winter BP check

[Guest guest]

As with many of you, I do my own vitals and all nursing tasks. As it gets colder, the patients are coming with the tight undershirts which are hard to roll all the way up high enough to place the BP cuff on the bare skin. Would anyone know if the BP cuff is placed over one thin layer of undershirt, but the stethoscope is placed directly on the skin under the undershirt, would the BP measurement be accurate?Thank you.HelenTo: From: myriaemeny@...Date: Mon, 10 Oct 2011 05:08:05 -0700Subject: Re: Slower schedule than you'd like?

Some of my insurances will pay both physical and E & M without a hitch. Others I have to send the note but then do get paid. Good luck.

To: Sent: Saturday, October 8, 2011 1:20 PMSubject: RE: Slower schedule than you'd like?

Every now and then I try to do this but in past, it usually has not been paid well. I might try again. Can’t hurt.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of ElainemdSent: Saturday, October 08, 2011 1:12 PMTo: Subject: Re: Slower schedule than you'd like?

You can bill physical and use modifier 25 and bill level 4 or 3. Most carriers pay both but not the pap. We deserve that as some of my physicals can last up to 2 hrs!

That’s great .

I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work.

If you are seeing no one, it’s certainly better than nothing. But I don’t know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M.

Kathy Saradarian, MD

Quality Family Practice

qualityfp@...

From: [mailto: ] On Behalf Of PrattSent: Saturday, October 08, 2011 10:56 AMTo: Subject: Slower schedule than you'd like?

Hi all,I just wanted to pass along what we have done to fill our schedule,just when we thought Steve might have to close the practice, as wecannot survive with 5 patients/day, 4 days/week. October ishistorically our slowest month (flu shots are the only thing that getspatients walking thru the door), followed closely by June, so weneeded to act quickly.Anyways, now that most health plans are covering preventives with nocopay/deductible, we have started sending out letters to all of ourpatients that have not been in for at least 18 months. We have neverdone this before, mainly because we have a young practice (6 yearsinto it now) and we were still trying to get our ducks in a row. Weare getting about a 20% response so far, and our schedule is fillingup nicely (not too busy, not too slow). The past 2 weeks (we startedsending out letters about 3 weeks ago), we have gone from

5follow-ups/day to yesterday being our busiest Friday ever with 12patients plus 6 flu shots! I know this is busier than some of youwant to be, but we need to fill our schedule most of the 4 days we arein the office in order to fulfill our financial responsibilities(mostly rent and house payment!). We offer 20 minute follow-ups, andour physicals are 40-60 minutes, depending on the age and complexityof the patient. On a busy day we can see 14 patients (although ourschedule has a max of 18 slots per day, we use multiple slots forPE's).For a small investment of time, envelopes, and stamps, we are seeing anice ROI, as 20 preventive exams pays about $2500 in our area(depending on age). We have yet to see if there is an improvement inthe health of our patients. No huge surprises or "saves" on any labsyet, but we are getting patients in for their mammos, colonoscopies,etc. much better than we were

previously.We have only gotten letters out to people on our list that popped upin our HMO's P4P reports plus everyone else A-J. This has been a nicesurprise for us to increase contact with our patients and make surethey are staying healthy.Just wanted to share, hope you all have a great weekend! Pratt