Re: open query - getting paid for physicals in the medicare population

[Guest guest]

I think it's fine -I actually use the system discussed in AAFP journal, let people know a physical is $130., offer to deduct any medical payments from Medicare from that charge (for the HTN, lipids, 99214, etc) and then bill them the difference. I have been thinking of having those medicare folks sign a simple waiver to either pay and receive a physical or sign and waive responsibility (not pay) for missing a physical if they do not want to pay for a physical. Am I crazy? I do easily 500 such physicals a year, and if I received 100 dollars that would make a significant difference in the bees wax. Adam Schwarz MDIMP since 4/7/2007Never miss a thing. Make Yahoo your homepage.

[Guest guest]

to do an exam properly for these folks it takes alot of time. They

have multiple medical problems. If you only see them yearly you have

a lot of ground to cover. You can easily justify a level 4-5 visit

with reviewing multiple health problems, ordering lab , counseling

regarding smoking cessation etc, pfts, EKG, stool checks for blood

with new immunoassay , prostate screening using G codes or pap smear

and not have to fight this fight. It is not realy a general exam for

kicks and grins. If you freeze a couple of actinic keratosis thrown

in to the mix occasionally along with lesion removal for cancerous

spots found then it can work pretty well financially.

Most docs in my area will not try to bill both a screening exam along

with a problem oriented exam that is quite complete.

Most will have obesity with appropriate elevated BMI

Diabetes,

hypertension

Knee or hip pain

actinic keratosis

seborrheic keratosis

Cataracts

Dental caries

Hearing loss

Family history of something

Athersclerotic heart disease

Congestive Heart Failure

So document away and do not worry, the biggest problem is when one is

so healthy you can not find anything, say oh well and move on . They

do not take too long.

Brent

>

> >

> > I have been thinking of having those medicare folks sign a

simple

> > waiver to either pay and receive a physical or sign and waive

> > responsibility (not pay) for missing a physical if they do not

want

> > to pay for a physical. Am I crazy? I do easily 500 such physicals

a

> > year, and if I received 100 dollars that would make a

significant

> > difference in the bees wax.

> >

> > Adam Schwarz MD

> > IMP since 4/7/2007

> >

> > Never miss a thing. Make Yahoo your homepage.

> >

> >

>

[Guest guest]

Medicare does not pay for physicals at all, you don't need a waiver for

something that is not covered. If a patient wants a physical, they have to pay

for it, you don't even have to send it in.

By the way, it is technically Medicare fraud to; have a patient request a

physical and then bill MDC for a level 3-5 E and M coded visit for multiple

problems. They feel you are trying to bill them for something they do not pay

for. If you were audited and the appointment book said patient was coming for PE

and you bill MDC for a 99215 for HTN, Obeisty and DM, that is not OK.

________________________________

From: on behalf of Guinn

Sent: Mon 1/7/2008 7:16 PM

To:

Subject: Re: open query - getting paid for physicals in

the medicare population

I think it's fine -

I actually use the system discussed in AAFP journal, let people know a physical

is $130., offer to deduct any medical payments from Medicare from that charge

(for the HTN, lipids, 99214, etc) and then bill them the difference.

I have been thinking of having those medicare folks sign a simple waiver to

either pay and receive a physical or sign and waive responsibility (not pay) for

missing a physical if they do not want to pay for a physical. Am I crazy? I do

easily 500 such physicals a year, and if I received 100 dollars that would make

a significant difference in the bees wax.

Adam Schwarz MD

IMP since 4/7/2007

________________________________

Never miss a thing. Make Yahoo your homepage.

<http://us.rd.yahoo.com/evt=51438/*http://www.yahoo.com/r/hs>

[Guest guest]

Someone on the list stated that Medicare doesn't pay for a physical. They Do, provided you offer this within the first 6 months of patients' effective coverage. Beyond that it is not reimbursed. I guess a waiver may have it's place but one may want to bill this to Medicare nevertheless, as proof of non-coverage to a particular patient.adam schwarz wrote: I have been thinking of having those medicare folks sign a simple

waiver to either pay and receive a physical or sign and waive responsibility (not pay) for missing a physical if they do not want to pay for a physical. Am I crazy? I do easily 500 such physicals a year, and if I received 100 dollars that would make a significant difference in the bees wax. Adam Schwarz MD IMP since 4/7/2007 Never miss a thing. Make Yahoo your homepage.

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

[Guest guest]

Art , Thanks for the response.

correct - the welcome to medicare physical is a different issue....the waiver clarifies my role as prevention doc or simply chronic disease doc and allows me to bill for services not medicare covered....the standard I hear is this is true for all medicare not covered issues, and the waiver is a time of service necessity, every time this waiver would go to the billing folks to generate a bill on uncovered medicare procedures.

Adam

Re: open query - getting paid for physicals in the medicare population

Someone on the list stated that Medicare doesn't pay for a physical. They Do, provided you offer this within the first 6 months of patients' effective coverage. Beyond that it is not reimbursed. I guess a waiver may have it's place but one may want to bill this to Medicare nevertheless, as proof of non-coverage to a particular patient.adam schwarz <adamschwrzyahoo (DOT) com> wrote:

I have been thinking of having those medicare folks sign a simple waiver to either pay and receive a physical or sign and waive responsibility (not pay) for missing a physical if they do not want to pay for a physical. Am I crazy? I do easily 500 such physicals a year, and if I received 100 dollars that would make a significant difference in the bees wax.

Adam Schwarz MD

IMP since 4/7/2007

Never miss a thing. Make Yahoo your homepage.

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

[Guest guest]

In my area its a mix, I do regretfully see folks like this example too, but the policy of trying to cover the waterfront with sick codes is troublesome...there is a prevention role and I've found with frequent fliers (DM of Coumadin pts) that a routine head to toe is just as essential as the person I see once a year...it makes me do the full magilla.

Adam

Re: open query - getting paid for physicals in the medicare population

to do an exam properly for these folks it takes alot of time. They have multiple medical problems. If you only see them yearly you have a lot of ground to cover. You can easily justify a level 4-5 visit with reviewing multiple health problems, ordering lab , counseling regarding smoking cessation etc, pfts, EKG, stool checks for blood with new immunoassay , prostate screening using G codes or pap smear and not have to fight this fight. It is not realy a general exam for kicks and grins. If you freeze a couple of actinic keratosis thrown in to the mix occasionally along with lesion removal for cancerous spots found then it can work pretty well financially. Most docs in my area will not try to bill both a screening exam along with a problem oriented exam that is quite complete. Most will have obesity with appropriate elevated BMIDiabetes, hypertension Knee or hip painactinic keratosis

seborrheic keratosis Cataracts Dental caries Hearing loss Family history of somethingAthersclerotic heart disease Congestive Heart Failure So document away and do not worry, the biggest problem is when one is so healthy you can not find anything, say oh well and move on . They do not take too long. Brent > > >> > I have been thinking of having those medicare folks sign a simple > > waiver to either pay and receive a physical or sign and waive > > responsibility (not pay) for missing a physical if they do not want > > to pay for a physical. Am I crazy? I do easily 500 such physicals a > > year, and if I received 100 dollars that would make a significant > > difference in the bees wax.> >> > Adam Schwarz MD> > IMP since 4/7/2007> >> > Never miss a thing. Make Yahoo your homepage.> >> >>

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

[Guest guest]

thanks - I will put out the waiver languge for feedback, and likely use it starting at my anniversary of the practice!

A

Re: open query - getting paid for physicals in the medicare population

I think it's fine -

I actually use the system discussed in AAFP journal, let people know a physical is $130., offer to deduct any medical payments from Medicare from that charge (for the HTN, lipids, 99214, etc) and then bill them the difference.

I have been thinking of having those medicare folks sign a simple waiver to either pay and receive a physical or sign and waive responsibility (not pay) for missing a physical if they do not want to pay for a physical. Am I crazy? I do easily 500 such physicals a year, and if I received 100 dollars that would make a significant difference in the bees wax.

Adam Schwarz MD

IMP since 4/7/2007

Never miss a thing. Make Yahoo your homepage.

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[Guest guest]

True, I did not mention the " welcome to Medicare " physical, because it is really

not a physical. You need to read what it actually entails, and an exam is not

actually part of it.

________________________________

From: on behalf of Art Heinrich

Sent: Tue 1/8/2008 5:39 AM

To:

Subject: Re: open query - getting paid for physicals in

the medicare population

Someone on the list stated that Medicare doesn't pay for a physical. They Do,

provided you offer this within the first 6 months of patients' effective

coverage. Beyond that it is not reimbursed. I guess a waiver may have it's place

but one may want to bill this to Medicare nevertheless, as proof of non-coverage

to a particular patient.

adam schwarz wrote:

I have been thinking of having those medicare folks sign a simple waiver to

either pay and receive a physical or sign and waive responsibility (not pay) for

missing a physical if they do not want to pay for a physical. Am I crazy? I do

easily 500 such physicals a year, and if I received 100 dollars that would make

a significant difference in the bees wax.

Adam Schwarz MD

IMP since 4/7/2007

________________________________

Never miss a thing. Make Yahoo your homepage.

<http://us.rd.yahoo.com/evt=51438/*http://www.yahoo.com/r/hs>

________________________________

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

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