From: "Matthew Levin" <mattlev@adelphia

From: "Matthew Levin" <mattlev@adelphia.net>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Thu, 12 Jan 2006 20:20:14 -0500
Subject: Re: [Practiceimprovement1] BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??
Reply-To: Practiceimprovement1@yahoogroups.com

RE Preventative "checkup" vs directed examination.

A number of times, pts will come in and say they "want a checkup" but really need a few things addressed. Had one today, who presented with snoring, but as we got into it, has a history of high cholesterol from annual work PE noone really follows up on. We made visit a high cholesterol, possible sleep apnea and a couple other things. Really didn't get to the "well care" part of things.

Also, we've been checking eligibility of "well care" coverage-- thankfully, 2 of the main insurers we can check online availability, the others we have to call. Typically, we call after the first appt, as I do everything possible to "avoid" the "well care" on the first visit, because, truly, lots of pts DO NOT HAVE well care coverage, even when they THINK they do. You MUST check the benefit, and can.

We also get coverage for E&M and well care same day; some insurers ask for 2 copays (yuk) and we've fought this issue of the 2 copays so pts don't think we're getting them for an unexpected copay. I also find we DO get paid for those who HAVE the benefit.

David-- check the policy each pt has; then, if the pt does NOT have the benefit, you indeed may not want to schedule the separate "checkup." Some insurances, though, are very specific, and insist on "1 visit, EITHER well care OR E&M/problem specific coverage." While I think this is a rotten policy, I end up bringing the pt back for it. Realize that of these I've seen, the "well care" benefit is a dollar amount "up to" a certain amount per calendar year, as the insurer is only covering what THEY think is well care, but it does work out.

I also annotate in my note (every note) when the "last" well care was completed, so I'll catch them weekly.

Hope this helps.

Dr Matt Levin

FP in low overhead ($10K/month, 2.5 FTE) practice

Pittsburgh, PA

----- Original Message -----

From: David Brock DO

To: Practiceimprovement1@yahoogroups.com

Sent: Thursday, January 12, 2006 9:10 AM

Subject: RE: [Practiceimprovement1] BILLING - SURG PROCEDURE and MED OFFICE VISIT SAME DAY??

That brings another question to mind for me. Do most of you do a lot of preventive visits/physicals? For some reason, my pt’s rarely come in & say “I need an annual physical.” Do you prompt the visit or do the pt’s? I usually end up doing all of the preventive items piece meal as I go along (ie, lets make sure you’ve had your colonoscopy, PSA, etc, ). Maybe I need to push pt’s more towards an annual preventive visit.

David