Guest guest Posted January 7, 2007 Report Share Posted January 7, 2007 , I sure do appreciate your view on this. I am responsible for starting it by asking about pc based ecgs in my office. I definitely feel that it is needed. I am starting fresh out of residency in July, and I want to do what is right for my patients. It sure does seem that many people only think about the bottom line and even liability has been thrown out there as an excuse not to do ekgs and stress tests. Maybe I am being a little nieve...and I expect to take my fair share of beatings trying to start on my own (with hospital guarantee), but I sure hope that practice doesn't ever change my mind about doing what I think is right. I am definitely going to offer ekg in my office and I think I may do stress tests as well. W. Blair, Jr., M.D. Texas > > >> > > > > >> > >>I also purchased the Cardio-Perfect on Ebay - it works > great - and > > >> > >> honestly, I have used in once in 6 months (other than > practicing) > > >> and I am so glad I did not spend a fortune. > > >> > >> > > >> > >> Greaves > > >> > >> > > >> > >> [Practiceimprovemen t1] PC Based EKG > > >> > >> > > >> > >> > > >> > >> > > >> > >>Hey everyone. I haven't posted in a while. I am a 3rd yr > fam med > > >> resident in Texas getting ready to begin solo startup in > > >> July-August > > >> > >> and looking around for office equipment. Has anyone had any > > >> experience > > >> > >> with PC based ekg equipment. I am specifically looking at > > >> cardiocard ($1550). It looks pretty neat and would interface > well > > >> with the EMR I plan to use. Please give any input you might have > > >> on this or other startup tips. Along the same lines they also > > >> make a spirometer > > >> that can > > >> > >> run with your laptop as well. Do you think this stuff is > any > > >> good? > > >> > >> > > >> > >>Dragon Naturally Speaking Medical Version 9 > > >> > >>Best deal I have found is on Amazon for ~$850, does anyone > know of > > >> a > > >> > >> better deal on this? > > >> > >> > > >> > >>Also, If you know anyone closing a practice, or a good > place to > > >> find > > >> > >> used office equipement please let me know. > > >> > >> > > >> > >>Thanks, > > >> > >> W. Blair, Jr., M.D. > > >> > >> > > >> > >> > > >> > >> > > >> > >>__________________________________________________ > > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2007 Report Share Posted January 7, 2007 Lou, do you mean that you dictate text files that are rich in medical vocabulary, just to teach Dragon those words? -------------- Original message ---------------------- > You can save money by trying the preferred version of Dragon > NaturallySpeaking. (I've seen it recently for $99). This will work > especially well if you're using an electronic health record and only > need nonmedical words for description. There are of course some > medical words that are part of the vocabulary. Another idea is if > you presently are doing any medical dictation you might want to try > to get your text files-you can run the files through Dragon > NaturallySpeaking and have it pick up the medical words. > > Lou Spikol > > > > > Hey everyone. I haven't posted in a while. I am a 3rd yr fam med > resident in Texas getting ready to begin solo startup in July- August > and looking around for office equipment. Has anyone had any experience > with PC based ekg equipment. I am specifically looking at cardiocard > ($1550). It looks pretty neat and would interface well with the EMR I > plan to use. Please give any input you might have on this or other > startup tips. Along the same lines they also make a spirometer that > can run with your laptop as well. Do you think this stuff is any good? > > Dragon Naturally Speaking Medical Version 9 > Best deal I have found is on Amazon for ~$850, does anyone know of a > better deal on this? > > > Also, If you know anyone closing a practice, or a good place to find > used office equipement please let me know. > > Thanks, > W. Blair, Jr., M.D. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2007 Report Share Posted January 7, 2007 , I agree with you that it’s a liability not to do EKG in your office sometimes unless you can get it done easily the same day, somewhere else. But things to keep in mind with stress testing. In my immediate neck of the wood, no one, not even the cardiologist, does stress testing in their office, they all do it at the hospital. I don’t know if you mentioned where you’d be hanging your shingle and whether you were going to participate with insurance plans or not. If you did, I forget, so sorry if you have to repeat yourself. You need to find out if anyone will pay you to do them. If you are on capitated plans, you won’t get paid. Some insurance companies won’t “credential” you to do them so again, you won’t get paid. And find out how much; can you get the facility charge and reading charges? What hoops will you have to jump through to get paid. I understand you idealism in doing everything for the patient as the epitome of a Family Physician. But bottom line, if your collecting food stamps in your idealism, is it worth it? Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2007 Report Share Posted January 7, 2007 " I wouldn't trade it for the medico-legal peace of mind it gives me when a patient presents with chest pain. " Be very careful with that line of thinking. In my opinion, the medical profession has become overly confident in the sensitivity & specificity of an EKG. You should use the EKG result as simply one piece of the Dx equation, but NEVER jump to the conclusion that this pt's chest pain is non-cardiac because the EKG is " normal " . Up to 25% of EKG's can be stone-cold normal in the face of an evolving AMI. Another classic example of this line of thinking happens all the time in the ER: a pt's chest pain improves with a GI cocktail & so it must not be cardiac . . . bingo, they go home & die of an AMI. I'm not saying to be overly " paranoid " or anal-retentive but just be careful about relying too much on an EKG result. > > > >> > [mailto: ] On Behalf Of > > > >> Levin Sent: Friday, January 05, 2007 6:11 PM > > >> > To: > > >> > Subject: Re: PC Based EKG > > >> > > > >> > > > >> > > > >> > RE testing in primary care offices. > > >> > > > >> > > > >> > > > >> > I respectfully disagree -- EKG, self interpretive well worth > the > > >> money. > > >> > > > >> > Reimbursement $30; 100 tests pay for the machine. Pick up > LVH, > > >> arrythmias. > > >> > I honestly think this is a better investment than my glucose > > >> monitor, which > > >> > I've had to fight for the $2.50 I ultimately get paid for any > I do > > >> in the > > >> > office. Curiously, think I should keep it, but mainly to > help pts > > >> learn how > > >> > to use their home machines. > > >> > > > >> > > > >> > > > >> > Spirometry too -- this is well worth it, as well as pulse > oximetry. > > >> COPD > > >> > monitoring as well as asthma should be monitored, folks, I > see few > > >> excuses > > >> > that make sense here. > > >> > > > >> > > > >> > > > >> > Now, as for flu shots, well, I DO send those out... anyone > get stuck > > >> with > > >> > flu shots this year unused? > > >> > > > >> > > > >> > > > >> > If anything, this demonstrates what a heterogeneous group > this is. > > >> > > > >> > > > >> > > > >> > Dr Matt Levin > > >> > > > >> > Solo FP since Dec 2004 > > >> > > > >> > Residency FP, 1988 > > >> > > > >> > SOAPware since 1997 > > >> > > > >> > > > >> > > > >> > [Practiceimprovemen t1] PC Based EKG > > >> > >> > > >> > >> > > >> > >> > > >> > >>Hey everyone. I haven't posted in a while. I am a 3rd yr > fam med > > >> resident in Texas getting ready to begin solo startup in > > >> July-August > > >> > >> and looking around for office equipment. Has anyone had any > > >> experience > > >> > >> with PC based ekg equipment. I am specifically looking at > > >> cardiocard ($1550). It looks pretty neat and would interface > well > > >> with the EMR I plan to use. Please give any input you might have > > >> on this or other startup tips. Along the same lines they also > > >> make a spirometer > > >> that can > > >> > >> run with your laptop as well. Do you think this stuff is > any > > >> good? > > >> > >> > > >> > >>Dragon Naturally Speaking Medical Version 9 > > >> > >>Best deal I have found is on Amazon for ~$850, does anyone > know of > > >> a > > >> > >> better deal on this? > > >> > >> > > >> > >>Also, If you know anyone closing a practice, or a good > place to > > >> find > > >> > >> used office equipement please let me know. > > >> > >> > > >> > >>Thanks, > > >> > >> W. Blair, Jr., M.D. > > >> > >> > > >> > >> > > >> > >> > > >> > >>__________________________________________________ > > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2007 Report Share Posted January 7, 2007 RE nonspecificity of ekg So why should we NOT have one in the office? [Practiceimprovemen t1] PC Based EKG> > >> > >>> > >> > >>> > >> > >>> > >> > >>Hey everyone. I haven't posted in a while. I am a 3rd yr > fam med> > >> resident in Texas getting ready to begin solo startup in> > >> July-August> > >> > >> and looking around for office equipment. Has anyone had any> > >> experience> > >> > >> with PC based ekg equipment. I am specifically looking at> > >> cardiocard ($1550). It looks pretty neat and would interface > well> > >> with the EMR I plan to use. Please give any input you might have> > >> on this or other startup tips. Along the same lines they also> > >> make a spirometer> > >> that can> > >> > >> run with your laptop as well. Do you think this stuff is > any> > >> good?> > >> > >>> > >> > >>Dragon Naturally Speaking Medical Version 9> > >> > >>Best deal I have found is on Amazon for ~$850, does anyone > know of> > >> a> > >> > >> better deal on this?> > >> > >>> > >> > >>Also, If you know anyone closing a practice, or a good > place to> > >> find> > >> > >> used office equipement please let me know.> > >> > >>> > >> > >>Thanks,> > >> > >> W. Blair, Jr., M.D.> > >> > >>> > >> > >>> > >> > >>> > >> > >>__________________________________________________> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2007 Report Share Posted January 7, 2007 DOES ANYONE BILL MEDICARE AND GET PAID WITH NO REFERRAL?? GEORD / > I have an old non pc based machine that I purchased 3rd hand for very > little, No machine interpretation and the ecg needs to be scanned in > but it was dirt cheap. I'm not sure the fancy PC based machine is > worth the money. Probably the majority of the ecg's I do are for pre- > op. I have a younger population. They certainly paid for the machine > in probably 2-3 months. > Larry Lindeman MD > > Larry Lindeman MD > > >> Couldn't resist weighing in on the to-have or not-to-have ECG >> machine debate: it's a need, not a want and the reimbursement equals >> roughly half of what I get for a 99213 with a lot less trouble. Two >> ECGs in one day equal an extra 99213. Every single ECG has been paid >> (granted I hve not billed Medicare yet). It takes my MA about 5 >> minutes to do and the billing is just one additional click on the CMS >> 1500. Well worth the time. Even if I have to do it myself when she's >> out, it's almost as fast for my rusty hands. I bought a used one for >> $500 from the local medical equipment repair guy, and we use it >> several times a week. It has paid for itself several times over in >> just one year. >> We NEED it for pre-op clearance. >> I wouldn't trade it for the medico-legal peace of mind it gives me >> when a patient presents with chest pain. >> I like to know if my hypertensives are developing LVH or my >> diabetics are developing silent ischemia. >> I agree completely with Matt... I respectfully disagree that it's not >> a necessary piece of equipment. >> , MD >> Trinity Medical Care, PC >> Virginia Beach, VA >> Solo since 1/3/06 >> >> > >> > [mailto: ] On Behalf Of >> >> > >> Levin Sent: Friday, January 05, 2007 6:11 PM >> > >> > To: >> > >> > Subject: Re: PC Based EKG >> > >> > >> > >> > >> > >> > >> > >> > RE testing in primary care offices. >> > >> > >> > >> > >> > >> > >> > >> > I respectfully disagree -- EKG, self interpretive well worth >> the >> > >> money. >> > >> > >> > >> > Reimbursement $30; 100 tests pay for the machine. Pick up >> LVH, >> > >> arrythmias. >> > >> > I honestly think this is a better investment than my glucose >> > >> monitor, which >> > >> > I've had to fight for the $2.50 I ultimately get paid for any >> I do >> > >> in the >> > >> > office. Curiously, think I should keep it, but mainly to >> help pts >> > >> learn how >> > >> > to use their home machines. >> > >> > >> > >> > >> > >> > >> > >> > Spirometry too -- this is well worth it, as well as pulse >> oximetry. >> > >> COPD >> > >> > monitoring as well as asthma should be monitored, folks, I >> see few >> > >> excuses >> > >> > that make sense here. >> > >> > >> > >> > >> > >> > >> > >> > Now, as for flu shots, well, I DO send those out... anyone >> get stuck >> > >> with >> > >> > flu shots this year unused? >> > >> > >> > >> > >> > >> > >> > >> > If anything, this demonstrates what a heterogeneous group >> this is. >> > >> > >> > >> > >> > >> > >> > >> > Dr Matt Levin >> > >> > >> > >> > Solo FP since Dec 2004 >> > >> > >> > >> > Residency FP, 1988 >> > >> > >> > >> > SOAPware since 1997 >> > >> > >> > >> > >> > >> > >> > >> > [Practiceimprovemen t1] PC Based EKG >> > >> > >> >> > >> > >> >> > >> > >> >> > >> > >>Hey everyone. I haven't posted in a while. I am a 3rd yr >> fam med >> > >> resident in Texas getting ready to begin solo startup in >> > >> July-August >> > >> > >> and looking around for office equipment. Has anyone had any >> > >> experience >> > >> > >> with PC based ekg equipment. I am specifically looking at >> > >> cardiocard ($1550). It looks pretty neat and would interface >> well >> > >> with the EMR I plan to use. Please give any input you might have >> on this or other startup tips. Along the same lines they also >> make a spirometer >> > >> that can >> > >> > >> run with your laptop as well. Do you think this stuff is >> any >> > >> good? >> > >> > >> >> > >> > >>Dragon Naturally Speaking Medical Version 9 >> > >> > >>Best deal I have found is on Amazon for ~$850, does anyone >> know of >> > >> a >> > >> > >> better deal on this? >> > >> > >> >> > >> > >>Also, If you know anyone closing a practice, or a good >> place to >> > >> find >> > >> > >> used office equipement please let me know. >> > >> > >> >> > >> > >>Thanks, >> > >> > >> W. Blair, Jr., M.D. >> > >> > >> >> > >> > >> >> > >> > >> >> > >> > >>__________________________________________________ >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2007 Report Share Posted January 7, 2007 I do have one & it is still generally useful, I just do not overly rely on it alone. Still, I know there are some docs that would argue that all patients with chest pain & at least one or two risk factors should be sent right to ER or cardiologist. For some, the line of reasoning goes like this: I do not even want the negative EKG result on the chart as it could still be cardiac related pain & it shows that I at least considered ischemia, but now I am forced to follow that DDX to conclusion (ie, the " normal " EKG still does not prove that the chest pain is not ischemia, nor does a " normal " exercise stress test for that matter). I do not believe that thinking, but I've heard some argue that. They argue that a patient with risk factors & chest pain need further eval no matter what the initial EKG shows. So, don,t get me wrong: I definitely advise having an EKG on hand & using it when appropriate, but if I think a pt has cardiac chest pain I still refer despite negative EKG. > > > Date: 2007/01/07 Sun AM 09:49:40 EST > To: < > > Subject: Re: Re: PC Based EKG > > RE nonspecificity of ekg > > So why should we NOT have one in the office? > > [Practiceimprovemen t1] PC Based EKG > > > >> > >> > > > >> > >> > > > >> > >> > > > >> > >>Hey everyone. I haven't posted in a while. I am a 3rd yr > > fam med > > > >> resident in Texas getting ready to begin solo startup in > > > >> July-August > > > >> > >> and looking around for office equipment. Has anyone had any > > > >> experience > > > >> > >> with PC based ekg equipment. I am specifically looking at > > > >> cardiocard ($1550). It looks pretty neat and would interface > > well > > > >> with the EMR I plan to use. Please give any input you might have > > > >> on this or other startup tips. Along the same lines they also > > > >> make a spirometer > > > >> that can > > > >> > >> run with your laptop as well. Do you think this stuff is > > any > > > >> good? > > > >> > >> > > > >> > >>Dragon Naturally Speaking Medical Version 9 > > > >> > >>Best deal I have found is on Amazon for ~$850, does anyone > > know of > > > >> a > > > >> > >> better deal on this? > > > >> > >> > > > >> > >>Also, If you know anyone closing a practice, or a good > > place to > > > >> find > > > >> > >> used office equipement please let me know. > > > >> > >> > > > >> > >>Thanks, > > > >> > >> W. Blair, Jr., M.D. > > > >> > >> > > > >> > >> > > > >> > >> > > > >> > >>__________________________________________________ > > > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2007 Report Share Posted January 8, 2007 Geord, I am afraid I don’t understand your question? Why would you need a referral for Medicare? I always get paid from Medicare (well not these 1st 2 weeks of the year.) Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2007 Report Share Posted January 8, 2007 they keep denying my bills for ekg and spirometry > Geord, > > > > I am afraid I don't understand your question? Why would you need a > referral for Medicare? I always get paid from Medicare (well not these > 1st 2 weeks of the year.) > > > > Kathy Saradarian, MD > > Branchville, NJ > > Solo low-staff practice since 4/03 > > In practice since 9/90 > > Practice Partner User since 5/03 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2007 Report Share Posted January 8, 2007 sorry they keep denying my blls for ekg and spirometry saying i lack a referral from another provider > Geord, > > > > I am afraid I don't understand your question? Why would you need a > referral for Medicare? I always get paid from Medicare (well not these > 1st 2 weeks of the year.) > > > > Kathy Saradarian, MD > > Branchville, NJ > > Solo low-staff practice since 4/03 > > In practice since 9/90 > > Practice Partner User since 5/03 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2007 Report Share Posted January 8, 2007 I would suggest you make a call to your local Medicare administrator. Or just rebill. Make sure the POS and TOS are correct. I used to get my urine dips and glucose denied saying I wasn’t an approved place of service usually just rebilling would get me paid. But I did call in the beginning and explain that this doesn’t require a special doctor and that Medicare doesn’t have referrals. The had to do something with my info to get it to work. It’s an error; just figuring out what the error is can be a problem. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2007 Report Share Posted January 8, 2007 I had an ECG in the group practice I left to start my IMP. I rarely used it then (maybe once a month with 2100 pts). I did not get one when I started in 7/03, and have not missed it. If my pt needs an ECG, it’s easy to get one done. If it needs to be done urgently, they are directed to the ER instead of coming into my office. I think getting an ECG or not is a personal decision (you like doing them or not), and also depends on availability/ease (time and hassle) to get it done in your community. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of docboops Sent: Saturday, January 06, 2007 8:36 PM To: Subject: Re: PC Based EKG Couldn't resist weighing in on the to-have or not-to-have ECG machine debate: it's a need, not a want and the reimbursement equals roughly half of what I get for a 99213 with a lot less trouble. Two ECGs in one day equal an extra 99213. Every single ECG has been paid (granted I hve not billed Medicare yet). It takes my MA about 5 minutes to do and the billing is just one additional click on the CMS 1500. Well worth the time. Even if I have to do it myself when she's out, it's almost as fast for my rusty hands. I bought a used one for $500 from the local medical equipment repair guy, and we use it several times a week. It has paid for itself several times over in just one year. We NEED it for pre-op clearance. I wouldn't trade it for the medico-legal peace of mind it gives me when a patient presents with chest pain. I like to know if my hypertensives are developing LVH or my diabetics are developing silent ischemia. I agree completely with Matt... I respectfully disagree that it's not a necessary piece of equipment. , MD Trinity Medical Care, PC Virginia Beach, VA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2007 Report Share Posted January 8, 2007 Geord, Check your claim form and be sure you have filled in something in box 17 " Name of Referring Physician or Other Source " - I put my name in there just the same as it is written in box 33. In box 17a put your UPIN No. I noticed this applies to most labs such as UA's, pregnacy tests etc. There are some changes coming to the CMS 1500 form because of the new National Provider ID No. But the old forms are valid until May 2007. I don't know if that box is affected by the National Provider ID yet. It seems weird the denial would be worded to imply that you needed a referral from another provider, but it is helpful to remember you are dealing with a computer, not a human being. It's probably one of thos e pre-Y2K era programs written in COBOL and the programmers have long since retired or passed on. :-) Caldwell M.D. Tulare, CA > > > sorry they keep denying my blls for ekg and spirometry saying i lack > referral from another provider > > Geord, > > > > > > > > I am afraid I don't understand your question? Why would you need a > > referral for Medicare? I always get paid from Medicare (well not these > > 1st 2 weeks of the year.) > > > > > > > > Kathy Saradarian, MD > > > > Branchville, NJ > > > > Solo low-staff practice since 4/03 > > > > In practice since 9/90 > > > > Practice Partner User since 5/03 > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2007 Report Share Posted January 8, 2007 ALEX , YOU ARE A WHIZZ ! I THINK THIS WILL WORK ALL THE BEST GEORD > Geord, > > Check your claim form and be sure you have filled in something in > box 17 " Name of Referring Physician or Other Source " - I put my name in > there just the same as it is written in box 33. In box 17a put your > UPIN No. I noticed this applies to most labs such as UA's, > pregnacy tests etc. There are some changes coming to the CMS 1500 form > because of the new National Provider ID No. But the old forms are valid > until May 2007. I don't know if that box is affected by the National > Provider ID yet. > > It seems weird the denial would be worded to imply that you needed a > referral from another provider, but it is helpful to remember you are > dealing with a computer, not a human being. It's probably one of thos e > pre-Y2K era programs written in COBOL and the programmers have long > since retired or passed on. :-) > > Caldwell M.D. > Tulare, CA > > >> >> >> sorry they keep denying my blls for ekg and spirometry saying i lack >> referral from another provider >> > Geord, >> > >> > >> > >> > I am afraid I don't understand your question? Why would you need a >> referral for Medicare? I always get paid from Medicare (well not > these >> > 1st 2 weeks of the year.) >> > >> > >> > >> > Kathy Saradarian, MD >> > >> > Branchville, NJ >> > >> > Solo low-staff practice since 4/03 >> > >> > In practice since 9/90 >> > >> > Practice Partner User since 5/03 >> > >> > Quote Link to comment Share on other sites More sharing options...
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