getting paid for paps Re: Re: Solo advice

[Guest guest]

The way the system works now, I cannot even code depression or anxiety because for certain payors (medicare, United) these are not covered on a random basis ( I think it is .267 of all claims from united are randomly denied and if appealed returned at times paid with a lower 'behavioral' fee schedule). Yes everyone has fatigue and malaise and insomnia. So no this is not working.LynnTo: From: carlygold@...Date: Wed, 10 Dec 2008 21:13:27 -0800Subject: Re: getting paid for paps Re: Re: Solo advice

I wholeheartedly agree but in considering how to move the system forward through change, one consideration for the "system" is that without coding, there is no data on disease statistics, morbidity etc... would you be willing to continue the current icd-9 coding system in EMRs for reporting purposes only? Perhaps mandatory reporting to some entity on a monthly basis? Maybe I'm off base, but as we re-design, I think we have to consider the full impact of change and how to offset some of the unintended losses.

Carla Gibson

From: chadcostley <chadcostleymac>Subject: getting paid for paps Re: Re: Solo adviceTo: Date: Wednesday, December 10, 2008, 4:37 PM

My addition to the rant...Exactly right. That's why cash-only practices with a blended membership and simple fee per visit model make sense. My approach is $80 per month covers virtual visits, 24 hour direct access etc. If you do need to be seen - a simple fee schedule - $40, $80 or $120 (complete physical including gyn if necessary) based upon time and complexity. Simple to understand, disincentive for overuse but appropriate reimbursement to the doc for things that in an insurance environment wouldn't be billable, no craziness. If someone needs an EKG - fine - we do it and we've already been compensated in the retainer or the visit charge. If someone needs a urinalysis - no stupidity about figuring out whether it's their diabetes ICD-9 code or their HTN ICD-9 code that needs to be linked to the test in order to get reimbursed. And back to the original subject of this thread, if a woman needs a gyn exam - you

do it because it's the right thing to do, without worrying about whether an insurance company is willing to carve it out of what would otherwise be defined as a complete physical under some crazy logic I don't care to try to understand. I remember when I was on faculty at Henry Ford Hospital in Detroit attending a Grand Rounds primarily focused on educating medical students and residents in which the entire talk was about how to be a good coder. I was disgusted. I couldn't believe we had lowered our educational mission to that point.Now the caveat. I recognize it's easy to preach about the virtue of cash-only, no-insurance practices when you're starting a practice in a city of 6 million people and you only need to convince a few hundred to make it work. Most doctors don't practice in areas like that, so I feel for those of you who have to struggle for your patients within the realm that almost drove me

away from clinical practice.But ...the answer to your question is "very stupid."Chad > >> > Don't do gyn > exams. When my sister stopped doing them, it really saved us alot of > > headaches. But I do understand that as cash only, you may want to > offer it--maybe as > part of the annual? We are trying to slowly > convert to cash only and are re-thinking the > issue.> > > > > > > > > > > > ____________ _________ _________ __> >> From: chadcostley > ...>> > To: Practiceimprovement <mailto:Practiceimprovement 1yahoogroups (DOT) com>> 1yahoogroups (DOT) com>

> > Sent: Tuesday, November 25, 2008 5:40:32 AM> > Subject: > [Practiceimprovemen t1] Solo advice> > > > I need some > advice. I am opening my cash-only practice in January and given the > > economy > > am realistic about how fast it will grow. I am > absolutely convinced it can be successful, > but > > the ramp up will > surely be slower than it would have been a couple of years ago. > > Therefore, > > I'm getting very serious about controlling overhead so > I can make it through the lean > months, > > and perhaps years, it will > take to get the practice where it needs to be. I've not been > overly > > > excited about practicing with no support, but the economic realities > may force that > decision. > > So the question - how can a male

> provider realistically practice solo-solo without a > > chaperone > available for gyn exams, or focused cardiac exams for that matter? How > are > > others solving this? > > > > Thanks -> > > > > Chad Costley> > chadcostley@ ... > > > > > > > ------------ --------- --------- ------> > > > Yahoo! > Groups Links> > > > > > > > http://docs. <http://docs. yahoo.com/ info/terms/> yahoo.com/> info/terms/> >> > > > > ------------ --------- --------- ------> > Yahoo! > Groups Links> > To visit your group on the web, go to:> > http://groups. <http://groups. yahoo.com/ group/Practiceim provement1/>> yahoo.com/ group/Practiceim provement1/> > > Your email settings:> Individual Email | > Traditional> > To change settings online go to:> > http://groups. yahoo.com/ group/Practiceim provement1/ join> <http://groups. yahoo.com/ group/Practiceim provement1/ join> > > (Yahoo! ID required)> > To change settings via > email:> mailto:Practiceimpr ovement> <mailto:Practiceimprovement 1-digest@ yahoogroups. com> 1-digest@> yahoogroups. com > > mailto:Practiceimpr ovement> <mailto:Practiceimprovement 1-fullfeatured@ yahoogroups. com>> 1-fullfeatured@ yahoogroups. com> > >

[Guest guest]

I’ll add my 2 cents worth here. I

have a retainer practice, and most of my pts like that I will give them a

completed HCFA 1500 (or whatever it is called now – CMS 1500?) for them

to submit to their insurance. My EMR requires that I use codes, and I still do

for everything, so that has not changed for me.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of Carla Gibson

Sent: Wednesday, December 10, 2008

10:13 PM

To:

Subject: Re: getting paid for paps

Re: Re: Solo advice

I wholeheartedly agree but in considering how to

move the system forward through change, one consideration for the

" system " is that without coding, there is no data on disease

statistics, morbidity etc... would you be willing to continue the current

icd-9 coding system in EMRs for reporting purposes only? Perhaps mandatory

reporting to some entity on a monthly basis? Maybe I'm off base, but as

we re-design, I think we have to consider the full impact of change and how

to offset some of the unintended losses.

Carla Gibson

From: chadcostley

<chadcostleymac>

Subject: getting paid for paps Re: Re: Solo

advice

To:

Date: Wednesday, December 10, 2008, 4:37 PM

My addition to the

rant...Exactly right. That's why cash-only practices with a blended

membership and simple fee per visit model make sense. My approach is $80 per

month

covers virtual visits, 24 hour direct access etc. If you do need to be seen -

a simple fee

schedule - $40, $80 or $120 (complete physical including gyn if necessary)

based upon

time and complexity. Simple to understand, disincentive for overuse but

appropriate

reimbursement to the doc for things that in an insurance environment wouldn't

be

billable, no craziness. If someone needs an EKG - fine - we do it and we've

already been

compensated in the retainer or the visit charge. If someone needs a

urinalysis - no

stupidity about figuring out whether it's their diabetes ICD-9 code or their

HTN ICD-9

code that needs to be linked to the test in order to get reimbursed. And back

to the

original subject of this thread, if a woman needs a gyn exam - you do it

because it's the

right thing to do, without worrying about whether an insurance company is

willing to carve

it out of what would otherwise be defined as a complete physical under some

crazy logic I

don't care to try to understand. I remember when I was on faculty at Henry Ford

Hospital

in Detroit

attending a Grand Rounds primarily focused on educating medical students and

residents in which the entire talk was about how to be a good coder. I was

disgusted. I

couldn't believe we had lowered our educational mission to that point.

Now the caveat. I recognize it's easy to preach about the virtue of

cash-only, no-

insurance practices when you're starting a practice in a city of 6 million

people and you

only need to convince a few hundred to make it work. Most doctors don't

practice in areas

like that, so I feel for those of you who have to struggle for your patients

within the realm

that almost drove me away from clinical practice.

But ...the answer to your question is " very stupid. "

Chad

> >

> > Don't do gyn

> exams. When my sister stopped doing them, it really saved us alot of

>

> headaches. But I do understand that as cash only, you may want to

> offer it--maybe as

> part of the annual? We are trying to slowly

> convert to cash only and are re-thinking the

> issue.

> >

> >

>

> >

> >

> >

> ____________ _________ _________ __

> >

> From: chadcostley

> ...>

> > To: Practiceimprovement <mailto:Practiceimprovement

1yahoogroups (DOT) com>

> 1yahoogroups (DOT) com

> >

> Sent: Tuesday, November 25, 2008 5:40:32 AM

> > Subject:

> [Practiceimprovemen t1] Solo advice

> >

> > I need some

> advice. I am opening my cash-only practice in January and given the

>

> economy

> > am realistic about how fast it will grow. I am

> absolutely convinced it can be successful,

> but

> > the ramp up will

> surely be slower than it would have been a couple of years ago.

>

> Therefore,

> > I'm getting very serious about controlling overhead so

> I can make it through the lean

> months,

> > and perhaps years, it will

> take to get the practice where it needs to be. I've not been

> overly

>

> > excited about practicing with no support, but the economic

realities

> may force that

> decision.

> > So the question - how can a male

> provider realistically practice solo-solo without a

> > chaperone

> available for gyn exams, or focused cardiac exams for that matter? How

> are

> > others solving this?

> >

> > Thanks -

> >

> >

> Chad

Costley

> > chadcostley@ ...

> >

> >

> >

> ------------ --------- --------- ------

> >

> > Yahoo!

> Groups Links

> >

> >

> >

> > http://docs. <http://docs.

yahoo.com/ info/terms/> yahoo.com/

> info/terms/

> >

>

>

>

>

> ------------ --------- --------- ------

>

> Yahoo!

> Groups Links

>

> To visit your group on the web, go to:

>

> http://groups. <http://groups.

yahoo.com/ group/Practiceim provement1/>

> yahoo.com/ group/Practiceim provement1/

>

>

> Your email settings:

> Individual Email |

> Traditional

>

> To change settings online go to:

>

> http://groups. yahoo.com/

group/Practiceim provement1/ join

> <http://groups. yahoo.com/ group/Practiceim provement1/ join>

>

> (Yahoo! ID required)

>

> To change settings via

> email:

> mailto:Practiceimpr ovement

> <mailto:Practiceimprovement 1-digest@ yahoogroups. com>

1-digest@

> yahoogroups. com

>

> mailto:Practiceimpr ovement

> <mailto:Practiceimprovement 1-fullfeatured@ yahoogroups. com>

> 1-fullfeatured@ yahoogroups. com

>

>

>

[Guest guest]

, Where can I get a copy of this form? StrazI’ll add my 2 cents worth here. I have a retainer practice, and most of my pts like that I will give them a completed HCFA 1500 (or whatever it is called now – CMS 1500?) for them to submit to their insurance. My EMR requires that I use codes, and I still do for everything, so that has not changed for me. A. Eads, M.D.Pinnacle Family Medicine, PLLC phone faxP.O. Box 7275Woodland Park, CO 80863www.PinnacleFamilyMedicine.comFrom: [mailto: ] On Behalf Of Carla GibsonSent: Wednesday, December 10, 2008 10:13 PMTo: Subject: Re: getting paid for paps Re: Re: Solo advice I wholeheartedly agree but in considering how to move the system forward through change, one consideration for the "system" is that without coding, there is no data on disease statistics, morbidity etc... would you be willing to continue the current icd-9 coding system in EMRs for reporting purposes only? Perhaps mandatory reporting to some entity on a monthly basis? Maybe I'm off base, but as we re-design, I think we have to consider the full impact of change and how to offset some of the unintended losses. Carla GibsonFrom: chadcostley <chadcostleymac>Subject: getting paid for paps Re: Re: Solo adviceTo: Date: Wednesday, December 10, 2008, 4:37 PMMy addition to the rant...Exactly right. That's why cash-only practices with a blended membership and simple fee per visit model make sense. My approach is $80 per month covers virtual visits, 24 hour direct access etc. If you do need to be seen - a simple fee schedule - $40, $80 or $120 (complete physical including gyn if necessary) based upon time and complexity. Simple to understand, disincentive for overuse but appropriate reimbursement to the doc for things that in an insurance environment wouldn't be billable, no craziness. If someone needs an EKG - fine - we do it and we've already been compensated in the retainer or the visit charge. If someone needs a urinalysis - no stupidity about figuring out whether it's their diabetes ICD-9 code or their HTN ICD-9 code that needs to be linked to the test in order to get reimbursed. And back to the original subject of this thread, if a woman needs a gyn exam - you do it because it's the right thing to do, without worrying about whether an insurance company is willing to carve it out of what would otherwise be defined as a complete physical under some crazy logic I don't care to try to understand. I remember when I was on faculty atHenry Ford Hospital in Detroit attending a Grand Rounds primarily focused on educating medical students and residents in which the entire talk was about how to be a good coder. I was disgusted. I couldn't believe we had lowered our educational mission to that point.Now the caveat. I recognize it's easy to preach about the virtue of cash-only, no-insurance practices when you're starting a practice in a city of 6 million people and you only need to convince a few hundred to make it work. Most doctors don't practice in areas like that, so I feel for those of you who have to struggle for your patients within the realm that almost drove me away from clinical practice.But ...the answer to your question is "very stupid."Chad > >> > Don't do gyn > exams. When my sister stopped doing them, it really saved us alot of > > headaches. But I do understand that as cash only, you may want to > offer it--maybe as > part of the annual? We are trying to slowly > convert to cash only and are re-thinking the > issue.> > > > > > > > > > > > ____________ _________ _________ __> >> From: chadcostley > ...>> > To: Practiceimprovement <mailto:Practiceimprovement 1yahoogroups (DOT) com>> 1yahoogroups (DOT) com> > > Sent: Tuesday, November 25, 2008 5:40:32 AM> > Subject: > [Practiceimprovemen t1] Solo advice> > > > I need some > advice. I am opening my cash-only practice in January and given the > > economy > > am realistic about how fast it will grow. I am > absolutely convinced it can be successful, > but > > the ramp up will > surely be slower than it would have been a couple of years ago. > > Therefore, > > I'm getting very serious about controlling overhead so > I can make it through the lean > months, > > and perhaps years, it will > take to get the practice where it needs to be. I've not been > overly > > > excited about practicing with no support, but the economic realities > may force that > decision. > > So the question - how can a male > provider realistically practice solo-solo without a > > chaperone > available for gyn exams, or focused cardiac exams for that matter? How > are > > others solving this? > > > > Thanks -> > > > > Chad Costley> > chadcostley@ ... > > > > > > > ------------ --------- --------- ------> > > > Yahoo! > Groups Links> > > > > > > > http://docs. <http://docs. yahoo.com/ info/terms/> yahoo.com/> info/terms/> >> > > > > ------------ --------- --------- ------> > Yahoo! > Groups Links> > To visit your group on the web, go to:> > http://groups. <http://groups. yahoo.com/ group/Practiceim provement1/>> yahoo.com/ group/Practiceim provement1/> > > Your email settings:> Individual Email | > Traditional> > To change settings online go to:> > http://groups. yahoo.com/ group/Practiceim provement1/ join> <http://groups. yahoo.com/ group/Practiceim provement1/ join> > > (Yahoo! ID required)> > To change settings via > email:> mailto:Practiceimpr ovement> <mailto:Practiceimprovement 1-digest@ yahoogroups. com> 1-digest@> yahoogroups. com > > mailto:Practiceimpr ovement> <mailto:Practiceimprovement 1-fullfeatured@ yahoogroups. com>> 1-fullfeatured@ yahoogroups. com> > >

[Guest guest]

Great example. The current system gives an illusion of disease tracking that

distorts

what's actually happening, and that leads to real harm. The lack of good data

about the

real prevalance of mental disease in the population and the resultant

underfunding for

mental health care is a perfect example. Rather than digging through a 1500

page book

or even scrolling through countless ICD-9 choices within an EMR, most of the

docs I know

default to a relatively short list of codes they remember that get the 99213 or

99214 visit

paid for but don't reflect the clinical picture in any meaningful way. It's

worse than no

tracking at all as it's pure garbage data. Of course there's always the option

of layering

overhead on a practice in the form of an overly-priced, sophisticated coding

assistant (i.e.

most EMRs) and spending less time actually caring for patients and more time

chasing

codes. Patients get sicker, doctors retire earlier, and insurance companies get

more

evidence that paying appropriately for primary care isn't in their best

interests. I'm an

evdience-based care disciple so hear the concern about lack of visibility into

practice

behaviors, but measuring quality through codes provided by docs at the point of

care is

completely ineffective.

> > >

> > > Don't do gyn

> > exams. When my sister stopped doing them, it really saved us alot of

> >

> > headaches. But I do understand that as cash only, you may want to

> > offer it--maybe as

> > part of the annual? We are trying to slowly

> > convert to cash only and are re-thinking the

> > issue.

> > >

> > >

> >

> > >

> > >

> > >

> > ____________ _________ _________ __

> > >

> > From: chadcostley

> > ...>

> > > To: Practiceimprovement <mailto:Practiceimprovement 1yahoogroups (DOT) com>

> > 1yahoogroups (DOT) com

> >

> >

> > Sent: Tuesday, November 25, 2008 5:40:32 AM

> > > Subject:

> > [Practiceimprovemen t1] Solo advice

> > >

> > > I need some

> > advice. I am opening my cash-only practice in January and given the

> >

> > economy

> > > am realistic about how fast it will grow. I am

> > absolutely convinced it can be successful,

> > but

> > > the ramp up will

> > surely be slower than it would have been a couple of years ago.

> >

> > Therefore,

> > > I'm getting very serious about controlling overhead so

> > I can make it through the lean

> > months,

> > > and perhaps years, it will

> > take to get the practice where it needs to be. I've not been

> > overly

> >

> > > excited about practicing with no support, but the economic realities

> > may force that

> > decision.

> > > So the question - how can a male

>

> > provider realistically practice solo-solo without a

> > > chaperone

> > available for gyn exams, or focused cardiac exams for that matter? How

> > are

> > > others solving this?

> > >

> > > Thanks -

> > >

> > >

> > Chad Costley

> > > chadcostley@ ...

> > >

> > >

> > >

> > ------------ --------- --------- ------

> > >

> > > Yahoo!

> > Groups Links

> > >

> > >

> > >

> > > http://docs. <http://docs. yahoo.com/ info/terms/> yahoo.com/

> > info/terms/

> > >

> >

> >

> >

> >

> > ------------ --------- --------- ------

> >

> > Yahoo!

> > Groups Links

> >

> > To visit your group on the web, go to:

> >

> > http://groups. <http://groups. yahoo.com/ group/Practiceim provement1/>

> > yahoo.com/ group/Practiceim provement1/

> >

> >

> > Your email settings:

> > Individual Email |

> > Traditional

> >

> > To change settings online go to:

> >

> > http://groups. yahoo.com/ group/Practiceim provement1/ join

> > <http://groups. yahoo.com/ group/Practiceim provement1/ join>

> >

> > (Yahoo! ID required)

> >

> > To change settings via

> > email:

> > mailto:Practiceimpr ovement

> > <mailto:Practiceimprovement 1-digest@ yahoogroups. com> 1-digest@

> > yahoogroups. com

> >

> > mailto:Practiceimpr ovement

> > <mailto:Practiceimprovement 1-fullfeatured@ yahoogroups. com>

> > 1-fullfeatured@ yahoogroups. com

> >

> >

> >

[Guest guest]

I have thought about this tooI wonder if we were paid very simply then we could actually submit very simply and uh actually truthfully the diagnoses we cared for .Simpley and truthfully what a concept No more abdominal pain disguises for depression dx.

When I w rote in to change.gov I suggested we stop this insanity of coding with modifiers /places of servcie/ global fee vs not/ numbering the order of the importance of the dx but limited to 4 /etc etc on an d on .Let Tom Daschle go sit in a one hr coding class and then give him a real patient preferably one who needs vaccines and an ABN also and who maybe has no part D and wants zostavax , but has htn dm djd and wants their ear wax flushed out, give the man an 1500 form and lock him in the room til he figures out how to do it right . NO food or water.MAybe bathroom privileges only.

Sorry Bad weather here.... crabbiness falling out of the skyIf we did not get paid like we worked in shirt factory if I only had to sew the shirts and make really g ood ones someone else could count the pile

Now I have to measure how soon my cuffs fray count the number of collar buttons survey the wearers for satifsafction and check on the quality of the cloth all reported on seperate forms after hrs after I make any money by sewing the shirts which I am paid for all the same shirt differently becasue some are sold to walmart and some to macy's

how simple things could be What a concept!LoveJean

In discussing the continued use of traditional codes if we were to go to patient as payer for primary care services, what I was wondering about is how the general " public health " data would be available if we did not have some central reporting system such as how many individual diabetics we see, how many diabetic visits per year, meds being used for diabetics etc.. where do those statistics come from now? Insurance companies? Beyond HYH how do we measure public health outcomes if our data sources no longer exist? I am not well educated on this topic- thus I'm asking. And in any healthcare re-design, some of these " small points " could become stumbling blocks.

Carla Gibson FNP

From: chadcostley <chadcostley@ mac.com>Subject: getting paid for paps Re: [Practiceimprovemen t1] Re: Solo advice

To: Practiceimprovement 1yahoogroups (DOT) comDate: Wednesday, December 10, 2008, 4:37 PM

My addition to the rant...Exactly right. That's why cash-only practices with a blended membership and simple fee per visit model make sense. My approach is $80 per month

covers virtual visits, 24 hour direct access etc. If you do need to be seen - a simple fee schedule - $40, $80 or $120 (complete physical including gyn if necessary) based upon time and complexity. Simple to understand, disincentive for overuse but appropriate

reimbursement to the doc for things that in an insurance environment wouldn't be billable, no craziness. If someone needs an EKG - fine - we do it and

we've already been compensated in the retainer or the visit charge. If someone needs a urinalysis - no stupidity about figuring out whether it's their diabetes ICD-9 code or their HTN ICD-9

code that needs to be linked to the test in order to get reimbursed. And back to the original subject of this thread, if a woman needs a gyn exam - you do it because it's the right thing to do, without worrying about whether an insurance company is willing to carve

it out of what would otherwise be defined as a complete physical under some crazy logic I don't care to try to understand. I remember when I was on faculty at

Henry Ford Hospital in Detroit attending a Grand Rounds primarily focused on educating medical students and residents in which the entire talk was about how to be a good coder. I was disgusted. I

couldn't believe we had lowered our educational mission to that point.Now the caveat. I recognize it's easy to preach about the virtue of cash-only, no-insurance practices when you're starting a practice in a city of 6 million people and you

only need to convince a few hundred to make it work. Most doctors don't practice in areas like that, so I feel for those of you who have to struggle for your patients within the realm

that almost drove me away from clinical practice.But ...the answer to your question is " very stupid. " Chad > >> > Don't do gyn > exams. When my sister stopped doing them, it really saved us alot of >

> headaches. But I do understand that as cash only, you may want to > offer it--maybe as > part of the annual? We are trying to slowly > convert to cash only and are re-thinking the

> issue.> > > > > > > > > > > > ____________ _________ _________ __> >

> From: chadcostley > ...>> > To: Practiceimprovement <mailto:Practiceimprovement 1yahoogroups (DOT) com>

> 1yahoogroups (DOT)

com> > > Sent: Tuesday, November 25, 2008 5:40:32 AM> > Subject: > [Practiceimprovemen t1] Solo advice> > > > I need some

> advice. I am opening my cash-only practice in January and given the > > economy > > am realistic about how fast it will grow. I am > absolutely convinced it can be successful,

> but > > the ramp up will > surely be slower

than it would have been a couple of years ago. > > Therefore, > > I'm getting very serious about controlling overhead so > I can make it through the lean

> months, > > and perhaps years, it will > take to get the practice where it needs to be. I've not been > overly >

> > excited about practicing with no support, but the economic realities > may force that > decision. > > So the question - how can a male

> provider realistically practice solo-solo without a > > chaperone > available for gyn exams, or focused cardiac exams for that matter? How > are

> > others solving this? > > > > Thanks -> > > > > Chad Costley>

> chadcostley@ ... > > > > > > > ------------ --------- --------- ------> > > > Yahoo!

> Groups Links> > > > > > > > http://docs. <http://docs. yahoo.com/ info/terms/> yahoo.com/

> info/terms/>

>> > > > > ------------ --------- --------- ------> > Yahoo! > Groups Links>

> To visit your group on the web, go to:> > http://groups. <http://groups. yahoo.com/ group/Practiceim provement1/>

> yahoo.com/ group/Practiceim provement1/> > > Your email settings:> Individual Email | > Traditional

> > To change settings online go to:> > http://groups. yahoo.com/ group/Practiceim provement1/ join

> <http://groups. yahoo.com/ group/Practiceim provement1/ join> > > (Yahoo! ID required)

> > To change

settings via > email:> mailto:Practiceimpr ovement> <mailto:Practiceimprovement 1-digest@ yahoogroups. com> 1-digest@

> yahoogroups. com > > mailto:Practiceimpr ovement> <mailto:Practiceimprovement 1-fullfeatured@ yahoogroups. com>

> 1-fullfeatured@ yahoogroups.

com> > >