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Re: Office Testing (RE: Thanks for the input, Keep it coming)

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You have already done all the work for lab billing when sending off

to quest. You will more than likely make more on the lab than you

think for simply adding it to your superbill and tying it to the

diagnosis.

I agree starting out is tough enough, but once you have the

complexity to draw, spin and fill out req form, you might as well

make the dollars off of it.

You can beat quest down on their prices pretty good. You can then

pick and chose which ones you want quest to bill.

Brent

>

> In IMP practice, minimize lab/hassle/overhead, keep life simple,

avoid

> stress (especially at the beginning). You can easily add

complexity later

> (if you're a glutton for punishment by then). Starting out is

tough enough

> without adding to complexity and confusion.

>

> In addition to simple tests like dipsticks & Hemoccult, I also use

Nitrazine

> pH paper tape for all vaginal exams -- it costs pennies per exam (a

half

> inch of tape), takes seconds, and only changes color (pH over 4.5)

if there

> is BV or trichomonas (both treated by Flagyl), so I call it BV if

odor, or

> trich if bubbles, but the treatment is right for both. Both are

contagious,

> while monilia is not but does not elevate pH or need partner

treatment, so I

> treat monilia only if itchy with pasty white discharge. I am a

recovering

> microscope addict who can't get one in the office where I work now,

but I

> find my treatment is just as good this way, and I even pick up some

cases

> where the patient didn't mention discharge in the chief complaint.

I always

> document pH in every vaginal exam (pH 4.5, 5.0, etc) to support

normal or

> vaginitis. Clinical judgment should also tell you if an elevated

pH is

> occasionally from atrophic vaginitis or a copious cervical discharge

> instead.

>

> I don't bother billing for a urine dipstick, Hemoccult or vaginal

pH,

> because it's not worth the hassle for seconds of my time (like

billing for

> tongue blades or table paper). I'm selling primarily my encounter

time and

> clinical judgment.

>

> I use a courier lab (Quest, which interfaces with my Praxis EMR)

for most

> tests, and I centrifuge blood & keep in fridge until pickup. X-

rays are

> sent out to hospital or free-standing facility, and they bill

> insurance/patient. They do the hassle, I just practice here.

>

> Wes Bradford

>

>

>

> Thanks for the input, Keep it

coming.

>

> I just want to thank everyone for the input. I think I may move

forward with

> a contract lawyer and see how it goes from there.

> Things I need an opinion from thos more experienced so I may sleep

better at

> night...

> 1. given that my practice will be very close to the new hospital I

will be

> able to send virtually all pts to their rad/lab for tests and could

limit my

> initial overhead. On the other hand I want to provide as much for

my pts as

> I can. I know I can grow a limited lab in my office but not sure

what I

> should start with. Coming from residency, I have no clue what lab

services

> are financially feasible and what are not. There are lots of new

> " minimalist " lab equipment from very small machines, to just fancy

clia

> waived dip tests for all kinds of things. Can you guys help me come

up with

> a start up plan for this stuff?

> 2. Not quite the micro practice, but here is my theoretical startup

plan.

> Start-up with eMDs and an office " manager " type person (a good

friend of

> mine who I can trust, is an accountant and can be very flexible

with $/time

> and willing to learn) to help with phones, billing, pt check in,

etc. And a

> medical assistant. With clear cut job descriptions that everybody

does

> everything as it needs done.

> Does that sound good or like too much?

> 3. As someone mentioned before, I will have to take all insurance

> plans/payors that the hospital takes " within reason. " But the town

has a

> good payor mix. Near Dallas, ~50% of the working pop commutes to

work in the

> city. The other half works in the many large corporations that are

located

> in/just outside the city. City is growing quickly and has a good

portion of

> young working people. This is the good thing about the whole area

around the

> DFW metroplex..it is growing rapidly and there are alot of workers

making it

> do so.

> Now the whole billing/collecting process is where I know I will

likely be

> burned and learn the hard way...but I will do my best to plan for

that. The

> medical office consultant is actually to help me to negotiate

insurance

> contracts...I can use them as needed. This may sound like a waste

to you,

> but since I really don't have working experience with this I would

rather

> invest in getting the help to try to do this right, esp since it

will be

> paid for as part of my " loan " to be paid of with time in the town.

(4 yrs

> after guarantee yr). I feel like I should take advantage of this

help.

>

> ..have much more to ask, but just got a page...gotta go round on

some

> cardiology patients! Have a good Sunday. God bless you all! ...and

keep the

> opinions/thoughts coming.

>

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