LIPPER Posted August 4, 2012 Share Posted August 4, 2012 How long is considered "too long" to wait until filling out paperwork? We (I) get FLMA, Disability, Insurance forms etc.... given to me to fill out all the time... Seemingly everyone wants it done while they wait. I don't charge for filling out forms. I don't submit for higher reimbursement either. I do say that I only fill out paperwork once a week. This seems to bother people occasionally.... Is there a law, an understood community standard or otherwise? Opinions? Link to comment Share on other sites More sharing options...
Contrarian Posted August 4, 2012 Share Posted August 4, 2012 Don't know of any "law." But my time ain't free, and/or could be used to actually treat a few more patients versus spending it filling out paperwork. Sooo... I simply have them schedule a follow up appointment (all our follow up slots are 30 mins) within the next week, where we sit together, chit-chat, drink "Mio" flavored water, and fill out the forms. Its a great break in a otherwise hectic schedule, its billable and gives them a chance to get to know me and to basically talk about whatever they want in a non-directed, open ended manner. Its actually really "therapeutic"... YMMV Contrarian Link to comment Share on other sites More sharing options...
LIPPER Posted August 4, 2012 Author Share Posted August 4, 2012 Do you make them pay another copayment? Link to comment Share on other sites More sharing options...
Joelseff Posted August 4, 2012 Share Posted August 4, 2012 Don't know of any "law." But my time ain't free, and/or could be used to actually treat a few more patients versus spending it filling out paperwork. Sooo... I simply have them schedule a follow up appointment (all our follow up slots are 30 mins) within the next week, where we sit together, chit-chat, drink "Mio" flavored water, and fill out the forms. Its a great break in a otherwise hectic schedule, its billable and gives them a chance to get to know me and to basically talk about whatever they want in a non-directed, open ended manner. Its actually really "therapeutic"... YMMV Contrarian That's a good idea. I charge 20 bucks for 1-5 pgs and 5 bucks each add'l pg. And I have a 3 day turn around time. But scheduling a ppwk appt might be better billable wise. What E/M code do u use? Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Contrarian Posted August 4, 2012 Share Posted August 4, 2012 Ummm... for me, its about perspective. I don't MAKE them do anything... Every person seen in our office pays a co-pay. Its the law and in the rules (check medicare/medicaid). I didn't pick their third party payor, therefore I don't set those co-pay rules that they agreed to when they signed up for those third party payors. Our practice NOT collecting a co-pay from them would be fraud according to te third-party payor contracts and unfair to the other patients who I do collect a co-pay from regardless of why they are there. It also further suggests that YOUR time isn't valuable and shouldn't cost them anything... which often leads to overuse/misuse of our limited medical resources (providers and healthcare dollars) and devalues you and your expertise. So to answer your question... YES the insurance plan that THEY chose, requires them to pay a copay each time they go to ANY contracted medical practice for services. NOT collecting the copay is fraud and contrary to the contract your practice signed with their chosen third party payor. AND results in a defacto further decrease in reimbursements from the third-party payor, because the collected co-pay is factored into the total reimbursement agreed upon between the practice and payor. Not collecting a copay is taking away money from the yrly profit/earnings calculations of the entire practice. Letting patients not pay the co-pay without your emloyers approval is almost stealing. It would be no different than my cousin letting people into the theatre he works in for free. Or another cousin letting folks into the zoo for free. Consider that if you are a hourly employee, spending 20 mins a day, 5 days a week filling out paperwork for free (not billing patients, third party payors and not collecting copays), your employer is paying overhead AND salary for 1.5hrs a week (75hrs per yr) for billiable hrs you didn't collect any reimbursement for and simply gave away for free. Again to some, could be considered theft. If this was NOT the case, and the co-pay didn't matter... why not just pocket it for three days a week and see what your employer would say about that. Just a few thoughts... YMMV Contrarian Link to comment Share on other sites More sharing options...
Contrarian Posted August 4, 2012 Share Posted August 4, 2012 ... scheduling a ppwk appt might be better billable wise. What E/M code do u use? Don't have it in front of me... but its the time oriented Counseling codes where you document time and state that "greater than 50% of your time was spent on counseling, and service coordination." Which is really what you are doing... talking to and counseling the patient on their disability, SSI, issues and doing service coordination by completing paperwork they require to handle the problem they are trying to get disability and SSI assistance with... See here: http://www.aafp.org/fpm/2003/0600/p27.html Link to comment Share on other sites More sharing options...
LIPPER Posted August 4, 2012 Author Share Posted August 4, 2012 I understand you... So do the office/SNF/hopsital codes cover JUST paperwork? Ie a 992.. Doesn't require vitals, multiple-system eval, etc.... Link to comment Share on other sites More sharing options...
Contrarian Posted August 4, 2012 Share Posted August 4, 2012 It Should... Read tha attached article above. specifically the part about the meetings and coordination of care. Ask your billing department for the appropriate codes. Make them work for their pay. As these codes change... and are different for me because I'm in a psych practice where physical exams and multi-system ROS/PEs are not required for billing. YMMV Contrarian P.S... another advantage to this is that simply billing for this using E/M codes is "cleaner" and less arbitrary than "cash on the barrel-head"... and can be credited to your productivity at year end when the numbers are tallied. Link to comment Share on other sites More sharing options...
Joelseff Posted August 4, 2012 Share Posted August 4, 2012 It Should... Read tha attached article above. specifically the part about the meetings and coordination of care. Ask your billing department for the appropriate codes. Make them work for their pay. As these codes change... and are different for me because I'm in a psych practice where physical exams and multi-system ROS/PEs are not required for billing. YMMV Contrarian P.S... another advantage to this is that simply billing for this using E/M codes is "cleaner" and less arbitrary than "cash on the barrel-head"... and can be credited to your productivity at year end when the numbers are tallied. Awesome stuff C. I'm gonna talk to my biller on Monday about this. Thanks! Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Contrarian Posted August 5, 2012 Share Posted August 5, 2012 Filling out formsQ What code(s) should I submit for filling out forms outside of an office visit? Would 99080, “Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form,” be appropriate? A There is no specific CPT code for completing a form outside a visit. According to CPT, 99080 is to be used as an adjunct to the basic service(s) rendered, which means it should not typically be reported by itself. You might consider submitting an unlisted CPT code, such as 99199, “Unlisted special service, procedure or report,” and then indicating on the claim form specifically what service this is intended to represent (insurance forms, in your case). CPT code 99199 is often used when there isn't a more suitable code. It is "Unlisted special service, procedure or report." It can be used for unusual treatments or even when a doctor charges to fill out forms for a camp or school physical. When a service is provided that does not have a specific CPT to be utilized, the services are usually authorized under this procedure code. Or Since you are being asked to attest to a condition and usually the severity of that conditon and/or how that condition affects the patient's functional capacity... you SHOULD have the patient present and be able to question and examine the patient (if necessary) to answer the questions on the form accurately and approprately. As these are legal and prosecutable forms. Therefore a office visit is appropriate to review/examine/assess the status of the condition that caused the "disability" and you should code for the "condition (s)" being reviewed that caused/contributes to the "disability" .. along with the V70.3 (submit v code last) This last one is what we do... because we are being asked to basically "testify" (on paper) that the patient has that problem... and that the problem is severe enough to preclude gainful employment and therefore the government ("We the People" as in YOU and I) should send them a monthly check. Or certify that the patient's condition is such that their "Family" member needs a few months off work to care for them. Umm... yeah, before I sign something attesting to this... I need to see, interview and if necessary, examine the patient. To do so, the patient must schedule a office visit. Link to comment Share on other sites More sharing options...
Contrarian Posted August 5, 2012 Share Posted August 5, 2012 Another interesing find: There are three new telephone codes (99441-99443) - yes! these are services you render over the telephone reporting Evaluation and Management services for established patients only (not for new patients!). These service is rendered upon the request of your patient. Take note though that you can not bill this code if you have just seen the patient within the last 24 hours. Or if the reason for the phonecall is regarding the same problem you saw the patient for E/M for the previous 7 days. Per New CPT: These are time-based codes. Telephone evaluation and management service provided by a physician to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available; 99441 - 5-10 minutes of medical discussion 99442 - 11-20 minutes of medical discussion 99443 - 21-30 minutes of medical discussion Now, if you are a physician who is a computer savvy, does a lot of emails. There is a new online E&M code (99444). This code is billed to report a physician's response via email and or online request by an established patient. A website for your practice is very useful if you have one where your patients can fill out inquiry forms on your website. Per New CPT: 99444 - Online evaluation and management service provided by a physician to an established patient, guardian or healthcare provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network. Take note (as I have always been reminding providers), these codes and services MUST be accurately and in real time be documented in the patient's medical record/chart. Check with your payors if these are billable per your contract with them or even if you are an out of network provider. So... as a "outside the box" thinker... A.) I would set up a system where patients could drop off their forms and then be scheduled in for a telephone conference to get their forms filled. Maybe template a schedule block for the last Half hour of the day. They would be required to call the office to initiate the conference. They would be required to remain on the phone and participate in a medical discussion about the issues I'm filling the form out for. Once form is completed, I'd wite a short chart note detailing the interaction, content of the conversation an time spent on the phone then I'd bill a 9944 (1,2,3) B.) I could also have the standard forms (SSDI, FMLA, Drivers License, Work Excuse, etc) scanned into the computer as fillable PDFs then uploaded on the practice website. Then require all patients that want these forms filled out to complete their portion online, save the form then attach it to a email and forward to the practice. I would then have two options: 1.) Have the patient call at a scheduled time for a conference to fill out the form then bill a 99441... 2.) Fill out the form online without the patient calling and bill a 99444 Ether way, once form is completed, I'd wite a short chart note detailing the interaction, content of the conversation/or purpose of the email and the time spent, then bill appropriately. I'm thinking that most of these interactions will likey be "Level II" visits. Again perfectly legal and "thinking outside the box," cause working for free SUCKS...!!! Especially when its cutting into limited personal time and affecting the "quality of life" of you and your family. Just a few thoughts.... Contrarian Link to comment Share on other sites More sharing options...
LIPPER Posted August 6, 2012 Author Share Posted August 6, 2012 99080 is not reimbursed via cms despite the code. I've been in our group 13 yes and has the upmost confidence in grit ability to squeeze $ where they can. I'll look into 99199... as far as 99441-3 goes I see patients in SNF and hospital settings so this wouldn't work either... Thus just a simple procedure/visit (since they're in my presence anyway) is the best we'll be able to do.... Thanks for the ideas though... Link to comment Share on other sites More sharing options...
Joelseff Posted August 6, 2012 Share Posted August 6, 2012 Another interesing find: So... as a "outside the box" thinker... A.) I would set up a system where patients could drop off their forms and then be scheduled in for a telephone conference to get their forms filled. Maybe template a schedule block for the last Half hour of the day. They would be required to call the office to initiate the conference. They would be required to remain on the phone and participate in a medical discussion about the issues I'm filling the form out for. Once form is completed, I'd wite a short chart note detailing the interaction, content of the conversation an time spent on the phone then I'd bill a 9944 (1,2,3) B.) I could also have the standard forms (SSDI, FMLA, Drivers License, Work Excuse, etc) scanned into the computer as fillable PDFs then uploaded on the practice website. Then require all patients that want these forms filled out to complete their portion online, save the form then attach it to a email and forward to the practice. I would then have two options: 1.) Have the patient call at a scheduled time for a conference to fill out the form then bill a 99441... 2.) Fill out the form online without the patient calling and bill a 99444 Ether way, once form is completed, I'd wite a short chart note detailing the interaction, content of the conversation/or purpose of the email and the time spent, then bill appropriately. I'm thinking that most of these interactions will likey be "Level II" visits. Again perfectly legal and "thinking outside the box," cause working for free SUCKS...!!! Especially when its cutting into limited personal time and affecting the "quality of life" of you and your family. Just a few thoughts.... Contrarian I hear ya on the phone codes. But CMS does not pay for it. We can bill for it but the pt would have to pay out of pocket. Unless they have a plan that covers phone consults. I just read an article about it a few weeks ago. Joe Link to comment Share on other sites More sharing options...
Contrarian Posted August 7, 2012 Share Posted August 7, 2012 Yeah CMS and other "third-party-payers" further "Pimping" providers... As I see it, them NOT paying for this is not much, if at all different than employers not paying you for your time on call... its unacceptable. Which is why patients have to schedule a office visit with me (and pay the co-pay)... so that we have dedicated, scheduled time to assess and discuss the medical problem (s) causing or contributing to the reason for the form... if they want me to spend 30mins filling out forms. Personally, I'm NOT "certifying" or "attesting" to any impairment, condition, ailment, or disability without a office visit scheduled specifically to assess and address that/those issues. YMMV Contrarian Link to comment Share on other sites More sharing options...
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