[golfing eagles]

[QUOTE=Aces4;2455786]

Originally Posted by golfing eagles

Just because a there is a lack of understanding on somebody's part doesn't make it "mumbo jumbo". On the other hand, 20 posts lacking a factual knowledge basis could be, and is, considered ridiculous nonsense. I'm still at a loss here----if somebody has an electrical problem in their home and hire a master electrician, do they try to debate with the expert?? And what would call somebody who actually does--in fact there are a number of names that apply.

Factual information does seem to be missing with the claim that being charged for a long office on Medicare billing doesn't exist and well as the CPT code for longer visits is printed, on record but someone can't grasp the truth. If coders at TVH are making all the billing decisions and the Drs have no imput as to what is being charged, that's a huge problem right there. And then there is the premise that Medicare shouldn't let the insureds know about CPT coding because it cause terrible confusion, like if you don't have MD behind your name you can't tell when your billing has been overcharged when a simple, no clothes removed 7-8 minute visit with no tests should be billed at the highest code for a long, complicated visit. Baloney.

And yet it continues. Do I have to post the criteria for 99215 for a third time? Ask it to be pointed out where the term "long visit" is located in the definition. Ask where "40-59 minutes" is located. Now, if somewhere on an EOB CMS tries to idiot proof the understanding of the charges are, fine, I've never looked at mine, because I DON"T HAVE TO, I already know everything there is to know about it. But yet some people are stuck on "7-8 minute" visit. AGAIN, TIME HAS NOTHING TO DO WITH IT.

Now , if you ask me the CORRECT question: Is it ethical to spend 7-8 minutes and bill 99215, even if it meets documentation criteria? Then I would agree with you, I don't thin k it is and I've never done that. But that's not the question at hand. The question has been "what are the requirements to bill 99214 or 99215" and the answer remains that it has everything to do with extent of history and physical and complexity of medical management, and nothing to do with time unless it is something like a psychiatric visit or a family conference.

[golfing eagles]

I think I now know how a theoretical physicist feels when trying to teach quantum field theory to a goldfish.

[Caymus]

Originally Posted by golfing eagles

I think I now know how a theoretical physicist feels when trying to teach quantum field theory to a goldfish.

There are studies that claim a goldfish has an attention span of 9 seconds vs 8 seconds for a human.

[Aces4]

[QUOTE=golfing eagles;2455792]

Originally Posted by Aces4

And yet it continues. Do I have to post the criteria for 99215 for a third time? Ask it to be pointed out where the term "long visit" is located in the definition. Ask where "40-59 minutes" is located. Now, if somewhere on an EOB CMS tries to idiot proof the understanding of the charges are, fine, I've never looked at mine, because I DON"T HAVE TO, I already know everything there is to know about it. But yet some people are stuck on "7-8 minute" visit. AGAIN, TIME HAS NOTHING TO DO WITH IT.

Now , if you ask me the CORRECT question: Is it ethical to spend 7-8 minutes and bill 99215, even if it meets documentation criteria? Then I would agree with you, I don't thin k it is and I've never done that. But that's not the question at hand. The question has been "what are the requirements to bill 99214 or 99215" and the answer remains that it has everything to do with extent of history and physical and complexity of medical management, and nothing to do with time unless it is something like a psychiatric visit or a family conference.

No one ever accused you of that coding deceit. This isn't about you, this is about some physicians practicing who do fudge the coding. And I'll say it again, if Drs. have no imput on the coding at TVH, that's a big problem right there, IMHO. I'm sure you know that when a patient of a Dr. for many years, comes in for a simple medical followup for medication under 10 minutes, something is awry when the 99215 CPT is used.

[golfing eagles]

Originally Posted by Caymus

There are studies that claim a goldfish has an attention span of 9 seconds vs 8 seconds for a human.

I think you're giving some humans too much credit

[golfing eagles]

[QUOTE=Aces4;2455797]

Originally Posted by golfing eagles

No one ever accused you of that coding deceit. This isn't about you, this is about some physicians practicing who do fudge the coding. And I'll say it again, if Drs. have no imput on the coding at TVH, that's a big problem right there, IMHO. I'm sure you know that when a patient of a Dr. for many years, comes in for a simple medical followup for medication under 10 minutes, something is awry.

Again, that's a different question. Upcoding is rampant, more the rule than the exception. But without any statistics to back it up, I think more practices have persons other than the physician doing the coding---it isn't necessarily a problem in and of itself, but it should be closely monitored. And I never took anything that was posted as a personal accusation (I would have head many more rolling, laughing little men)

[Aces4]

[QUOTE=golfing eagles;2455799]

Originally Posted by Aces4

Again, that's a different question. Upcoding is rampant, more the rule than the exception. But without any statistics to back it up, I think more practices have persons other than the physician doing the coding---it isn't necessarily a problem in and of itself, but it should be closely monitored. And I never took anything that was posted as a personal accusation (I would have head many more rolling, laughing little men)

Sorry you missed it, upcoding has been the point all along.

[IPrescribeWine]

I’m a bit late to this thread because it literally took weeks for the administrator to approve my account. I’m not new to the Villages, but new to TOTV. I’ve been following along. I’m a semi-retired doc who, in my current role did a LOT of work to help prevent Medicare fraud in my organization, mostly about ensuring that we were compliant with legitimately reporting conditions for MA patients.

Since I am new on TOTV, the moderators won’t let me post links to some interesting articles But I will tell you what to google.

I’ve read the bankruptcy filings like everyone else and haven’t noticed many people focusing on the Risk Scores as the area of concern. While I don’t have inside knowledge of TVH inside workings, I understand how “overbilling” can happen with the risk scores and want to provide my perspective.

As a reminder, traditional medicare doesn’t use risk scores. But for MA, if a patient is more complex, then TVH gets more money to care for them in the outpatient setting.

Nearly EVERY MAJOR insurer has been caught with their hand in the cookie jar with “overbilling” (fraud) with adding unsupported risk scores. Don’t believe me? Then google “which insurers have been caught for fraud with medicare advantage risk scores”. One of the biggest offenders is United Health. The difference for TVH is that they can’t pay the fines and so had to file for bankruptcy.

Google another: OIG report finds insurers collected billions in questionable MA payments.

I also did not notice anyone mentioning that Florida Blue also filed a claim yesterday in TVH bankruptcy filing accusing TVH of adding unsupported diagnoses (also know as inflating risk scores). Google: Florida blue accuses villages health of adding false codes.

I’m not implying that TVH did this, only that other insurers did. But this article from WSJ outlines how United Health and other insurers hired ARNP’s to do home visits and pressured them to add “questionably” supported diagnoses (inflating risk scores). Each ARNP visit was estimated to inflate yearly payments by $2500-ish per patient. Google: The one hour nurse visits that let insurers collect $15B from medicare

Last, I’m calling out the apparent absence of oversight in TVH billing practices. Computer error or not, there should have been a corporate compliance officer who oversaw billing. Even if it was an innocent error, the compliance officer is accountable for this.

[Rainger99]

Originally Posted by IPrescribeWine

I also did not notice anyone mentioning that Florida Blue also filed a claim yesterday in TVH bankruptcy filing accusing TVH of adding unsupported diagnoses (also know as inflating risk scores). Google: Florida blue accuses villages health of adding false codes.

There are two separate threads. This one and Villages Health Bankruptcy.

Check out post 98 on that thread. It mentions Florida Blue.

[OrangeBlossomBaby]

Originally Posted by margaretmattson

The name Parr was mentioned in a court document. She is a member of the Morse Family.I have not seen any individual doctors named in the court documents. I believe it IS YOU who is conflating. Bankruptcy filing has nothing to do with incorrect medical coding. They are different issues. Again, to legally prove bankruptcy, you must have more debt than assets. Nothing more! Simply provide the court DEBTS AND ASSETS. And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family.

"The Morse Family" doesn't own TVH. Jennifer Parr, a singular, individual Morse family member, is listed as a principal of TVH. Jennifer Parr does not make up the entirety of The Morse Family.

Imagine your third cousin filing for bankruptcy. Would the court look at YOUR assets, just because you're a blood relative? No, it wouldn't.

[OrangeBlossomBaby]

Originally Posted by dewilson58

"And YES! The court will absolutely require ALL ASSETS be accounted. Including any owned, large or small, by the Morse Family."

Sounds like personal assets.

Originally Posted by margaretmattson

Exactly! Large or small assets FROM THIS BUSINESS. Geez!

The Morse family isn't a business. "...any owned, large or small, by the Morse Family" is not applicable in this thread, because the Morse family isn't a business. It's a family. And the Villages Health is not owned by the family. It has a 60% ownership by the holding company, which is owned by Jennifer Parr and her two siblings. The other 40% ownership is - something other than the holding company led by someone other than a member of the Morse family.

[OrangeBlossomBaby]

Originally Posted by IPrescribeWine

...
Nearly EVERY MAJOR insurer has been caught with their hand in the cookie jar with “overbilling” (fraud) with adding unsupported risk scores. Don’t believe me? Then google “which insurers have been caught for fraud with medicare advantage risk scores”. One of the biggest offenders is United Health. The difference for TVH is that they can’t pay the fines and so had to file for bankruptcy.

Google another: OIG report finds insurers collected billions in questionable MA payments.

...

I’m not implying that TVH did this, only that other insurers did. But this article from WSJ outlines how United Health and other insurers hired ARNP’s to do home visits and pressured them to add “questionably” supported diagnoses (inflating risk scores). Each ARNP visit was estimated to inflate yearly payments by $2500-ish per patient. Google: The one hour nurse visits that let insurers collect $15B from medicare

TVH isn't an insurer. It's a medical practice. United Health is an insurer. If insurers are committing fraud, that's nothing to do with TVH, because TVH isn't an insurer.
Totally different topic.

[Aces4]

Originally Posted by OrangeBlossomBaby

The Morse family isn't a business. "...any owned, large or small, by the Morse Family" is not applicable in this thread, because the Morse family isn't a business. It's a family. And the Villages Health is not owned by the family. It has a 60% ownership by the holding company, which is owned by Jennifer Parr and her two siblings. The other 40% ownership is - something other than the holding company led by someone other than a member of the Morse family.

The 60% ownership is the family, the three Morse siblings and their family business. I'd like to see the details of the other 40% ownership.

[OrangeBlossomBaby]

Originally Posted by Aces4

The 60% ownership is the family, the three Morse siblings and their family business. I'd like to see the details of the other 40% ownership.

You can look it up, it's public record.

[Aces4]

Originally Posted by OrangeBlossomBaby

You can look it up, it's public record.

Look up what? You stated that Jennifer Parr and her two siblings, the "holding company" own 60%, was that incorrect info? Otherwise, those are Morse siblings that own 60%.