is.

[Guest guest]

The Medicaid HMO’s

here in Ohio actually pay 5% more than straight Medicaid. We actually get

something like $55 or so for a 99214, throw in a rapid strep test or other

minor procedure as needed & it sometimes brings in upwards of $68. If I

were only getting a maximum of $30/visit I would stop taking all Medicaid

today. That’s ludicrous.

Re:

Medicare co-pay & deductible -- Medicaid a joke

reimbursement

RE Medicaid as a payor???

This insurance is NOT reimbursement,

but a downloading from the state system to make docs do charity care.

I take 1 of the 3 " managed

care " plans, who all pay ONLY $29.97 for any visit of any type.

Will as I get closer to capacity cut

it off.

Annie, I'm glad that the system is

getting restricted -- this is the only way for the state to understand Medical

assistance does not in any way justify the cost. With this shortage, I'd

bet that the hospital will end up setting up " clinics " (like the

residency programs have done in past) and insist they take all of these

pts. I'm certain that this also is starting to stack up on the hospital

" affiliated " practices in my area.

These pts really should reimburse

MORE, not less, as they take more time and effort.

Sounds callous, doesn't it?

Just like the hospital getting its raise, and I'm not. They'll need to

afford it, I can't.

Sadly,

Dr Matt Levin

East of Pittsburgh, PA

FP, solo since Dec 2004

Just paying the office bills now

after almost 2 years.

Happy though

Residency completed 1988

Worked for hospital 8 years

1996-2004

Medicare co-pay & deductible

For those on the list that still

accept Medicare: does anyone write off that 20% or the annual deductible that

the patient is responsible for? We still get patients that expect us to

just accept the 80% that Medicare pays as payment in full, which blows my

mind. They say that there are docs out there that do that. Is that

true? That is business suicide, if so. I doubt anyone on this list

does this, but I’m just curious how common the practice is.

[Guest guest]

,

A couple of notes. In Virginia, Medicaid as a secondary pays zero (after the deductible) as they

figure Medicare has already paid more than they pay, so we need to write off

the rest. Secondly, and perhaps more disturbing is that I recently had the

pleasure of listening to someone rather high up in the insurance world discuss

their HMO Medicaid product. Indeed they paid 5% more than straight Medicaid,

but when asked how this program does financially, she quickly reported that it

was one of the most profitable programs the insurance had. So, that’s

right, although I am seeing these patients essentially for charity (<50% of

the reimbursement from BCBS), the insurance company that is “managing”

them is raking in the profits paid for by our state tax dollars. What a

wonderful system.

Re:

Medicare co-pay & deductible -- Medicaid a joke reimbursement

RE Medicaid as a payor???

This insurance is NOT reimbursement, but a downloading from

the state system to make docs do charity care.

I take 1 of the 3 " managed care " plans, who all

pay ONLY $29.97 for any visit of any type.

Will as I get closer to capacity cut it off.

Annie, I'm glad that the system is getting restricted --

this is the only way for the state to understand Medical assistance does not in

any way justify the cost. With this shortage, I'd bet that the hospital

will end up setting up " clinics " (like the residency programs have

done in past) and insist they take all of these pts. I'm certain that

this also is starting to stack up on the hospital " affiliated "

practices in my area.

These pts really should reimburse MORE, not less, as they

take more time and effort.

Sounds callous, doesn't it? Just like the hospital

getting its raise, and I'm not. They'll need to afford it, I can't.

Sadly,

Dr Matt Levin

East of Pittsburgh, PA

FP, solo since Dec 2004

Just paying the office bills now after almost 2 years.

Happy though

Residency completed 1988

Worked for hospital 8 years 1996-2004

Medicare co-pay & deductible

For those on the list that still accept Medicare: does

anyone write off that 20% or the annual deductible that the patient is

responsible for? We still get patients that expect us to just accept the

80% that Medicare pays as payment in full, which blows my mind. They say

that there are docs out there that do that. Is that true? That is

business suicide, if so. I doubt anyone on this list does this, but

I’m just curious how common the practice is.

[Guest guest]

Yes, I have heard the same thing re: Medicaid HMO’s; namely, that they

are very profitable for the companies that take them on. I guess that is

obvious from the recent fierce competition that took place recently here between

competitors to be selected as one of the three “lucky” HMO’s

here in my central Ohio county (winners: Molina, CareSource, Anthem). There were

about 8 – 10 companies gunning for those three coveted spots. However,

Medicaid here is certainly not paying me <50% of what our local BCBS carrier

(Anthem) would pay. A Medicaid 99214 pays maybe 30% less than what BCBS

(and other payors) would pay here. I agree the Medicaid reimbursement is

not great but it is also certainly not “charity” work for me.

Re:

Medicare co-pay & deductible -- Medicaid a joke reimbursement

RE Medicaid as a payor???

This insurance is NOT reimbursement,

but a downloading from the state system to make docs do charity care.

I take 1 of the 3 " managed

care " plans, who all pay ONLY $29.97 for any visit of any type.

Will as I get closer to capacity cut

it off.

Annie, I'm glad that the system is

getting restricted -- this is the only way for the state to understand Medical

assistance does not in any way justify the cost. With this shortage, I'd

bet that the hospital will end up setting up " clinics " (like the

residency programs have done in past) and insist they take all of these

pts. I'm certain that this also is starting to stack up on the hospital

" affiliated " practices in my area.

These pts really should reimburse

MORE, not less, as they take more time and effort.

Sounds callous, doesn't it?

Just like the hospital getting its raise, and I'm not. They'll need to

afford it, I can't.

Sadly,

Dr Matt Levin

East of Pittsburgh, PA

FP, solo since Dec 2004

Just paying the office bills now

after almost 2 years.

Happy though

Residency completed 1988

Worked for hospital 8 years 1996-2004

Medicare co-pay & deductible

For those on the list that still

accept Medicare: does anyone write off that 20% or the annual deductible that

the patient is responsible for? We still get patients that expect us to

just accept the 80% that Medicare pays as payment in full, which blows my

mind. They say that there are docs out there that do that. Is that

true? That is business suicide, if so. I doubt anyone on this list

does this, but I’m just curious how common the practice is.

[Guest guest]

: Illinois Department of Family Services sent out a representative today to encourage me to sign up as a PCP for Illinois Health Connect. A program to help reduce the State of Illinois's cost of providing medical care to these patients. It should decrease the ER visits when patients must select a medical home. For each patient that selects me as PCP, I will receive a list of all my medicaid patients monthly and $3/patient/month. I can limit my panel, but cannot end relationship without red tape. for children up to age 18 99213 = 46.56, 99214=72.97 all others 99213 = 28.35 and 99214 = 42.50 currently medicare pays $49 for 99213, $78 for 99214 Should I open up my practice to Illinois Health Connect? Should I take 50

patient, 100,1000, or maximum 1800 per provider? My current overhead runs $8-9/patient/month with 850 patients. I would collect $36/year per patient. Average visits 2.4/patient per year. Estimate high, all 99214's average collection per medicaid patient would be about $138. Estimate low, all 99213's $92. At the low rate I would need to sign up 2000 patients. What should I do? Brock DO wrote: The Medicaid HMO’s here in Ohio actually pay 5% more than straight Medicaid. We actually get something like $55 or so for a 99214, throw in a rapid strep test or other minor procedure as needed & it sometimes brings in upwards of $68. If I were only getting a maximum of $30/visit I would stop taking all Medicaid today. That’s ludicrous. -----Original Message-----From: [mailto: ] On Behalf Of LevinSent: Wednesday, November 15, 2006 8:46 AMTo: Subject: Re: Medicare co-pay & deductible -- Medicaid a joke

reimbursement RE Medicaid as a payor??? This insurance is NOT reimbursement, but a downloading from the state system to make docs do charity care. I take 1 of the 3 "managed care" plans, who all pay ONLY $29.97 for any visit of any type. Will as I get closer to capacity cut it off. Annie, I'm glad that the system is getting restricted -- this is the only way for the state to understand Medical assistance does not in any way justify the cost. With this shortage, I'd bet that the hospital will end up setting up "clinics" (like the residency programs have done in past) and insist they take all of these pts. I'm certain that this also is starting to stack up on the hospital "affiliated" practices in my area. These pts really should reimburse MORE, not less, as they take more time and effort. Sounds callous, doesn't it? Just like the hospital getting its raise, and I'm not. They'll need to afford it, I can't. Sadly, Dr Matt Levin East of Pittsburgh, PA FP, solo since Dec 2004 Just paying the office bills now after almost 2 years. Happy though Residency completed

1988 Worked for hospital 8 years 1996-2004 RE: Medicare co-pay & deductible I certainly expect to be paid by the patients for their “patient responsibility” portions, and so far as I can find out, the same is true in all the practices in Lexington. When I hear from patients that they are accustomed to NOT paying, it always turns out that it was “Ole Doc So’n’so” who just retired/died/had a heart attack, so he can’t keep seeing the 80 patients per day he was seeing out in the wilderness somewhere. Incidentally, today I spoke with a hospital employee who runs the physician finder service and who

told me that she has no primary care doctors at all to whom she can send Medicaid patients, and gets 25 to 50 calls per week from Medicare beneficiaries who say they can’t find a doctor who will take new Medicare patients, and she only knows two primary care docs to send them to….scary! ( I told her I would take a few, but not to go crazy) Annie -----Original Message-----From: [mailto: ] On Behalf Of Brock DOSent:

Tuesday, November 14, 2006 1:52 PMTo: Subject: Medicare co-pay & deductible For those on the list that still accept Medicare: does anyone write off that 20% or the annual deductible that the patient is responsible for? We still get patients that expect us to just accept the 80% that Medicare pays as payment in full, which blows my mind. They say that there are docs out there that do that. Is that true? That is business suicide, if so. I doubt anyone on this list does this, but I’m just curious how common the practice is.

Sponsored LinkMortgage rates near 39yr lows. $420,000 Mortgage for $1,399/mo - Calculate new house payment

[Guest guest]

RE Medicaid -- cheap for the state, bad for the doc

Run run run!!

You cannot keep up this level of care for 2000 pts. Even if they were cooperative, were easy to deal with, the reimbursement is just not worth it.

I take the 1 MA plan now, as that insurer made it easy for me to be on their entire panel, but will cut it off once my pt base grows further. Just not worth the effort for the $29.97/visit.

For the kids up to 18, bet you need to provide the shots too? Who pays the costs for that?

Good luck,

Dr Matt Levin

Pittsburgh, PA

RE: Medicare co-pay & deductible

I certainly expect to be paid by the patients for their “patient responsibility” portions, and so far as I can find out, the same is true in all the practices in Lexington. When I hear from patients that they are accustomed to NOT paying, it always turns out that it was “Ole Doc So’n’so” who just retired/died/had a heart attack, so he can’t keep seeing the 80 patients per day he was seeing out in the wilderness somewhere.

Incidentally, today I spoke with a hospital employee who runs the physician finder service and who told me that she has no primary care doctors at all to whom she can send Medicaid patients, and gets 25 to 50 calls per week from Medicare beneficiaries who say they can’t find a doctor who will take new Medicare patients, and she only knows two primary care docs to send them to….scary! ( I told her I would take a few, but not to go crazy)

Annie

-----Original Message-----From: [mailto: ] On Behalf Of Brock DOSent: Tuesday, November 14, 2006 1:52 PMTo: Subject: Medicare co-pay & deductible

For those on the list that still accept Medicare: does anyone write off that 20% or the annual deductible that the patient is responsible for? We still get patients that expect us to just accept the 80% that Medicare pays as payment in full, which blows my mind. They say that there are docs out there that do that. Is that true? That is business suicide, if so. I doubt anyone on this list does this, but I’m just curious how common the practice is.

Sponsored LinkMortgage rates near 39yr lows. $420,000 Mortgage for $1,399/mo - Calculate new house payment

[Guest guest]

I agree with the others – avoid this

one like the plague!

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From: [mailto: ] On Behalf Of Egly

Sent: Wednesday, November 15, 2006

6:12 PM

To:

Subject: RE:

Medicare co-pay & deductible -- Medicaid a joke

reimbursement

:

Illinois Department of Family Services sent out a representative today

to encourage me to sign up as a PCP for Illinois Health Connect. A

program to help reduce the State of Illinois's

cost of providing medical care to these patients. It should decrease the

ER visits when patients must select a medical home. For each patient that

selects me as PCP, I will receive a list of all my medicaid patients monthly

and $3/patient/month. I can limit my panel, but cannot end relationship

without red tape.

for children up to age 18 99213 =

46.56, 99214=72.97

all others 99213 = 28.35 and 99214 = 42.50

currently medicare pays $49 for 99213, $78 for 99214

Should I open up my practice to Illinois Health Connect?

Should I take 50 patient, 100,1000, or maximum 1800 per provider?

My current overhead runs $8-9/patient/month with 850 patients.

I would collect $36/year per patient. Average visits 2.4/patient per

year. Estimate high, all 99214's average collection per medicaid patient would

be about $138. Estimate low, all 99213's $92. At the low rate

I would need to sign up 2000 patients.

What should I do?

Brock DO

<drbrockrrohio> wrote:

The Medicaid HMO’s here in Ohio actually pay 5%

more than straight Medicaid. We actually get something like $55 or so for

a 99214, throw in a rapid strep test or other minor procedure as needed &

it sometimes brings in upwards of $68. If I were only getting a maximum

of $30/visit I would stop taking all Medicaid today. That’s ludicrous.

Re:

Medicare co-pay & deductible -- Medicaid a joke reimbursement

RE Medicaid as a payor???

This insurance is NOT reimbursement, but a downloading from

the state system to make docs do charity care.

I take 1 of the 3 " managed care " plans, who all

pay ONLY $29.97 for any visit of any type.

Will as I get closer to capacity cut it off.

Annie, I'm glad that the system is getting restricted --

this is the only way for the state to understand Medical assistance does not in

any way justify the cost. With this shortage, I'd bet that the hospital

will end up setting up " clinics " (like the residency programs have

done in past) and insist they take all of these pts. I'm certain that

this also is starting to stack up on the hospital " affiliated "

practices in my area.

These pts really should reimburse MORE, not less, as they

take more time and effort.

Sounds callous, doesn't it? Just like the hospital

getting its raise, and I'm not. They'll need to afford it, I can't.

Sadly,

Dr Matt Levin

East of Pittsburgh,

PA

FP, solo since Dec 2004

Just paying the office bills now after almost 2 years.

Happy though

Residency completed 1988

Worked for hospital 8 years 1996-2004

Medicare co-pay & deductible

For those on the list that still accept Medicare: does

anyone write off that 20% or the annual deductible that the patient is

responsible for? We still get patients that expect us to just accept the

80% that Medicare pays as payment in full, which blows my mind. They say

that there are docs out there that do that. Is that true? That is

business suicide, if so. I doubt anyone on this list does this, but

I’m just curious how common the practice is.

Sponsored Link

Mortgage rates near 39yr lows. $420,000 Mortgage for $1,399/mo - Calculate

new house payment

[Guest guest]

Yes,

it sounds way too complicated if nothing else.

Re:

Medicare co-pay & deductible -- Medicaid a joke reimbursement

RE Medicaid as a payor???

This insurance is NOT reimbursement,

but a downloading from the state system to make docs do charity care.

I take 1 of the 3 " managed

care " plans, who all pay ONLY $29.97 for any visit of any type.

Will as I get closer to capacity cut

it off.

Annie, I'm glad that the system is

getting restricted -- this is the only way for the state to understand Medical

assistance does not in any way justify the cost. With this shortage, I'd

bet that the hospital will end up setting up " clinics " (like the

residency programs have done in past) and insist they take all of these

pts. I'm certain that this also is starting to stack up on the hospital

" affiliated " practices in my area.

These pts really should reimburse

MORE, not less, as they take more time and effort.

Sounds callous, doesn't it?

Just like the hospital getting its raise, and I'm not. They'll need to

afford it, I can't.

Sadly,

Dr Matt Levin

East of Pittsburgh, PA

FP, solo since Dec 2004

Just paying the office bills now

after almost 2 years.

Happy though

Residency completed 1988

Worked for hospital 8 years 1996-2004

Medicare co-pay & deductible

For those on the list that still

accept Medicare: does anyone write off that 20% or the annual deductible that

the patient is responsible for? We still get patients that expect us to

just accept the 80% that Medicare pays as payment in full, which blows my mind.

They say that there are docs out there that do that. Is that true?

That is business suicide, if so. I doubt anyone on this list does this,

but I’m just curious how common the practice is.

Sponsored

Link

Mortgage rates near 39yr lows. $420,000 Mortgage for $1,399/mo - Calculate

new house payment

[Guest guest]

Yes,

it sounds way too complicated if nothing else.

Re:

Medicare co-pay & deductible -- Medicaid a joke reimbursement

RE Medicaid as a payor???

This insurance is NOT reimbursement,

but a downloading from the state system to make docs do charity care.

I take 1 of the 3 " managed

care " plans, who all pay ONLY $29.97 for any visit of any type.

Will as I get closer to capacity cut

it off.

Annie, I'm glad that the system is

getting restricted -- this is the only way for the state to understand Medical

assistance does not in any way justify the cost. With this shortage, I'd

bet that the hospital will end up setting up " clinics " (like the

residency programs have done in past) and insist they take all of these

pts. I'm certain that this also is starting to stack up on the hospital

" affiliated " practices in my area.

These pts really should reimburse

MORE, not less, as they take more time and effort.

Sounds callous, doesn't it?

Just like the hospital getting its raise, and I'm not. They'll need to

afford it, I can't.

Sadly,

Dr Matt Levin

East of Pittsburgh, PA

FP, solo since Dec 2004

Just paying the office bills now

after almost 2 years.

Happy though

Residency completed 1988

Worked for hospital 8 years 1996-2004

Medicare co-pay & deductible

For those on the list that still

accept Medicare: does anyone write off that 20% or the annual deductible that

the patient is responsible for? We still get patients that expect us to

just accept the 80% that Medicare pays as payment in full, which blows my mind.

They say that there are docs out there that do that. Is that true?

That is business suicide, if so. I doubt anyone on this list does this,

but I’m just curious how common the practice is.

Sponsored

Link

Mortgage rates near 39yr lows. $420,000 Mortgage for $1,399/mo - Calculate

new house payment