Disability forms

[DYK343]

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I get so many. It can get overwhelming. My staff can only fill out so much
What is your policy?

Next thread will be peer to peer...

 

[heybrother]

Charge money. You won't get the money, but maybe you can reduce the number of requests, "modifications", etc.

$25. In a perfect world the nurse/MA who does them would get a cut because its the worst job in the world and I say that as a person who cuts nails.

 

[Feli]

I don't think there's much that can be done. Surgery = paperwork. (major injuries too)

For me, it's more Fmla and short term disability stuff, work comp injuries, RTW and off work notes... mostly paperwork for working ppl. They just need to be off work or limted for a bit... but looking to go back.
If you're talking long term disability or apply for permanent disability, that sucks... I don't really mess with those. I just tell them to have their disability attorney or disability doc's office request records and that I don't do those disability evals and exams... "just the foot doctor" (but very few people in my area do that long term disability with apply for MCR early, etc... most are gainfully employed). I will generally support it for Charcot, major OA of trauma, major deformities, drop foot or other neuro stuff, etc... but they can just get a disability lawyer and then request my notes. I skip those pages or refuse any forms that want all the percent disability and full body exam and bla bla bla.

I only have my staff do the demographics parts on the forms as able (my office name, add, ph, fax, etc etc)... then I do the med parts. I just find that fastest. A lot of big pain or ortho groups obviously have the case mgr RN or whatever, but the docs still have to do some of it. Anyone hates paperwork, but I can do it many times faster and better, and I sure don't want to re-do it if avoidable. It's our policy to tell pts "we aim to turn those around within a week" (I typically do them same/next day as I hate to have them sitting around in to-do pile).

One thing I'd say is to scan them all into EMR. The letters (MS Word docs in secure folder for later edits/updates), but especially the Fmla and STD and other forms. It's obviously common the RTW timeline changes or needs an update, and much easier to copy most of it for the icds, cpts, dates of injury/surg/hosp, and other details from the form prior. GL

...The (fairly) good thing is that work comp pays higher to much higher than normal MCR or private insurances, so at least there's that. In my area, work comp fee schedule is a lot more for e/m, a good bit more for proc/surgery, and a bit less for dme stuff ("at cost"). It's also negotiable with most (they send proposed pay, and biller can approve or ask for more, and then they send funds). Probably doesn't help out podiatrists who are salary PP employee or hospital employ rvu, but it'll boost anyone owner or on collections (if you have good billers who can deal with work comp, collect well, and know the state/local fee schedules). 🤓

 

[Hybrocure]

Your staff fills out disability forms?

You don’t know how good you have it..

 

[Adam Smasher]

We charge $15 per stack of forms. Up front. So if you have 2 jobs and your husband needs fmla to be your caregiver, that'll be $45.

They're not the absolute worst. Most of it is copying dates of service and name address and license number etc. Under medical facts I always write the same thing. "Had foot surgery. Needs time off feet." Everyone gets 2 months off, even neuroma excision. The only person who ever wanted to get back to work quick was a lady who owned her own pizzeria, funny how being on the dole makes people heal slower for some reason 🙄

Also I NEVER do fmla for people I haven't operated on.

EDIT:
1. I said 2 months above but if you're doing bigger cases than me, which you probably are, more time is obviously appropriate.

2. Watch out for pts who try to get fmla for minor procedures. They come on a Thursday morning for an ingrown, then ask to have today and tomorrow off so they can heal over the weekend, then a day after you write the excuse note for work, you get the forms. I'll write them a letter for work but I make it clear to them I will NOT sign any fmla forms

 

[Retrograde_Nail]

My orthopedic department has a nurse who is trained to do the FMLA paperwork. She reads your notes and makes pretty accurate estimations on proper return to work times based on the range of dates I document that patients will be non weight bearing, weight bearing in CAM boot and then back to shoe. It is incredible.

 

[MicroPod]

I hate doing these forms. It’s almost as if they intentionally make questions confusing or hard to answer… I started just ignoring some of the portions and write down what is going on and how much time I anticipate they will need off.

 

[Calogero]

My orthopedic department has a nurse who is trained to do the FMLA paperwork. She reads your notes and makes pretty accurate estimations on proper return to work times based on the range of dates I document that patients will be non weight bearing, weight bearing in CAM boot and then back to shoe. It is incredible.

Most real jobs have this type of set up. Most private practices you are buried in it if you are doing lots of surgery.

 

[GreenHousePub]

My orthopedic department has a nurse who is trained to do the FMLA paperwork. She reads your notes and makes pretty accurate estimations on proper return to work times based on the range of dates I document that patients will be non weight bearing, weight bearing in CAM boot and then back to shoe. It is incredible.

still a podiatrist

 

[Feli]

My orthopedic department has a nurse who is trained to do the FMLA paperwork. She reads your notes and makes pretty accurate estimations on proper return to work times based on the range of dates I document that patients will be non weight bearing, weight bearing in CAM boot and then back to shoe. It is incredible.

They will probably have AI that does this seamlessly... I'm sure it'll be released and working well the day after we retire. 😜

 

[Feli]

Most real jobs have this type of set up. Most private practices you are buried in it if you are doing lots of surgery.

In podiatry, yeah...

For ortho, trauma, gen surg, etc, I'd estimate med forms/paperwork is probably 80% done my case mgr, 10% doc does some, maybe 10% doc does all.
For podiatry, it's more like the opposite... 80% situations doc does it all, 10% doc does some, 10% case mgr RN does all.

"The rich man has his ice in the summer and the poor man gets his in the winter." 🥶

 

[Retrograde_Nail]

Most real jobs have this type of set up. Most private practices you are buried in it if you are doing lots of surgery.

Didn’t have it at my first hospital job

 

[Adam Smasher]

One of the reasons I've practically stopped doing total contact casts is because it effectively disables the patient, and next thing you know you have to play guessing games about how quick will the wound heal and write a new set of forms everytime something changes.

Of course, another reason I stopped doing tcc is because @air bud taught me these patients need surgical offloading

 

[DYK343]

For me, it's more Fmla and short term disability stuff, work comp injuries, RTW and off work notes... mostly paperwork for working ppl. They just need to be off work or limted for a bit... but looking to go back.

Yes I somewhat mispoke when I said "disability" I meant FMLA/short term stuff
I dont do anything permenant.

Charge money. You won't get the money, but maybe you can reduce the number of requests, "modifications", etc.

The modifications is the worst. Its what I think the patient needs. Not what they think. But patients keep redropping off forms at the front desk expecting me to read their mind. They want things refilled out with no clarification.

I have started to making patients make an appointment with me to fill them out. I fill it out with the patient and charge a 99213.

 

[Weirdy]

One of the reasons I've practically stopped doing total contact casts is because it effectively disables the patient, and next thing you know you have to play guessing games about how quick will the wound heal and write a new set of forms everytime something changes.

Of course, another reason I stopped doing tcc is because @air bud taught me these patients need surgical offloading

The TCCs just didn't make sense financially for me.
We were slapping them on left and right when it was indicated in residency.
Go out and try to start a practice you realize how expensive this stuff is.

 

[Adam Smasher]

If you bulk-buy webril, 4" elastic plaster, 4" regular plaster, 4" fiberglass, 4cmx4cm foam squares*, felt straps for padding, paper tape, gauze squares, and foam padding to protect the toes**, then the unit cost came out to $22/kit***

*these are $4/square, probably the most expensive component lol

**I had to order this from a heating/insulation company, got a huge square that has lasted me going on 6+ years, don't remember who to reorder from

***not included, the most expensive component: the cost of your time preparing the kits, applying the cast, and taking it off next visit, which--let's be honest--in PP you have no help with.

 

[Hybrocure]

If you bulk-buy webril, 4" elastic plaster, 4" regular plaster, 4" fiberglass, 4cmx4cm foam squares*, felt straps for padding, paper tape, gauze squares, and foam padding to protect the toes**, then the unit cost came out to $22/kit***

*these are $4/square, probably the most expensive component lol

**I had to order this from a heating/insulation company, got a huge square that has lasted me going on 6+ years, don't remember who to reorder from

***not included, the most expensive component: the cost of your time preparing the kits, applying the cast, and taking it off next visit, which--let's be honest--in PP you have no help with.

Also not included: the call from a patient saying their leg feels weird and you need to wonder if everything is turning into a gas swamp underneath the ulcer cast that can’t be checked without a saw

 

[Adam Smasher]

I had an epiphany recently. Our accountants had to prepare a 1099 for us. This is a 1/2 page long form with some numbers in boxes. They invoiced use $75.

I've been charging way too little for completing disability packets.

 

[Carbon13]

I billed one time for a large FMLA packet after surgery few years ago.
Surgery went perfect. Charged 15$ bucks or so to the patient and rushed to complete for him.
Got immediate bad Google review. Thanks, man.

 

[Adam Smasher]

I've already begun to bring this to pt's attention at time of scheduling and putting it on my consent form. If they're displeased with this, we do not need to proceed with surgery and we can part ways amicably. It's become too onerous to do for free anymore. Charging pts money for forms will be received less well post operative.

 

[Boba Foot]

I mean, attorneys won’t even read a document without charging. And their rates aren’t dictated by a third party middleman. Time is money.

 

[Feli]

I billed one time for a large FMLA packet after surgery few years ago.
Surgery went perfect. Charged 15$ bucks or so to the patient and rushed to complete for him.
Got immediate bad Google review. Thanks, man.

100%... the paperwork fees, late fees, no show fees, sending ppl to collections are all losing propositions.

In PP, those policies are nothing but a great way to have them leave negative reviews (and bad-talk your office to friends/fam/pcp/social, not ever send refers).

It's always better to just smile, do the paperwork when you can, and know we net consistently 2x or sometimes 3-4x the money employed docs get (keep) for the same visit + proc + dme + otc + etc.

I mean, attorneys won’t even read a document without charging. And their rates aren’t dictated by a third party middleman. Time is money.

Attorneys (and other professionals) can set their rates. We can't set our rates.
We are viewed as rich and wanting to help ppl... not "greedy."
This isn't a 5-star restaurant or 24hr plumbing service or a luxe cash pay shrink or aesthetician .

Ppl are already mad that their $40 copay is too high, deductible applied, or they had to pay $25.82 bill for their portion after insurance paid on a new pt visit.
It's very lame, but that is the game we got into.
You can make money on clever OTC stuff and cash services and the CPTs, but if you charge them fees in a med office, they won't love.

 

[Boba Foot]

Ppl are already mad that their $40 copay is too high

"Sir, did you not read the benefits package you signed up for?" That's literally a contract between them and their insurance company. We shouldn't be the ones having to collect it, but that's a whole different convo. It is asinine when people get upset over being asked for the rate they signed up for.

 

[heybrother]

My clinic has done pretty well with $25 fees (beats zero) and some of my nurses have expressed something resembling pride/satisfaction that they've gotten patients to pay the $25 each time they've demanded an update/extension of disability.

My concern always is that a patient with an extensive recovery / need for updates will view us as gouging them for a recovery that should have gone better.

That said - I think it mostly takes a special kind of patient to leave a negative review. You do the right thing - most patients are still going to say nothing, good or bad. The review game is won by pursuing good reviews and having a good process that avoids unnecessary negatives.

I try to learn something from my negative reviews, but its hard. People slaughtering my receptionist. This is literally a receptionist who learns every patients name and knows about their families. People claiming we didn't get them in fast enough when we never received a referral/call about them. People refusing all therapy and then claiming we did nothing for them.

 

[Adam Smasher]

I did a hammertoe arthroplasty on a lady recently. No implants or pins. Not only does she want short term disability, she needed forms filled out for her husband to be out on medical leave also to be her full time caregiver. Again this is an argument I'd rather have before surgery.

 

[Adam Smasher]

I have a lady scheduled next month for a bunionectomy. She works 3 jobs so she dropped off 3 stacks of disability forms. I called her and told her it would be $50 per stack so $150 total.

 

[Sendin_Toes_2market]

I have a lady scheduled next month for a bunionectomy. She works 3 jobs so she dropped off 3 stacks of disability forms. I called her and told her it would be $50 per stack so $150 total.

I dont charge. I have my MA fill it out with 1 of my 5 templates. I just sign it by end of the day after reviewing it.

 

[Adam Smasher]

I dont charge. I have my MA fill it out with 1 of my 5 templates. I just sign it by end of the day after reviewing it.

Would you please share the template for when the family member needs medical leave to provide round the clock care for a pt recovering from their hammertoe?

 

[Feeter]

We have a protocol for time off written out for each injury and surgery.

MA fills out ICD, CPT and restrictions based on this protocol. After that surgeon can sign or modify and sign. Makes it easier but still costly.

 

[Adam Smasher]

What is the protocol for when patients don't fit into a protocol?

I had one lady who wanted a gradual RTW. After being out 3 months, she wanted to return 20 hours/week for no more than 6 hours/shift. I hate when patients have these excruciatingly specific requests. I could farm it out to my MA but any mistakes and the pt is taking it up with me.

Also I had a different patient recently who had a hammertoe arthroplasty. Youngish guy, say late 20s. After 2 months out of work, he came to me with his parents and his mother indignantly pointed remarked that "whoever filled this form out marked that this was not a work related injury." I told her, no it wasn't, it was an elective hammertoe. She said according to whatever she pulled up on google, a hammertoe could be considered a work related injury if his work aggravated the pain he was having, and that he should be collecting workman's comp in addition to short term disability. Annoyed, I responded that workman's comp is for when you lacerate your hand on a saw or fall off a ladder and injure your neck, not for hammertoes. I then told her I wasn't going to commit perjury just so they could get more free money.

I swear, those hammertoe arthroplasties have some serious surgical morbidity!

 

[Carbon13]

What is the protocol for when patients don't fit into a protocol?

I had one lady who wanted a gradual RTW. After being out 3 months, she wanted to return 20 hours/week for no more than 6 hours/shift. I hate when patients have these excruciatingly specific requests. I could farm it out to my MA but any mistakes and the pt is taking it up with me.

Also I had a different patient recently who had a hammertoe arthroplasty. Youngish guy, say late 20s. After 2 months out of work, he came to me with his parents and his mother indignantly pointed remarked that "whoever filled this form out marked that this was not a work related injury." I told her, no it wasn't, it was an elective hammertoe. She said according to whatever she pulled up on google, a hammertoe could be considered a work related injury if his work aggravated the pain he was having, and that he should be collecting workman's comp in addition to short term disability. Annoyed, I responded that workman's comp is for when you lacerate your hand on a saw or fall off a ladder and injure your neck, not for hammertoes. I then told her I wasn't going to commit perjury just so they could get more free money.

I swear, those hammertoe arthroplasties have some serious surgical morbidity!

 

[Weirdy]

I did a hammertoe arthroplasty on a lady recently. No implants or pins. Not only does she want short term disability, she needed forms filled out for her husband to be out on medical leave also to be her full time caregiver. Again this is an argument I'd rather have before surgery.

New patient with plantar fasciitis
Someone else already operated on her
Someone else already extended her FMLA and also work disability so she can sit 80% of the time

First time seeing her.
She wants the same accommodations.
Brought the paperwork with her for me to fill out.

Its ridiculous.

 

[Stormblest]

Worst part about the paperwork is I feel like it’s intentionally confusing and annoying to fill out. You have to do chart review to fill it out. A couple of times we had to resubmit because we weren’t specific enough for the company. Maybe this is wrong but I put TBD for a lot of the stuff because how can I exactly predict how the patients recovery will go.

 

[Adam Smasher]

This isn't a disability story but a paperwork story and also a "VA doctors are fat and lazy and overpaid and possibly have erectile dysfunction" story.

Veteran comes to my office, Sent from the VA because he couldn't see a VA podiatrist anytime soon. Nothing urgent, just needs a new pair of custom foot orthotics, his old ones were wearing out. Great, finally the VA refers me something that reimburses good. Not so fast. He just needed me to sign off on forms to be faxed back to the VA so he could then be referred to a prosthetist to make the orthotics. WTF was he even doing with me then? Why TF couldn't his PCP at the VA sign the form? Why TF couldn't he wait however many months it takes for a VA podiatrist appt to sign the damn form?

 

[Sendin_Toes_2market]

This isn't a disability story but a paperwork story and also a "VA doctors are fat and lazy and overpaid and possibly have erectile dysfunction" story.

Veteran comes to my office, Sent from the VA because he couldn't see a VA podiatrist anytime soon. Nothing urgent, just needs a new pair of custom foot orthotics, his old ones were wearing out. Great, finally the VA refers me something that reimburses good. Not so fast. He just needed me to sign off on forms to be faxed back to the VA so he could then be referred to a prosthetist to make the orthotics. WTF was he even doing with me then? Why TF couldn't his PCP at the VA sign the form? Why TF couldn't he wait however many months it takes for a VA podiatrist appt to sign the damn form?

My local pod does this.

What is the protocol for when patients don't fit into a protocol?

I had one lady who wanted a gradual RTW. After being out 3 months, she wanted to return 20 hours/week for no more than 6 hours/shift. I hate when patients have these excruciatingly specific requests. I could farm it out to my MA but any mistakes and the pt is taking it up with me.

Also I had a different patient recently who had a hammertoe arthroplasty. Youngish guy, say late 20s. After 2 months out of work, he came to me with his parents and his mother indignantly pointed remarked that "whoever filled this form out marked that this was not a work related injury." I told her, no it wasn't, it was an elective hammertoe. She said according to whatever she pulled up on google, a hammertoe could be considered a work related injury if his work aggravated the pain he was having, and that he should be collecting workman's comp in addition to short term disability. Annoyed, I responded that workman's comp is for when you lacerate your hand on a saw or fall off a ladder and injure your neck, not for hammertoes. I then told her I wasn't going to commit perjury just so they could get more free money.

I swear, those hammertoe arthroplasties have some serious surgical morbidity!

The only time i fix hammertoes is distal ulcers or overriding toes. No reward for them.

New patient with plantar fasciitis
Someone else already operated on her
Someone else already extended her FMLA and also work disability so she can sit 80% of the time

First time seeing her.
She wants the same accommodations.
Brought the paperwork with her for me to fill out.

Its ridiculous.

Don’t fill it out until they bring you notes and a letter from the doctor why they didnt do it, so you can extend it. 8/10 they never come back.

 

[Adam Smasher]

Latest inane question from disability form:

"Please list things the patient CANNOT do:"
-unable to stand/walk extended durations in closed toe shoes
"Please list things the patient SHOULD NOT do:"
-juggle chainsaws

 

[heybrother]

Latest inane question from disability form:

"Please list things the patient CANNOT do:"
-unable to stand/walk extended durations in closed toe shoes
"Please list things the patient SHOULD NOT do:"
-juggle chainsaws

You really earned your $25 there 🙂

 

[Bluecollarmed]

Just had a patient come in asking for accommodations at work. She said she was supposed to be in a 50/50 seated standing position but has been mostly standing. She's also like 400lbs but miraculously didn't have pain on exam. Well the form wasn't completed quick enough per her liking (during the visit) and she sent a nice little mychart message stating she drove x distance and it's unacceptable etc... I just laugh at these. You're welcome for filling out a form stating "anti fatigue mat where applicable and more seated work throughout the day as can be accommodated". We had an ortho doc that used to love the term "vocational retraining" aka find a new job!