Re: becoming a member plus

[Guest guest]

Can't answer #1 or 2, but a good rule of thumb for #3 is a % of Medicare allowable.  Take your highest contract and add 10% + for your billed amount. Cpt codes for AWV are available on the CMS website, and you can also find exactly how much they will pay you.  CMS is an open book test, you really just have to understand how and where to search for the answers.

Pratt

 

HI all,

We need a little help here at Ballard Neighborhood Doctors.

1.  are we members and if not, please let us know what to send where to become members?

2.  how can a, our new billing person, have access to the information on this list serve?

3. how do we best figure out how much to bill for various cpt codes? I have my method but not sure easiest/ best.

 

I am part of a four person group, Ballard Neighborhood Doctors. I have been the main one on the list serve, although my partner in crime, Dr Bell, has come to IMP camp and participated in various IMP activities.

We now have a new billing person who could use advice and information, ie the Cpt code for the new medicare wellness visist and how much we are allowed to bill for it (or how we can easiest figure that out as we're not " allowed " to actually say).

and I know this thread has gone through, but I " m not sure how to instruct her to look through for the thread.

 

And I don't remember if we actually sent in funds to be members as we've meant to and maybe have done this.

 

Thanks!

Weakland, MD

Ballard Neighborhood Doctors

To: ;

Sent: Wednesday, November 16, 2011 6:08 PMSubject: Selling your medical practice

 

Just making an enquiry if any of you have had any experience buying or selling a practice, if so, please email me off listThanksSoma

;

To: < >; Subject: Re: Natural Thyroid Hormone Sent: Thu, Nov 17, 2011 12:14:04 AM

 

Thank you so much for all the helpful responses!

 

 

I Rx Armour if patient requests it. Some feels better with both T3 and T4. Here is the info from Epocrates on Armour:

 

Adult Dosing .

Dosage forms:  0.25,0.5,1,1.5,2,3,4,5 grains

Special Note

[strength clarification]

Info: thyroid (porcine) contains liothyronine (T3) and levothyroxine (T4) in approx. 1:4 ratio; 1 grain = 9 mcg T3/38 mcg T4

[thyroid product equivalencies]

Info: for product conversion purposes, thyroid (porcine) 1 grain = levothyroxine 100 mcg = liothyronine 25 mcg = liotrix 1 grain

hypothyroidism

[1-2 grains PO qd]

Start: 0.5 grain PO qd, incr. 0.25 grain/day q6wk; Info: use lower start dose, slower titration if elderly, long-standing dz, myxedema, or cardiac dz/risk factors; may start full replacement dose for healthy pts <65 yo w/o cardiac dz; suspect malabsorption, drug interaction, or noncompliance if failed response to 3 grains/day

Wen Liang, MD

San Mateo, CA

 

 

HI!I use Armour all the time. I found that many of my patient feel better on it. Its available at all the regular pharmacy's...Rite Aid etc and is used by lots of MD's. I will admit that I was residency trained on the East Coast to only use L thyroxine....but 11 years in practice has taught me some new tricks!Warm Regards,Dannielle Harwood, MDwww.MyStudioMD.com

To: Sent: Wed, November 16, 2011 2:29:32 PM

Subject: Natural Thyroid Hormone

 

I have a patient who is hypothyroid and needs thyroid hormone replacement. She states her naturopath placed her on Armour thyroid many years ago and this worked for her. She only wants the natural medicine and not the synthetic hormone.

I have used levothyroxine for my pts and one pt in the past who was on Armour for 50 years but my experience is only with L thryoxine.How do you convey the info to pt; patient convinced natural is better. Thinking of having naturopath prescribe the med rather than me.

Any thoughts?

San Mateo, CA

 

 

HI!I use Armour all the time. I found that many of my patient feel better on it. Its available at all the regular pharmacy's...Rite Aid etc and is used by lots of MD's. I will admit that I was residency trained on the East Coast to only use L thyroxine....but 11 years in practice has taught me some new tricks!Warm Regards,Dannielle Harwood, MDwww.MyStudioMD.com

To: Sent: Wed, November 16, 2011 2:29:32 PM

Subject: Natural Thyroid Hormone

 

I have a patient who is hypothyroid and needs thyroid hormone replacement. She states her naturopath placed her on Armour thyroid many years ago and this worked for her. She only wants the natural medicine and not the synthetic hormone.

I have used levothyroxine for my pts and one pt in the past who was on Armour for 50 years but my experience is only with L thryoxine.How do you convey the info to pt; patient convinced natural is better. Thinking of having naturopath prescribe the med rather than me.

Any thoughts?

[Guest guest]

,In answer to #2, a can subscribe to the Practice Improvement listserve by sending a blank e-mail to "-subscribe ". If she wants to be able to access previous messages, then she will need to join the Practice Improvement Yahoo Group at http://health.groups.yahoo.com/group/ and sign up (which is free).I think can answer #1. SetoAdmin

HI all,

We need a little help here at Ballard Neighborhood Doctors.

1. are we members and if not, please let us know what to send where to become members?

2. how can a, our new billing person, have access to the information on this list serve?

3. how do we best figure out how much to bill for various cpt codes? I have my method but not sure easiest/ best.

I am part of a four person group, Ballard Neighborhood Doctors. I have been the main one on the list serve, although my partner in crime, Dr Bell, has come to IMP camp and participated in various IMP activities.

We now have a new billing person who could use advice and information, ie the Cpt code for the new medicare wellness visist and how much we are allowed to bill for it (or how we can easiest figure that out as we're not "allowed" to actually say).

and I know this thread has gone through, but I"m not sure how to instruct her to look through for the thread.

And I don't remember if we actually sent in funds to be members as we've meant to and maybe have done this.

Thanks!

Weakland, MD

Ballard Neighborhood Doctors

[Guest guest]

HI ,Yeah  after IMP became a  nonprofit a 501©(3)---I write this for others  here  as well, good reminder, as lots of folk sare lurking and  some are new ones likely,  well we established   membership to support paying for the monthly cme calls( wonderful 1 hr calls  held two separate days a month to  problem solve and share  and  create community),and for support of the organization and its goals and tools on a website( website being un glitched  presenlty  should be nicer soon) and  to support Camp our annual conference (camp is well run and is almost slef supporting   anyway though.Some nonprofits raise money through events We do the opposite- keep our event affordable so people can attend and learn)

 Membership is 250.00/yr You join by going to impcenter.org and hitting donate( you might think you would hit join but the website is being redesigned and worked on so join doesn;t work "

hit donate please.  it lets you pay by paypal. But you can also mail in a check if you prefer.. Then  Kris Oaks(membership registrar) and or I will get back in touch about a user name and ID to work the website- where as a member you can hear the podcasts of the calls and access tools and bibliography and such.Being a member gives you a lower rate fro Camp also.

 Actually Brady is in charge of membership but  GAry said I would answer haha  so I did . Any of the officers- currently Gordon Sharon me and Brady - are happy to help you further about  IMP's work,  let us know(Officers turn over in part  soon, our terms are up)

how to  set charges and how much mcr pays etc is a whole other topic that I presume other better typists will  chime in on.Jean

 

HI all,

We need a little help here at Ballard Neighborhood Doctors.

1.  are we members and if not, please let us know what to send where to become members?

2.  how can a, our new billing person, have access to the information on this list serve?

3. how do we best figure out how much to bill for various cpt codes? I have my method but not sure easiest/ best.

 

I am part of a four person group, Ballard Neighborhood Doctors. I have been the main one on the list serve, although my partner in crime, Dr Bell, has come to IMP camp and participated in various IMP activities.

We now have a new billing person who could use advice and information, ie the Cpt code for the new medicare wellness visist and how much we are allowed to bill for it (or how we can easiest figure that out as we're not " allowed " to actually say).

and I know this thread has gone through, but I " m not sure how to instruct her to look through for the thread.

 

And I don't remember if we actually sent in funds to be members as we've meant to and maybe have done this.

 

Thanks!

Weakland, MD

Ballard Neighborhood Doctors

To: ;

Sent: Wednesday, November 16, 2011 6:08 PMSubject: Selling your medical practice

 

Just making an enquiry if any of you have had any experience buying or selling a practice, if so, please email me off listThanksSoma

;

To: < >; Subject: Re: Natural Thyroid Hormone

Sent: Thu, Nov 17, 2011 12:14:04 AM

 

Thank you so much for all the helpful responses!

 

 

I Rx Armour if patient requests it. Some feels better with both T3 and T4. Here is the info from Epocrates on Armour:

 

Adult Dosing .

Dosage forms:  0.25,0.5,1,1.5,2,3,4,5 grains

Special Note

[strength clarification]

Info: thyroid (porcine) contains liothyronine (T3) and levothyroxine (T4) in approx. 1:4 ratio; 1 grain = 9 mcg T3/38 mcg T4

[thyroid product equivalencies]

Info: for product conversion purposes, thyroid (porcine) 1 grain = levothyroxine 100 mcg = liothyronine 25 mcg = liotrix 1 grain

hypothyroidism

[1-2 grains PO qd]

Start: 0.5 grain PO qd, incr. 0.25 grain/day q6wk; Info: use lower start dose, slower titration if elderly, long-standing dz, myxedema, or cardiac dz/risk factors; may start full replacement dose for healthy pts <65 yo w/o cardiac dz; suspect malabsorption, drug interaction, or noncompliance if failed response to 3 grains/day

Wen Liang, MD

San Mateo, CA

 

 

HI!I use Armour all the time. I found that many of my patient feel better on it. Its available at all the regular pharmacy's...Rite Aid etc and is used by lots of MD's. I will admit that I was residency trained on the East Coast to only use L thyroxine....but 11 years in practice has taught me some new tricks!Warm Regards,Dannielle Harwood, MDwww.MyStudioMD.com

To:

Sent: Wed, November 16, 2011 2:29:32 PMSubject: Natural Thyroid Hormone

 

I have a patient who is hypothyroid and needs thyroid hormone replacement. She states her naturopath placed her on Armour thyroid many years ago and this worked for her. She only wants the natural medicine and not the synthetic hormone.

I have used levothyroxine for my pts and one pt in the past who was on Armour for 50 years but my experience is only with L thryoxine.How do you convey the info to pt; patient convinced natural is better. Thinking of having naturopath prescribe the med rather than me.

Any thoughts?

San Mateo, CA

 

 

HI!I use Armour all the time. I found that many of my patient feel better on it. Its available at all the regular pharmacy's...Rite Aid etc and is used by lots of MD's. I will admit that I was residency trained on the East Coast to only use L thyroxine....but 11 years in practice has taught me some new tricks!Warm Regards,Dannielle Harwood, MDwww.MyStudioMD.com

To:

Sent: Wed, November 16, 2011 2:29:32 PMSubject: Natural Thyroid Hormone

 

I have a patient who is hypothyroid and needs thyroid hormone replacement. She states her naturopath placed her on Armour thyroid many years ago and this worked for her. She only wants the natural medicine and not the synthetic hormone.

I have used levothyroxine for my pts and one pt in the past who was on Armour for 50 years but my experience is only with L thryoxine.How do you convey the info to pt; patient convinced natural is better. Thinking of having naturopath prescribe the med rather than me.

Any thoughts?

--      MD          ph    fax

[Guest guest]

The theoretically correct way according to Medicare (I think, no data to back this statement up), is to establish a 'conversion number' (ours is $65, Medicare's here is $35) and multiply the RVU's associated with the CPT code by your conversion number. This is supposed to keep one out of the 'randomly assigning' prices. I always go through after I do this and tweak it a bit. Some seem way too high and, of course, others are way too low. It does give you somewhere to start, though. RVU's are accessible on Medicare's website.

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee.  If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

BTW, a super quick way for your New Biller to get half up and running would be to go thru your system and find a few of the same kind of visits, since we all seem to really do the same kind of stuff, 98% of the time for the most part..... and simply follow what the last person did as long as they were doing a good job. This will keep those invoices flying out to keep your cash flow, flowing and allow this person half a chance to get up to speed. Also, again if the old person was a good biller, they can learn much of what they need to know and or establish a reasonable baseline of understanding from where to then start expanding, questioning, and taking it to the next level.... and obviously have them read these exchanges a couple of times a week as able....

But yes, reviewing all your main codes and paid contracts and or fee schedules to see who your highest payors are on various codes and then setting some semi-reasonable amount above that is a good idea to make sure you are not leaving money on the table.... Also, some of your contracting payors might actual cough up fee schedules or at least a list of your top 25-50 codes if requested. Our local Blues, has FINALLY posted its fee schedule to PAR folks with a password and even has an editting program too. So we can clearly see just how badly the lop off certain extra codes ala women's wellcare and the like... But at least you know....

Lastly, unless this person is Family like and you trust them implicitely to look out for your BEST interests, like my wife and I and other family like arraingments here... I strongly suggest doing some of the fee schedule, contracting and fee setting yourself.... There is a real difference between those who work for a living doing a good job in general verses those who actually EAT from the business, live and die from it.... and in the end you are the one who gets hungout to dry if and when your coding goes from you getting shorted to THEM attempting to set you up as fraudulent in your coding.... In our case that is MY WIFE who gets torn to shreads, and our meager funds that have to be squandered to paid some over priced lawyer to defend her should that day come. Much like playing the stock market only YOU can really determine your comfort level with certain things. And in our case, we tend to make sure

we are a good half a step on the right, safe side of things in stead of getting a bit too agressive. This does not mean we do not fight for every dollar we deserve for her hard work, but it does mean I research like a bloodhound from various intelligent, very experienced sources to make sure whatever our coding or policies are, she and I both feel not only safe, but firm and defendable, ethical in our choices. And again that doesn't always mean taking the cheat ourselves path. But it does mean doing my due diligence, ala double and triple checking, laws, regs, policies whatever happens to influence or impact that particular situation.... And in all honesty, only the doc herself, himself, super trusted family like people can make those kinds of calls, choices in this insane, unfair, BS business....

To: Sent: Thursday, November 17, 2011 9:34 AMSubject: Re: becoming a member plus

The theoretically correct way according to Medicare (I think, no data to back this statement up), is to establish a 'conversion number' (ours is $65, Medicare's here is $35) and multiply the RVU's associated with the CPT code by your conversion number. This is supposed to keep one out of the 'randomly assigning' prices. I always go through after I do this and tweak it a bit. Some seem way too high and, of course, others are way too low. It does give you somewhere to start, though. RVU's are accessible on Medicare's website. Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your

computer.

[Guest guest]

Wow, this time I read 's entire email! Good for me. Just kidding.

 

Regarding women's wellcare, like routine physical with gyn exam and pap smear S6010 and S6012, has anyone got paid for doing the gyn part? Put aside whom we should check annually and the age to stop checking it. I sent in the physical G0402 code for medicare patient or 99385 for non-medicare patient with Gyn exam CPT code S6010 or S6012, the local HMO system pays for it cuz they encourage patients to stay with PCP for the test. I havn't got any PPO or Medicare compensate for that. The Speculum is not free to order and it really could take time to check it. I wonder if adding the modifier like 25 or 59 makes a difference. Any experience? 

 

Thanks,

Wen Liang, MD

San Mateo, CA

 

 

BTW, a super quick way for your New Biller to get half up and running would be to go thru your system and find a few of the same kind of visits, since we all seem to really do the same kind of stuff, 98% of the time for the most part..... and simply follow what the last person did as long as they were doing a good job. This will keep those invoices flying out to keep your cash flow, flowing and allow this person half a chance to get up to speed. Also, again if the old person was a good biller, they can learn much of what they need to know and or establish a reasonable baseline of understanding from where to then start expanding, questioning, and taking it to the next level.... and obviously have them read these exchanges a couple of times a week as able....

 

But yes, reviewing all your main codes and paid contracts and or fee schedules to see who your highest payors are on various codes and then setting some semi-reasonable amount above that is a good idea to make sure you are not leaving money on the table.... Also, some of your contracting payors might actual cough up fee schedules or at least a list of your top 25-50 codes if requested. Our local Blues, has FINALLY posted its fee schedule to PAR folks with a password and even has an editting program too. So we can clearly see just how badly the lop off certain extra codes ala women's wellcare and the like... But at least you know....

 

Lastly, unless this person is Family like and you trust them implicitely to look out for your BEST interests, like my wife and I and other family like arraingments here... I strongly suggest doing some of the fee schedule, contracting and fee setting yourself.... There is a real difference between those who work for a living doing a good job in general verses those who actually EAT from the business, live and die from it.... and in the end you are the one who gets hungout to dry if and when your coding goes from you getting shorted to THEM attempting to set you up as fraudulent in your coding.... In our case that is MY WIFE who gets torn to shreads, and our meager funds that have to be squandered to paid some over priced lawyer to defend her should that day come. Much like playing the stock market only YOU can really determine your comfort level with certain things. And in our case, we tend to make sure we are a good half a step on the right, safe side of things in stead of getting a bit too agressive. This does not mean we do not fight for every dollar we deserve for her hard work, but it does mean I research like a bloodhound from various intelligent, very experienced sources to make sure whatever our coding or policies are, she and I both feel not only safe, but firm and defendable, ethical in our choices. And again that doesn't always mean taking the cheat ourselves path. But it does mean doing my due diligence, ala double and triple checking, laws, regs, policies whatever happens to influence or impact that particular situation.... And in all honesty, only the doc herself, himself, super trusted family like people can make those kinds of calls, choices in this insane, unfair, BS business....

To: Sent: Thursday, November 17, 2011 9:34 AM

Subject: Re: becoming a member plus

 

The theoretically correct way according to Medicare (I think, no data to back this statement up), is to establish a 'conversion number' (ours is $65, Medicare's here is $35) and multiply the RVU's associated with the CPT code by your conversion number. This is supposed to keep one out of the 'randomly assigning' prices. I always go through after I do this and tweak it a bit. Some seem way too high and, of course, others are way too low. It does give you somewhere to start, though. RVU's are accessible on Medicare's website.

Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee.  If you have received this email in error, please notify the sender immediately and delete it from your computer.