[golfing eagles]

Originally Posted by Eg_cruz

She is reporting the doctor today to the insurance company and Medicare

Excellent. In 40 years of practice, I never encountered anything so egregious, much less imagine it. You should check the Medicare EOB for the CPT visit code they billed. If it something other than a telemedicine visit, they are "screwed". In particular, look for new patient code 99202-99205, which have certain physical examination criteria, which are impossible to meet if the "physician" isn't in the room. At the very least this should trigger a Medicare audit in which they will look at 25 to 100 patient visits and documentation to see if it meets coding criteria. If blatantly guilty, they can be banned from participating in Medicare for 2 years. I am appalled at this scenario and embarrassed for my profession.

[ThirdOfFive]

Originally Posted by Topspinmo

More $$$$$.

Definitely.

Lots of stuff seems to go on in Florida that is a bit on the shady side. At my last physical the NP recited three words and said she'd aske me what they were in a few minutes. I had never had this happen before but repeated the words and didn't think much about it until for some reason I checked the printout I got from my insurance following the visit. The insurance paid something like $60 extra for that visit for a "dementia screening"!

Not bad pay for one question.

[retiredguy123]

Originally Posted by ThirdOfFive

Definitely.

Lots of stuff seems to go on in Florida that is a bit on the shady side. At my last physical the NP recited three words and said she'd aske me what they were in a few minutes. I had never had this happen before but repeated the words and didn't think much about it until for some reason I checked the printout I got from my insurance following the visit. The insurance paid something like $60 extra for that visit for a "dementia screening"!

Not bad pay for one question.

If a medical doctor has 10 patients in a nursing home, they can visit the facility every day, 7 days per week, and bill Medicare for 70 home visits every week, even though they may just stop in to ask how they are feeling. For 70 visits, they can collect about $5,600 or more even though they may only spend less than a hour in the facility. If they have 5 nursing homes on their route, they can make $28,000 per week. I have seen this happen.

[Pugchief]

Originally Posted by golfing eagles

Excellent. In 40 years of practice, I never encountered anything so egregious, much less imagine it. You should check the Medicare EOB for the CPT visit code they billed. If it something other than a telemedicine visit, they are "screwed". In particular, look for new patient code 99202-99205, which have certain physical examination criteria, which are impossible to meet if the "physician" isn't in the room. At the very least this should trigger a Medicare audit in which they will look at 25 to 100 patient visits and documentation to see if it meets coding criteria. If blatantly guilty, they can be banned from participating in Medicare for 2 years. I am appalled at this scenario and embarrassed for my profession.

Shady for sure. Can you comment on ACA, HIPAA, and EMR causing a deterioration of the doctor-patient relationship?

[Stu from NYC]

Originally Posted by ThirdOfFive

Definitely.

Lots of stuff seems to go on in Florida that is a bit on the shady side. At my last physical the NP recited three words and said she'd aske me what they were in a few minutes. I had never had this happen before but repeated the words and didn't think much about it until for some reason I checked the printout I got from my insurance following the visit. The insurance paid something like $60 extra for that visit for a "dementia screening"!

Not bad pay for one question.

My first thought was medicare wellness exam but lots more question go into that. Fraud for sure

[blueash]

Per the rules: An annual wellness visit is ok using telehealth. A Welcome to Medicare is not


14. Can I provide the Welcome to Medicare and Annual Wellness Visit (AWV) via telehealth?

The Medicare AWV codes (HCPCS codes G0438 and G0439) are on the list of approved Medicare telemedicine services. CMS states that self-reported vitals may be used when a beneficiary is at home and has access to the types of equipment they would need to self-report vitals. The visit must also meet all other requirements.

The Welcome to Medicare visit (code G0402, “Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment”) is not on the list of approved Medicare telemedicine services.

[Eg_cruz]

Originally Posted by Two Bills

Most of my discourse with my GP (PCD) these days is by phone.
Saves me a journey, and their time.
I only visit for tests, examination or treatment.
Works for my wife and I.

That’s all good, I too do most of mine by phone. BUT I don’t travel to the doctor sit in the lobby for over a hour to talk to the doctor on a screen. I sit in my home and I know my apt is a phone call.

[Eg_cruz]

Originally Posted by golfing eagles

Excellent. In 40 years of practice, I never encountered anything so egregious, much less imagine it. You should check the Medicare EOB for the CPT visit code they billed. If it something other than a telemedicine visit, they are "screwed". In particular, look for new patient code 99202-99205, which have certain physical examination criteria, which are impossible to meet if the "physician" isn't in the room. At the very least this should trigger a Medicare audit in which they will look at 25 to 100 patient visits and documentation to see if it meets coding criteria. If blatantly guilty, they can be banned from participating in Medicare for 2 years. I am appalled at this scenario and embarrassed for my profession.

Thank you for your feedback, will pass the info to her.
I was very taken back.

[golfing eagles]

Originally Posted by Eg_cruz

Thank you for your feedback, will pass the info to her.
I was very taken back.

Also pass along the info from Blueash re: wellness and welcome to Medicare coding.

[Girlcopper]

Originally Posted by Eg_cruz

Yesterday a friend went to Premier Medical at Santa Barbara Blvd. This was her first appointment with the doctor, she traveled from Ocala on a referral. She waiting in the lobby for over an hour. She was brought back into the examination room and put in front of a screen where the doctor pops up.

Yes her appointment at his office was over a computer screen. I have never heard of this it blew my mind.

Are we really at this point that you travel to see a in person doctor wait in his lobby for over an hour to talk to him on a tv screen. The big problem was his accent was very heavy and he spoke very fast so she walked out of there without knowing what was spoken about (part was she was so taken back) She couldn’t tell you what the doctor said it was beyond sad.

I found this way to operate your practice is shameful. Really what the point of traveling to the office to talk to a screen.

Has anyone had this happen to you? Do other doctors do this as well?

I find this kind of odd. I’ve had in person visits and video visits many times and always knew in advance what was going on. I’ve never showed up in person for a visit and been put in front of a video screen I have never had to go to a drs office for a video visit just so the insurance would pay for it. They’ve paid after a home video visit every time. Did the dr get sick at the last minute and they couldn’t reach all patients to cancel in time? Was the patient told in advance that it would be a video visit and they didn’t have a computer or access to one or didnt know how to connect? Was there some other unexpected issue? This sounds more like a miscommunication than an intentional action by the dr.

[Ignatz]

Originally Posted by retiredguy123

If a medical doctor has 10 patients in a nursing home, they can visit the facility every day, 7 days per week, and bill Medicare for 70 home visits every week, even though they may just stop in to ask how they are feeling. For 70 visits, they can collect about $5,600 or more even though they may only spend less than a hour in the facility. If they have 5 nursing homes on their route, they can make $28,000 per week. I have seen this happen.

Once again, I sure picked the wrong career!!! 😝

[Nana2Teddy]

Google Premier Medical Associates in The Villages. They’ve been fined $750K more than once for Medicare fraud, so I’m not sure how they’re still in business. Most personal experience reviews I’ve read about them in a FB group for Villages Medical/Dental recommendations have been really bad, but wow your friend’s experience is appalling.

[Robojo]

Originally Posted by Eg_cruz

Yesterday a friend went to Premier Medical at Santa Barbara Blvd. This was her first appointment with the doctor, she traveled from Ocala on a referral. She waiting in the lobby for over an hour. She was brought back into the examination room and put in front of a screen where the doctor pops up.

Yes her appointment at his office was over a computer screen. I have never heard of this it blew my mind.

Are we really at this point that you travel to see a in person doctor wait in his lobby for over an hour to talk to him on a tv screen. The big problem was his accent was very heavy and he spoke very fast so she walked out of there without knowing what was spoken about (part was she was so taken back) She couldn’t tell you what the doctor said it was beyond sad.

I found this way to operate your practice is shameful. Really what the point of traveling to the office to talk to a screen.

Has anyone had this happen to you? Do other doctors do this as well?

I would walk out immediately and not pay a dime.

[waterflower]

Doctors only PRACTICE medicine. They will be replaced with energy healing machines.
Lawyers are going to be replaced with "Common Law' practitioners- B.A.R.-british accredited registry-"Maritime Law"
Nov 7 (Reuters) - Law graduates will be able to become licensed in Oregon without taking the bar exam, starting in May 2024.
Changes are coming. Be patient

[msilagy]

I went to Premier to see my Endocrinologist - same thing they took me to a room and didn't even tell me I was to see him on a screen. Bad, very bad.