Absolutely MUST comment to CMS here!

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
emd123

emd123

Full Member
10+ Year Member
Joined
Feb 25, 2010
Messages
4,263
Reaction score
1,560
To officially comment to CMS on this, here is the link:

http://www.regulations.gov/#!documentDetail;D=CMS-2013-0155-10181

We all must, MUST, MUST, comment here too, directly to CMS to be heard. Let 'EM have it with you best argument. Outrageous cuts to CESI 58%, and how much skill, time and risk is involved in this procedure. Also, outrageous cuts to LESI 51%. Draconian across the board cuts to all IPM procedures of 5-10%. Also, a crushing cut to spinal cord stim with 100% reduction of L8680 and outrageously inadequate increase in 63650.

Explain how this will threaten your ability to provide these procedures to senior citizens and the disabled, threaten to force you to shut your practice down and leave the specialty, promote increased opiate prescribing, and hurt patient care. Also will drive care to the five fold more expensive hospital setting with it's very large facility fees.

If you don't comment here, the people who REALLY can change it won't even know you're upset.

Let's throw a Hail Mary, and maybe, just maybe they'll realize, "Wow, maybe we went a little too far here."

Let them know how highly trained you are and how you are NOT abusing these procedures AND YOUR PATIENTS SHOULD NOT BE FORCED TO SUFFER.

5% cuts are one thing, but 51% LESI, 58% CESI, and 75-90% stim/l8680 are purely punitive.

These cuts are punitive and all the thousands of good senior citizens in pain and ethical Pain doctors should NOT BE PUNISHED.

If you're not outraged enough to let CMS have it with you comments directly when will you be? When you are unemployed, forced to work for a hospital the FIRED because a patient filed a Press Ganey complaint that you didn't RX enough opiates!

Blow a gasket! Blow it on CMS!

Click the link!!!!!!!!!!!!

/Now!


H£6+&$78-&&!!!!!£kskejkNj8:&;$
Members don't see this ad.
 
Last edited:
Here's mine:

"As a Pain Physician, I would like to personally explain that these cuts in Interventional Pain Procedures will severely, drastically and unfairly cut access to chronic pain care for senior citizens and other Medicare beneficiaries and at the same time promote the worsening of the prescription drug abuse epidemic. They amount to much, much greater than the initially advertised "4% cuts in Pain Management."

Cutting Cervical ESI 62310 by 58% is outrageous and draconian, and is one of the most common procedures Pain Subspecialists perform. This is an extremely delicate procedure, where a needle is put 1 mm from a patient's spinal cord. To cut this drastically means, doctors just won't be able to offer the procedure to their patients. It is not a "quick and easy" procedure if performed safely. A 1-2% cut is understandable, but 58% is punitive and outrageous. The risks of this procedure performed poorly by an untrained person are catastrophic: paralysis from the neck down. This code should not be cut, at all, and certainly not so drastically. This procedure is an essential option for those with pinched nerves in the neck and other painful neck conditions. This procedure when performed properly, takes much, much longer than that calculated in your rule.

Cutting LESI 62311 by 51% is also punitive and completely unnecessary, and also one of the most common pain relieving procedures performed by Pain physicians. When performed properly, with contrast, and fluoroscopic guidance by a skilled pain physician, it takes significant time. Just getting a patient in pain in the fluoroscopy room, on a fluoro table, positioned and off the table again after the procedure takes much, much more time that you calculated in this rule. (This applies to the 62310 procedure above, also). This is a punitive cut that will crush this procedure and nearly stop its performance completely.

Cutting the L8680 spinal cord stimulator code 100% is even more punitive and drastic. The token increase in the 63650 code comes nowhere near replacing the L 8680 reimbursement. Performing a properly done spinal cord stimulator trial in one's office, in sterile near-OR like conditions takes a tremendous amount of skill and training. To perform it carefully, properly and well, takes time and careful, methodical technique. Threading one or two stimulator wires up someone's spine safely and properly 1-2 mm from someone's spinal cord without risking permanent paralysis is extremely difficult for anyone without the utmost training. This procedure should not have been cut 75-90% which it was, when combining the 63650 and L8680 codes. To even perform an in-office spinal cord stimulator trial, a physician has to buy the leads for >$1000 out of his or her own pocket ($500-$1,000 per lead).

Furthermore, you cut nearly every IPM code across the board 4-25%. The only ones you increased are the one's no one does like 64605 (destruction of trigeminal nerve) and 64630 (destruction of pudendal nerve).

As a physician who is just starting his own in-office practice and who specifically tries to offer as many non-narcotic and non-addictive treatment options during this country's terrible prescription drug abuse epidemic, these cuts are drastic, punitive and devastating, especially considering I use the procedures judiciously, and do not abuse or overuse them. The advertised "4% cut of Pain Management" procedures is misleading. It doesn't take into effect the L8680 elimination, and must factor in token increases in procedures no one does, as well as a false "increase" in 63650. If almost all of the procedures are cut 4-58%, only one stays the same (facet nerve ablation), plus the L8680 code cut 100%, how can that possibly average out to only 4%? It doesn't. The overall cut is massive, absolutely massive.

If not reversed, these cuts will be devastating to senior citizens and the disabled in pain. They also will be devastating particularly to pain physicians in the early phases of their practices, and to those who feel it’s best to offer as many non-opiate and non-addictive treatments as possible. Please, reconsider these payments and reverse them for the sake of the disabled and senior citizens of this country who are suffering in Pain, and for the doctors who are trying to combat the prescription narcotic epidemic by offering other treatments to their patients such as Interventional Pain procedures. Thank you."
 
Members don't see this ad :)
Hey guys-

cut and paste this. IT's from ASIPP


-------------------------------------------



I write to you today out of great concern. On November 27, 2013, Centers for Medicare and Medicaid Services (CMS) posted the 2014 final rules for physician payments(CMS-1600-P) as well as hospital outpatient and ambulatory surgical center payments (CMS-1601-P) with the new rates to go into effect on January 1, 2014.

These cuts are draconian and will devastate our specialty. Unless we act upon the issue this may be the end of interventional pain management practices for almost 40% of the physicians who practice in an office setting.

The cuts for physician payment for epidural injections are 36% and 58% for office settings. This does not include the 20% SGR cuts. Spinal cord stimulation has also been deeply cut. We are also facing cuts for transforaminal epidural injections as well as facet joint interventions. Across the board cuts such as these will force office based physicians to either close or move into the more expensive hospital setting. Either outcome will have a devastating effect on patient access to care.

All the while, hospitals payments are being increased by almost 20% for the same procedures, whereas in-office procedures are facing almost 60% cut, with same operational expenses. There were many reckless flaws in determining process:

• Medicare did not take into consideration Medicare Economic Index (MEI) which has been increasing substantially. Now the gap with SGR cuts will be 90% and without SGR cuts will be 70% between expenses and the revenue.
• The RUC process did not involve all of the physicians and even then, the AMA has recommended continuing the same payment schedule.
• The data was available in 2012, yet the proposed schedule in July did not include the proposed cuts. The required comment period was not provided.
• Medicare has not taken into consideration MedPAC recommendation of widening gap between hospitals and physician payments.

These actions will program expenses by $187 million just for 2 codes by moving them into the hospital setting. Co-pays for the hospital setting will be 4 times the office-based rate. These cuts will create an unprecedented financial hardship on patients.

We respectfully ask that you either eliminate the cuts or revert back to the 2013 payment rates. Please act immediately as this is important to me and all the American public. Without your help millions of chronic pain patients will be left with no where to turn. Thank you for all your help.
 
It's okay to use the ASIPP letter as a guide to get started, but make sure you at least add your own feelings and comments. If they see that they're just getting 10,000 of the same cut and pasted letters, it'll have less impact than 10,000 heartfelt individual letters.
 
thanks for the link, done.
 
JEEZ - worse than the healthcare.gov website: "The Regulations.gov hosting facility is performing scheduled software maintenance and as a result the site may be intermittently unavailable Saturday, December 14, from 6:00 am through 10:00 am (eastern time)."
 
Done

emd123 said:
To officially comment to CMS on this, here is the link:

http://www.regulations.gov/#!documentDetail;D=CMS-2013-0155-10181

We all must, MUST, MUST, comment here too, directly to CMS to be heard. Let 'EM have it with you best argument. Outrageous cuts to CESI 58%, and how much skill, time and risk is involved in this procedure. Also, outrageous cuts to LESI 51%. Draconian across the board cuts to all IPM procedures of 5-10%. Also, a crushing cut to spinal cord stim with 100% reduction of L8680 and outrageously inadequate increase in 63650.

Explain how this will threaten your ability to provide these procedures to senior citizens and the disabled, threaten to force you to shut your practice down and leave the specialty, promote increased opiate prescribing, and hurt patient care. Also will drive care to the five fold more expensive hospital setting with it's very large facility fees.

If you don't comment here, the people who REALLY can change it won't even know you're upset.

Let's throw a Hail Mary, and maybe, just maybe they'll realize, "Wow, maybe we went a little too far here."

Let them know how highly trained you are and how you are NOT abusing these procedures AND YOUR PATIENTS SHOULD NOT BE FORCED TO SUFFER.

5% cuts are one thing, but 51% LESI, 58% CESI, and 75-90% stim/l8680 are purely punitive.

These cuts are punitive and all the thousands of good senior citizens in pain and ethical Pain doctors should NOT BE PUNISHED.

If you're not outraged enough to let CMS have it with you comments directly when will you be? When you are unemployed, forced to work for a hospital the FIRED because a patient filed a Press Ganey complaint that you didn't RX enough opiates!

Blow a gasket! Blow it on CMS!

Click the link!!!!!!!!!!!!

/Now!


H£6+&$78-&&!!!!!£kskejkNj8:&;$
Click to expand...
 
AXM, just so you are aware, I tried to contact my primary specialty Academy (AAPM&R) to see what they were doing to address this crisis. Several years ago, I concluded that AAPM&R had demonstrated that they were largely active in defending inpatient and PT payments, and were leaving interventional to other organizations. As a result, I let my membership lapse.

I figured there was no harm in seeing if I was wrong, and so contacted the Academy Tuesday. I emailed Sarah D’Orsie, AAPM&R's Director of Government Affairs. She referred me to Jenny Jackson, the Academy's Manager of Health Finance and Reimbursement. She wrote back:

"The AAPM&R Committee that handles coding and reimbursement issues is working on this and other issues that will affect PM&R physicians. We encourage you to rejoin the Academy as we are always seeking input from interested Academy members on this and other reimbursement issues."​

If you ever wonder why most interventional pain physiatrists chose not to remain members of the Academy, non-responsive answers that essentially blow off potential members asking reasonable questions rank at the top of my list.

I said as much when I wrote Ms. Jackson back:

The Academy has NEVER been responsive to interventional pain members like myself, which is why I chose not to renew my membership in the first place.

I contacted AAPM, NASS, ISIS, ASIPP, AAPM, and AAPM&R when I learned of this issue today. All the organizations other than AAPM&R were willing to chat about how best to resolve this issue.

Rather than blowing me off, perhaps a better approach might be to demonstrate why being a member of my primary specialty's Academy might actually add value. A dismissive response like "we're working on it" without any further details is rude, disrespectful, and in no way inspires confidence that anything useful is actually being done. I hoped this crisis presented an opportunity for the Academy to represent the interests of its interventional members.

I have contacted two local physicians who are members of Congress. I have contacted both my Senators. I have contacted the presidents and/or chairmen of the boards of the above-mentioned groups. Each has been willing to allow me to bend their ears, so I might assist in reversing these cuts. AAPM&R? Based on your response? Not so much.​
 
Last edited:
Members don't see this ad :)
There's 15 ****ing comments on there as of now!! Yayyyy that'll do a lot....ughhhhh. We need like 100x that
 
Has anyone initiated into their practice the website link for patients to email Congress in opposition to the cuts? If so, how are you going about this? Placing on practice website? Handouts to patients?

Anyone who has tried this, what has been the received feedback from patients?
 
PittsburghPain said:
Has anyone initiated into their practice the website link for patients to email Congress in opposition to the cuts? If so, how are you going about this? Placing on practice website? Handouts to patients?

Anyone who has tried this, what has been the received feedback from patients?
Click to expand...

Had my group do a mass emailing through the EMR since we do collect patients emails. So it went out to the majority. I made a brief letter then put the "Capwiz for patients" link at the bottom from the ASIPP website. Haven't gotten any feedback yet.
 
What legislation are you asking them to support?
 
Neurology went through this last year with similar Draconian last minute cuts to NCS and we all expressed the same outrage to absolutely no avail. Write as many letters as you want but unfortunately CMS doesn't give a rat's ass. I sincerely hope you have a better outcome with your campaign than we did last year. Good luck.
 
I was hoping they would comment on the Defense Budget for the next fiscal year.
 
Done

We print a hard copy of the letter, have our patients read and sign it with their contact info and then I have one of my office staff enter the letter and the patient info into either the cms website or the capwiz link from asipps site. It worked well we got 16 letters sent out today which was the first day we tried it. We also emailed the link to our patients.
 
I called Congressman Bill Cassidy, an Louisiana-based internist who sits on the House Energy and Commerce Committee, which oversees CMS. His legislative aid in charge of health care spent 30 minutes with me.

What he explained is that this process is data driven. Arguing "patient access" and "increased cost" makes sense, but back up the arguments with specifics, not just theory.
 
ampaphb said:
I called Congressman Bill Cassidy, an Louisiana-based internist who sits on the House Energy and Commerce Committee, which oversees CMS. His legislative aid in charge of health care spent 30 minutes with me.

What he explained is that this process is data driven. Arguing "patient access" and "increased cost" makes sense, but back up the arguments with specifics, not just theory.
Click to expand...

Okay, how about the different inflation metrics used to calculated office, ASC, and HOPD rates? Is that data or donation driven?

How about if our specialty societies work with CMS to create medically sensible rules for access to IPM procedures? Would that not be a data driven way to show how cost can be controlled while maintaining access and not creating adverse incentives to IPM practices to drive up volume further?
 
powermd said:
Okay, how about the different inflation metrics used to calculated office, ASC, and HOPD rates? Is that data or donation driven?

How about if our specialty societies work with CMS to create medically sensible rules for access to IPM procedures? Would that not be a data driven way to show how cost can be controlled while maintaining access and not creating adverse incentives to IPM practices to drive up volume further?
Click to expand...

All seem like perfectly reasonable issues to raise. Why don't you try and couch them in less hostile terms (i.e. edit "donation driven") and see how it goes?
 
Seems like a lot to expect from an organization that can't figure out a more elegant solution than "hmm.. there were a lot more epidural injections this year than last. Let's just cut the price in half, that way everyone who wants one in 2014 can have an epidural!"
 
Ok I've had all family members post comments on here, that's an additional 15 comments. We are now up to 45…. still weak. Why are there not close to 100 comments by now?!? I honestly don't understand; I mean there's been 1,300 views of this thread! Are people really doing nothing!?
 
I know where our cuts went - to increase hospital payments

Technical Components of ESIs done in hospital went up ~$100!

62310
Hospital gets $669.91
Doc gets $70.43

Total $740.34 for 62310

Same procedure done in the office TOTAL $110.14 (<15% of hospital)!
 
I almost took a position with a group invested in physician owned hospital a few years back. Looks like I should have.
 
mid|ine said:
I know where our cuts went - to increase hospital payments

Technical Components of ESIs done in hospital went up ~$100!

62310
Hospital gets $669.91
Doc gets $70.43

Total $740.34 for 62310

Same procedure done in the office TOTAL $110.14 (<15% of hospital)!
Click to expand...

This is the point I'm driving home with the patients I'm having send the letter: that while they talk of "saving money" by cutting payments for pain treatments to doctors, they are sickeningly increasing what they'll pay for the same procedure in a hospital when it's already 7 times more expensive to get the same procedure in a hospital.

It's madness.

This is how corrupt our government is. To "save money" they pay 7 times more for the same procedure in a hospital, cut payments to the ones doing it more efficiently and cheaper and increase it to those doing the same for 7 times the cost.

This is like the $700 wrenches our government was paying for in the 1980's under military contracts. The lid needs to be blown off of this insanity.
 
Every doc on here needs to pass this along to their patients and the media! Only then will they start to feel the pressure....and again, I can't understand why there are only 48 comments on the cms comment site. 15 of them are from myself and family members!
 
Speaking of bloated hospital fees, I just got the bill for a routine office visit for my 21 month old to follow up on a resolving episode of croup and make sure she didn't have an ear infection. Our peds group is the best in the area, but of course, a HOPD since they were acquired by the local monster hospital system.

$185 charge, for which I am asked to pay $158 cash!

We have a HDHP with Harvard Pilgrim- great insurance if you exceed the $4500 individual deductible.

Imagine how well a local pediatrician could do if he were able to charge $100 cash direct pay per visit with minimal billing/admin staff?
 
powermd said:
Speaking of bloated hospital fees, I just got the bill for a routine office visit for my 21 month old to follow up on a resolving episode of croup and make sure she didn't have an ear infection. Our peds group is the best in the area, but of course, a HOPD since they were acquired by the local monster hospital system.

$185 charge, for which I am asked to pay $158 cash!

We have a HDHP with Harvard Pilgrim- great insurance if you exceed the $4500 individual deductible.

Imagine how well a local pediatrician could do if he were able to charge $100 cash direct pay per visit with minimal billing/admin staff?
Click to expand...


not to be too critical, but...

does HOPD and ASC charge for consultation codes, such as 99201 up to 99245?

the final fee schedules posted on ASIPP do not list any HOPD or ASC charges for consultation or outpatient visit... and of note, the facility rates are less expensive than the non-facility/office based rates for these codes, by 20-30%.
 
Here's what I have put together to have patients sign. See any problems with giving every patient one of these?

Dear patient,

On November 27th, the Centers for Medicare and Medicaid Services (CMS) cut reimbursement for X-ray guided epidural steroid injections by over 50% when performed specifically in the office setting. Nonsensically, CMS simultaneously decided to increases hospital reimbursements when these same procedures are performed in the hospital setting. As of January 1st, an epidural steroid injection will cost the patient ~$750 when done in the hospital - approximately 7x more than when done in the office. Unfortunately due to these drastic cuts, offices may be unable to continue providing these services. As access to care becomes limited, many patients will be forced into the hospital to receive these treatments at approximately 7x the cost! This does not sound like the affordable health care Obama had promised. We are unsure of Medicare’s intent, but are asking for your help to stop these cuts that will ultimately force treatment out of the more affordable and cost efficient office setting and into the hospital.

If you wish to speak out please sign below. With your signature, we will electronically send CMS and your state representatives a pre-written statement opposing these cuts on your behalf. Thank you for your help in stopping this misguided, wasteful and restrictive healthcare initiative.
 
clubdeac said:
Here's what I have put together to have patients sign. See any problems with giving every patient one of these?

Dear patient,

On November 27th, the Centers for Medicare and Medicaid Services (CMS) cut reimbursement for X-ray guided epidural steroid injections by over 50% when performed specifically in the office setting. Nonsensically, CMS simultaneously decided to increases hospital reimbursements when these same procedures are performed in the hospital setting. As of January 1st, an epidural steroid injection will cost the patient ~$750 when done in the hospital - approximately 7x more than when done in the office. Unfortunately due to these drastic cuts, offices may be unable to continue providing these services. As access to care becomes limited, many patients will be forced into the hospital to receive these treatments at approximately 7x the cost! This does not sound like the affordable health care Obama had promised. We are unsure of Medicare’s intent, but are asking for your help to stop these cuts that will ultimately force treatment out of the more affordable and cost efficient office setting and into the hospital.

If you wish to speak out please sign below. With your signature, we will electronically send CMS and your state representatives a pre-written statement opposing these cuts on your behalf. Thank you for your help in stopping this misguided, wasteful and restrictive healthcare initiative.
Click to expand...

I like the idea but does it truly cost the patient or CMS $750? If seniors had to pay 7x out of pocket then we could get traction. No one appears to care if it is just the government wasting money....
 
pastafan said:
I like the idea but does it truly cost the patient or CMS $750? If seniors had to pay 7x out of pocket then we could get traction. No one appears to care if it is just the government wasting money....
Click to expand...
unfortunately, this is the great disconnect.

patients pay nothing if they are medicare, straight full medicaid, and they dont get injections (usually) if they are managed medicaid.

also, private insurance patients will not be affected yet, and their insurances will tell them that there has been no change to their coverage. its only later that it will affect their access.

clubdeac, specifically, CMS cut reimbursement across the board on the physician portion of epidural steroid injections, both non-facility and facility. ASC reimbursements also went up with this, but i guess since ASC rates are a lot less, then that is okay - it seems everyone on this forum ignores the change in ASC rates.


your post could use slight tune up - specifically, some small typos (increase not increases, for example.) also, technically these injections are costing care/caid patients $0.


based on your feelings about bringing in politics to the discussion, consider either presenting the letter in a non-political and non-judgemental manner (more a statement of facts kind of letter without the politically biased points) or be much more emphatic.

the people most directly affected initially by CMS changes are those on Medicare/Medicaid, not known for being a right wing faction. and they are not paying a dime for their injections.


On the other hand, you could eliminate the term healthcare initiative to complete the political statement and use more apropro terms such as healthcare fiasco or impending disaster.
 
Thank you for the constructive criticism. " Initiative" may not be the exact word I'm looking for but doesn't "healthcare fiasco or impending disaster" sound much more biased and politically charged. Or are you inferring that that would appropriately complete my biased rant? ;)

And you're right, the wording "will cost the patient ~$750" is misleading but I don't believe it will be free either. I thought most Medicare patients had a 20% copay. Is that not correct? If it is, the out of pocket difference will be about ~$130, still a significant waste. And don't forget about the taxpayer (you and me) who will be paying for these superfluous expenditures
 
I was thinking you should go full speed ahead. In that case , it's not an initiative. It's Fubar or Snafu.

We can collect a copay of 20% from straight Care patients. Mine does not because of the difficulties with calculating the actual payments. Ultimately the vast majority of these are $0, as the hospital ends up writing it off.

Also , Because of LCD or some other compromise, the hospital I work for does not charge the full allowable amount that CMS "authorizes", which makes collecting copays that much more complicated. ( ie. $300 right now for ESI , not 2013 Asipp rates of $500 +)


This is probably partly why my A/R is a teeny bit over 90 (+180) days....
 
I like the clubdeac letter, tuneup or not the patients get the message. It would be nice if we had all of our patient's email addresses so that we could send them all letters like this. This is the approach that many political groups are using now to send petitions to congressmen.

In my neck of the woods medicare pays 80%, medicaid and public aid do not contribute. If you have MC/AARP or some other good supplemental then you have 100% coverage. If you have MC that is managed by BC then you have 80% coverage. If you have MC that is managed by Pacificsource then 80% and they require a PA, and they PA stuff for MC that they wouldn't for purely private insurance customers. I am afraid that they plan to apply the same restrictions to their MC patients that they do to private insurance customers.

It's a little scary to think that someone would not charge what CMS "authorizes". I'm assuming that you (ducttape) mean that they don't charge as much as medicare will pay. I do all of my procedures in other people's facilities, mostly small rural hospitals. One used to charge less than what medicare would pay and so I told them that if they were going to waste the oportunity that I was providing then I would take my service elsewhere. At the time they were in the news for being ready to go belly-up, and they changed quickly. I don't think that they knew what to charge, but that has changed. MC will pay the facility about $1100 for an ESI around here. They pay me about $100 with fluoro, unless I have the hospital collect for me. When Noridian, the subcontractor, audited MBB/RFAs they held up my reimbursements but they never delayed or questioned the the hospital's money. MC seems to have in interest in keeping small rural hospitals afloat.
 
As I alluded to... This office is not getting the full amount that CMS allows. To the best if my knowledge , it is billing the max it can - that's what I have been informed by admin up to the VP level. The copays are being billed also instead of collected.

Many are Medicare/ Medicaid, which as u mentioned there is no copay.
 
Interesting! There is someone saying how much you can bill and then again how much you get paid. That is what my group's ASC used to say, when they billed $600 for a 2 level bilateral RFA. The ortho group's ASC, where I work now, bills over $4000. Both ASCs? I went to our last group membership meeting and made a spectacle of myself complaining that we were leaving money on the table, and then an OB/gyn and an ENT agreed with me. So the CEO has agreed to look into it.
 
I know very little about the billing. Can someone explain to me how write off's work. Like if you bill $500 for an ESI and get paid $200, you would then "write off" the remaining $300 as a loss? And what does that mean exactly. Does that mean the practice gets to subtract that amount from the total collections on which they pay taxes?
 
Usually you decide on a reimbursement rate that you want to charge. You charge everyone the same amount. My group set the rate at $100/RVU and said their reasoning was that no one pays that much. Not sure about the reasoning there. Then the insurance company looks at what you did and pays 80% of what they allow, say $30/RVU. Either the patient pays the remaining 20% or their secondary insurance pays the 20%. You get to write off the $70/RVU that the insurance company wouldn't allow. Sometimes the insurance company will state that they allow $30, but they aren't paying any (because of deductibles or whatever) so the patient is stuck with the bill for $30. Some insurances are worthless and simply say that they aren't paying because of deductibles or whatever, and they don't comment on what they allow. Then the patient is stuck with the $100 charge. If the patient is uninsured then they are stuck with the $100 charge. Legally you should be charging everyone the same thing or you could be charged with fraud. You have to send everyone a bill. You don't have to send everyone who doesn't pay to a bill collecter. Your collections are the money that you get. Your write off is not a part of income or tax calculations.
 
A write off is the difference between your charge and your contractual obligation. If you charge $500 and Medicare pays $100 the difference is the write off. It is not deductible for tax purposes.
 
Thanks for the info. I guess I don't understand then what the benefit is of "writing off" anything. In other words, why would anyone charge more than what is allowed by insurance or medicare/medicaid etc. ?
 
This is the ridiculous system would work under but there are occasionally some advantages. Rarely an insurance company will pay a percentage of charges or when doing personal-injury work you are paid based on your charges.

While you must charge everyone the same, there is no prohibition against giving discounts for prompt payment, hardship patients, or self-pay patients as long as you have a uniform policy that does not discriminate when discounting your charges.
 
You must log in or register to reply here.
Next unread thread

Similar threads

MedZeppelin
ASC vs. HOPD - CMS rules
Replies
33
Views
1K
bedrock
bedrock
I
PRP LinkedIn comment section gone to the gutter
Replies
9
Views
654
Ducttape
D
T
CMS facet updates 12/1
Replies
31
Views
2K
SSdoc33
S
O
New CMS Palmetto LCD for SI joint pain
Replies
20
Views
2K
MitchLevi
MitchLevi
Ronin1
CMS proposed authorization for facet procedures
Replies
8
Views
1K
drpainfree
D
Top