RE: Medicare co-pay & deductible

[Guest guest]

I am not taking any medicaid either, around here, the folks who do seem to be in the 40 patients a day camp. I know from my one patient with medicaid secondary, in addition to not paying well at all, the remarkable amount of administrative work just makes it hard to manage unless you can make money on volume.

[Guest guest]

--

You may be right. Such a plan may backfire. However, the doc is paying the

office manager to be there (I assume the office manager is not paid as

hourly employee) so though it may be more time for he/she to do that

follow up, it may not have a clear dollar figure.

What you refer to about patients being fed-up, or the doc/staff getting

tired of explaining it, and the underlying hassles of the added efforts

needed, I think are all very true. Those would be examples that could be

added to the list of wasted energies in the current medical system. The

standard hamster-wheel model has lots of those, and I hope our IMP efforts

are winning battles against them.

But considering the " bottom line " and not the subjective efforts and

frustration, I still think the money would look better even if it means

paying ahead on the bills/loans thereby cutting down the interest and then

paying back to the patient later. The fact that " economic " decisions are

made without regard to the toll they have on the individual people

(patients, staff, doc) is standard in our healthcare system.

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

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> I'm not defending the system at all, as I agree entirely with Larry, but

> I think your assumption is wrong. How much interest do you make on one

> month of say $100? How much time will it take his office manager

> (because I bet the doc doesn't do the billing) to figure out how much to

> pay back all these patients three months down the road? Do you have to

> hire someone to do this task? What about the patients? How many get fed

> up with this process (What?! I have to pay you $115 up front?! But I

> have Medicare!!) and leave the office. So yes, initially you may get

> more money which is great for the first quarter of the year, but I think

> you also push up the overhead and decrease patient satisfaction which

> would end up costing much more.

>

>

> 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]

Agreed. And that is why many doctors are shunning the reimbursement current

system and going to boutique practices or finding alternative means of making

ends meet (ex. aesthetics J). The current reimbursement system is a joke which increases the

cost of medicine by about 40% (think the cost of improved medical records for

documentation, improved billing systems, billing services, practice

managers/collections) and does nothing to increase quality. On the contrary, by

forcing docs to see so many more patients, it decreases quality. I’m not certain

how we got here, but, like Larry, I am eager to find a way out.

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]

As someone who works for a hospital, this information for me is

actually superb. If I were to ever go out into private IMP practice

this is the information I would need to know and would be most

valuable for me. (Who knows-I'm not that old yet!). Anyway, my

point is I'm hoping some of this information gets posted on the WIKI

for easy access.

Alternatively, we are in the process of upgrading the Center for

health information technology website. Most of the information there

relates to electronic health records, but certainly there can be

placed other valuable information. If you go to the website

(www.centerforhit.org) you will see the four phases of the

electronic health lifecycle-preparation, selection, implementation

and maintenance. The section on maintenance is fairly weak and

certainly we could use some articles similar to " how to use your

electronic health record for billing purposes " -by doing this we could

sneak in some of the good information that has been going on in this

thread. If anyone is interested, please let me know-since I'm one of

those in charge of the website content (at least I think I am)-I have

the capability of getting it posted and I think possibly I could get

an honorarium for anyone willing to do content (I would have to check

this).

Regards,

Lou Spikol

Louis Spikol M.D.

Senior Healthcare Information Technology Consultant

Center for Health Information Technology

American Academy of Family Physicians

lspikol@...

lspikol@...

mobile:

>

> Agreed. And that is why many doctors are shunning the reimbursement

> current system and going to boutique practices or finding

alternative

> means of making ends meet (ex. aesthetics :-)). The current

> reimbursement system is a joke which increases the cost of medicine

by

> about 40% (think the cost of improved medical records for

documentation,

> improved billing systems, billing services, practice

> managers/collections) and does nothing to increase quality. On the

> contrary, by forcing docs to see so many more patients, it decreases

> quality. I'm not certain how we got here, but, like Larry, I am

eager to

> find a way out.

>

>

> 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]

Wow,

you know a psychologist in central Ohio that actually still accepts insurances? Maybe I should get

the name from you because I have not seen many that do, and there are

essentially zero psychiatrists in office practice that accept insurance.

Re:

Medicare co-pay & deductible

Almost,

but not quite right. Medicare sets a fee schedule, lets say $54 for a 99213

(and say your fee is $80). Medicare then pays you 80% of the $54 if you

are participating, the patient is expected to pay the other 20% of the

$54. That is after they have met their deductible. But either way,

it is based on CMS fee schedule. If you are non-participating you can

charge whatever your fee is, medicare pays 80% of whatever their fee schedule

is for non-participating doctors (I think it is less than for participating

docs) and you can bill the remainder of your entire fee to the patient.

Back to

the question of deductibles, I know many of the commercial carriers are letting

people check deductible balances when you (or if) you check eligibility. You

can then look at their fee schedule for the service you are performing (or at

the end of the visit) and have the patient pay right then. I have been

trying to figure out how I can do this after the first of the year. Is

anyone else doing that? My best friend is a psychologist and does so on

every patient, so each one pays at the time of service whatever their portion

is. She of course has only 5 or so cpt codes to deal with though.

[Guest guest]

In Ohio, the Medicare w/ Medicaid as secondary actually pays the entire

allowed amount w/o having to collect anything from the patient, so it is not

so bad. Are you certain you are billing the Medicaid as secondary

correctly?

Medicare co-pay & deductible

>Date: Tue, 14 Nov 2006 13:51:42 -0500

>

>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.

>

>

>

>

>

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[Guest guest]

Psychologists still take insurance, Psychiatrists do not. Your right most psychiatrists here in Columbus don't take insurance, mostly because they can't stay in business if they do because of the remarkably poor reimbursement. Most of those few still taking insurance are doing 15 min med checks only and barely scraping by.

[Guest guest]

Psychologists still take insurance, Psychiatrists do not. Your right most psychiatrists here in Columbus don't take insurance, mostly because they can't stay in business if they do because of the remarkably poor reimbursement. Most of those few still taking insurance are doing 15 min med checks only and barely scraping by.

[Guest guest]

I have talked with sevice professionals at the state medicaid office and they explain that since medicare paid more than there allowable no additional payment will be made. That gives every medicare patient a 25% discount so I only collect 80%. If you have some magic submission HCFA 1500 I would appreciate the info. Brock DO wrote: In Ohio, the Medicare w/ Medicaid as secondary actually pays the entireallowed

amount w/o having to collect anything from the patient, so it is notso bad. Are you certain you are billing the Medicaid as secondarycorrectly? Medicare co-pay & deductible>Date: Tue, 14 Nov 2006 13:51:42 -0500>>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.>>>>>__________________________________________________________Find a local pizza place, music store, museum and more.then map the best route! http://local.live.com?FORM=MGA001

[Guest guest]

I

wonder if that's just an Ohio

thing. It takes a while to get it set up, but yes, we get the entire 100% and

it is prompt. You have to call Medicare provider relations and have your

Medicare/Medicaid IDS linked and then Medicare automatically forwards the claim

to Medicaid and then Medicaid pays the deductible and remaining 20% a couple

weeks later. These are called crossovers. You can also type them and send

them directly to Medicaid on the 6780 form if you don't have your IDS linked.

We had to do that for a while. If patients have private insurance though, with

Medicaid as a secondary, we get nothing from Medicaid (unless the private

doesn't pay), because the reimbursement without the co-pay is more than Medicaids.

For some reason, which is good for us, this just applies to private insurance,

not Medicare. Sounds like that is not always the case in some states.

Medicare co-pay & deductible

>Date: Tue, 14 Nov 2006 13:51:42 -0500

>

>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.

>

>

>

>

>

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[Guest guest]

right as david says these are the crossovers.

I wonder though since every state adminsiters its medicaid differenlty if

that is why it can vary state by state?

Or is it one more expample of making things so incomprehensible to docstors

that we will give and go away and write off teh 20%.

I am in a sad mode this week

Medicare co-pay & deductible

>Date: Tue, 14 Nov 2006 13:51:42 -0500

>

>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.

>

>

>

>

>

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[Guest guest]

Every state does administer its Medicaid separately, which is why there are regional differences in reimbursement. The states that reimburse at less than Medicare rate generally don't pay any part of the crossover claim on a Medicare/Medicaid patient. I get 1.72 for my secondary on a 99214 Medicare/Medicaid visit. right as david says these are the crossovers.I wonder though since every state adminsiters its medicaid differenlty ifthat is why it can vary state by state?Or is it one more expample of making things so incomprehensible to docstorsthat we will give and go away and write off teh 20%.I am in a sad mode this week Medicare co-pay & deductible>Date: Tue, 14 Nov 2006 13:51:42 -0500>>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? Westill>get patients that expect us to just accept the 80% that Medicare paysas>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 commonthe>practice is.>>>>>__________________________________________________________Find a local pizza place, music store, museum and more.then map the bestroute! http://local. <http://local.live.com/?FORM=MGA001>live.com?FORM=MGA001