Fraud

[ExperiencedDPM]

I was recently hired as a consultant to review claims for services provided by about 2 dozen DPMs. The fraud and the abuse are staggering.

Most of those involved are young associates in private practices. The practice owners impressed these associates with how much money they can make if they bill as instructed.

I have reviewed cases for an initial visit with unilateral heel pain. The patient ended up with BILATERAL xrays, ultrasound and fluoroscopy all for “comparison”. Patients received an injection, orthoses, 5 PT modalities (all require 15 min treatment but the visit was 20 min), a night splint, strapping and Cam Walker. The bill was several thousand dollars.

The next case, a doc cuts the nails and bills 11755 (nail biopsy) 10 times. Cutting a piece of nail and sending it away isn’t a biopsy.

Doctors unbundling one surgery into 10 codes. Doctors billing 8 codes for one hammertoe.

These are all young docs who have to pay back big money, will be kicked off the insurance panel and will be sanctioned and possibly lose their licenses.

The repeating theme is that they were all “taught” to do this by their residency directors or bosses.

These docs were bringing in BIG bucks for this fraud and as a result they put them self on the radar and got nabbed. And of course the boss and residency director was no where to be seen when it came to helping.

Do NOT admire your director or boss because he or she is raking it in by billing fraudulently.

Do NOT think you’ll get away with it.

Do NOT stay in any job that operates this way.

The insurers are smart and with newer computer programs they are going after this big time. I made a lot of money reviewing these cases and I’ve been completely embarrassed that the fraud is so gross, it can not be defended as much as I tried.

Be smart, be honest do NOT follow the money.

---

Members don't see this ad.

 

[Utvolsdpm]

That’s why I would stay far away from any associate job unless you personally knew the individual hiring really well before any type of agreement. You just don’t know what you’re getting in to.
When I was a new grad I interviewed for an associate position that sounded decent. I ended up passing on the opportunity. Something just didn’t feel right and I was looking for a better job anyway, so I passed. My friends brother (another new grad) took the job though and ended up relocating to work there. Not long after starting the owner was telling this new grad to do things that were clearly fraudulent. If he didn’t do as instructed he was threatened with termination. Well luckily he was strong and left as soon as possible. About a year later the owner was hit with Medicare fraud charges. The owner moved towns and worked for a year or two waiting for his case, but he eventually had to shut down and permanently lost his license. Avoided jail time somehow.
It ended up he had been committing fraud for years. It has to be so hard to be a new grad fresh out of residency, in a new town, just signed a lease or bought a house and this person that’s supposed to be guiding you a bit is actually sabotaging you, potentially ruining your life. Some things are just out right fraud. Other things they may present as “tricks” that you learn along the way. And it must be ok since they’ve been doing it for years without any problems right?
It sucks for our profession, but I would really never recommend working for another podiatrist, especially those in the classified listings or those that you don’t know very well beforehand.

 

[pod18]

Healthcare Business

The Business of Healthcare in North Texas

healthcare.dmagazine.com

Speaking of healthcare fraud, I didn’t happen to see the article above mentioned in PMNews (I could have missed it though, not an avid reader).

Pretty sure the podiatrist mentioned in the article was just elected to the ACFAS board of directors last year. Mysteriously not listed on the ACFAS website as a director any longer. And these are our “leaders”...

 

[DYK343]

It's kind of scary we (MD/DO too) dont get any training in billing but could go to jail over it. Graduating residency all I had was the ACFAS billing and coding course under my belt and some things I picked up in clinic from various attendings.

The CPT code book is not always clear on what to bill. I often can not find the right code and have to find one that "works"

I took the billing and coding course but it seemed like they were stretching what could be billed too much. Ex: "Document hypermobile 1st tarsal metatarsal joint for midfoot fusion then bill silver bunionectomy with it instead of lapidus"

Honestly... I could see it moving towards 100% of elective cases requiring prior auth where we upload x-rays and physical exams for physician to physician consult with the insurance company and agree on appropriate procedures before surgery. 10 years. I give it 10 years. Its going to suck.

Side note...Patient walked out on me today because I told her she was not a candidate for insurance covered diabetic shoes. Man was she pissed because another doctor gave them to her in the past. I'm sure I'll get in trouble by my manager and a negative review over that one.

 

[JewOnThis]

Podiatry- the blind leading the blind.

 

[DYK343]

Podiatry- the blind leading the blind.

It's not only podiatry..... This is medicine in general.

 

[PeaJay]

It's kind of scary we (MD/DO too) dont get any training in billing but could go to jail over it. Graduating residency all I had was the ACFAS billing and coding course under my belt and some things I picked up in clinic from various attendings.

The CPT code book is not always clear on what to bill. I often can not find the right code and have to find one that "works"

I took the billing and coding course but it seemed like they were stretching what could be billed too much. Ex: "Document hypermobile 1st tarsal metatarsal joint for midfoot fusion then bill silver bunionectomy with it instead of lapidus"

Honestly... I could see it moving towards 100% of elective cases requiring prior auth where we upload x-rays and physical exams for physician to physician consult with the insurance company and agree on appropriate procedures before surgery. 10 years. I give it 10 years. Its going to suck.

Side note...Patient walked out on me today because I told her she was not a candidate for insurance covered diabetic shoes. Man was she pissed because another doctor gave them to her in the past. I'm sure I'll get in trouble by my manager and a negative review over that one.

The days of fraudulent surgeons calling a styloid fracture a Jones and then fixing it for the 58yo obese athlete will soon be over.

 

[king22]

Honestly... I could see it moving towards 100% of elective cases requiring prior auth where we upload x-rays and physical exams for physician to physician consult with the insurance company and agree on appropriate procedures before surgery. 10 years. I give it 10 years. Its going to suck.

There's a limit to how involved an insurance company will get it. If they start "choosing" which procedure is appropriate they will inevitably find themselves tangled in medical mal cases.

I do agree however billing/coding training is lacking. IMO, no one is really an "expert" in billing/coding; not even insurers or Medicare itself. They don't even know their own rules half the time. We all operate under what's essentially a "grey zone".

 

[AttackNME]

@ExperiencedDPM thanks for sharing, so those examples I’m not surprised they got nailed for that, but were there any subtle examples where you one might be surprised was caught? A common error some of us do without realizing it?

 

[ExperiencedDPM]

It's kind of scary we (MD/DO too) dont get any training in billing but could go to jail over it. Graduating residency all I had was the ACFAS billing and coding course under my belt and some things I picked up in clinic from various attendings.

The CPT code book is not always clear on what to bill. I often can not find the right code and have to find one that "works"

I took the billing and coding course but it seemed like they were stretching what could be billed too much. Ex: "Document hypermobile 1st tarsal metatarsal joint for midfoot fusion then bill silver bunionectomy with it instead of lapidus"

Honestly... I could see it moving towards 100% of elective cases requiring prior auth where we upload x-rays and physical exams for physician to physician consult with the insurance company and agree on appropriate procedures before surgery. 10 years. I give it 10 years. Its going to suck.

Side note...Patient walked out on me today because I told her she was not a candidate for insurance covered diabetic shoes. Man was she pissed because another doctor gave them to her in the past. I'm sure I'll get in trouble by my manager and a negative review over that one.

You are 100% correct regarding the inaccurate recommendations of many coding courses. Your comment regarding the Lapidus procedure is a prime example. The idea that you should bill the procedure as two separate procedures is complete bull****. Their claim is that you bill the 28740 for a “hyper mobile“ joint. However, Lapidis described the procedure for a hypermobile joint/unstable joint. And no matter how much they want to find a loophole, the bottom line is that the procedure performed IS a bunionectomy and a first metatarsal cuneiform arthrodesis. And there IS a single code that describes that exact procedure and it should be billed appropriately as ONE procedure. Interestingly, I received a memo regarding this issue last week from a company that I consult with and this exact scenario is now on their radar.

 

[GreenHousePub]

I was recently hired as a consultant to review claims for services provided by about 2 dozen DPMs. The fraud and the abuse are staggering.

How'd you get this gig? Seems like a good side job to have.

 

[DYK343]

I spent over an hour reviewing medical history of a patient in the ICU. Patient has been in the ICU for 21 days and has a complex history. I am consulted for surgical opinion. Discussed care on ICU rounds with all involved physicians and residents. Can I bill a 99291 critical care E&M?

 

[heybrother]

A few experiences:

#1 - I use a certain EHR. It has small templates built into it for procedures. The flexor tenotomy template is actually defaulted to a flexor tenotomy and capsulotomy. My experience is that the vast majority of these I have performed have been simply tenotomies without the need for a capsulotomy.

#2 - A certain hardware company frequently suggests to people billing a 1-joint midfoot fusion as a multi-midfoot fusion through the addition of an additional screw. Its such win for all involved after all. You are paid for a bigger procedure, the surgery center is receiving a bigger reimbursement, likely due to the presumption that more hardware would have been needed.

#3 - Unfortunately I've told a few people this story, but eh. Fancy dinner. Pitched this convoluted scheme. Here's the scheme in the correct order so you can tell what's happening. You exclusively use the hardware of a brand new company. You create an insurance company (which you have to pay for and pay for auditing, and what not) and then the hardware company will purchase from you esoteric insurance policies which they will never call on you to collect. Once the money sits in your insurance company long enough it acquires a tax favorable treatment and you can invest it and pay less in taxes on it and keep it. So essentially they are paying you through your insurance company for using their hardware. What does that sound like to you?

That's not how it was pitched though. They brought all the local podiatrists and the private practice orthopedists to a dinner. No one who was hospital employed was invited because they didn't want the hospitals to know about it (wonder why). You all are being screwed. We need to take back the power. You are going to start your own insurance company - it will be great. You'll buy nifty rare products from it at a tax advantaged rate? Healthcare? No, don't do that. You don't want to self-insure that. Tax benefits, tax benefits - you'll do great. Ok, we good. Time for part 2!

Also - we are starting a hardware company. You should use our hardware. We'll bring it at the next meeting but you'll need to sign a non-disclosure.

Rambling, Rambling, Rambling.

Super experience orthopedic surgeon: Why would I want to use your piece of s^&* hardware?

Weird outburst from one of the fancy guys in suits: Don't you get it?!?! The insurance policies that we buy from you that we don't call in allowing you to keep the money are paid for out of the hardware you use.

Kind of wish I'd been wearing a wire at that point but I don't think the authorities will have trouble figuring it out.

 

[GreenHousePub]

#2 - A certain hardware company frequently suggests to people billing a 1-joint midfoot fusion as a multi-midfoot fusion through the addition of an additional screw. Its such win for all involved after all. You are paid for a bigger procedure, the surgery center is receiving a bigger reimbursement, likely due to the presumption that more hardware would have been needed.

I know exactly which one you are talking about. When they suggested doing that to me that alarm bells immediately went off.

 

[DYK343]

The days of fraudulent surgeons calling a styloid fracture a Jones and then fixing it for the 58yo obese athlete will soon be over.

Those zone 1 fractures have shown to be problematic in my practice. pending displacement I still recommend conservative treatment but I've had quite a few treated conservatively for many weeks only to go onto fixation 12+ weeks out.

 

[ExperiencedDPM]

I know exactly which one you are talking about. When they suggested doing that to me that alarm bells immediately went off.

Don’t worry, they will get some of our esteemed colleagues to jump on board.

One of my buddies went to a seminar outside of Philly. There’s a DPM who lectured on the HyProCure. The guy was stupid enough to brag to the audience that he always bills 28585, ORIF of a talo tarsal dislocation!!! And apparently does a load of these and said he always gets paid. i assure you that if he was audited he’d be writing a big check back.

He practices in New Jersey. If anyone knows anyone there in the insurance industry or the OIG, message me and I’ll give you his name. Maybe you can win a whistle blower case.

 

[JewOnThis]

The days of fraudulent surgeons calling a styloid fracture a Jones and then fixing it for the 58yo obese athlete will soon be over.

Isn’t that what they teach all the upmc residents? Lol

 

[GreenHousePub]

Don’t worry, they will get some of our esteemed colleagues to jump on board.

One of my buddies went to a seminar outside of Philly. There’s a DPM who lectured on the HyProCure. The guy was stupid enough to brag to the audience that he always bills 28585, ORIF of a talo tarsal dislocation!!! And apparently does a load of these and said he always gets paid. i assure you that if he was audited he’d be writing a big check back.

He practices in New Jersey. If anyone knows anyone there in the insurance industry or the OIG, message me and I’ll give you his name. Maybe you can win a whistle blower case.

I forgot which one, but there is a Present lecture from maybe 6-7 years back where a guy says he bills all office visits for pes planus as tarso/talar dislocations. And he has been in practice for at least 30 years. I wonder if it's the same guy, it's around the right region lol.

 

[ExperiencedDPM]

I forgot which one, but there is a Present lecture from maybe 6-7 years back where a guy says he bills all office visits for pes planus as tarso/talar dislocations. And he has been in practice for at least 30 years. I wonder if it's the same guy, it's around the right region lol.

It is likely him. A true thief who found his little fraudulent niche to steal money from insurance companies.

 

[PeaJay]

Those zone 1 fractures have shown to be problematic in my practice. pending displacement I still recommend conservative treatment but I've had quite a few treated conservatively for many weeks only to go onto fixation 12+ weeks out.

If there is significant displacement of course there is an indication, but speaking in generalities zone one fractures heal reliably nonoperatively. Albeit sometimes slower than I would like. As far as I have read literature would support mainly conservative treatment. It just bothers me when they are labeled Jones fractures and then the surgery is falsely justified by poor blood flow.

 

[Pronation]

If there is significant displacement of course there is an indication, but speaking in generalities zone one fractures heal reliably nonoperatively. Albeit sometimes slower than I would like. As far as I have read literature would support mainly conservative treatment. It just bothers me when they are labeled Jones fractures and then the surgery is falsely justified by poor blood flow.

I find that these heal much better with 2-3 PRP injections and placement of custom made orthotics Into a CAM boot during the healing phase.

 

[G0dFather]

I have reviewed cases for an initial visit with unilateral heel pain. The patient ended up with BILATERAL xrays, ultrasound and fluoroscopy all for “comparison”. Patients received an injection, orthoses, 5 PT modalities (all require 15 min treatment but the visit was 20 min), a night splint, strapping and Cam Walker. The bill was several thousand dollars.

The next case, a doc cuts the nails and bills 11755 (nail biopsy) 10 times. Cutting a piece of nail and sending it away isn’t a biopsy.

Doctors unbundling one surgery into 10 codes. Doctors billing 8 codes for one hammertoe.

WOOOW!! ....if this is whats going on then i guess i could sleep well at night now not having to worry about a 99213 vs 99214 etc... this is crazy 11755 10X LOL

 

[air bud]

If there is significant displacement of course there is an indication, but speaking in generalities zone one fractures heal reliably nonoperatively. Albeit sometimes slower than I would like. As far as I have read literature would support mainly conservative treatment. It just bothers me when they are labeled Jones fractures and then the surgery is falsely justified by poor blood flow.

I find these heal just fine in a tall boot for 6 weeks, don't take off other than to shower for first 4. Works literally every time never fixed one. And then don't need to waste money on custom orthotics. Side note 99 percent of people are just fine with some OTC orthotics. Powersteps. A little cavus sure get some donjoy arch rival.

 

[DYK343]

I find these heal just fine in a tall boot for 6 weeks, don't take off other than to shower for first 4. Works literally every time never fixed one. And then don't need to waste money on custom orthotics. Side note 99 percent of people are just fine with some OTC orthotics. Powersteps. A little cavus sure get some donjoy arch rival.

I see about 3-4 of these a week. Honestly, I have had a significant percentage of them not heal (30-40% is my best guess). Displaced or non displaced. Distal 5th met fractures always heal but these Zone 1 have really given me trouble.

There is a paper out there. Been awhile since I read it but it states somewhere around the lines of only 10% of people will actually wear the boot consistently.

 

[air bud]

I see about 3-4 of these a week. Honestly, I have had a significant percentage of them not heal (30-40% is my best guess). Displaced or non displaced. Distal 5th met fractures always heal but these Zone 1 have really given me trouble.

There is a paper out there. Been awhile since I read it but it states somewhere around the lines of only 10% of people will actually wear the boot consistently.

I think I have been lucky, I am pretty confident I have a higher compliance rate. Most of mine have been on older patients that actually listen to me. But yeah you obviously have a higher N than me.

 

[totalshoein]

Bringing the topic back to fraud, I have a question about the legitimacy of my clinic's billing practices. I work for a FQHC, and the PCPs send me ALL patients who need nail care, even if they do not have any neurovascular deficiencies. Sometimes the patients do not even have diabetes, and the only indication is that "patient cannot bend down" or "nail is too thick for patient to cut themselves." Providers do not do any billing themselves, so when I asked the billing department about this situation, they simply said that all visits are covered regardless of what is done. Knowing the Medicare and Medi-cal guidelines for nail debridement/trimming, it does not sit well with me to just cut everyone's nails. I am new to practice, so I'd really appreciate it if anyone can shed some light on this for me. Thanks in advance!

 

[dtrack22]

Have fun in jail...

 

[G0dFather]

Have fun in jail...

In all seriousness, how is this helpful to the poster who is in a predicament that many find themselves in ?

 

[dtrack22]

In all seriousness, how is this helpful to the poster who is in a predicament that many find themselves in ?

how is posting in an anonymous message board helpful when there are these people called attorneys who could actually give you accurate information?

not to mention the question says nothing about what is actually being billed by said billing department. There isn’t close to enough information for anyone to give this individual a great answer...Other than federal prison isn’t nearly as bad as San Quentin

I am here for my own entertainment

 

[totalshoein]

I was under the impression that this is a community where we could ask each other questions pertaining to our practice freely. Didn't realize I needed to consult a lawyer before posting.

The code billed is 11721 for patients with thick, dystrophic nails. Under Medicare guidelines, mycotic nails can be treated if it causes limited ambulation, pain, or secondary infection. So if I document pain in the subjective and thick, dystrophic, discolored nails in the objective, is that enough? And how often can this patient be seen for debridement?

My other issue is with patients who simply have long nails but are not diabetic and do not have other neurovascular deficiencies.. as I understand it, FQHC receives a preset amount of money for each visit, which is why the billing dept is probably telling me it doesn't matter what services I provide. They use
11719 code. Does this seem at least odd to anyone?

 

[DYK343]

You're going to have to talk to your FQHC medical director about your concerns. Medicare makes the laws and you have to follow them. If you dont you are liable. There is no way around it. The biller is not going to care because to them it is all the same but you really should because should you be convicted of fraud medicare will be asking for their money back and you could get jail time. Medicare is not going to care if its a universal reimbursement fee for being seen. If its not a covered service that you are routinely seeing patients back for and they find out... Game over.

Patients (and referring doctors) get upset. I have patients write negative reviews because I wont cut their nails. I've had PCPs send me nasty notes. But I'm really protecting myself. They can go elsewhere. Not worth the risk.

 

[CutsWithFury]

You're going to have to talk to your FQHC medical director about your concerns. Medicare makes the laws and you have to follow them. If you dont you are liable. There is no way around it. The biller is not going to care because to them it is all the same but you really should because should you be convicted of fraud medicare will be asking for their money back and you could get jail time. Medicare is not going to care if its a universal reimbursement fee for being seen. If its not a covered service that you are routinely seeing patients back for and they find out... Game over.

Patients (and referring doctors) get upset. I have patients write negative reviews because I wont cut their nails. I've had PCPs send me nasty notes. But I'm really protecting myself. They can go elsewhere. Not worth the risk.

I would totally tell the PCP to **** themselves. I’m in a MSG and tell all my PCPs I won’t see non diabetic toenails. They just get clever and refer them to me for “foot pain” or “ingrown toenail” instead. It’s a total game of cat and mouse and it’s all over toenails. Trying to reverse a precedent, set by old school podiatrists who fraudulently billed toenails in the community for 30 years and retired, is challenging.




Sent from my iPhone using SDN

 

[DYK343]

I would totally tell the PCP to **** themselves. I’m in a MSG and tell all my PCPs I won’t see non diabetic toenails. They just get clever and refer them to me for “foot pain” instead. It’s a total game of cat and mouse and it’s all over toenails. Trying to reverse a precedent, set by old school podiatrists who fraudulently billed toenails in the community for 30 years and retired, is challenging.




Sent from my iPhone using SDN

You know... I totally agree. I get the same thing. Usually mine say "infection urgent referral" for onychomycosis haha

 

[ExperiencedDPM]

Or you can simply grow some stones and realize that those chiropody days are gone and do what I decided. I do not cut, trim, debride, schnide or clip nails. It’s not part of my armamentarium.

I just can’t wrap my head around the idea that I’m supposed to “find” a legitimate diagnosis for the nail BS, to wait 8 weeks to get paid crap, while the nail salon has no chart or paperwork and gets paid cash on the spot.

No clippers or chippers in this guy’s tool box.

 

[air bud]

Or you can simply grow some stones and realize that those chiropody days are gone and do what I decided. I do not cut, trim, debride, schnide or clip nails. It’s not part of my armamentarium.

I just can’t wrap my head around the idea that I’m supposed to “find” a legitimate diagnosis for the nail BS, to wait 8 weeks to get paid crap, while the nail salon has no chart or paperwork and gets paid cash on the spot.

No clippers or chippers in this guy’s tool box.

What about nippers?

 

[JewOnThis]

Bringing the topic back to fraud, I have a question about the legitimacy of my clinic's billing practices. I work for a FQHC, and the PCPs send me ALL patients who need nail care, even if they do not have any neurovascular deficiencies. Sometimes the patients do not even have diabetes, and the only indication is that "patient cannot bend down" or "nail is too thick for patient to cut themselves." Providers do not do any billing themselves, so when I asked the billing department about this situation, they simply said that all visits are covered regardless of what is done. Knowing the Medicare and Medi-cal guidelines for nail debridement/trimming, it does not sit well with me to just cut everyone's nails. I am new to practice, so I'd really appreciate it if anyone can shed some light on this for me. Thanks in advance!

You have a couple of options on how to approach this:

1) keep your mouth shut and have a job
2) open your mouth and not have a job

 

[DYK343]

Or you can simply grow some stones and realize that those chiropody days are gone and do what I decided. I do not cut, trim, debride, schnide or clip nails. It’s not part of my armamentarium.

I just can’t wrap my head around the idea that I’m supposed to “find” a legitimate diagnosis for the nail BS, to wait 8 weeks to get paid crap, while the nail salon has no chart or paperwork and gets paid cash on the spot.

No clippers or chippers in this guy’s tool box.

I want to ditch diabetic care so bad. I envy you...

 

[DYK343]

You have a couple of options on how to approach this:

1) keep your mouth shut and have a job
2) open your mouth and not have a job

Fired for not committing fraud? Hire a lawyer. Any will do...

 

[dtrack22]

Fired for not committing fraud? Hire a lawyer. Any will do...

or don’t hire a lawyer and ask SDN...

even though the “community” has yet to tell the poster anything concrete about the legality of his/her situation other than (the best response so far) to speak with the medical director about these concerns.

Fine, no more jokes or cranky responses from me. The community can and should continue to handle this one

 

[king22]

Or you can simply grow some stones and realize that those chiropody days are gone and do what I decided. I do not cut, trim, debride, schnide or clip nails. It’s not part of my armamentarium.

I just can’t wrap my head around the idea that I’m supposed to “find” a legitimate diagnosis for the nail BS, to wait 8 weeks to get paid crap, while the nail salon has no chart or paperwork and gets paid cash on the spot.

No clippers or chippers in this guy’s tool box.

Paid crap? Medicare pays in my geographic location around $55 for a 11721, and around $42 for a 11720. Most private payers will pay between $50-60 for a level 3 subsequent visit. I can do around 6 "nail" patient's in an hour. Yes, it's mindless a times, but it's not a bad revenue generator for the effort expended

 

[dtrack22]

Paid crap? Medicare pays in my geographic location around $55 for a 11721, and around $42 for a 11720. Most private payers will pay between $50-60 for a level 3 subsequent visit. I can do around 6 "nail" patient's in an hour. Yes, it's mindless a times, but it's not a bad revenue generator for the effort expended

Medicare is very rigid/formulaic. If your conversion factor and geographic rate allow for the fee schedule of 11721 to be $55, then Medicare should pay you over $80 for a level 3 office visit. That means, according to you, your commercial contracts have a fee schedule that is about 70% of Medicare?

what I’m trying to say is...

 

[king22]

Medicare is very rigid/formulaic. If your conversion factor and geographic rate allow for the fee schedule of 11721 to be $55, then Medicare should pay you over $80 for a level 3 office visit. That means, according to you, your commercial contracts have a fee schedule that is about 70% of Medicare?

what I’m trying to say is...

All my commercial payers, with the exception of BCBS (which pays 131%), pay far below Medicare. Just FYI, the only reason BCBS rates are so high is thanks to the IPA i belong too. Here is a general breakdown for my major payers


99213
Medicare- $87
UHC- $58
Aetna- $57 (used to be $59 until 2014 when they dropped it)
Oxford-$52
Cigna- $55
BCBS- $111
Magnacare- $35
GHI- $40

 

[dtrack22]

All my commercial payers, with the exception of BCBS (which pays 131%), pay far below Medicare. Just FYI, the only reason BCBS rates are so high is thanks to the IPA i belong too. Here is a general breakdown for my major payers


99213
Medicare- $87
UHC- $58
Aetna- $57 (used to be $59 until 2014 when they dropped it)
Oxford-$52
Cigna- $55
BCBS- $111
Magnacare- $35
GHI- $40

you are in an IPA with other physicians who all agreed to take 66% of Medicare fee schedule from Aetna, Cigna, and UHC? And not each of those company’s Medicare advantage plan but their commercial PPOs? Again, I don’t believe you.

you could do better than that on your own as a solo podiatrist asking to join those networks.

 

[king22]

you are in an IPA with other physicians who all agreed to take 66% of Medicare fee schedule from Aetna, Cigna, and UHC? And not each of those company’s Medicare advantage plan but their commercial PPOs? Again, I don’t believe you.

you could do better than that on your own as a solo podiatrist asking to join those networks.

The IPA really only helped with BCBS. Supposedly we are supposed to see an increase of 40% across the board for Aetna Commercial plans (NOT MA plans) sometime this year. Even still, the majority of my Aetna patients are Aetna MA which will end up keeping the same crappy schedule. I also think it did slightly help with my UHC reimbursements since I used to be paid $51 as individual and it jumped to about $58

 

[king22]

you are in an IPA with other physicians who all agreed to take 66% of Medicare fee schedule from Aetna, Cigna, and UHC? And not each of those company’s Medicare advantage plan but their commercial PPOs? Again, I don’t believe you.

you could do better than that on your own as a solo podiatrist asking to join those networks.

Here's a copy of one of my fee schedules. Long story short, 70% of Medicare would be an upgrade

 

[JewOnThis]

Fired for not committing fraud? Hire a lawyer. Any will do...

they just need one reason or in some states no reason to let him/her go.

there Are a ton of pods waiting for that vacant spot.

 

[DYK343]

I can do around 6 "nail" patient's in an hour.

This would kill me.

Today I did more nail care than I have done any day in practice since being on my own. At least 15 patients came in today for nail debridements. Most of which were BS referals that I had to be nice and tell them ill do it just once and I cant bill for it so I wont do it in the future (thats the best approach I have found to not get a negative review...). It was an extremely unrewarding day.


And dont get me started on patients wanting me to remove their calcaneal spur because their PCP told them it needed done.... If I hear that crap one more time...

 

[king22]

This would kill me.

Today I did more nail care than I have done any day in practice since being on my own. At least 15 patients came in today for nail debridements. Most of which were BS referals that I had to be nice and tell them ill do it just once and I cant bill for it so I wont do it in the future (thats the best approach I have found to not get a negative review...). It was an extremely unrewarding day.


And dont get me started on patients wanting me to remove their calcaneal spur because their PCP told them it needed done.... If I hear that crap one more time...

My hand does hurt after awhile lol. My average day at the office I do see around 30-40 patients of which about half are usually routine care. I'm lucky that I don't usually get "BS" nail care referrals. Most of them are quite legitimate (class findings, DM w/ neuropathy, severely dystrophic, etc).

 

[G0dFather]

This would kill me.

Today I did more nail care than I have done any day in practice since being on my own. At least 15 patients came in today for nail debridements. Most of which were BS referals that I had to be nice and tell them ill do it just once and I cant bill for it so I wont do it in the future (thats the best approach I have found to not get a negative review...). It was an extremely unrewarding day.


And dont get me started on patients wanting me to remove their calcaneal spur because their PCP told them it needed done.... If I hear that crap one more time...

The overwhelming majority of PODs do routine foot care.... it's part of being a podiatrist, if you look at the top 10 billed codes in podiatry all across the country the majority if them have something to do with a nail ... 28285 comes in at like number 25 and that is the first real surgical code encountered on that list, so much for foot and ankle surgeons .... not wanting to do RFC as a podiatrist is like trying to avoid seeing kids as a pediatrician lol or not wanting to examine the prostate as a proctologist..... RFC is integral to our profession and is very lucrative to boot I will never understand why podiatrists always try to avoid it .... yet the stats speak a different tone .... I will never forget when Medicare unmasked can online back in 2012 to 2015 and exposed people... all these so called self proclaimed surgical gurus and acfas folks all appeared to be billing RFC yet they always flaunted otherwise

 

[DYK343]

The overwhelming majority of PODs do routine foot care.... it's part of being a podiatrist, if you look at the top 10 billed codes in podiatry all across the country the majority if them have something to do with a nail ... 28285 comes in at like number 25 and that is the first real surgical code encountered on that list, so much for foot and ankle surgeons .... not wanting to do RFC as a podiatrist is like trying to avoid seeing kids as a pediatrician lol or not wanting to examine the prostate as a proctologist..... RFC is integral to our profession and is very lucrative to boot I will never understand why podiatrists always try to avoid it .... yet the stats speak a different tone .... I will never forget when Medicare unmasked can online back in 2012 to 2015 and exposed people... all these so called self proclaimed surgical gurus and acfas folks all appeared to be billing RFC yet they always flaunted otherwise

There is nothing more disgusting than breathing in nail dust all day.

I dont do much of it it. It opens up appointments for more interesting pathology. I get a lot of trauma/sprains/bumps/lumps/bunions/etc, etc because they didnt want to wait 6 weeks for the guy up the road to burn thru his booked out schedule of nail fungus. To each their own.

And honestly, I dont mind it for patients who truly need it. But my situation is I get a ton of referrals that simply do not qualify for nail care. I can forge it and "make them eligible" but Im not willing to commit fraud. That's the bottom line, at least in my practice location/situation.