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]

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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