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About NeoTrion

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  1. I wanted to ask some of you billing gurus on a subject. So up until recently we were billing incident to and I did bring up the fact that we should not be doing this. On a number of occasions, they were billing this even when the physician was not in the building. Upon further reading it also appears that in order to bill incident to that the MD must see the patient for the initial visit. Our practice is a single MD and he does not see new patients except for a rare occasion (10 a year). I brought this up to our practice manager with an article from CMS stating this and she stated that there was a loop hole somewhere. After about 1.5 months she finally admitted in a meeting that we could definitely not bill incident to when our MD is out of clinic. She is now telling us that we can use direct billing for the initial visit and then incident to for the billing thereafter. According to CMS to bill incident to at all the new patient has to have their initial visit completed by the MD. She states that she talked to a “billing expert” and this is not the case. She once again stated that we can do direct billing for the initial visit and incident to on the follow up visit. Can someone direct me to someone in Medicare I can talk with in order to confirm or permanently correct her? I am also open to education on the forum here if things have changed. My MD is a good man but has gotten bad advice in the past on billing. She did admit that she missed some of the incident to rules on her watch, but she also holds herself to be a billing professional as well. Any information would be greatly appreciated as I do not think we can bill through the MD based on incident to guidelines per Medicare. I do not mind fighting with her on this but I want some data and opinions on this before I go digging a trench for myself.
  2. Rev Ronin, that is what I was thinking as well. The closest I can find to a "no that it can't be done" is a recommendation for a committee. Thus far I have not been able to get anyone to call me back on this that is on these committees or on the various medical boards. In fairness COVID may be causing some of this communication difficulty.
  3. Thank you for the comments. Unfortunately Appriss is the one that keeps track of our inquiries and I have found that they do not always log the inquiry. We have showed them proof of this and initially they blew me off. After about two weeks the reopened the ticket I initially opened (that they closed the same day) and stated there was a "known issue." Naturally if I am in pain management and I relying on them to cover my butt with the state, this does make a me a little nervous when relying on them to log my inquiries. I also like to have the actual report scanned into the EMR to prove what I put in the dictation. I have had several patients put in as a nick name or middle name when their name does not match what we wrote on their script or in the EMR. (Ex. real name is Leslie but they go by Dale on PMP, or names are shortened from Marylin to Mary, etc......). I have also had some pharmacies go in and edit the PMP or put the wrong drug/prescriber on the PMP. This was brought to the attention of the PMP advisory board to which the pharmacy board and Appriss did not want to take responsibility. So naturally I would rather make sure there is a copy in the EMR that cannot be changed. I would appreciate if anyone else knows if their state prohibits them from printing or scanning into the chart. Like some of you have said it does not make sense if you do not have this supporting documentation for your medical decision making. I was hoping some of you could say "yes I know we can't print or scan and this is why....."
  4. I was hoping to get some wisdom from some of you in different states. In Texas we are required to check the PDMP before prescribing any narcotics. I currently work in pain management and this is an issue, but has been seen as a necessary step. We have been trying to work with our EMR on seeing if we can save the PDMP into the EMR. The reason why we are doing this is that we have caught the database not updating/logging our searches. As you know if it is not documented it did not happen. We were advised by our professional society to make sure a copy is in the EMR to prove we did pull the report. This has cost us labor hours (to scan it back into the system) as well as paper cost to cover our butts. This is why we want our EMR to allow a save button so we can simply save and sign it to the chart. During a call with them they stated in some states that it is not legal to print the PDMP or save it to the chart. One example is Kansas and I cannot find any rule that says it cannot be printed or put in the chart, but that the advisory committee for K-Tracs (Kansas PDMP) recommends it not go in the chart. I am looking to see if some of us in other states know if this information is correct as it does not appear so in Kansas. I currently have a call out to K-Tracs but because of COVID they are saying it is taking them longer than usual to respond. Does everyone else just pull the report and hope it tracks your inquiry like it is suppose to? I think the information given by our EMR is not the total truth concerning saving and printing the PDMP, but I wanted to ask the brain trust here and see if what they are saying is true. Their argument is they need a product that can be sold in every state, even if it is at the expense of a needed feature in another state. PDMP print and save.xlsx
  5. I graduated from Lynchburg and felt the curriculum was great. Without seeing the other side of the coin (ATSU) I cannot really compare.
  6. Ventana you were exactly right in my case. Mercer was about 1/3rd from that of CM&F for the coverage I was interested in. Anyone have any other places they like?
  7. I was hoping to connect with someone on the legislative team for the West Virginia Association of Physician Assistants. I had some questions concerning the recent change in the collaborative agreement from supervisory agreement that was made recently. I would appreciate if someone could post or send me a pm so I could pick there brain.
  8. I graduated earlier this year and felt that the workload was appropriate. I did have to set aside specific time away from the family or from work to get things done. If you are disciplined enough to do that then you shouldn't have a problem.
  9. I did not like my eko. To much ambient noise. I still use my Littmann that I got 5+ years ago. It is showing its age and is missing a few buttons but works great. Not impressed with eko and only use it as a last resort when my electronic Littmann or cardiology STC can't be found.
  10. I would just pick up the phone and say "By the way did you see this?" I have done that in multiple specialties and it usually ends up with a pause on the phone. It doesn't matter to me if they think I am an arse. There have been times when I have called them and they put the blame on someone else and it was probable. I would want to know if I missed something but probably an issue of just trying to move on to the next patient and refer out.
  11. Arthropathy that is the stance I have taken and have pushed them to the SP. Neither myself or the other APPs I work with do not mind letting them see these patients as we have a full load of patients without them. I am just looking for someone that can point me to the law in Texas on this one. I remember learning about this in school years ago but wanted to ask the brain trust here if they can point me to it in writing. Personally I do not want to see them if trust cannot be built in the first place. I can always remember that you rarely get sued by friends and those that trust your judgement. Thank you for removing the apostrophe Medicine Power.
  12. So lately we have had some patient's request to see the MD only. That is honestly no skin off my back and I am happy to let the MD see these people. As I recall there is a law in Texas that says the patient has the right to see a MD if they request. Does anyone know where I can find the text to that law?
  13. Sounds like splash damage and you were hit by it. I would think more could be said, but perhaps they used the old "you can resign or we can fire you" bit. If you find out more it would be interesting to share. It would help others in the future that come against the same situation.
  14. We had the same problem at a hospital here in Texas. We had to get our state chapter involved and claim the restriction of trade. They were making this decision based on a nursing position statement that the Board of Nursing posted on the website. The admin, that was made up of all nurses with the exception of the legal counsel and the CMO, stated: "we have to protect our nurses." Our state chapter reached out to the medical board and basically pointed out that the nurses are deciding who can practice medicine in our state. That caused a meeting between the medical board and the nursing board, and hence that position statement was heavily edited. The nursing board now recognizes PAs. We then went back to the hospital admin that then tried to blame it on corporate. When the state chapter lawyers contacted corporate they had no idea what that hospital was talking about. Eventually, we were given parity with the NPs at that hospital. The nursing admin was not happy about that, and neither was the head of the medical privilege office which was run by an RN. The key was the help we got from our state chapter. I will say this little hospital in Texas was educated and credentialing from Baylor and MD Anderson considering PAs and NPs was shown to them on paper. I had the CMO and CNO say "that is them and this is our hospital." They did make it sound like their hospital was better than either Baylor or MD Anderson. Basically, they did not want to be educated The only thing they responded to was a legal counsel to legal counsel discussion. It is the main reason why I choose to get involved in the state chapter. The difference was that I was already on medical staff there and not trying to get a job. This may be worth going to your state chapter or asking why you need a co-signer. In our state, we have no OTP but NPs are not independent. Neither requires a co-signature unless admitting or discharging. I should add that the NPs in the hospital were not opposed to us and even the RNs were happy to take orders from us. The RNs in our department also signed a petition. Our obstacle was the RNs in administration.
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