I am not surprised to see all these comments on how the medical profession has become a profession that is working the system. I am always trying to figure out ahead of time, how they gonna get me. It is sad. You used to go to your doctor as a trusted ally. Now we are on different sides trying to get the most out of our dollars.. and I do believe all these upcharges and forced visits are driving the expanded cost of Medicare. There is also "medical coding" which is how an office gets the most dollars for their charges. That has become a huge area for fraud.

I guess Dr. Marcus Welby retired and sold his practice to Village Health

Not sure I understand this practice. Who's taking the vitals, a med assistant, a lab tech, or a nurse practitioner? Seems like the only way an office visit could be charged is if you see a provider, physician or nurse practitioner. I would call my ins company and ask if they know they are paying for an office visit when a provider was not seen. Med records used to have to back up any office visit and I actually thought this is still true today. My understanding is that every visit should (or must?) have a format in which they obtain the reason for your visit, a review of systems, an exam and then an assessment and plan. They must have found some loophole and I find this shameful. I am in the med field and just can't believe they are doing something like this.

Hi Medtrans: How many people actually received their med bills and of those how many bother to read them?. if coded as an office visit who is going to challenge it?

In ,y view a strong motivator for all of this is that medicare is cutting payments to the bone along with private insurers challenging bills. doc need to get pay somehow to mange their offices and meet all the regulations and paper work demanded by both the government and private insurers

True Rubicon but if I'm being asked for a co-pay as an office visit and I didn't see a provider then I would sure ask my health ins company about it. IMHO.

The Villages health has the patient portal where you can send an email to your doctor. I think the doctors need to be made aware of this practice. They should be able to give you a script to have your blood drawn elsewhere

I'm pretty sure the doctors know about this. Don't forget they are on a salary and that money has to come from somewhere.

Lots of misinformation/misunderstanding in the posts above.
Physician payments are not causing any significant increase in Medicare expenditure. In fact the last two years, 2012 and 2013 have amazingly had negative growth in payment to physicians per enrollee.

http://www.cms.gov/Research-Statisti...ads/TR2014.pdf page 136

Yes there are doctors churning office visits.

Office visits for evaluation and management (E&M) are divided into five levels of service. These are the codes for a typical office visit. Of these 5 codes there is 1, code 99211, which does not require face to face interaction with a physician (or NP or PA).
"“Office or other outpatient visits for the evaluation and management of an established. patient, that may not require the presence of a physician. Usually, the presenting. problem(s) are minimal."
"The medical record should indicate the nature of E/M service that occurred for the date of service being billed. If the service is being provided “Incident to,” the medical record should demonstrate that the service is an integral, although incidental, part of the physician’s professional service. The following clinical scenarios are meant to provide some general examples of documentation that would support billing procedure code 99211, and, is not an all-inclusive list:

A blood pressure (B/P) written down on the medical record does not demonstrate a presenting problem and need for an E/M service. The medical record should indicate why the patient came in for a B/P check (e.g., follow-up after medication adjustment, the previous note in the medical record documented elevated B/P and the provider wrote instructions for the patient to come in weekly for three weeks for B/P reevaluation, etc.).

A diabetic patient comes in for a monthly weight check related to an ongoing weight reduction plan for control of blood glucose levels. The medical record should document that the monthly weight check is an integral part of the patient’s plan of care and that some form of face-to-face E/M occurred either by the provider or “Incident to” (e.g., the weight is documented and the patient was questioned regarding appetite, any associated problems, etc.).

A patient comes in for a renewal of a prescribed medication. The medical record should demonstrate that the medication is part of the patient’s plan of care and that some form of face-to-face E/M occurred either by the provider or “Incident to” (e.g., prescription documented and instructions given to the patient regarding medication, side effects, etc.).

A patient comes in for E/M of his/her anticoagulation medication. The medical record should demonstrate that some form of face-to-face E/M occurred either by the provider or “Incident to” (e.g., the lab result is documented and a note made as to whether modification was made to the medication dosage)."

Clarification for use of 99211 code » Office of Physician Billing Compliance » College of Medicine » University of Florida


The above is from UF website but summarizes well my understanding of the use of 99211. Note it is a service usually done by a nurse or medical assistant, but it should require some physician input. The tricky part of this would be that if the nurse does the vitals and independently realizes they are fine, draws the blood, and signs off the encounter then 99211 clearly is not applicable. If however the office protocol requires that the physician review the information (even though that seems superfluous with a properly trained nurse or MA) the office could argue that 99211 qualified to be charged. There should be some sort of management documented even if the documentation is that no changes in therapy were required. Again, my opinion is that an office which is offering an option of having your weight and BP done when you come for a blood draw, then calling it a 99211 is on or over the line. It is especially so if they are willing to draw your blood without doing a couple of vital signs. Thus they cannot argue that they feel that knowing your BP is normal is an essential component of assessing (evaluating) your ability to tolerate a blood draw.

Again, I would suggest that if you are a patient of a practice with this policy you might let the doctor know how you feel about it, and take your lab business elsewhere or refuse the vital signs.

I agree!!