FaceMyDoc Q&A

[FMDCEO]

After reading a few posts on here that seem to be quite misinformed about our company, I thought I'd present this opportunity to answer anything you'd like to know.  In the mean time, I invite you to read the following article here.

We started FaceMyDoc by developing then piloting our software with some of the largest research hospitals in the country and have since grown into a full suite of products and services offering licensed healthcare providers an opportunity to launch their own virtual clinic. 

I will attempt to respond to each and everyone of your questions within a reasonable time frame or you can simply email info@facemydoctor.com directly. 

Edited February 13 by FMDCEO

[Reality Check 2]

Simple math and your website told me all I needed to know.

No thank you. 

[FMDCEO]

Would you mind showing me this "simple math" equation that you have inside your head?

It seems based on your other posts that you love posting your opinions on just about everything!  Thanks for the feedback!

[ventana]

Please provide financials for PA looking at your company 

[FMDCEO]

The math is simple...

MODEL #1 - REGULAR TELE-VISITS (MODERATE COMPLEXITY)

Here are the average reimbursements for moderate complexity visits (see CMS Physician Fee Schedule for national averages and input relevant CPT codes

Through Medicare reimbursements are $120-$140 per visit and I've seen AR Reports for private payers that are reimbursing over $200 per visit.

Let's assume you only did 20 visits per month (5 per week) and they were split between 10 Medicare and 10 Private Payer. Let's assume an average $130 per visit Medicare and a flat $200 Private Payer ($1,300 + $2,000) would give you a total of $3,300.  For PA's, the Medicare reimbursement rate is only 85% ($1,300 x 0.85) so it would lower Medicare reimbursement to $1,105 giving you a total of $3,105 instead of $3,300.

Now you need to pay your Collaborating Physician $10 per chart so 20 charts is $200 which lowers you to $2,905. Last but not least, we need to factor in your malpractice policy which for Physician Assistants averages about $1,000 for the year but let's assume that its much higher.  Let's assume your policy is $200 per MONTH which brings total revenue to $2,705.

$2,705 / 20 visits equals:

• $135.25 PER VISIT AVERAGE
• The average visit is completed in 3-7 mins for an average time of 5 mins.
• 20 visits at 5 mins each is 100 mins which equals 1.66 hours.
• I will round this up to 3 hours to factor in time between patients to wrap up notes, use the restroom and get a drink of water. 
• So $2,705 / 3 hours equals $900 PER HOUR. 

 

MODEL # 2 - REMOTE PATIENT MONITORING

Now we haven't even touched on Remote Patient Monitoring (RPM) yet.... through RPM, Medicare is reimbursing ~$63 per patient per month (for life of patient) but I will round it down to $60 for even numbers sake.

Let's say you were only moonlighting and building your practice in your spare time and it took you an entire year to get 100 senior citizens enrolled in the RPM program (at no cost to the patient and no cost to the provider). That is 100 patients at $60 per month per patient for a total of $6,000 PER MONTH or $72,000 PER YEAR.  

This is paid for the LIFE of the patient so if you enroll a patient once they turn 65 and they live until 75, that is 10 years of a residual income of almost 6 figures per year for doing nothing but referring them to us so we can set them up and you can monitor them.

Keep in mind that monitoring only consists of responding to the platform alert when something dramatic happens and a drastic change in the monitoring metrics occurs where you may have to send an ambulance to their home etc. You aren't meeting or talking with the patient every day as once they are setup you're basically on autopilot. 

MODEL # 3 - COMBINE BOTH

You can combine both Models 1 and 2 and easily get into a six figure income, building up your practice with our help on a part time basis for a year.

________________________________________________

If you have an issue with my math or find a discrepancy, please share your thoughts as I know I'm only human and I'm not perfect.  But I also know that we have providers all over the country who have significantly changed their lives and the lives of their patients by opening their own telehealth clinics with us. 

And for those of you who are still pessimistic or negative about this wonderful opportunity I've invested my life savings into creating while sacrificing thousands of hours away from my family in order to build something different and special, I will tell you what one of my mentors told me many years ago...."You can make money or you can make excuses but you can't do both". 

So here we are in a New Year, it is 2022....ask yourself, which one would you rather make?

 

P.S. - I know one of you will mention the deductions for taxes. I'm not a CPA nor do we offer tax advice but I can tell you that you're setup with your own business, and as such, can write off way more than you ever did as an employee. Not to mention, with your own business, you don't have to show a profit every year and with clever accounting you can lower your tax obligations dramatically in your first few years.  Please consult with an accounting professional for more information. 

 

[PAtoMD]

This is the funniest thing on the forum right now secondary to "Stochastic Terrorism" between CAA and ANESMCR.

[iconic]

Jeeezus we don't need any more business people ruining healthcare 

[ventana]

Please pass the koolaid Mr CEO

Where can a PA get a $1000 med mal policy?  I have paid between $2000 and $6000 per year

Also the reimbursement figures you quote are simply wrong - as are the claim that a "visit" is 5 (yes 5) minutes.  I can say that I don't think I have ever (in 20 years of practice) had a visit that was 5 min that was billed at a 99214 (which is what you are basing your $$ on.  Time for 214 with Medicare is like 25-30 minutes.

I also do not see where your company is getting paid, and who is paying to bill medicare and the other insurance companies - billing companies charge 6-12% and classically you loose 7-15% of collection to non-payment (medicare only pays 80% with secondary paying the balance - or if no secondary you have to chase the patient)  Who pays for this?

Who pays for credentialing with insurance companies?

So you are saying it is 1/6 the time that it really takes, underestimating the cost of med mal by 100-600%

Also this RPM - actually has a fair amount of requirements to be able to bill it.  It is not just free money

 

Another question - other PA's have stated there is a "buy in" to your company - please explain any and ALL costs a PA would have in order to see patient #1.

 

Are they 1099?   Who pays Med Mal, who pays workers comp, who pays GL policy. 

 

 

Sorry to be critical but this high flash, bolded sales pitch has holes in it big enough to drive a small bus through.

[FMDCEO]

Here are my answers next to each of your questions in bold:

Where can a PA get a $1000 med mal policy?  I have paid between $2000 and $6000 per year Price of policies is mostly dependent on location, credentials, and history. Telehealth policies are much cheaper than standard medmal. If you'd like to get a quote with our partner, contact me privately and I can introduce you so you can see exactly what it would be for you.  I have PA's who pay as low as $267 per year for a straight telehealth medmal policy so when I tell you an average I'm basing it on real numbers I've seen with my own eyes.  

Also the reimbursement figures you quote are simply wrong - as are the claim that a "visit" is 5 (yes 5) minutes.  I can say that I don't think I have ever (in 20 years of practice) had a visit that was 5 min that was billed at a 99214 (which is what you are basing your $$ on.  Time for 214 with Medicare is like 25-30 minutes. With the switch to value-based care, time is only relevant in behavioral health.  Now, visits are billed according to their level of complexity (determined by a medical decision making chart that adds points as the complexity increases and determines the code i.e. 99213, 99214 etc. 

I also do not see where your company is getting paid, and who is paying to bill medicare and the other insurance companies - billing companies charge 6-12% and classically you loose 7-15% of collection to non-payment (medicare only pays 80% with secondary paying the balance - or if no secondary you have to chase the patient)  Who pays for this? We charge a percentage of monies collected by the provider for medical billing. We have an in-house and a remote billing/credentialing team that has almost 100 years of combined experience. The billing revenue is actually one of our biggest revenue streams so we have a huge incentive to drive patient acquisition and engagement. 

Who pays for credentialing with insurance companies? We pay for the credentialing. 

So you are saying it is 1/6 the time that it really takes, underestimating the cost of med mal by 100-600% Already addressed this above. 

Also this RPM - actually has a fair amount of requirements to be able to bill it.  It is not just free money Our partner who handles the RPM equipment placement to the patients, setup, training of the providers and the billing is aware of this and yes it is very easy to do.  They have the former head of CMS on their board along with former presidents of United and Anthem.  They are the most qualified people in the world to handle this. 

 

Another question - other PA's have stated there is a "buy in" to your company. The providers only pay for access to our software platform and to be listed in our provider directory.  Currently, it works out to 30-50% less than you're average monthly EHR cost but this price is likely to go up as our demand is going up. 

I'm not hear to sell anyone anything- otherwise we would let just anyone sign up. In fact, all providers have to be cleared through our review board and we turn down on average about 30% of applicants. 

[FMDCEO]

I forgot to address your 1099 question....we help set the providers up with their own practice to obtain an EIN for credentialing purpose.  Whether they choose to issue themselves a 1099 or a W-2 is entirely up to them as it is their own business.  As stated in an earlier post, I'm not a tax professional and I would defer any questions regarding this to a CPA. However, I know there are a ton of advantages to owning your own company versus being an employee, mainly being the write offs.

There is no Workers Comp as they don't have employees (unless they hire other mid levels or physicians to work for them in their virtual practice that is a different story).  The General Liability policy is the Professional Liability/MedMal policy which the providers pay for as stated in the post above. 

[ANESMCR]

I don’t have any skin or interest in this but I will say this is true: I bill 214 all of the time for less than 10min visits. The bad news is, a 20-40min visit will likely need to be billed exactly the same. Very difficult now to bill high complexity. 

“With the switch to value-based care, time is only relevant in behavioral health.  Now, visits are billed according to their level of complexity (determined by a medical decision making chart that adds points as the complexity increases and determines the code i.e. 99213, 99214 etc.”

Edited January 12, 2022 by ANESMCR

[LKPAC]

FMDCEO, thank you for having the guts to come here and answer questions. 

[ventana]

So in you initial post you did not mention billing percentage.  What % do you charge?

concerned some misrepresentation on billing. Time is absolutely a factor in billing and supports higher billing. As well new billing guidelines now allow us to include chart review. Hosp review and other time directly attributable to pt care where previous billing did not.  Complexity does now have a roll but saying every visit hills at a 214 is stretching it.  As well the private companies I have credentialed with are not paying much more the 125% of Medicare rates. 
 

please address collection of co-insurance and copays.   Who decides when to write off as bad debt?
 

please address PA paying for “access to software and lusting in provider directory”.  Specific $ or percentages. Not vague please. 
 

 

to summarize 

PA pays you to become an 1099

PA then has to pay 

?% for collections 

? # of dollars for software per month (sounds like flat fee so slow month and PA could owe you money). Industry norm is the billing and collections % should cover this fee-not an additional fee

You all do all the leg work, paperwork for free to get the PA credentialed (what about between sign up and when credentialed-do PA owe all software and provider listing fees?)

PA has to set up and maintain their own company(llc, pc, ssn) and pay all fees and taxes to support this.  Including all federal and state payroll taxes and assessments I.e. comp and unemployment.  

1099 is not free nor a deal for some people. Consulting industry about 30% of revenue list to overhead so the $100/hr is really $70/hr.  Family health insurance will run close to 20k per year yet cost me only 3500 as my employer pay rest.  They also fund short and long term disability which a 1099 would have to self fund. 

PA has to maintain own med mal.  And sorry I am skeptical of your quotes and would want a hard copy from an industry leader on what a telephone Med mal at 1m/3m costs.  I simply do not believe anyone is paying <$300 a year for such coverage esp as occurrence(claims made should never be considered, it just screws the PA)

what about who controls future increases in fees?  

Is there a guaranteed  amount of business the you will provide?

who pays physician Med mal?

how do you ensure there is a reputable physician who will adhere to each state regulations?

slightly scared that you think Med mal is the same as a GL/BOP policy.  I will let you learn the difference.  They are not the same.  
 

“almost 100 years” of insurance and credential experience is not all that great.  My company is a small company in New England and they gave a handful of employees and they have some thing like 200+ years as a small little company. 

I appreciate you coming here to discuss but just still have questions. 

[ANESMCR]

10 hours ago, ventana said:

Complexity does now have a roll but saying every visit hills at a 214 is stretching it.

No, it’s the exact opposite. Time does now have a roll. Visit time is now only a modifier.