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Message
1
Posted on 8/11/17 at 8:29 am to LEASTBAY
What happens if the acne only looks like acne but is something else? Or something seems like flu but isn't? That's the problem.
Posted on 8/11/17 at 8:29 am to ctiger69
quote:
My insurance pays for one free physical per year. It needs to be billed this way.
Just make sure you specify that, and they should do it
Posted on 8/11/17 at 8:30 am to ctiger69
Double post
This post was edited on 8/11/17 at 8:31 am
Posted on 8/11/17 at 8:37 am to LSUAfro
quote:
I could be wrong. That was just not my experience auditing health care groups
Depending on the type of visit, your provider can bill for counseling, or coordination of care, which can be billed based upon time.
Posted on 8/11/17 at 8:40 am to Hopeful Doc
quote:
My insurance pays for one free physical per year. It needs to be billed this way. Just make sure you specify that, and they should do it
But remember, A physical is just that. If a pt comes in with a laundry list of new or unstable issues, they may be billed for a "problem" visit as well. This depends on the insurer. A well check is just that. Too many people abuse it and think they can save up a year of shite to drop on their provider and get it all treated and done in one free visit. Sorry folks, that's not how it works.
Posted on 8/11/17 at 8:44 am to Kafka
frick you
Posted on 8/11/17 at 8:45 am to Epic Cajun
quote:
Depending on the type of visit, your provider can bill for counseling, or coordination of care, which can be billed based upon time.
The visit can be billed by one set of standards (amount of description documented, number of problems) OR time, and then in addition to the 992(0/1)(1-5), there are an additional set of codes that can be billed for extra time spent with the above for things that take unusual amount of time.
It includes some very specific language, but if someone spends an hour on the phone with family, another physician or two, and decide to put a patient in a nursing home and move that along, they can bill for that.
That said, I do not think that anyone bills the "extra" time to their patients- heck, most physicians don't even know the codes exist. But it is kind of nice to be able to get a little bit of reimbursement from the insurance company for all the time spent doing something after hours for the patient.
Posted on 8/11/17 at 8:45 am to Epic Cajun
quote:
Depending on the type of visit, your provider can bill for counseling, or coordination of care, which can be billed based upon time.
This. Can bill for complexity and decision making or time. If I'm smart and efficient, I may be able to justify a high level visit in just a few minutes. Other times, I'm stuck in their sorting through shite and listening to someone run on and on about trivial shite, but not able to justify more than a low level code. Blame insurers, they set the rules and the prices. They make the rules, we play the game and the pt's are the unfortunate pawns. There's not doubt the system is fricked. But I don't think pt's realize how expensive it is to run a practice and have all the services and staffing they expect available when they want it and need it. You're not just paying for the time you are there. You're paying for the time you're not there. I'm not defending all doctors and their billing practices, but it's not nearly as clear cut as it seems.
Posted on 8/11/17 at 8:47 am to SmackoverHawg
quote:
But remember, A physical is just that. If a pt comes in with a laundry list of new or unstable issues, they may be billed for a "problem" visit as well. This depends on the insurer. A well check is just that. Too many people abuse it and think they can save up a year of shite to drop on their provider and get it all treated and done in one free visit. Sorry folks, that's not how it works
And they usually want you to spend 15 minutes in everyone else's room so you are exactly on time, but Heaven help you if you try to stop them at their fifth problem for this visit...
ETA- I did overlook problem and wellness same day when I wrote that. For most of my patients, that isn't covered, so I'll write a laundry list plan under a "wellness" code because if a single non-Z code is listed, the visit is also not covered under wellness.
This post was edited on 8/11/17 at 8:50 am
Posted on 8/11/17 at 9:13 am to pjab
Do only mid level providers misdiagnose?
In every profession there are people that are good at what they do and people that are bad. The initials behind the name doesn't guarantee a quality product. It only means that they have completed the bare minimum to be licensed in their feild.
In every profession there are people that are good at what they do and people that are bad. The initials behind the name doesn't guarantee a quality product. It only means that they have completed the bare minimum to be licensed in their feild.
Posted on 8/11/17 at 9:13 am to SmackoverHawg
quote:
But remember, A physical is just that. If a pt comes in with a laundry list of new or unstable issues, they may be billed for a "problem" visit as well. This depends on the insurer. A well check is just that. Too many people abuse it and think they can save up a year of shite to drop on their provider and get it all treated and done in one free visit. Sorry folks, that's not how it works.
So what do you think crosses the line from annual wellness visit to cha-ching cha-ching? Specific examples, please. How many issues? Assume it's all done in one visit in the allotted time.
I'm asking because every time I go for my "annual wellness visit," I'm told at the desk it's free, but then if I comment on anything, no matter how minor, my doctor codes it differently, I get charged for it, and I have to spend 30 minutes on the phone getting it fixed. I've gotten it fixed every time, but I'm sick of this shite. I'm looking for a new doctor because of it.
Posted on 8/11/17 at 9:48 am to Ireallyamgerman
quote:
In every profession there are people that are good at what they do and people that are bad. The initials behind the name doesn't guarantee a quality product. It only means that they have completed the bare minimum to be licensed in their feild.
Agreed. Also, the MD or DO is delegating certain tasks/pt populations/visits to their mid level providers that they are comfortable delegating. The mid level should be properly trained by the same doctors that you are wanting to see in the first place. If you don't trust that the MD has delegated the tasks correctly, you should seek a second opinion because ultimately the supervising physician is the boss. Obviously there are certain diagnoses that need MD counsel and treatment, but honestly a lot of the mid levels see the most common conditions more than the MDs on a daily basis, because the MDs concentrate on the harder cases/surgeries/cosmetics(at least in derm).
Posted on 8/11/17 at 9:53 am to Spock's Eyebrow
quote:
"annual wellness visit," I'm told at the desk it's free, but then if I comment on anything, no matter how minor, my doctor codes it differently
If you are bringing problems to a "wellness visit", then it obviously isn't a wellness visit and should be billed accordingly. I don't really see the issue?
Posted on 8/11/17 at 10:08 am to Spock's Eyebrow
quote:
So what do you think crosses the line from annual wellness visit to cha-ching cha-ching? Specific examples, please. How many issues? Assume it's all done in one visit in the allotted time.
I'm asking because every time I go for my "annual wellness visit," I'm told at the desk it's free, but then if I comment on anything, no matter how minor, my doctor codes it differently, I get charged for it, and I have to spend 30 minutes on the phone getting it fixed. I've gotten it fixed every time, but I'm sick of this shite. I'm looking for a new doctor because of it.
Preface: coding and billing is a topic that can be discussed for hours and nuances exist all over the place.
So, it isn't about "cha ching," so much as it is what is going to be scrutinized by the insurance company. A wellness visit means "I have these old problems that you know about and treat me for but am doing fine" or "sometimes I can't sleep when I drink coffee after 5pm" or the like.
When you come with a new problem, such as knee pain, however innocuous it may seem, the insurance company no longer considers that "wellness." They consider it a "problem." I and my practice (still in residency, but we run a private clinic and have a majority of privately insured patients + medicare with a decent Medicaid population, too) will usually just ignore problem codes and bill wellness even if we change a few minor things. They pay us differently because of this.
What they require from every visit is a few things. 1) the level of care (wellness code, problem (complexity) code, or procedure code). Each of these is very different to the insurer. What they also have is a list of problems (icd 10 codes, essentially a 1-10 word summary of the visit boiled down to a generic code like "left hand pain" or "well adult exam" or "osteoarthritis of right knee" or "laceration of face." Each insurance only will allow the charge (wellness, procedure, or problem) based on the icd10 code. This means that when you talk about knee pain at a wellness visit and the doc puts the icd10 code for knee pain in (as they want you to do for accuracy) as well as the one for wellness, they will frequently (depending on the insurance company) reject the "wellness" charge and will not reimburse the visit. Some allow you to bill the wellness + problems. Some allow you to code the wellness + problems. There is no consistency here, unfortunately- it varies by insurance.
So the docs essentially do nothing different for the visit, but when it comes to coding/billing, it requires some judgment and development of a practice pattern. Some lose out on money they could have billed for looking at a new bump on the skin. Some code and bill for all they can because the rules not only say they can, they say they should.
Posted on 8/11/17 at 10:20 am to buffbraz
quote:
If you are bringing problems to a "wellness visit", then it obviously isn't a wellness visit and should be billed accordingly. I don't really see the issue?
Devil's advocate: patients come in for the free visit. The insurance tells them it's free. The office tells them it's free. They think that talking to the doctor and getting a diagnosis is free, so they bring up all their problems and talk openly about disease.
Other problem: insurance decided to reimburse based on "how complex" things are. So you get paid the same to diagnose hypertension that is treated with exercise as hypertension that needs 3 drugs and a host of labs to find the reason why (though these patients should/do come in more often, so that sort of "ups" the reimbursement). They also want to reward you for doing a wellness overview as well as diagnosing new disease in some cases, so they let you bill for both.
Problem with that is that the patient is responsible for x% of problem focused visits due to their insurance, so they don't like their "free" visit being no longer "free" because the doc found something.
The same problem exists for a few other things. Example: if I do a colonoscopy and don't find anything of interest, I get paid one amount. If I see something abnormal and take a biopsy (minimal time increase), the reimbursement nearly doubles for doing the same procedure. There are times that a scope with biopsy takes LESS time than one without, but it pays MORE.
The counter argument stands, though, that the more difficult something is, the more it's worth the insurance company to pay so that people do look for the complex things. But two identical procedures/exams are performed, the only difference is that the findings are what get reimbursed. It both makes sense and doesn't make sense. It's complex. There isn't a good answer. The system is stupid. But that's kind of the system.
Posted on 8/11/17 at 10:26 am to Hopeful Doc
I agree it can be complicated situation, especially in primary care. I can only speak for my experience doing derm, but when I do "free mole checks", I can certainly do a full body skin exam, and let the patient know if any treatment is necessary or not. If the patient decides that they want to have additional treatment, then after a discussion of what the potential cost would be, the appropriate CPT code is billed.
Posted on 8/11/17 at 10:47 am to Ireallyamgerman
quote:
Do only mid level providers misdiagnose? In every profession there are people that are good at what they do and people that are bad. The initials behind the name doesn't guarantee a quality product. It only means that they have completed the bare minimum to be licensed in their feild.
The bare minimum for physician is completion of medical school and residency in the field they are practicing. Board certification further demonstrates that the physician is an expert in their field..
The bare minimum for an NP is an online NP diploma mill and shadowing the preceptor of their choice, often times not even in the field they're currently working.
Posted on 8/11/17 at 11:09 am to schwartzy
My guess?
Gym rat doing steroids
Gym rat doing steroids
Posted on 8/11/17 at 11:11 am to Hopeful Doc
quote:
Devil's advocate: patients come in for the free visit. The insurance tells them it's free. The office tells them it's free. They think that talking to the doctor and getting a diagnosis is free, so they bring up all their problems and talk openly about disease.
Other problem: insurance decided to reimburse based on "how complex" things are. So you get paid the same to diagnose hypertension that is treated with exercise as hypertension that needs 3 drugs and a host of labs to find the reason why (though these patients should/do come in more often, so that sort of "ups" the reimbursement). They also want to reward you for doing a wellness overview as well as diagnosing new disease in some cases, so they let you bill for both.
Problem with that is that the patient is responsible for x% of problem focused visits due to their insurance, so they don't like their "free" visit being no longer "free" because the doc found something.
Good summary.
A certain amount of time is allotted to the visit. Anything discussed and handled in that time should be covered. I'm not talking about trying to get free treatment for an acute condition. I'm talking about the ability to answer the question, "Anything you want to talk about?" without it being a trick question, whose rules and costs you can only discover after the fact. A casual remark that takes 30 seconds to address and for which nothing is done should not turn the free visit into a $200 expense on top of the $7,000+ per year I pay for my pre-Obamacare HSA plan. I'm also talking about simple diagnoses that don't require follow-up visits between the annual checkups.
What if you do have an acute minor condition such as a sinus infection that coincides with your "annual wellness visit" scheduled months in advance? I have no doubt I'd be charged for that even though I wouldn't have come in for it. Under our system, I'd need to postpone my annual physical until I'm well. It's nuts.
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