7+ Year Member
- Apr 26, 2015
- Reaction score
This thread has been very informative! Thank you all!
You guys are killing this thread. @Creflo has no need to defend himself to anyone on this forum and none of us has any right to demand explanations from him. Offering advice is one thing, but demanding explanations on an internet forum like this is just ludicrous. This thread has been very popular and beneficial, and let's try to keep it headed in a positive direction
Creflo, please continue updating us. I appreciate reading about your travails.
Questions and concerns that could potentially harm a colleague should probably be via private message. That's what I would want.
My MCAT results are due next Tuesday. I joke with people that if it is too low I'm pretty sure I can line up a sweet gig at the local Burger King. Now I'm wondering if I need to line that gig up even if my MCAT is reasonable. You know, supplemental income for car payments and such......So my car is about 9 years old, American made, something's always breaking on it. The last issue was the trunk stopped opening. I was able to fix with a drill and a $3 switch from the hardware store. Then this week the car stopped shifting into reverse. So at my day job yesterday I'm doing an ORIF, and when I'm done I have to physically push my car out of the parking place at the surgery center. It was nice that my screw and plate rep was leaving at the same time, he helped me push the car out. I noticed afterwards he got into his new Lexus, it pulled out just fine.
You are definitely inspiring me to not work for the government.So my car is about 9 years old, American made, something's always breaking on it. The last issue was the trunk stopped opening. I was able to fix with a drill and a $3 switch from the hardware store. Then this week the car stopped shifting into reverse. So at my day job yesterday I'm doing an ORIF, and when I'm done I have to physically push my car out of the parking place at the surgery center. It was nice that my screw and plate rep was leaving at the same time, he helped me push the car out. I noticed afterwards he got into his new Lexus, it pulled out just fine.
You are definitely inspiring me to not work for the government.
Had to re-invoice one patient's family, but they paid. All accounts receivables are current. Saw some nursing home patients this week, one new one and some follow ups. Was offered a gig working on saturdays for a local podiatry group, not house calls. They would fill the day with patients, provide support staff and billing, and pay me 35 to 40%. I plan to stick with my own practice for now. I never heard anything about the ethics investigation at my government job, so asked my boss for clarification, will have a meeting next week with my boss and the next higher up boss.
They threw it on you on purpose because you did something they didn't like?? Or accidental??Haven't been posting lately, thanks for checking in. Practice is alive and well. Just this morning had a patient throw their milkshake on me. Got my lab coat pretty good and my scrubs, but my face and hair were spared. And it was the first patient of the day. Next time I'm gonna take her meal tray away before I treat her.
Sounds like my wife's electrical work in our house. She installed a light dimmer in a bedroom, and when you dim the light the room down the hall light comes on. Car got flooded in a storm, total loss. Got a used Kia soul and the ride is bumpy but it gets beat to death with house call driving, gets the job done. Just bought an airtouch x ray, so my 3 thousand dollar car is carrying a 25 thousand dollar x ray machine.Your car still working? Mines still kicking from back then as well. Past month all of the systems gradually turned off while I was driving. First it was the radio, then the electric, then the power steering, then the power brakes, then everything. Luckily I was at the top of a hill and I coasted it a quarter mile right into my driveway.
Needed a new alternator. After installation found that the automatic lights turning on would take the car out of cruise, drop it into 2nd gear and turn the brights on. Culprate ended up being some LEDs lights I installed back in 2014. Took them out and it works fine.
Sounds like my wife's electrical work in our house. She installed a light dimmer in a bedroom, and when you dim the light the room down the hall light comes on. Car got flooded in a storm, total loss. Got a used Kia soul and the ride is bumpy but it gets beat to death with house call driving, gets the job done. Just bought an airtouch x ray, so my 3 thousand dollar car is carrying a 25 thousand dollar x ray machine.
So you take that X ray machine from house to house??? I'm having a hard time even imagining practicing like this haha. Looks like you've been at it for about 4 years, so it must be working out. I'm looking forward to the updates.
Got a used Kia soul and the ride is bumpy but it gets beat to death with house call driving, gets the job done. Just bought an airtouch x ray, so my 3 thousand dollar car is carrying a 25 thousand dollar x ray machine.
I have privileges at only one hospital, about 2 miles down the street from where I live. But it's time consuming to go there. If something can be done in the home, I'll do it there.So you take that X ray machine from house to house??? I'm having a hard time even imagining practicing like this haha. Looks like you've been at it for about 4 years, so it must be working out. I'm looking forward to the updates.
Also it's probably good you don't drive a Mercedes--someone would probably break into it and steal your X ray machine. Kia Soul--thieves just walk on by without giving it another look...
Do you miss doing surgery at the hospitals? What kind of procedures do you do in people's homes? I mean, I sure wouldn't miss the post op visits...but I'm sure I would miss the OR.
they start all podiatrists with this level of contract in my state
Blue Cross called yesterday, said they wanted to offer me a contract. How much does it pay, I asked. They responded in vague terms, something like 85% of 2010 Medicare allowable ranging to 66% of current Medicare rates. It was confusing, so I said to simplify I basically want to be paid what Medicare pays. They said no way, they start all podiatrists with this level of contract in my state, there is no way around it, that I can negotiate for higher rates in the future. I said thanks for calling but no thanks...
How long does it take to join an IPA. What is the process like
How long does it take to join an IPA. What is the process like
Big names in podiatry like Paul Kesselman? My single malt scotch just exited my nose like a hurricane from laughter.So at this point I'm not at my goal of a full cash pay practice, but I have managed to keep insurance allowed at medicare only. I still see some cash pay patients, maybe 15% of the revenue. So 2 weeks ago I received my first medicare audit, from a RAC (recovery audit contractor). It's a DME audit. I hear they work on commission, and that the reviewer is not a doctor. This is not a surprise as I have read that DME is heavily audited, so I have been meticulous with my notes. The audit is for one claim only, but I went ahead and turned it in to my malpractice carrier. I've always been a little bit nervous about administrative defense coverage with any carrier other than PICA. I tried to get PICA a few years ago and the agent blew me off. I never understood why, perhaps its because I do house calls. But it always made me wonder why they would advertise so heavily to podiatrists and then not be open to quoting me. In my state its administered by a contractor I believe, so that may be the problem. Anyway, I turned in the claim, and when the adjuster called, I asked him if I would be able to use the big names in podiatry for this type of stuff, like attorney Kevin West, or podiatrist Paul Kesselman. His response was that they use an attorney in my state that does all of these claims for them, and I asked is he podiatry specific, and he said "no, but there is a lot of overlap between podiatry and other medical specialties." That scares me, but at this stage its only for one claim, so I'll see how it goes. The attorney called me, said to forward my note to him, and sent me a contract to sign. He said the auditor will audit me one more time for more claims if I pass this one, and if I pass the second one they will lay off me for a while. He said he will not hire a coding expert on this one since it's only for one claim. Again, scares me because its vitally important to pass the first one. So I called my DME supplier who agreed to have one of their coding experts review the chart. Upon review, the expect said it looks good, but I made one typo for a small dollar portion of the claim, about twenty dollars. He said that he has seen notes that are 99% pefect fail, and he has seen bad notes pass, so he can't predict how I will fare. I emailed the lawyer 4 days ago to ask him how this may play out, if they would make a big deal over the twenty dollars, and he has not responded.
Then a week later I received a targeted probe audit from medicare, for toenail and callus codes. So I start inquiring with my malpractice insurance agent, and anyone else I can ask who may have a valued opinion, if I start turning in these claims will my malpractice premium go up due to claims frequency. The consensus is go ahead and turn it in, so that is what I did. I'm starting to feel like meat on a hook in a tiger cage with the audits and the trial lawyers on about half of the billboards in town, with their ads on TV constantly.
So I turn in the probe audit to my carrier, and call the nurse who will be handling the audit. She sends me an email with educational information about how to chart for toenails and calluses. First I wonder why nobody in podiatry school or residency has ever gotten their hands on this and distributed it to us and said "your survival depends on this." (I know the information, but I had to dig for it) Then I read through it, and I find a few concerning things. First of all, it says chronic venous insufficiency will qualify the patient for at risk toenail and callus care. I know the LCD backwards and forwards for my state, and this is not the case. So my second thought is my auditor is sending me erroneous information and thus may not be truly qualified to perform the audit. I have read that often you have to appeal the audits as the early stages are done by auditors that may not fully understand the LCD's. It says to call the auditor to acknowledge receipt of the audit. I call, she is very nice. I say I'm concerned and will give her whatever she needs and to let me know if she needs anything along the way. She says don't worry most people do fine and it will only result in education to help me. I ask her preferred method of submission. I see on the audit that it is for a time period of the prior year, but she says it is a prepayment audit and that claims will be put on hold, then they will request the chart, then if it passes they will pay, and at the end she will provide me education on anything I missed. I ask to clarify is this for claims from the last year, or claims going forward, and she gets a little defensive and doesn't really answer the question. I quickly back off and say thank you, for fear of rubbing my auditor the wrong way.
I have always wondered why at our podiatry education seminars, in podiatry school, and in residency we don't focus more on audit survival. To me this is one of the most important things we should be aware of. In my residency they taught us to fear medicare big time, and since then I have spent a ton of time and money trying to be prepared. I stand out from the typical podiatrist because I see only about 10-12 patients per day. I spend more than average time with each, and very often I use a 25 modifier as I treat more than just nails and calluses. At least in my case they more often than not have other pathologies at the same time, such as tinea, maceration, skin lesions for biopsy, ulcers, etc. It would be malpractice to ignore these things, yet if you treat them you have a target on your back with medicare. As I understand it Medicare keeps records of how my billing and coding differs from others in my specialty, and if I am an outlier, they don't like it. Since I know this, I chart with photos and extensive documentation, and keep money on the side to defend myself when they come.
I attended a seminar recently where Allen Jacobs encouraged us to not fear the "medicare police" and be real doctors, and treat more than just toenails and calluses. For me he's preaching to the choir, but medicare doesn't like it...
I see no relevance to your comments. It’s later afternoon SOMEWHERE.It's not even 8am! Oh wait, you're three hours ahead...