They go after plenty of crooks also....I did not pass the DME audit...
...They aren't auditing for dishonesty, they are auditing for money, it's a game. Fortunately I passed another DME audit, so I've passed 2 out of 3. If you think they only go after crooks, you are mistaken. They will come after hard working, honest, legitimate podiatrists who are providing a needed service to patients, with good documentation, even if they can find a single deficiency in the note to ding you on. ...
Either going to love him or hate him. He makes a lot of good points and you wont go net negative following what he says.He is far from a 'financial guru.'
You have obviously rendered much more efficient care. The boot was unnecessary. While foreign bodies can at times be difficult to remove you've done good work getting it out without running up the bill in a surgery center. The ED is going to give that patient a bill for thousands of dollars.So I get a call from an ED friend on Saturday. He texts me a photo of a toe with a needle embedded. I say I can meet the patient in the office in 3 hours. Patient has HMO, I say will be self pay, I'll take it out for $500. Patient says ok, shows up at my office with new shiny fracture boot with orthopedic clinic logo on front. I ask him why he is wearing a fracture boot, he goes no to tell how much he has been through to this point to try to get the needle out. First he went to urgent care, he was given Doxycycline. Then he went to a local orthopedic clinic, they "made" him buy the fracture boot. They want to take him to surgery center to remove the needle, are "waiting on referral." Then he goes to ED. At this point he says he is tired of going to all the doctors and just wants it out and is willing to pay. I figure I saved somebody around 10 grand by numbing his toe and removing the needle in my office, no referrals, no anesthesiologists, no scheduling delays, etc.
The DME auditor sends another audit, this one for an AFO. I've dispensed a total of one AFO through DME, ever. That's a 100% audit rate on AFO's.
Reading this reminded me of this post. Small sample size, but sounds rough out there.You have obviously rendered much more efficient care. The boot was unnecessary. While foreign bodies can at times be difficult to remove you've done good work getting it out without running up the bill in a surgery center. The ED is going to give that patient a bill for thousands of dollars.
So here's my weird final issue for you. EVERYONE got paid - except you. $500 is real money. We should question how much our services are worth, are we offering good value. How much should a family should have to pay for a small procedure performed in an office? I made a sheet of all the foreign body codes awhile back to help keep track of the descriptions of each code. I also included the Medicare fee schedule values from a few years ago. Obviously there's some flexibility based on which code was selected and the difficulty of the procedure. That said - my rough calculation is you charged this patient less than you would have been paid by BCBS PPO in my area. BCBS commercial plans are probably more fair/reasonable than a lot of other insurances. We win on some codes. We probably lose on others if there's a lot of follow-up. I probably wouldn't fret something like this if you were just knocking out $500 procedures all day in a low overhead. That said, cash pay patients are one of the few opportunities for a physician to actually ask a patient for what they believe the service is worth and I say all of this as a person who probably needs to increase their cash fee schedule again for certain codes. That said, I think there's room to increase your pricing by potentially 20-50%.
My suspicion is you somewhat have your own system of morals/honor concerning what is right / fair for how to treat patients. You probably aren't one of those people listing 20550 as $800 like I saw when a "amnio injection" company sent me someone's EOB. Your idea of fair is probably somewhat "sticky" to what Medicare charges. Here's my problem for you - 10-15 years ago Medicare paid $200ish for a 11750. Medicare paid like over $80 for every foot injection (its like $50 now). When you figure out the overhead and expenses of your practice - do you factor in getting audited for trying to write an AFO? Do you factor in your plural audits for wound care products? At some point what insurance and Medicare pay for our services have no reflection at all on the cost of doing business. Right now United is paying me sub-Medicare locked to like 2018. Nothing, nothing I do for their patients is worth anything and they deny things left and right. The other day they denied the betamethasone in an injection. Meanwhile they want 8% more for their insurance premiums. Equipment pricing is increasing. Staff pricing is increasing. The impression I'm under is you accept Medicare and everything else is cash pay. You are in an ideal system to ask for what you need and the world is only getting more expensive. I think your post is somewhat a commentary on the ridiculousness of the system, but if our prices stay stagnant the rest of the world will just keep increasing in cost around them.
Jokingly, I'm worse than that person. I saw a VA job that interested me the other day and thought - boy will my 50% ownership clinic be surprised when I just show up one day and quit.Reading this reminded me of this post. Small sample size, but sounds rough out there.
Athena sucks so much. On every front its terrible.Jokingly, I'm worse than that person. I saw a VA job that interested me the other day and thought - boy will my 50% ownership clinic be surprised when I just show up one day and quit.
That said - that person does sound fairly depressed. I would describe myself merely as "weary of the things I can't change fast enough". I'd love to drop Athena who is massively jerking us around to the tune of tens of thousands of dollars. My partner refuses. My office manager claimed she'd reviewed our expenses, services, equipment pricing etc, but the other day I found 2 items we are massively overpaying for. The savings are likely to be thousands of dollars a year. I have no shortage of insurances I want to severe ties with. I'm reading about in office MIS - I hope Feli doesn't see this.
That said - let's say I drove my visit values up. Added new profitable services. I will say - I'm still drowning in notes. Not sure how to solve that problem. I suppose if I added more profitable services I could decrease visits to offer them but we'll see!
Final funny thought. I flatter myself that no one else in town is very dynamic. Its true. Many also have terrible personalities. That said - nothing I'm offering is new. I can't imagine what it would be like trying to compete in a big city.
Yep. They are awful. Blows my mind when they adjust claims down to zero where the patient owes us the full amount. Or where they misread the EOB and wipe-out the copay the pay owes us. I've said this before - I have an insurance that pays 165% of the Medicare non-facility value. Athena kept deleting $60 copays and writing down our payment so that $90 injections became $30 or $124 99213s become $64. Billing Medicare for DME with them is a nightmare.Athena sucks so much. On every front its terrible.
So - how much should billing + EHR cost. That's something I'd love for someone to talk about.This can be said of at least a half dozen common plans
. I can't imagine what it would be like trying to compete in a big city.
I pay 5% of collections (insurance, not OTC obviously) to the billing company.So - how much should billing + EHR cost. That's something I'd love for someone to talk about.
In my area - Athena was letting new MDs join for 5% of collections. Where I'm sitting, that seems like enormous savings, but its interesting that for a group with high enough collections - having your own biller/coder will set a finite ceiling on your billing costs ie. 4% of millions vs just paying $50K for a coder is an easy win.
Interesting. We would be tens of thousands ahead with this arrangement though it would be fascinating to find a way to fix these prices at a set amount.I pay 5% of collections (insurance, not OTC obviously) to the billing company.
I interviewed a few, and this one had great references from other specialty surgeons (ophtho, plastics, pedi spec surg, retired DPM, etc). I'm probably their lowest earner, but they seem fine taking care of me too. Credential is $100/hr, but they got me on all meaningful plans very fast, getting me onto remaining crap straggler plans that I don't want but get appts with occasionally, and I sometimes get ACH paid for surgery or office pts in 3days or not much longer than that. They will also help the front desk by email or phone with prior auth tips, work comp, etc and are pretty responsive. I would say I'm way above avg for DPM for coding, but I've learned a few new things already. I'm not sure it gets much better than that. I don't have the physical space or volume or desire to ever do in-house billing... but it works for some ppl or bigger groups.
Kareo is about $650/mo w tax (EHR + billing/sched side) after 2 or 3mo free.
I could probably pay less (for both billing and EMR), but I have seen too many garbage EMRs over my various jobs. The EMR and its lag and difficulty - or lack thereof - is key to your efficiency. I wanted one that's pretty easy to learn. The staff like it and picked it up fast, I had liked it before, makes one or 2pg notes easy to read and easy to send to PCPs, biller recommended considering it. It can get your payments to post right from payers into pt account, it sends appt reminders, it sends pt statements for biller (free email, like 85c for mailed), ppl can pay through the website. I have used AdvancedMD (crap, much lag/crash) and eClinical Works (meh... long notes that look weird) and Epic (good, but very expensive for solo) and govt IHS/VA (average) and many others before. Kareo's not perfect, but it works well overall.
We switched to Athena at the MSG.This can be said of at least a half dozen common plans