Re: Re: Doctors going out of business

[Guest guest]

1 hour visits got downcoded to 40 minute visits - I thought maybe I forgot to add "1 hour with patient > 1/2 in counseling" but it was in all the notes! (these were all "pre audited" before payment) so now I'm wondering if the computers have been set to reject all 1 hour home visits and kick it to a pre-audit. I know the computers have been set to reject all prolonged office visits as per a CMS representative so I don't even use them any more.

To: Sent: Wednesday, January 11, 2012 9:14 PMSubject: RE: Re: Doctors going out of business

I do some home visits. Can you share what level you billed and what level they down coded to? It’s always harder to document all the details of a home visit when I get back, unlike office visits I can do mostly at the time of service.

My sympathies for having to deal with this.

Tonya S. Little, MD

1704 Glendale Drive SW, Suite C

NC 27893

fax

cell

tslittle@...

From: [mailto: ] On Behalf Of MyriaSent: Wednesday, January 11, 2012 9:02 PMTo: Subject: Re: Re: Doctors going out of business

House calls for 1 hour visit pays between 79 and 119. I just had Medicare pre-audit my notes and down code every house call - 7 so are and 5 not yet received back. I have 10 home care patients. Do only if you have to.

I am appealing.

To: " " < > Sent: Wednesday, January 11, 2012 9:34 AMSubject: Re: Re: Doctors going out of business

Have you considered doing house calls? If your schedule is not full, could you take 1-2 days per month to go to your patients that can't get to you? Or close early one day/week? Obviously doesn't help the pt with the Picc line (no home health nurses?), but could help your other patients. Steve does a few for non-ambulatory pts. We do not advertise it, and the pt has to be established and Steve offers if he sees it is a difficult situation. He does them at lunch or at the end of the day - about 1-2 visits per month. They do pay better than an office visit. Just a though....

Pratt

same here as Deb and KAthy and Sharlene I look back at a full schedule of yr ago to see 2 who have died(Maine is the oldest state in the union and the oldest people live in my town I swear) 1or 2 have moved to find work- the economy was so bad here before the recession we never saw much differnce there is nothing here one or two may have moved on for another reason There is an abundance of PCPs here the hospitla keeps getting more and can offer sliding fees to see people for 5.00 whicih I cannot do, and they take the mainecare folks thogh I see plenty of those I cannot see enough to be paid well.Last yr I had the best financial yr I ever had I brought home 14,800 more than 2010 But I struggle to keep the schedule

full weird but true The model works but I do hrs and hrs of work for folks have no money and no transportation When they cannot get in I cannot get paid Yesterday a woman discharged form a hospital 1 hr away with a PICC line needing 6 days of antibx that this hospital says I have to write the orders for becasue I am the one with local prvileges and she cannot come in to see me and is not getting the antibx and is out there calling me stuck in the woods with now a non flushed picc line. augh!The guy upstairs is a family doc- who works a day a week in industrial setting and mostly does derm now. Others have tiny offices and spouses with good jobs and churn patietns Everyone has something to try to survive really it is a mess for docs and bad for patietns out hereIf we cannot join up together as professionals and do what is good for patietns and good for

primary care soon boy we is doomed.

My patients are over 50% medicaid. Some don't even have vehicles to make it to my suburban office. They drive unregistered vehicles or get rides

When I started ; I live in the next town; I didn't realize the poverty in our area. Some have so many issues as they haven't been able to get a PCP ho took their insurance. When they need specialists it is difficult to find them for these pts.

It really is sad...

"But those that innovate away from the system will and should thrive." Steve, I really don't think that is true in all locations. I live in a relatively poor, rural area, and I know without a doubt that I would lose most of my patients if I did not accept their insurance. They love the care and service that I give, but the bottom line is their budgets, and most of those are stretched to the limits. And I really can't blame them for wanting to use the insurance that they are paying so much for. This past summer, I really searched my soul to see if I even dared to charge a $200 noncovered benefits fee, but I decided that most of them would leave even over that. Also, although there are quite a few uninsured people around, they tend not to come in until they are wrecks, and they are so poor that I feel

obligated to undercharge them for the amount of time and energy I spend trying to help them. I also feel some extra malpractice risk when I care for them, because they usually won't even go for any labs or tests. (There are no discounted labs anywhere around, and NY State sees fit to "protect" them from those cool, discounted deals you see on the internet.) Now, I know I could pull up stakes and start all over in some more affluent area, but this is where all my family is, and the thought of starting over after the past 3+ years of hard work is pretty much unbearable, besides the fact there is no money left. I do dream about it sometimes, though!---Sharlene

> > > >>>> > > >>>> **> > > >>>>> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > >>>> per month. I had no idea that is how oncology works.> > > >>>>> > > >>>>> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>> > > >>>>> > > >>>> g> > > >>>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>> =======> > > >>> Email scanned by PC Tools - No viruses or

spyware found.> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >>> =======> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>> =======> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >

>>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >>> =======> > > >>>> > > >>>> > > >>> > > > > > > >> > >> >>

-- MD ph fax

[Guest guest]

I agree, but there is as much chance of that as there is of  docs dropping the insurances isn't it?Sangeetha

 

"

BUT if we are to fight back as a group at this needs to be challenged, till it costs the payers more to DENY than to PAY it.   " Good luck with that.  If you really want to stop this, drop the payer(s) that do this.  If enough of  you do that, they'll stop.   If not enough do this, at least you're rid of them instead of wasting your time appealing automatic downcodes.

If the patients are upset about you dropping the payer, let them complain to their payer and employer.  We find this can be surprisingly effective.

> > > My sympathies for having to deal with this.

> > >  

> > > Tonya S. Little, MD

> > > 1704 Glendale Drive SW, Suite C

> > > NC 27893

> > >

> > > fax

> > > cell

> > > tslittle@

> > >

> > > ________________________________

> > >

> > > From: [mailto: ] On Behalf Of Myria

> > > Sent: Wednesday, January 11, 2012 9:02 PM

> > > To:

> > > Subject: Re: Re: Doctors going out of business

> > >  

> > >  

> > > House calls for 1 hour visit pays between 79 and 119.  I just had Medicare pre-audit my notes and down code every house call - 7 so are and 5 not yet received back. I have 10 home care patients.  Do only if you have to.

> > > I am appealing.

> > >  

> > > From: Pratt <kpratt.1022@>

> > > To: " " < >

> > > Sent: Wednesday, January 11, 2012 9:34 AM

> > > Subject: Re: Re: Doctors going out of business

> > >  

> > >  

> > >

> > > Have you considered doing house calls?  If your schedule is not full, could you take 1-2 days per month to go to your patients that can't get to you?  Or close early one day/week?  Obviously doesn't help the pt with the Picc line (no home health nurses?), but could help your other patients.  Steve does a few for non-ambulatory pts.  We do not advertise it, and the pt has to be established and Steve offers if he sees it is a difficult situation.  He does them at lunch or at the end of the day - about 1-2 visits per month.  They do pay better than an office visit.  Just a though....

> > >

> > >

> > > Pratt

> > >

> > > On Jan 11, 2012, at 5:41 AM, <jnantonucci@> wrote:

> > >  

> > > >same here as Deb and KAthy and Sharlene

> > > > I look  back at a full schedule of yr ago to see  2 who have died(Maine is the oldest state in the union  and the oldest people live in my town I swear) 1or 2 have moved to find work- the economy was so bad here before the recession we never saw much differnce there is nothing here  one or  two may have moved on for another reason There is an abundance of PCPs here the hospitla keeps getting more and  can offer sliding fees  to see people for 5.00 whicih I cannot do,  and they  take the mainecare folks  thogh I see plenty of those I cannot see enough to be paid well.

> > > >Last yr I had the best financial yr I ever had I brought home 14,800 more than  2010 But I struggle to keep the schedule  full   weird  but true  The model works but I do  hrs and hrs of work for folks  have no money and no transportation  When they cannot get in   I cannot get paid Yesterday a woman discharged form  a hospital 1 hr away with a PICC line needing 6 days of antibx that this hospital says I have to write the orders for becasue I am the one with local prvileges and she cannot come in to see me and  is not getting the antibx and is out there calling me stuck in the woods with now  a non flushed picc line. augh!

> > > >The guy upstairs is a family doc- who works a day a week  in industrial setting and mostly does derm now. Others have tiny offices and spouses with good jobs and churn patietns  Everyone has  something to try to survive really it is a mess for docs and bad for patietns out here

> > > >If we cannot join up  together as professionals and do what is good for patietns and good for primary care  soon boy  we is doomed.

> > > >

> > > >

> > > >On Tue, Jan 10, 2012 at 10:51 PM, Debra Karinski <dkarinskinp@> wrote:

> > > > 

> > > >My patients are over 50% medicaid. Some don't even have vehicles to make it to my suburban office.  They drive unregistered vehicles or get rides

> > > >When I started ; I live in the next town; I didn't realize the poverty in our area. Some have so many issues as they haven't been able to get a PCP ho took their insurance.  When they need specialists it is difficult to find them for these pts.

> > > >It really is sad...

> > > >

> > > > 

> > > > " But those that innovate away from the system will and should thrive. " Steve, I really don't think that is true in all locations. I live in a relatively poor, rural area, and I know without a doubt that I would lose most of my patients if I did not accept their insurance. They love the care and service that I give, but the bottom line is their budgets, and most of those are stretched to the limits. And I really can't blame them for wanting to use the insurance that they are paying so much for. This past summer, I really searched my soul to see if I even dared to charge a $200 noncovered benefits fee, but I decided that most of them would leave even over that. Also, although there are quite a few uninsured people around, they tend not to come in until they are wrecks, and they are so poor that I feel obligated to undercharge them for the amount of time and energy I spend trying to help them. I also feel some extra malpractice risk when I care for

> them,

> > > because they usually won't even go for any labs or tests. (There are no discounted labs anywhere around, and NY State sees fit to " protect " them from those cool, discounted deals you see on the internet.) Now, I know I could pull up stakes and start all over in some more affluent area, but this is where all my family is, and the thought of starting over after the past 3+ years of hard work is pretty much unbearable, besides the fact there is no money left. I do dream about it sometimes, though!---Sharlene

> > > >

> > > >

> > > >

> > > >> > > >>>

> > > >> > > >>>> **

> > > >> > > >>>>

> > > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil

> > > >> > > >>>> per month. I had no idea that is how oncology works.

> > > >> > > >>>>

> > > >> > > >>>>

> > > >> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>

> > > >> > > >>>>

> > > >> > > >>>> g

> > > >> > > >>>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>> =======

> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >> > > >>> =======

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>> =======

> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >> > > >>> =======

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>

> > > >> > > >

> > > >> > > >

> > > >> > >

> > > >> >

> > > >>

> > > > 

> > > >

> > > >

> > > >

> > > >--

> > > >

> > > >

> > > >

> > > >     MD

> > > >    

> > > >    

> > > >ph    fax

> > > >

> > >  

> > >

> >

>

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[Guest guest]

  " There are times when you must speak, not because you are going to change the other person, but because if you don't speak, they have changed you. " Quinn  "

I guess I work on that principle sometimes..Sangeetha

I agree, but there is as much chance of that as there is of  docs dropping the insurances isn't it?

Sangeetha

 

"

BUT if we are to fight back as a group at this needs to be challenged, till it costs the payers more to DENY than to PAY it.   " Good luck with that.  If you really want to stop this, drop the payer(s) that do this.  If enough of  you do that, they'll stop.   If not enough do this, at least you're rid of them instead of wasting your time appealing automatic downcodes.

If the patients are upset about you dropping the payer, let them complain to their payer and employer.  We find this can be surprisingly effective.

> > > My sympathies for having to deal with this.

> > >  

> > > Tonya S. Little, MD

> > > 1704 Glendale Drive SW, Suite C

> > > NC 27893

> > >

> > > fax

> > > cell

> > > tslittle@

> > >

> > > ________________________________

> > >

> > > From: [mailto: ] On Behalf Of Myria

> > > Sent: Wednesday, January 11, 2012 9:02 PM

> > > To:

> > > Subject: Re: Re: Doctors going out of business

> > >  

> > >  

> > > House calls for 1 hour visit pays between 79 and 119.  I just had Medicare pre-audit my notes and down code every house call - 7 so are and 5 not yet received back. I have 10 home care patients.  Do only if you have to.

> > > I am appealing.

> > >  

> > > From: Pratt <kpratt.1022@>

> > > To: " " < >

> > > Sent: Wednesday, January 11, 2012 9:34 AM

> > > Subject: Re: Re: Doctors going out of business

> > >  

> > >  

> > >

> > > Have you considered doing house calls?  If your schedule is not full, could you take 1-2 days per month to go to your patients that can't get to you?  Or close early one day/week?  Obviously doesn't help the pt with the Picc line (no home health nurses?), but could help your other patients.  Steve does a few for non-ambulatory pts.  We do not advertise it, and the pt has to be established and Steve offers if he sees it is a difficult situation.  He does them at lunch or at the end of the day - about 1-2 visits per month.  They do pay better than an office visit.  Just a though....

> > >

> > >

> > > Pratt

> > >

> > > On Jan 11, 2012, at 5:41 AM, <jnantonucci@> wrote:

> > >  

> > > >same here as Deb and KAthy and Sharlene

> > > > I look  back at a full schedule of yr ago to see  2 who have died(Maine is the oldest state in the union  and the oldest people live in my town I swear) 1or 2 have moved to find work- the economy was so bad here before the recession we never saw much differnce there is nothing here  one or  two may have moved on for another reason There is an abundance of PCPs here the hospitla keeps getting more and  can offer sliding fees  to see people for 5.00 whicih I cannot do,  and they  take the mainecare folks  thogh I see plenty of those I cannot see enough to be paid well.

> > > >Last yr I had the best financial yr I ever had I brought home 14,800 more than  2010 But I struggle to keep the schedule  full   weird  but true  The model works but I do  hrs and hrs of work for folks  have no money and no transportation  When they cannot get in   I cannot get paid Yesterday a woman discharged form  a hospital 1 hr away with a PICC line needing 6 days of antibx that this hospital says I have to write the orders for becasue I am the one with local prvileges and she cannot come in to see me and  is not getting the antibx and is out there calling me stuck in the woods with now  a non flushed picc line. augh!

> > > >The guy upstairs is a family doc- who works a day a week  in industrial setting and mostly does derm now. Others have tiny offices and spouses with good jobs and churn patietns  Everyone has  something to try to survive really it is a mess for docs and bad for patietns out here

> > > >If we cannot join up  together as professionals and do what is good for patietns and good for primary care  soon boy  we is doomed.

> > > >

> > > >

> > > >On Tue, Jan 10, 2012 at 10:51 PM, Debra Karinski <dkarinskinp@> wrote:

> > > > 

> > > >My patients are over 50% medicaid. Some don't even have vehicles to make it to my suburban office.  They drive unregistered vehicles or get rides

> > > >When I started ; I live in the next town; I didn't realize the poverty in our area. Some have so many issues as they haven't been able to get a PCP ho took their insurance.  When they need specialists it is difficult to find them for these pts.

> > > >It really is sad...

> > > >

> > > > 

> > > > " But those that innovate away from the system will and should thrive. " Steve, I really don't think that is true in all locations. I live in a relatively poor, rural area, and I know without a doubt that I would lose most of my patients if I did not accept their insurance. They love the care and service that I give, but the bottom line is their budgets, and most of those are stretched to the limits. And I really can't blame them for wanting to use the insurance that they are paying so much for. This past summer, I really searched my soul to see if I even dared to charge a $200 noncovered benefits fee, but I decided that most of them would leave even over that. Also, although there are quite a few uninsured people around, they tend not to come in until they are wrecks, and they are so poor that I feel obligated to undercharge them for the amount of time and energy I spend trying to help them. I also feel some extra malpractice risk when I care for

> them,

> > > because they usually won't even go for any labs or tests. (There are no discounted labs anywhere around, and NY State sees fit to " protect " them from those cool, discounted deals you see on the internet.) Now, I know I could pull up stakes and start all over in some more affluent area, but this is where all my family is, and the thought of starting over after the past 3+ years of hard work is pretty much unbearable, besides the fact there is no money left. I do dream about it sometimes, though!---Sharlene

> > > >

> > > >

> > > >

> > > >> > > >>>

> > > >> > > >>>> **

> > > >> > > >>>>

> > > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil

> > > >> > > >>>> per month. I had no idea that is how oncology works.

> > > >> > > >>>>

> > > >> > > >>>>

> > > >> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>

> > > >> > > >>>>

> > > >> > > >>>> g

> > > >> > > >>>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>> =======

> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >> > > >>> =======

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>> =======

> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >> > > >>> =======

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>

> > > >> > > >

> > > >> > > >

> > > >> > >

> > > >> >

> > > >>

> > > > 

> > > >

> > > >

> > > >

> > > >--

> > > >

> > > >

> > > >

> > > >     MD

> > > >    

> > > >    

> > > >ph    fax

> > > >

> > >  

> > >

> >

>

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[Guest guest]

good quote Not unlike    the only thing necessary for evil is that good men do nothing( or, well somethin g like that ) Much in health care is changing LIkeey becasue people do speak and  speak repeatedly and do their work

FFS is  going to go away  Health insurance will be universal it is just slow and many are suffering now

 

  " There are times when you must speak, not because you are going to change the other person, but because if you don't speak, they have changed you. " Quinn  "

I guess I work on that principle sometimes..Sangeetha

I agree, but there is as much chance of that as there is of  docs dropping the insurances isn't it?

Sangeetha

 

"

BUT if we are to fight back as a group at this needs to be challenged, till it costs the payers more to DENY than to PAY it.   " Good luck with that.  If you really want to stop this, drop the payer(s) that do this.  If enough of  you do that, they'll stop.   If not enough do this, at least you're rid of them instead of wasting your time appealing automatic downcodes.

If the patients are upset about you dropping the payer, let them complain to their payer and employer.  We find this can be surprisingly effective.

> > > My sympathies for having to deal with this.

> > >  

> > > Tonya S. Little, MD

> > > 1704 Glendale Drive SW, Suite C

> > > NC 27893

> > >

> > > fax

> > > cell

> > > tslittle@

> > >

> > > ________________________________

> > >

> > > From: [mailto: ] On Behalf Of Myria

> > > Sent: Wednesday, January 11, 2012 9:02 PM

> > > To:

> > > Subject: Re: Re: Doctors going out of business

> > >  

> > >  

> > > House calls for 1 hour visit pays between 79 and 119.  I just had Medicare pre-audit my notes and down code every house call - 7 so are and 5 not yet received back. I have 10 home care patients.  Do only if you have to.

> > > I am appealing.

> > >  

> > > From: Pratt <kpratt.1022@>

> > > To: " " < >

> > > Sent: Wednesday, January 11, 2012 9:34 AM

> > > Subject: Re: Re: Doctors going out of business

> > >  

> > >  

> > >

> > > Have you considered doing house calls?  If your schedule is not full, could you take 1-2 days per month to go to your patients that can't get to you?  Or close early one day/week?  Obviously doesn't help the pt with the Picc line (no home health nurses?), but could help your other patients.  Steve does a few for non-ambulatory pts.  We do not advertise it, and the pt has to be established and Steve offers if he sees it is a difficult situation.  He does them at lunch or at the end of the day - about 1-2 visits per month.  They do pay better than an office visit.  Just a though....

> > >

> > >

> > > Pratt

> > >

> > > On Jan 11, 2012, at 5:41 AM, <jnantonucci@> wrote:

> > >  

> > > >same here as Deb and KAthy and Sharlene

> > > > I look  back at a full schedule of yr ago to see  2 who have died(Maine is the oldest state in the union  and the oldest people live in my town I swear) 1or 2 have moved to find work- the economy was so bad here before the recession we never saw much differnce there is nothing here  one or  two may have moved on for another reason There is an abundance of PCPs here the hospitla keeps getting more and  can offer sliding fees  to see people for 5.00 whicih I cannot do,  and they  take the mainecare folks  thogh I see plenty of those I cannot see enough to be paid well.

> > > >Last yr I had the best financial yr I ever had I brought home 14,800 more than  2010 But I struggle to keep the schedule  full   weird  but true  The model works but I do  hrs and hrs of work for folks  have no money and no transportation  When they cannot get in   I cannot get paid Yesterday a woman discharged form  a hospital 1 hr away with a PICC line needing 6 days of antibx that this hospital says I have to write the orders for becasue I am the one with local prvileges and she cannot come in to see me and  is not getting the antibx and is out there calling me stuck in the woods with now  a non flushed picc line. augh!

> > > >The guy upstairs is a family doc- who works a day a week  in industrial setting and mostly does derm now. Others have tiny offices and spouses with good jobs and churn patietns  Everyone has  something to try to survive really it is a mess for docs and bad for patietns out here

> > > >If we cannot join up  together as professionals and do what is good for patietns and good for primary care  soon boy  we is doomed.

> > > >

> > > >

> > > >On Tue, Jan 10, 2012 at 10:51 PM, Debra Karinski <dkarinskinp@> wrote:

> > > > 

> > > >My patients are over 50% medicaid. Some don't even have vehicles to make it to my suburban office.  They drive unregistered vehicles or get rides

> > > >When I started ; I live in the next town; I didn't realize the poverty in our area. Some have so many issues as they haven't been able to get a PCP ho took their insurance.  When they need specialists it is difficult to find them for these pts.

> > > >It really is sad...

> > > >

> > > > 

> > > > " But those that innovate away from the system will and should thrive. " Steve, I really don't think that is true in all locations. I live in a relatively poor, rural area, and I know without a doubt that I would lose most of my patients if I did not accept their insurance. They love the care and service that I give, but the bottom line is their budgets, and most of those are stretched to the limits. And I really can't blame them for wanting to use the insurance that they are paying so much for. This past summer, I really searched my soul to see if I even dared to charge a $200 noncovered benefits fee, but I decided that most of them would leave even over that. Also, although there are quite a few uninsured people around, they tend not to come in until they are wrecks, and they are so poor that I feel obligated to undercharge them for the amount of time and energy I spend trying to help them. I also feel some extra malpractice risk when I care for

> them,

> > > because they usually won't even go for any labs or tests. (There are no discounted labs anywhere around, and NY State sees fit to " protect " them from those cool, discounted deals you see on the internet.) Now, I know I could pull up stakes and start all over in some more affluent area, but this is where all my family is, and the thought of starting over after the past 3+ years of hard work is pretty much unbearable, besides the fact there is no money left. I do dream about it sometimes, though!---Sharlene

> > > >

> > > >

> > > >

> > > >> > > >>>

> > > >> > > >>>> **

> > > >> > > >>>>

> > > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil

> > > >> > > >>>> per month. I had no idea that is how oncology works.

> > > >> > > >>>>

> > > >> > > >>>>

> > > >> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>

> > > >> > > >>>>

> > > >> > > >>>> g

> > > >> > > >>>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>> =======

> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >> > > >>> =======

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>> =======

> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >> > > >>> =======

> > > >> > > >>>

> > > >> > > >>>

> > > >> > > >>

> > > >> > > >

> > > >> > > >

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> > > >>

> > > > 

> > > >

> > > >

> > > >

> > > >--

> > > >

> > > >

> > > >

> > > >     MD

> > > >    

> > > >    

> > > >ph    fax

> > > >

> > >  

> > >

> >

>

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Visit Your Grou

--      MD          ph    fax

[Guest guest]

If you let them downcode then I suspect they will set it up to always downcode. I'm worth more than that. If I can choose to clean toilets and shovel snow to keep myself out of the hamster wheel then I am certainly going to appeal. Fortunately I do have a wondeful volunteer who does 6 hours of billing weekly with me. I think she reclaims about 400 dollars in appeals monthly and spends 2 hours or less weekly specifically on appeals. Right now they are requesting every home visit chart. Hopefully Sharlene is right and putting the face to face time on each claim will stop this down coding nonsense.

To: Sent: Tuesday, January 17, 2012 12:19 PMSubject: Re: Re: Doctors going out of business

I agree it is not worth the time if you are looking at immediate gains AT the individual level, AND that is exactly why there is routine downcoding.Because we can be counted on not to follow through.

BUT if we are to fight back as a group at this needs to be challenged, till it costs the payers more to DENY than to PAY it.

Having said that, yes I do NOT follow these claims plenty of times :(Sangeetha

Myria:I do not wish to be a nuisance, just interested in the numbers.Have you calculated out how much time you spent overall preparing for and doing the appeals, and how much money you recieved for your efforts?Is the $$/hour worth it?Stevemoorestown, NJ

> > > >> > > >>>> > > >> > > >>>>

**> > > >> > > >>>>> > > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > >> > > >>>> per month. I had no idea that is how oncology works.> > > >> > > >>>>> > > >> > > >>>>> > > >> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>> > > >> > > >>>>> > > >> > > >>>> g> > > >> > > >>>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>> =======> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database:

6.19000)> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >> > > >>> =======> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>> =======> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >> > >

>>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >> > > >>> =======> > > >> > > >>>> > > >> > > >>>> > > >> > > >>> > > >> > > > > > > >> > > >> > > >> > >> > > >> >> > > >>> > > > > >

> >> > > >> > > >> > > >-- > > > >> > > >> > > >> > > >   MD> > > >   > > > >   > > > >ph   fax > > > >> > >  > > >> >>

[Guest guest]

In the audit trail I suspect this is calculated and when I open the chart it has the start time but it changes to the closed time rather than showing me the elaspsed time. I have a wonderful wind up antique clock that chimes on the 1/4 hour and it's right on my desk so it shouldn't be hard to make the trasistion. Heck if I do MU changes which are not gaining me individual claims I can do this. I would have appreciated an update before denials and audits started!

To: Sent: Monday, January 16, 2012 3:16 PMSubject: Re: Re: Doctors going out of business

The EMRs can do this #$%$# work for you IF you do the note when you start the visit and finish it at the end of the vi sit Not possible for alot of us There is a timer thing to turn on on mine that can document. IF you can do your notes that waythe machine can do this automatically for you.Aw you probably knew that

Sharlene thanks, I have not been informed that they now required clock time (what are we babies who can't tell time or thiefs like the system is?)

Yes, it's worth the time to appeal. I win about 2/3 of the time.

To: Sent: Monday, January 16, 2012 11:37 AMSubject: Re: Doctors going out of business

is it truly worth your time to appeal?Steve Horvitz> > >> > > >>>> > >> > > >>>> **> > >> > > >>>>> > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > >> > > >>>> per month. I had no idea that is how oncology works.> > >> > > >>>>> > >> > > >>>>> > >> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>> > >> > > >>>>> > >> > > >>>> g> > >> > > >>>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>> =======> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> >

>> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > >> > > >>> =======> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>> =======> > >> > > >>> Email scanned by PC Tools - No viruses or spyware

found.> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > >> > > >>> =======> > >> > > >>>> > >> > > >>>> > >> > > >>> > >> > > > > > >> > > >> > >> > >> > >> >> > >>> > >Â > > >> > >> >

>> > >-- > > >> > >> > >> > >   MD> > >   > > >   > > >ph   fax > > >> >  > >>

-- MD ph fax

[Guest guest]

go myria!! What bothers me is the stuff I hear form the New York State crowd about  medicare denying things the rest of  can get. grr

 

In the audit trail I suspect this is calculated and when I open the chart it has the start time but it changes to the closed time rather than showing me the elaspsed time.  I have a wonderful wind up antique clock that chimes on the 1/4 hour and it's right on my desk so it shouldn't be hard to make the trasistion.  Heck if I do MU changes which are not gaining me individual claims I can do this.  I would have appreciated an update before denials and audits started!

To: Sent: Monday, January 16, 2012 3:16 PM

Subject: Re: Re: Doctors going out of business

 

The EMRs can do this #$%$#  work for you IF you do the note when  you start the visit  and finish  it at the end of the vi sit Not possible for alot of us There  is a timer thing to turn on on mine that can document. IF you can do your notes that waythe machine can do this  automatically for you.Aw you probably knew that

 

Sharlene thanks, I have not been informed that they now required clock time (what are we babies who can't tell time or thiefs like the system is?)

Yes, it's worth the time to appeal.  I win about 2/3 of the time.

To: Sent: Monday, January 16, 2012 11:37 AM

Subject: Re: Doctors going out of business

 

is it truly worth your time to appeal?Steve Horvitz> > >> > > >>>> > >> > > >>>> **

> > >> > > >>>>> > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > >> > > >>>> per month. I had no idea that is how oncology works.

> > >> > > >>>>> > >> > > >>>>> > >> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>

> > >> > > >>>>> > >> > > >>>> g> > >> > > >>>>> > >> > > >>>> > >> > > >>>

> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>

> > >> > > >>> =======> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> >

>> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > >> > > >>> =======> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>

> > >> > > >>>> > >> > > >>> =======> > >> > > >>> Email scanned by PC Tools - No viruses or spyware

found.> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > >> > > >>> =======> > >> > > >>>> > >> > > >>>> > >> > > >>> > >> > > >

> > >> > > >> > >> > >> > >> >> > >>> > > > > >> > >> >

>> > >-- > > >> > >> > >> > >     MD> > >     > > >     > > >ph    fax

> > >> >  > >>

--      MD          ph    fax

--      MD          ph    fax

[Guest guest]

did a 99214 for total time 30 minutes but was downgraded brcause only two diagnositic codes. We wrote two explainations and could never get anyone on the phone, just the writen denialk that claim did not meet medical necessity.

Left us scratching our heads.

Too much time for 10-20 dollars!!!

Subject: Re: Doctors going out of businessTo: Date: Tuesday, January 17, 2012, 10:06 AM

Myria:I do not wish to be a nuisance, just interested in the numbers.Have you calculated out how much time you spent overall preparing for and doing the appeals, and how much money you recieved for your efforts?Is the $$/hour worth it?Stevemoorestown, NJ> > > >> > > >>>> > > >> > > >>>> **> > > >> > > >>>>> > > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > >> > > >>>> per month. I had no idea

that is how oncology works.> > > >> > > >>>>> > > >> > > >>>>> > > >> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>> > > >> > > >>>>> > > >> > > >>>> g> > > >> > > >>>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > >

>>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>> =======> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >> > > >>> =======> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > >

>>>> > > >> > > >>>> > > >> > > >>> =======> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >> > > >>> =======> > > >> > > >>>> > > >> > > >>>> > > >> > > >>> > > >> > > > > > > >> > > >> > > >> > >> > >

>> >> > > >>> > > > > > > >> > > >> > > >> > > >-- > > > >> > > >> > > >> > > >   MD> > > >   > > > >   > > > >ph   fax > > > >> > >  > > >> >>

[Guest guest]

Yes , Isnt that exactly where we are? and where you have chosen not to be?Sangeetha

 

Then all docs and patients lose by default!

Horvitz

stown, NJ

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>> **

> >>> > > > >> > > >>>>

> >>> > > > >> > > >>>> On cnn page today. I cant even imagine having expenses

> >>> of 1.5 mil

> >>> > > > >> > > >>>> per month. I had no idea that is how oncology works.

> >>> > > > >> > > >>>>

> >>> > > > >> > > >>>>

> >>> > > > >> > > >>>>

> >>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3

> >>> <

> >>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3

> >>> >

> >>> > > > >> > > >>>>

> >>> > > > >> > > >>>> g

> >>> > > > >> > > >>>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>> =======

> >>> > > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> >>> > > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> >>> > > > >> > > >>> http://www.pctools.com<

> >>> http://www.pctools.com/?cclick=EmailFooterClean_51>

> >>> > > > >> > > >>> =======

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

> >>> > > > >> > > >>> =======

> >>> > > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> >>> > > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> >>> > > > >> > > >>> http://www.pctools.com<

> >>> http://www.pctools.com/?cclick=EmailFooterClean_51>

> >>> > > > >> > > >>> =======

> >>> > > > >> > > >>>

> >>> > > > >> > > >>>

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> >>> > > > >>

> >>> > > > >ÂÂ

> >>> > > > >

> >>> > > > >

> >>> > > > >

> >>> > > > >--

> >>> > > > >

> >>> > > > >

> >>> > > > >

> >>> > > > >   MD

> >>> > > > >  ÂÂ

> >>> > > > >  ÂÂ

> >>> > > > >ph   fax

> >>> > > > >

> >>> > > > ÂÂ

> >>> > > >

> >>> > >

> >>> >

> >>>

> >>>

> >> Reply to sender<sangeethamurthy@...?subject=Re%3A%20%5B%5D%20Re%3A%20Doctors%20going%20out%20of%20business>| Reply

> >> to group< ?subject=Re%3A%20%5B%5D%20Re%3A%20Doctors%20going%20out%20of%20business>| Reply

> >> via web post<http://groups.yahoo.com/group//post;_ylc=X3oDMTJxMHYwMGZzBF9TAzk3MzU5NzE0BGdycElkAzkzNjA5MTQEZ3Jwc3BJZAMxNzA1MDYxMzI3BG1zZ0lkAzU3NTQ5BHNlYwNmdHIEc2xrA3JwbHkEc3RpbWUDMTMyNjgyMDgwNQ--?act=reply & messageNum=57549>| Start

> >> a New Topic<http://groups.yahoo.com/group//post;_ylc=X3oDMTJlM3ExaDVmBF9TAzk3MzU5NzE0BGdycElkAzkzNjA5MTQEZ3Jwc3BJZAMxNzA1MDYxMzI3BHNlYwNmdHIEc2xrA250cGMEc3RpbWUDMTMyNjgyMDgwNQ-->

> >> Messages in this topic<http://groups.yahoo.com/group//message/57330;_ylc=X3oDMTM2dTZqNWF0BF9TAzk3MzU5NzE0BGdycElkAzkzNjA5MTQEZ3Jwc3BJZAMxNzA1MDYxMzI3BG1zZ0lkAzU3NTQ5BHNlYwNmdHIEc2xrA3Z0cGMEc3RpbWUDMTMyNjgyMDgwNQR0cGNJZAM1NzMzMA-->(

> >> 66)

> >> Recent Activity:

> >>

> >> - New Members<http://groups.yahoo.com/group//members;_ylc=X3oDMTJmcDA3OGczBF9TAzk3MzU5NzE0BGdycElkAzkzNjA5MTQEZ3Jwc3BJZAMxNzA1MDYxMzI3BHNlYwN2dGwEc2xrA3ZtYnJzBHN0aW1lAzEzMjY4MjA4MDU-?o=6>

> >> 2

> >>

> >> Visit Your Grou<http://groups.yahoo.com/group/;_ylc=X3oDMTJlZXZjOHRiBF9TAzk3MzU5NzE0BGdycElkAzkzNjA5MTQEZ3Jwc3BJZAMxNzA1MDYxMzI3BHNlYwN2dGwEc2xrA3ZnaHAEc3RpbWUDMTMyNjgyMDgwNQ-->

> >>

> >

> >

>

[Guest guest]

Yes Steve I agree with you !!

I have a patient with United Health.

Not sure which program.. Her husband pays a high monthly fee for the

family plan.

They paid me $ 6.40 for her visit..$ 30 co-pay.

I am sure that her husband had no idea that would occur or even

consider this when he purchased this plan...

I think the public need to know as you know they think we make so much money...

> Deb:

>

> I understand your point.

>

> But....

>

> We are still playing by their rules, that we signed onto, that are stacked

> against us.

>

> It makes no sense.

>

> I have said this many times, but will say it again.

>

> Until docs start putting their own value into their services by charging

> their own fees, not some cock-a-manie copay-third party system that we have

> now, we will never get back our profession, or the respect of our patients.

>

> Steve

>

>

>> >> > >> > > >>>

>> >> > >> > > >>>> **

>> >> > >> > > >>>>

>> >> > >> > > >>>> On cnn page today. I cant even imagine having expenses of

>> >> > >> > > >>>> 1.5 mil

>> >> > >> > > >>>> per month. I had no idea that is how oncology works.

>> >> > >> > > >>>>

>> >> > >> > > >>>>

>> >> > >> > > >>>>

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<\

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3\

>

>> >> > >> > > >>>>

>> >> > >> > > >>>> g

>> >> > >> > > >>>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>> =======

>> >> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

>> >> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

>> >> > >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

>> >> > >> > > >>> =======

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>> =======

>> >> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

>> >> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

>> >> > >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

>> >> > >> > > >>> =======

>> >> > >> > > >>>

>> >> > >> > > >>>

>> >> > >> > > >>

>> >> > >> > > >

>> >> > >> > > >

>> >> > >> > >

>> >> > >> >

>> >> > >>

>> >> > >Â

>> >> > >

>> >> > >

>> >> > >

>> >> > >--

>> >> > >

>> >> > >

>> >> > >

>> >> > >Â Â Â MD

>> >> > >Â Â Â

>> >> > >Â Â Â

>> >> > >ph   fax

>> >> > >

>> >> > Â

>> >> >

>> >>

>> >

>> >

>> >

>>

>

>

>