Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 To do House call, especially Medicare patients, do we need to register with Medicare for a different location other than office? I think for office, it is number 11. Wen On the other end of the spectrum, here is an example of how different medical reimbursements can be. I lucked into a situation 2 years ago where an overseas health management company calls me about once every 2 months to make a house call whenever one of their client's employees get sick. They found my name on the Internet as someone who does house calls. The employees are flight attendants who stay overnight in a local hotel, but may develop ear infections, UTIs, back pain, etc. Always straightforward problems. I go to their hotel for a house call and typically spend 15-20 minutes there, call in a prescription if needed, and for this I have been charging $200 for up to a 30 minute visit. It is paid by the health management company without any discount or negotiation. It seems crazy how easy this is, compared to what I used to get from Medicare for house calls. On top of this, I have looked around the Internet and I think I am undercharging as I have seen hotel house call doctors post prices of $300-400 or more for a visit. There aren't enough of these visits for me to abandon my office practice, but it is refreshing to just get paid the amount I ask for my services. I'm not trying to make anyone feel bad with this story. I'm just pointing out how crazy out of touch our third party health care system is with its " negotiated rates " and middlemen, compared to a truly competitive free market system where we are allowed to set our own fees, and get paid what we actually charge. Unfortunately, out of reach for most of us. SetoSouth Pasadena, CA 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 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 nice story . Have always been curious about hotel house call docs. . . Pamela > > > 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 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 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 I do home visits and about 5 years ago, I was asked to see a patient who lives about 25 minutes away. I said that I couldn’t do it as it was too far away from the office. The patient’s son then said, “I will pay you $350 in addition to what you charge Medicare if you come out and see my mother.” I told him that was quite generous but was also illegal. I also told him that it would be illegal for me not to charge Medicare and just take the cash if I am still seeing other Medicare patients in the office. But the $350 number was intriguing, so I asked him why did he offer that amount. He said, “that is how much it costs me to pay for an ambulance to come out here and bring my mother to any facility other than an Emergency Room.” That was kind of eye opening. If I do a home visit, I save the patient an untold amount of discomfort, probably 4-5 hours of travel and waiting, and I save the family $350. For this service, I make about $100.By the way, a plumber or appliance repairman makes $75 just to come to the house with time and parts being extra. So perhaps I should fix the toilet at the same time I go out to see the patient. Then I might could make some real money. J From: [mailto: ] On Behalf Of SetoSent: Wednesday, January 11, 2012 9:31 PMTo: Subject: House calls On the other end of the spectrum, here is an example of how different medical reimbursements can be. I lucked into a situation 2 years ago where an overseas health management company calls me about once every 2 months to make a house call whenever one of their client's employees get sick. They found my name on the Internet as someone who does house calls. The employees are flight attendants who stay overnight in a local hotel, but may develop ear infections, UTIs, back pain, etc. Always straightforward problems. I go to their hotel for a house call and typically spend 15-20 minutes there, call in a prescription if needed, and for this I have been charging $200 for up to a 30 minute visit. It is paid by the health management company without any discount or negotiation. It seems crazy how easy this is, compared to what I used to get from Medicare for house calls. On top of this, I have looked around the Internet and I think I am undercharging as I have seen hotel house call doctors post prices of $300-400 or more for a visit. There aren't enough of these visits for me to abandon my office practice, but it is refreshing to just get paid the amount I ask for my services. I'm not trying to make anyone feel bad with this story. I'm just pointing out how crazy out of touch our third party health care system is with its " negotiated rates " and middlemen, compared to a truly competitive free market system where we are allowed to set our own fees, and get paid what we actually charge. Unfortunately, out of reach for most of us. SetoSouth Pasadena, CA 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Place of service is 12 Code 99349 for me moderately complex To do House call, especially Medicare patients, do we need to register with Medicare for a different location other than office? I think for office, it is number 11. Wen On the other end of the spectrum, here is an example of how different medical reimbursements can be. I lucked into a situation 2 years ago where an overseas health management company calls me about once every 2 months to make a house call whenever one of their client's employees get sick. They found my name on the Internet as someone who does house calls. The employees are flight attendants who stay overnight in a local hotel, but may develop ear infections, UTIs, back pain, etc. Always straightforward problems. I go to their hotel for a house call and typically spend 15-20 minutes there, call in a prescription if needed, and for this I have been charging $200 for up to a 30 minute visit. It is paid by the health management company without any discount or negotiation. It seems crazy how easy this is, compared to what I used to get from Medicare for house calls. On top of this, I have looked around the Internet and I think I am undercharging as I have seen hotel house call doctors post prices of $300-400 or more for a visit. There aren't enough of these visits for me to abandon my office practice, but it is refreshing to just get paid the amount I ask for my services. I'm not trying to make anyone feel bad with this story. I'm just pointing out how crazy out of touch our third party health care system is with its "negotiated rates" and middlemen, compared to a truly competitive free market system where we are allowed to set our own fees, and get paid what we actually charge. Unfortunately, out of reach for most of us. SetoSouth Pasadena, CA 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 No,You simply bill it as a house call. Not at the office, so not sure what the # is. My system is automatically set up to know that those CPT codes are not in the office, but in the pt home To do House call, especially Medicare patients, do we need to register with Medicare for a different location other than office? I think for office, it is number 11. Wen On the other end of the spectrum, here is an example of how different medical reimbursements can be. I lucked into a situation 2 years ago where an overseas health management company calls me about once every 2 months to make a house call whenever one of their client's employees get sick. They found my name on the Internet as someone who does house calls. The employees are flight attendants who stay overnight in a local hotel, but may develop ear infections, UTIs, back pain, etc. Always straightforward problems. I go to their hotel for a house call and typically spend 15-20 minutes there, call in a prescription if needed, and for this I have been charging $200 for up to a 30 minute visit. It is paid by the health management company without any discount or negotiation. It seems crazy how easy this is, compared to what I used to get from Medicare for house calls. On top of this, I have looked around the Internet and I think I am undercharging as I have seen hotel house call doctors post prices of $300-400 or more for a visit. There aren't enough of these visits for me to abandon my office practice, but it is refreshing to just get paid the amount I ask for my services. I'm not trying to make anyone feel bad with this story. I'm just pointing out how crazy out of touch our third party health care system is with its "negotiated rates" and middlemen, compared to a truly competitive free market system where we are allowed to set our own fees, and get paid what we actually charge. Unfortunately, out of reach for most of us. SetoSouth Pasadena, CA 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Not that we do this, but could you charge mileage? And have the patient sign an ABN? How would it be any different that any other non-covered benefit? Or is time and mileage assumed in the MDC reimbursement ? (siting in a skating rink and not with my CPT book in front of me!) I do home visits and about 5 years ago, I was asked to see a patient who lives about 25 minutes away. I said that I couldn’t do it as it was too far away from the office. The patient’s son then said, “I will pay you $350 in addition to what you charge Medicare if you come out and see my mother.†I told him that was quite generous but was also illegal. I also told him that it would be illegal for me not to charge Medicare and just take the cash if I am still seeing other Medicare patients in the office. But the $350 number was intriguing, so I asked him why did he offer that amount. He said, “that is how much it costs me to pay for an ambulance to come out here and bring my mother to any facility other than an Emergency Room.†That was kind of eye opening. If I do a home visit, I save the patient an untold amount of discomfort, probably 4-5 hours of travel and waiting, and I save the family $350. For this service, I make about $100.By the way, a plumber or appliance repairman makes $75 just to come to the house with time and parts being extra. So perhaps I should fix the toilet at the same time I go out to see the patient. Then I might could make some real money. J From: [mailto: ] On Behalf Of SetoSent: Wednesday, January 11, 2012 9:31 PMTo: Subject: House calls On the other end of the spectrum, here is an example of how different medical reimbursements can be. I lucked into a situation 2 years ago where an overseas health management company calls me about once every 2 months to make a house call whenever one of their client's employees get sick. They found my name on the Internet as someone who does house calls. The employees are flight attendants who stay overnight in a local hotel, but may develop ear infections, UTIs, back pain, etc. Always straightforward problems. I go to their hotel for a house call and typically spend 15-20 minutes there, call in a prescription if needed, and for this I have been charging $200 for up to a 30 minute visit. It is paid by the health management company without any discount or negotiation. It seems crazy how easy this is, compared to what I used to get from Medicare for house calls. On top of this, I have looked around the Internet and I think I am undercharging as I have seen hotel house call doctors post prices of $300-400 or more for a visit. There aren't enough of these visits for me to abandon my office practice, but it is refreshing to just get paid the amount I ask for my services. I'm not trying to make anyone feel bad with this story. I'm just pointing out how crazy out of touch our third party health care system is with its "negotiated rates" and middlemen, compared to a truly competitive free market system where we are allowed to set our own fees, and get paid what we actually charge. Unfortunately, out of reach for most of us. SetoSouth Pasadena, CA 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 , I'm not so sure that it would (or should, anyway!) be illegal to accept extra money for travel time for a home visit. Medicare clearly does not pay for any time not spent face-to-face with the patient, and the description of the home visit CPT codes does not say anything about travel time being included in the codes. Therefore, I would say that a prolonged travel time is a non-covered benefit, and we should be able to have them sign an advance beneficiary notice and pay for it. If I were going to try it, though, I guess I would set the fee at something that Medicare considers a " reasonable " payment for my time, such as $100 for each 25 minutes of driving time. (I realize your point is that they grossly undervalue our time, of course.) I've never done it, but my farthest travel time for a home visit has been 15 minutes each way. Have you ever seen it specifed by a reliable source that this would be illegal? Just curious. ---Sharlene > > > > > > 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 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 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 No. No specified source. I just wouldn’t want to push the envelope too hard to find out. You are probably correct in that if the patient signs an ABN and you charge for a “non-covered service” it might work out. I never go more than 10 minutes for a home visit, so I had not considered doing it that way. From: [mailto: ] On Behalf Of sharkinnSent: Thursday, January 12, 2012 9:39 AMTo: Subject: Re: House calls , I'm not so sure that it would (or should, anyway!) be illegal to accept extra money for travel time for a home visit. Medicare clearly does not pay for any time not spent face-to-face with the patient, and the description of the home visit CPT codes does not say anything about travel time being included in the codes. Therefore, I would say that a prolonged travel time is a non-covered benefit, and we should be able to have them sign an advance beneficiary notice and pay for it. If I were going to try it, though, I guess I would set the fee at something that Medicare considers a " reasonable " payment for my time, such as $100 for each 25 minutes of driving time. (I realize your point is that they grossly undervalue our time, of course.) I've never done it, but my farthest travel time for a home visit has been 15 minutes each way. Have you ever seen it specifed by a reliable source that this would be illegal? Just curious. ---Sharlene> > > > > > 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 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> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Bring him a sandwich , charge for food delivery?? I do home visits and about 5 years ago, I was asked to see a patient who lives about 25 minutes away. I said that I couldn’t do it as it was too far away from the office. The patient’s son then said, “I will pay you $350 in addition to what you charge Medicare if you come out and see my mother.” I told him that was quite generous but was also illegal. I also told him that it would be illegal for me not to charge Medicare and just take the cash if I am still seeing other Medicare patients in the office. But the $350 number was intriguing, so I asked him why did he offer that amount. He said, “that is how much it costs me to pay for an ambulance to come out here and bring my mother to any facility other than an Emergency Room.” That was kind of eye opening. If I do a home visit, I save the patient an untold amount of discomfort, probably 4-5 hours of travel and waiting, and I save the family $350. For this service, I make about $100. By the way, a plumber or appliance repairman makes $75 just to come to the house with time and parts being extra. So perhaps I should fix the toilet at the same time I go out to see the patient. Then I might could make some real money. J From: [mailto: ] On Behalf Of Seto Sent: Wednesday, January 11, 2012 9:31 PMTo: Subject: House calls On the other end of the spectrum, here is an example of how different medical reimbursements can be. I lucked into a situation 2 years ago where an overseas health management company calls me about once every 2 months to make a house call whenever one of their client's employees get sick. They found my name on the Internet as someone who does house calls. The employees are flight attendants who stay overnight in a local hotel, but may develop ear infections, UTIs, back pain, etc. Always straightforward problems. I go to their hotel for a house call and typically spend 15-20 minutes there, call in a prescription if needed, and for this I have been charging $200 for up to a 30 minute visit. It is paid by the health management company without any discount or negotiation. It seems crazy how easy this is, compared to what I used to get from Medicare for house calls. On top of this, I have looked around the Internet and I think I am undercharging as I have seen hotel house call doctors post prices of $300-400 or more for a visit. There aren't enough of these visits for me to abandon my office practice, but it is refreshing to just get paid the amount I ask for my services. I'm not trying to make anyone feel bad with this story. I'm just pointing out how crazy out of touch our third party health care system is with its " negotiated rates " and middlemen, compared to a truly competitive free market system where we are allowed to set our own fees, and get paid what we actually charge. Unfortunately, out of reach for most of us. SetoSouth Pasadena, CA 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 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 -- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined. This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 You could of course deduct the mileage as part of your expenses on your tax forms. I would also think that if you did any kind of regular use of your vehicle in this manner you could start to deduct at least a percent of the maintenance and cost of the vehicle. I know this does not make up for the time out of the office but every little bit counts!! Dannielle Harwood, MD To: Sent: Thu, January 12, 2012 6:38:35 AMSubject: Re: House calls , I'm not so sure that it would (or should, anyway!) be illegal to accept extra money for travel time for a home visit. Medicare clearly does not pay for any time not spent face-to-face with the patient, and the description of the home visit CPT codes does not say anything about travel time being included in the codes. Therefore, I would say that a prolonged travel time is a non-covered benefit, and we should be able to have them sign an advance beneficiary notice and pay for it. If I were going to try it, though, I guess I would set the fee at something that Medicare considers a "reasonable" payment for my time, such as $100 for each 25 minutes of driving time. (I realize your point is that they grossly undervalue our time, of course.) I've never done it, but my farthest travel time for a home visit has been 15 minutes each way. Have you ever seen it specifed by a reliable source that this would be illegal? Just curious. ---Sharlene> > > > > > 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 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> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Just to chime in....what's ironic is that Medicare in NJ pays less for a home visit than an office visit for the same level of complexity. Just my 2 cents To: Sent: Thursday, January 12, 2012 10:20 AMSubject: RE: Re: House calls No. No specified source. I just wouldn’t want to push the envelope too hard to find out. You are probably correct in that if the patient signs an ABN and you charge for a “non-covered service†it might work out. I never go more than 10 minutes for a home visit, so I had not considered doing it that way. From: [mailto: ] On Behalf Of sharkinnSent: Thursday, January 12, 2012 9:39 AMTo: Subject: Re: House calls , I'm not so sure that it would (or should, anyway!) be illegal to accept extra money for travel time for a home visit. Medicare clearly does not pay for any time not spent face-to-face with the patient, and the description of the home visit CPT codes does not say anything about travel time being included in the codes. Therefore, I would say that a prolonged travel time is a non-covered benefit, and we should be able to have them sign an advance beneficiary notice and pay for it. If I were going to try it, though, I guess I would set the fee at something that Medicare considers a "reasonable" payment for my time, such as $100 for each 25 minutes of driving time. (I realize your point is that they grossly undervalue our time, of course.) I've never done it, but my farthest travel time for a home visit has been 15 minutes each way. Have you ever seen it specifed by a reliable source that this would be illegal? Just curious. ---Sharlene--- In , "Dr. Brady" wrote:>> I do home visits and about 5 years ago, I was asked to see a patient who> lives about 25 minutes away. I said that I couldn't do it as it was too far> away from the office. The patient's son then said, "I will pay you $350 in> addition to what you charge Medicare if you come out and see my mother." I> told him that was quite generous but was also illegal. I also told him that> it would be illegal for me not to charge Medicare and just take the cash if> I am still seeing other Medicare patients in the office. But the $350 number> was intriguing, so I asked him why did he offer that amount. He said, "that> is how much it costs me to pay for an ambulance to come out here and bring> my mother to any facility other than an Emergency Room." That was kind of> eye opening. If I do a home visit, I save the patient an untold amount of> discomfort, probably 4-5 hours of travel and waiting, and I save the family> $350. For this service, I make about $100.> > By the way, a plumber or appliance repairman makes $75 just to come to the> house with time and parts being extra. So perhaps I should fix the toilet at> the same time I go out to see the patient. Then I might could make some real> money. J> > > > > > From: > [mailto: ] On Behalf Of Seto> Sent: Wednesday, January 11, 2012 9:31 PM> To: > Subject: House calls> > > > > > On the other end of the spectrum, here is an example of how different> medical reimbursements can be. I lucked into a situation 2 years ago where> an overseas health management company calls me about once every 2 months to> make a house call whenever one of their client's employees get sick. They> found my name on the Internet as someone who does house calls. The employees> are flight attendants who stay overnight in a local hotel, but may develop> ear infections, UTIs, back pain, etc. Always straightforward problems. I go> to their hotel for a house call and typically spend 15-20 minutes there,> call in a prescription if needed, and for this I have been charging $200 for> up to a 30 minute visit. It is paid by the health management company without> any discount or negotiation. It seems crazy how easy this is, compared to> what I used to get from Medicare for house calls. On top of this, I have> looked around the Internet and I think I am undercharging as I have seen> hotel house call doctors post prices of $300-400 or more for a visit. There> aren't enough of these visits for me to abandon my office practice, but it> is refreshing to just get paid the amount I ask for my services. > > > > I'm not trying to make anyone feel bad with this story. I'm just pointing> out how crazy out of touch our third party health care system is with its> "negotiated rates" and middlemen, compared to a truly competitive free> market system where we are allowed to set our own fees, and get paid what we> actually charge. Unfortunately, out of reach for most of us. > > > > Seto> > South Pasadena, CA> > > > > > > > > > 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 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> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 While not an authoritative source, this thread from the Medical Association of Billers says you cannot bill for mileage on a house call:http://medicalassociationofbillers.yuku.com/topic/8797/house-call-can-I-bill-for-travelI wonder if it would be possible/legal to bill Medicare for the home visit, and then the patient's son make a "tip" or "donation" to your practice of an amount of his choosing? That is, I know it is illegal for doctors to charge extra for Medicare services, but are Medicare patients allowed to pay extra if they choose to? My guess is Medicare would frown on this, too. SetoSouth Pasadena, CA No. No specified source. I just wouldn’t want to push the envelope too hard to find out. You are probably correct in that if the patient signs an ABN and you charge for a “non-covered service” it might work out. I never go more than 10 minutes for a home visit, so I had not considered doing it that way. From: [mailto: ] On Behalf Of sharkinnSent: Thursday, January 12, 2012 9:39 AMTo: Subject: Re: House calls , I'm not so sure that it would (or should, anyway!) be illegal to accept extra money for travel time for a home visit. Medicare clearly does not pay for any time not spent face-to-face with the patient, and the description of the home visit CPT codes does not say anything about travel time being included in the codes. Therefore, I would say that a prolonged travel time is a non-covered benefit, and we should be able to have them sign an advance beneficiary notice and pay for it. If I were going to try it, though, I guess I would set the fee at something that Medicare considers a "reasonable" payment for my time, such as $100 for each 25 minutes of driving time. (I realize your point is that they grossly undervalue our time, of course.) I've never done it, but my farthest travel time for a home visit has been 15 minutes each way. Have you ever seen it specifed by a reliable source that this would be illegal? Just curious. ---Sharlene> > > > > > 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 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> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Check this out! It is a group of 23 physicians in North Carolina. Scroll down to the Medicare section. http://www.doctorsmakinghousecalls.com/about-us/media/ Insurance Commercial / Private Insurance Doctors Making Housecalls is an " in network " provider for all Blue Cross Blue Shield, Humana and Cigna insurance plans. We also accept Medicare and Medicaid, and take assignment. We file all insurance forms and, for convenience, we accept payment by credit card for deductibles or co-pays, if applicable. Doctors Making Housecalls charges a " trip fee " of $95.00 when we see patients in a private residence, which compensates our physicians for their travel time. We waive the fee when we see multiple patients on a scheduled visit in a business, retirement community, or other communal setting. Our trip charge is not covered by insurance. Insurance companies consider it a charge for " convenience " and therefore not medically necessary. We bill the fee to your credit card on the day of your appointment. Our professional fees — what our physicians charge for their services — are dictated by your insurance company. They are comparable to those of office-based physicians in the same specialty. The actual charge for a visit varies according to the time our physician spends, which depends on the number and complexity of your medical problem(s). If the physician orders laboratory tests or radiologic procedures, whoever performs those services will bill you separately. Your insurance carrier will pay those fees just as they would if they were ordered from a typical office practice. Medicare We accept assignment, which means we bill Medicare directly, and all secondary (Medigap) insurance plans. You only pay what's not covered by your insurance. Medicare reimburses 80% of our physician's professional fee, once you've met your annual deductible. Many supplemental insurance plans pay the remaining 20% of the physician's fee, and some even pay your annual deductible. Some supplemental plans pay our practice directly, but some send payment directly to you. We ask Medicare patients without supplemental insurance to pay their 20% co-pay at the time of service. Similarly, if your supplemental carrier sends payment to you, we ask that you pay us at the time of service since you will be reimbursed directly by your supplemental carrier. We charge a service fee of $95.00 for visits to a patient's home or place of business. We do not charge that fee when we see patients in one of the senior or assisted living communities we visit on a regularly scheduled basis. And of course we do not charge that fee to patients who see us in one of our offices. Medicare does not reimburse our service fee because it is an administrative charge for scheduling the physician, not a fee for the physician's professional services; therefore it is not considered " medically necessary " by Medicare. Comments are closed. > > > > > > > > > > > > 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 > > > http://www.doctorsmakinghousecalls.com/about-us/media/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Same here in upstate NY. A 99214 OV is estimated to take 25 minutes of provider time and pays $98.82. A 99349 home visit of the same level of complexity (Hx, Exam, and MDM) is estimated to take 40 minutes of face-to-face provider time (not counting travel time) and pays $97.86! I NEVER curse, but let me chime in for and say WTF???!!!??? I'm going to do a little more snooping around on the internet and consider adding a travel fee for any new home patients I sign up. Of course, I will probably hear their sad stories and waive them all, anyway!---Sharlene > > > > > > > > > > > > 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Doctors cannot receive tips. Donations only if you are set up as a charitable organization and have benefactors. I think there is a new bill to make any “gift” of $10 or more from a pharmaceutical company reportable too. That’s coffee for the office. L Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of SetoSent: Thursday, January 12, 2012 11:22 AMTo: Subject: Re: House calls While not an authoritative source, this thread from the Medical Association of Billers says you cannot bill for mileage on a house call:http://medicalassociationofbillers.yuku.com/topic/8797/house-call-can-I-bill-for-travel I wonder if it would be possible/legal to bill Medicare for the home visit, and then the patient's son make a " tip " or " donation " to your practice of an amount of his choosing? That is, I know it is illegal for doctors to charge extra for Medicare services, but are Medicare patients allowed to pay extra if they choose to? My guess is Medicare would frown on this, too. SetoSouth Pasadena, CA No. No specified source. I just wouldn’t want to push the envelope too hard to find out. You are probably correct in that if the patient signs an ABN and you charge for a “non-covered service” it might work out. I never go more than 10 minutes for a home visit, so I had not considered doing it that way. From: [mailto: ] On Behalf Of sharkinnSent: Thursday, January 12, 2012 9:39 AMTo: Subject: Re: House calls , I'm not so sure that it would (or should, anyway!) be illegal to accept extra money for travel time for a home visit. Medicare clearly does not pay for any time not spent face-to-face with the patient, and the description of the home visit CPT codes does not say anything about travel time being included in the codes. Therefore, I would say that a prolonged travel time is a non-covered benefit, and we should be able to have them sign an advance beneficiary notice and pay for it. If I were going to try it, though, I guess I would set the fee at something that Medicare considers a " reasonable " payment for my time, such as $100 for each 25 minutes of driving time. (I realize your point is that they grossly undervalue our time, of course.) I've never done it, but my farthest travel time for a home visit has been 15 minutes each way. Have you ever seen it specifed by a reliable source that this would be illegal? Just curious. ---Sharlene> > > > > > 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 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> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 I wonder if they are charging 99214s or 99349. Medicare requires people to be homebound to pay for home care visits. But if these doctors are doing convenience house calls and billing as if office visits, I think they can charge a convenience fee.  But on a homebound patient, I somehow question that that is billable. I don’t know if there is a way to find out. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of sharkinnSent: Thursday, January 12, 2012 1:11 PMTo: Subject: Re: House calls Check this out! It is a group of 23 physicians in North Carolina. Scroll down to the Medicare section.http://www.doctorsmakinghousecalls.com/about-us/media/InsuranceCommercial / Private InsuranceDoctors Making Housecalls is an " in network " provider for all Blue Cross Blue Shield, Humana and Cigna insurance plans. We also accept Medicare and Medicaid, and take assignment.We file all insurance forms and, for convenience, we accept payment by credit card for deductibles or co-pays, if applicable.Doctors Making Housecalls charges a " trip fee " of $95.00 when we see patients in a private residence, which compensates our physicians for their travel time. We waive the fee when we see multiple patients on a scheduled visit in a business, retirement community, or other communal setting.Our trip charge is not covered by insurance. Insurance companies consider it a charge for " convenience " and therefore not medically necessary. We bill the fee to your credit card on the day of your appointment.Our professional fees — what our physicians charge for their services — are dictated by your insurance company. They are comparable to those of office-based physicians in the same specialty. The actual charge for a visit varies according to the time our physician spends, which depends on the number and complexity of your medical problem(s).If the physician orders laboratory tests or radiologic procedures, whoever performs those services will bill you separately. Your insurance carrier will pay those fees just as they would if they were ordered from a typical office practice.MedicareWe accept assignment, which means we bill Medicare directly, and all secondary (Medigap) insurance plans. You only pay what's not covered by your insurance.Medicare reimburses 80% of our physician's professional fee, once you've met your annual deductible. Many supplemental insurance plans pay the remaining 20% of the physician's fee, and some even pay your annual deductible. Some supplemental plans pay our practice directly, but some send payment directly to you.We ask Medicare patients without supplemental insurance to pay their 20% co-pay at the time of service. Similarly, if your supplemental carrier sends payment to you, we ask that you pay us at the time of service since you will be reimbursed directly by your supplemental carrier.We charge a service fee of $95.00 for visits to a patient's home or place of business. We do not charge that fee when we see patients in one of the senior or assisted living communities we visit on a regularly scheduled basis. And of course we do not charge that fee to patients who see us in one of our offices.Medicare does not reimburse our service fee because it is an administrative charge for scheduling the physician, not a fee for the physician's professional services; therefore it is not considered " medically necessary " by Medicare.Comments are closed.> > > > > > > > > > > > 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> >>http://www.doctorsmakinghousecalls.com/about-us/media/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 But patients can give gifts to physicians, right? You know, years ago, I used to receive handmade blankets, homemade treats at the holidays, little dolls when patients were returning from abroad, etc. When my first baby was born, I received dozens of gifts for him from patients. Was I supposed to report these as income?So, could the $350.00 be a “gift”? (in the form, perhaps of gift cards to the supermarket?) J And why can’t doctors receive tips? Is that a law? Ramona G. Seidel, MDwww.baycrossingfamilymedicine.comArnold, MD410 518-9808 From: [mailto: ] On Behalf Of Kathy SaradarianSent: Thursday, January 12, 2012 2:46 PMTo: Subject: RE: House calls Doctors cannot receive tips. Donations only if you are set up as a charitable organization and have benefactors. I think there is a new bill to make any “gift” of $10 or more from a pharmaceutical company reportable too. That’s coffee for the office. L Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of SetoSent: Thursday, January 12, 2012 11:22 AMTo: Subject: Re: House calls While not an authoritative source, this thread from the Medical Association of Billers says you cannot bill for mileage on a house call:http://medicalassociationofbillers.yuku.com/topic/8797/house-call-can-I-bill-for-travel I wonder if it would be possible/legal to bill Medicare for the home visit, and then the patient's son make a " tip " or " donation " to your practice of an amount of his choosing? That is, I know it is illegal for doctors to charge extra for Medicare services, but are Medicare patients allowed to pay extra if they choose to? My guess is Medicare would frown on this, too. SetoSouth Pasadena, CA No. No specified source. I just wouldn’t want to push the envelope too hard to find out. You are probably correct in that if the patient signs an ABN and you charge for a “non-covered service” it might work out. I never go more than 10 minutes for a home visit, so I had not considered doing it that way. From: [mailto: ] On Behalf Of sharkinnSent: Thursday, January 12, 2012 9:39 AMTo: Subject: Re: House calls , I'm not so sure that it would (or should, anyway!) be illegal to accept extra money for travel time for a home visit. Medicare clearly does not pay for any time not spent face-to-face with the patient, and the description of the home visit CPT codes does not say anything about travel time being included in the codes. Therefore, I would say that a prolonged travel time is a non-covered benefit, and we should be able to have them sign an advance beneficiary notice and pay for it. If I were going to try it, though, I guess I would set the fee at something that Medicare considers a " reasonable " payment for my time, such as $100 for each 25 minutes of driving time. (I realize your point is that they grossly undervalue our time, of course.) I've never done it, but my farthest travel time for a home visit has been 15 minutes each way. Have you ever seen it specifed by a reliable source that this would be illegal? Just curious. ---Sharlene> > > > > > 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 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> Quote Link to comment Share on other sites More sharing options...
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