Journeys of Don, Angie & Cookie

MAR 5 - Not Many Reading Don's Latest News

donself@donself.com (Don Self) — Tue, 06 Mar 2012 03:50:50 GMT

In January, I started a LATEST NEWS addition to my main website to be able to update folks every couple of days to issues that affect many in the medical reimbursement business. I was advised that this may help folks, so I let it run for 2 months and on March 1st, I started a survey to see who was actually reading the LATEST NEWS. The article on the 1st offered a free gift to those reading the article if they took the 3 minute survey to tell me how often they read the LATEST NEWS and how often they visit the website. The free gifts were a choice of my mailing them a free E&M Documentation Sliderule that I normally sell for $12.00 on my website or the Excel file for their own specialty showing the bell curve data from Medicare in graphical format. Ok - the results were a little surprising to me. After running that LATEST NEWS and survey from the 1st through the 5th of March, I only had 9 people do the survey and take advantage of the free gift. Interestingly, one of the 9 said it was their first time to visit the website. So - due to a lack of interest in the LATEST NEWS section, I am discontinuing it. I guess enough folks get their data from my monthly subscription newsletter that I send out each month or my free email listserv.

ok - so now I'm going to do the same thing for 1 day for the readers of the BLOG to determine if folks are reading this or I'm wasting my time on the blog. So - if you will - please take the 3 minute survey and you also get a free gift at the end.

https://www.surveymonkey.com/s/QFXGNVT

Thank you - Don

MAR 1, 2012 - CREATIONISM

donself@donself.com (Don Self) — Thu, 01 Mar 2012 17:05:10 GMT

A CREATION STATEMENT EVERYONE AGREES WITH

It doesn't matter if you believe in Creation or if you believe in the theory of Evolution. Everyone enjoys this one. Click on the powerpoint link here and enjoy it. I would love to hear what you think by emailing me.

CREATION POWERPOINT TO MAKE YOU SMILE

FEB 21 - 2 SURVEYS TO HELP DON

donself@donself.com (Don Self) — Tue, 21 Feb 2012 21:36:01 GMT

As you may have noticed, I'm curious why some practices have not reported on PQRI and also - why many offices are so confused about the Annual Wellness Visits that they pass up the $14,000 a month that is easily made from these - if they typically see at least 8 Medicare patients a day.

For this reason, I have created 2 Surveys for folks to spend about 3 minutes on that will not only educate the person taking it - but will help me understand and perhaps help me develop a new template for either to help these doctors, managers and billers. If you don't mind - please click on each of the 2 links below and take these surveys to help me.

AWV SURVEY

and

PQRI 2011 SURVEY

FEB 18 - ELEVEN DAYS TO REPORT PQRI

donself@donself.com (Don Self) — Sat, 18 Feb 2012 13:49:16 GMT

Many people have not reported PQRI for 2011. I honestly believe that alot of doctors think their staff has done it - when in fact - they haven't - and that is ridiculous. Some are waiting on EHR - and I have NO IDEA why they would want to. If it were their OWN money, there is no way that many of the managers would not take advantage of it. If Medicare came out with a bonus for medical office managers that the manager could take the check home and use it to pay bills, I can almost guarantee that every MOM in the country would take the 2 or 3 hours to do what it takes to get the $2,000 to $4,000 - so why is every single one not doing it for the doctors?

You have until March 1st to do so and get your doctors the check this year and the fact that you're doing E-RX or doing Meaningful Use has NOTHING TO DO with reporting PQRI for last year - so do it. Here are two websites you can use (use either one - it's your choice as they both have deadlines for March 1st).

1st Accent is $279 before the discount and $229 after. Use DonSelf as the code (capital D and capital S) and it takes $50 off the registration and that adds up if you have quite a few doctors! 1stAscentPQRS

or you can use:
PQRWIZARD.COM and use DONSELF2011 as the coupon. - PQRI Wizard is $299 before the discount and $249 after.

OCCUPY GOLF!

donself@donself.com (Don Self) — Fri, 17 Feb 2012 14:26:00 GMT

I am not a very good golfer, although I do enjoy it. I haven't spent the hundreds to thousands of hours practicing. I spent my money on wasteful things like movies, entertainment, the latest cell phones, Christmas decorations, etc... instead of on greens fees, lessons, tutors, etc... I also did not have the skills to be the very best.

Now, though, I feel that I should be paid by the successful professional golfers for trying. I did try and I do play every couple of years or so. It just isn't fair that those that worked harder, studied the game, have better skills and spent tens of thousands to develop their game should make more and have more money than I. I know they give $ to charities - but they get to write that off taxes - so it doesn't help me.

I think money should be taken from them to be given to me because I want to be better at golf even though I'm not willing to do what it takes to be better. I want to get others together and we'll OCCUPY a golf course and demand that those who are better pay us that are not as good. Who is with me?

Feb 15 - THEY WANT EVERYTHING FOR FREE

donself@donself.com (Don Self) — Wed, 15 Feb 2012 22:47:19 GMT

THEY WANT IT FOR FREE

Every single day we are surrounded by people wanting something for free. Patients want you to see them without them having to pay a co-pay, deductible or co-insurance. You may have employees expecting the "company" to pay for whatever holiday that Congress has created. You have patients wanting you to provide them with free drug samples so they don't have to pay for a prescription. You have the President wanting you to provide additional healthcare benefits to your employees and if you fail to do so - then you will be looking at fines in 2014 and later. I must get at least 2 calls a day - every day from doctors wanting to get free advice - but they don't want to subscribe to my newsletter, buy my book or hire me. It doesn't stop there. The kids today expect mom and dad to provide not only a high school education - but they think they are ENTITLED to a college education and perhaps it goes further that they want you to pay for a Masters or a Doctorate. Where does it stop?

We can't change what we did 20 or 30 years ago with our children in teaching them to expect everything be handed to them - which is evident by the number of people on foodstamps, public assistance, etc… but we can re-train our patients to expect to be responsible for paying for the services you provide in your office. Later this month, I'm teaching a seminar on collections and while that may help - we need to start the retraining process alot earlier than we have in the past.

It's time you start educating your patients BEFORE the doctor sees them that they will be held responsible. Responsible for the co-pay, responsible if they fail to keep the appointment, responsible for bringing in their medications with them on every visit, responsible for bringing their insurance card (and wallet) every time they show up, responsible for paying (in advance) when they want forms filled out that will take time, responsible for following the doctor's advice or they may need to find a new doctor, responsible for following office policy on HIPAA, privacy, respect, dress code, controlling their children, etc…

WAKE UP PEOPLE. It's time we (management, physicians, staff, physicians (yes - I said physicians twice as we really require their help) start holding our patients and our customers responsible for following the office policies - but until we hold the staff responsible - we will not be successful at holding the patients responsible. Before you can clean up your neighborhood, you have to clean up your own house - so I think we need to know that this is possible. It may not be easy - but it is possible. Start working on your own compliance plans first and next week we have a Credentialing seminar and the week after a collection seminar and next month we're going to start a COMPLIANCE seminar series with a couple of experts. Watch our website and our Blog for this information.

Feb 9, 2012 - BELL CURVE DATA NOW AVAILABLE

donself@donself.com (Don Self) — Thu, 09 Feb 2012 23:12:27 GMT

I have spent more than 120 hours over the past week and a half (Including while watching the Super Bowl) creating new tools to help you and as of this week - they are on my webshop. First - I also updated my website and added new pages to my website - plus a new design - including a page on BELL-CURVEs, a new one on the Code-Portal and one on CANS-MCI that I'm still developing.

How often do you wonder whether your physician or physician extender is coding within the normal parameters of others in your specialty? (seriously - how often?)

Have you wondered if you're over-coding or flagging audits? (I know you have!)

Have you tried to express to your doctor that they are under-coding, based on a comparison to the other doctors in the same specialty? (yes - you can do this) Have you questioned the validity of the letter you received from Aetna or Blue Cross or Anthem or whomever saying your doctor is using 99214 more often other others in his or her specialty? (you should question it as they may tell you a big fat fib!!)

You now have an availability of finding out how your doctor compares to others in their OWN specialty by using the 2010 data (most recent data released by CMS) which I found in a very large file and extrapolated the data. They say a picture is worth a thousand words? OK - now you can show your doctor a graph of how they compare and that is very effective. I've been using graphs for more than 20 years when performing a fee/code/charge analysis for practices and it gets the physician's attention much more than numbers when you show them how they compare. Check out http://www.donself.com/bell-curve.html. I believe you'll find it very helpful.

Feb 6, 2010 - Try Our Coding Portal Free for 29 DAYS

donself@donself.com (Don Self) — Mon, 06 Feb 2012 23:50:08 GMT

We received some requests from folks asking for an opportunity to try my Coding Portal for free, without a credit card - for up to 29 days - so we have decided to do so. The Coding Portal allows you to look up any CPT, any HCPCS, any ICD-9 or ICD-10 or Modifier or Place of Service immediately. it allows you to cross over from an ICD-9 to the appropriate ICD-10 without having to take a class on ICD-10. It gives you not only the Medicare Global Fee Period on every CPT/HCPCS code but also the Medicare allowed amount in EVERY locality in the country. You also get Don's personal coding/reimbursement advice on hundreds of codes to help you make sure you're not coding or documenting illegally to keep you out of trouble.

The one part of my Coding Portal that most people rant and rave about is the Claims Scrubber that allows you to scrub the claim to see if the payer will pay for it. We probably get more people praising us for that portion of the Portal than any other. So - now you can check it out and try it and use it without a credit card for up to 29 days before deciding to subscribe to it on a month to month or annual basis. If you compare it to all of the other programs, I believe you will find it costs you less than 25% of other ones similar to it, at $30 per month. Click on the box on the left at http://www.donself.com for DON'S CODING ADVISOR on the left menu to try it out.

FEB 1, 2012 - MAJORING ON THE MINOR

donself@donself.com (Don Self) — Thu, 02 Feb 2012 05:20:30 GMT

The patient was brought in on a stretcher, in critical condition and the on-call surgeon was paged to the ICU. The EMTs and nurses updated the physician that the patient had been hit and drug by a truck along the highway for at least 30 feet. The patient's left lung had collapsed, the patient was unresponsive and the head trauma looked severe. The physician spent a few minutes looking over the patient and then proceeded to pull shards of glass and bits of rock out of the patient's superficial wounds on his legs until the patient expires.

Sounds ridiculous doesn't it? It's a great thing for the patients that most physicians are so much better at medicine than they are business because if most physicians practiced medicine the way they run their business, we as patients would be in real trouble. What I am talking about is the massive urgency that so many physicians are concentrating on to achieve Meaningful Use. The main objective by almost every one of them is to qualify to get the $44,000 bonus (if they achieve it for five full years), so let's look at that for a minute or two.

$44,000 / 5 years = $8,800 a year
$8,800 / 12 months = $733.33 a month
$733.33 / 4.3 weeks = $170.54 a week
$170.54 / 5 days = $ 34.10 a day

It seems like it would be alot easier to adopt even one of the things I've been telling folks about to get 25 times the $34.10 a day and there would be no doubt you would get it.

Yep - you folks are going to alot of trouble for $34.10 a day (that's what it will average out to over 5 years, by the way)

So let's look at the maximum you can get from MU per year:

So - if you started last year, the maximum you can get in MU is $44K - but that means you get $18,000 this year, $12K next year, $8K in 2014, $4K in 2015 and your check in 2016 from meeting it in 2015 will be $2,000.

If you start this year, you can max out at $44K - just putting the checks one year later

if you don't start till 2013 - you'll max out at $39K and if you wait until 2014, then you'll only max out at $24K.

So - $18,000 this year. That sounds better. Let's look at this year.

$18,000 / 12 = $ 1500 per month
$ 1,500 / 4.3 = $ 348.83 per week
$ 348.83 / 5 = $ 69.76 a day

And if you get the Hydrostat I sell and do just one Hydrostat on a patient with GERD or abdominal pain or flatulence a day, you make a net of $73.10 per day and that takes about 4 minutes of a staff's time. If you do one Annual Wellness Visit on a Medicare patient per day and you use my test to determine cognitive level, you make $211 per day for your nurse spending about 25 minutes with a patient.

OK - My innerds are not getting real tickled about Meaningful Use yet. Forgive me.

And, if you're going after the Medicaid MU instead, you should know that the Medicaid incentives will be paid by the States, but the timing will vary according to State - and if you're in a state that has given away all of their money, like California - do you really expect them to have any money to pay MU?

Folks - don't get me wrong. You need to do it as it is money that the Congress put our grandchildren into further debt for and it's already borrowed money that we have to pay interest on, whether you take it or not (if you don't take it - they'll spend it on something else) - so you should get it because you deserve it.

JAN 30, 2012 - ARE YOU GETTING THE 1% E-RX CUT?

donself@donself.com (Don Self) — Tue, 31 Jan 2012 06:04:45 GMT

Many physicians did not listen last year when we pointed out that they needed to do at least 10 electronic prescriptions or they would get a 1% reduction in Medicare allowed on their payments in 2012. Now - they are getting the 1% reduction and calling me to find out how to fix it. You can't. You had a deadline last year and you have one this year too.

There is a change in the reporting requirements for 2012 and 2013 with regards to avoiding penalties for 2013 and 2014. You don't want to lose 2% in 2013, so you need to pay attention. During the first six months of 2012, you simply have to report G8553, the code that indicates you did an eRx during a visit ten times. So any time you do an eRx (for a Medicare Part B patient) during the 1st six months, you should report the G8553 code, and by doing that 10 times you will avoid the payment reduction the following year. That 2% in 2013 can add up as the 1% in 2012 already is, so you should look into doing at least 10.

GOP PRIMARY ELECTION

donself@donself.com (Don Self) — Mon, 30 Jan 2012 14:37:24 GMT

It seems there are still 4 men trying to get elected to be the GOP candidate to face Obama. Of those 4, it really boils down to 2 (Romney and Gingrich), as Santorum is not as well known throughout the country and Paul is a little too libertarian for most Republicans (myself included).

Don't get me wrong, as I do think Paul has SOME good ideas on fiscal issues - and some social issues, but his views on foreign policy, legalization of drugs, abortion and other things are just too out there for me. I also like Santorum but I do not think he has what it takes to beat Obama and that should be the first consideration of anyone voting in the GOP primary, in my opinion.

Seriously, why vote for someone if you do not think he/she has a chance on beating Obama and getting elected in November? Why waste your vote. Alot of Americans did that very thing in 92 and voted for Perot, even though he had the same chance on getting elected as Paul. So - if I'm looking at which of the two (Romney or Gingrich) do I think has a chance on beating Obama, then I need to look at the major issues: Economy, Foreign Policy, Obamacare - and Honesty.

What will happen when the GOP candidate is facing Obama in the debates or on the news bites when it comes to these 3 policies. Economy is going to be a top issue due to the number of people unemployed, the number of businesses sending jobs overseas, the amount of inflation we have (and we have alot of inflation right now folks!), the tax proposals that the president will embrace, interest rates, rate of printing money, etc... If we look at Romney's history as governor, we see (in my opinion) too many tax increases while he was there and we look at his own history of investing overseas in businesses himself (again in my opinion). Yes - he knows HOW to make money as a business - but I don't see that he is a conservative leader in that regard - as the way he does it is by investing in alot of overseas companies. If we look at Gingrich, it appears that his voting record - and especially as the speaker of the house was to reduce taxes that resulted in increased spending in the economy as well as increased number of jobs. I like that approach. It worked for Reagan and if both of the Bush's had stayed the course with it - we would not have had Clinton and we would have had a much better 2008 & 2009. While Obama's record is dismal when it comes to the economy and his spend spend spend approach & the unsurmountable debt it causes will have to be faced by my 3 grandchildren (ages 9 months, 3 years and 7 years), I have to think that Gingrich has a better chance on beating Obama than Romney on this issue.

With foreign policy, I think Romney lacks the experience in this regard that Gingrich has and since we're facing North Korea, Iran, Somalia, China and a resurge in Russian power in the middle east, I definitely lean towards Gingrich in this area.

Obamacare is one that is constantly on my mind as that one has impacted every one of my clients, my business and my own income more than foreign policy, unemployment, interest rates, etc... Santorum brought up an excellent point in last Friday's debate that I had not thought about previously. Obama touted the Mass. Healthcare System when he promoted Obamacare back in 2009. Obama used Romney's advisors to develop the plan. Romney touted the idea that federalizing his state's system would benefit the country. This means that when it comes to the debates prior to November, all Obama has to do is point at Romney and say "you were behind it, you helped develop it, your people helped me draft it - so now the only reason you say you don't like it is so that you can be elected". I think Romney is terrible on this issue - so again I have to go with Gingrich who has been very vocally fighting Obamacare since the beginning.

Honesty: If we look at the advertisements that are endorsed by each of the two men - we see some dishonesty. Romney is running ads saying that Gingrich was fined by the Ethics committee - yet when you look back at the reports - he wasn't. Romney ads say that the ethics charges against Romney forced him to resign in disgrace, yet the timing of when Gingrich left Congress doesn't jive with that as Gingrich had already been cleared of any wrongdoing by the Ethics board and said the charges brought against Gingrich was not supported in any way and the judge said the same thing. It appears that Romney is saying that someone being accused of something is tantamount to them being guilty and I don't like him lying to me as a voter.

I would, I think, prefer Jan Brewer or Sarah Palin or even Chris Christie as my first choice as the GOP candidate and I'm glad Rick dropped out (but I wish he would do his job on our border instead of waiting on the feds or Obama to do it), but I think I'm in favor of Gingrich for the GOP candidate this year.

If you agree, disagree or have an opinion - feel free to post it in the comments.

JAN 26 - DON'T WAIT TILL IT'S TOO LATE

donself@donself.com (Don Self) — Fri, 27 Jan 2012 17:03:46 GMT

As a medical provider, you would much rather the patient come to see you and follow your advice BEFORE they get to the point where it's too late to help them. It has to be so frustrating to have a patent with COPD not decide to put cigarettes down and quit smoking until the doctor gives them 3 months to live. By then - it's too late to add any days to their lives. It's almost the same way with me and physicians. In the past 5 years, the number of physicians that have waited until they have destroyed their practice, their income, their credit rating before they either come to me for help or they decide to start listening to me. It's equally frustrating when I know that I could have helped them had they not been so darn stubborn, set in their ways and unwilling to listen until their pride finally allowed sense to sink in.

Doctor, how do YOU feel if you have penicillin (that you have used hundreds of times to help patients with strep throat) and the patient refuses to let you give them an injection of it because they don't believe it will work or they didn't read anything about it in the latest issue of the Wall Street Journal? You know you have a 95% chance on helping them if they will just listen and follow your advice and YOU are the expert in this field - yet they don't. How frustrating!

Here is an email posted by a Family Physician who listened to me for 15 years before he finally started doing what I was recommending. He posted this today on the free email forum that I run that has 820 physicians, coders, billers and consultants on, when an office manager said her doctor was complaining of reduced income and sad because he couldn't give raises to his staff for another year.

"We are preparing our annual reviews and I plan to give raises to my staff and have given raises the past 4 years because 4 years ago I finally listened to Don and took his advice and implemented his recommendations. As suchI have been blessed, all of our vendors are paid, we have not missed a payroll and later this year several of the equipment leases will mature and I expect to give myself a pay raise as well. Praise the Lord!

What's the definition of insanity? Doing the same thing the same way but expecting a different outcome. You all need to encourage your docs to visit with Don and implement his recommendations. Pull out the ansar, pft, abi, VAT and labs cpt codes get the average reimbursements for these from him and let him perform an analysis of your practice and you will be shocked at the potential revenues walking out of your offices. Don can confirm this. I am simply telling you as a FP in Texas that I did this 4 years ago and it works!" Michael Benavides, D.O. - DALLAS

Money Magazine, CNN, Wall Street Journal and others have been reporting that physicians have been taking out loans to keep their businesses afloat and keep from laying off employees. Most are not giving raises and some are not taking paychecks home. Yet they refuse to take the penicillin or even let me explain how penicillin may help them!

Don't be like Dr. B was and wait 15 years before letting me help. Call me before you destroy your credit record with late pays. Sometimes just a little investment, as small as $4K in your practice can result in $6K a month increase in net income - and more importantly - you'll be able to help patient conditions that you're not helping now.

JAN 25, 2012 - MEDICARE ADVANTAGE VS MEDICARE TRADITIONAL

donself@donself.com (Don Self) — Thu, 26 Jan 2012 21:31:36 GMT

Many of your patients have switched their Medicare coverage from the original Medicare to the Medicare Advantage plans - often to the patient's detriment (in my opinion). Medicare Advantage plans do not always cover everything that traditional Medicare covers and sometimes there are more hoops for the physician's office to jump through to get paid. For that reason, more and more physician offices, clinics and others have chosen to NOT accept patients with the Medicare Advantage plans. The problem is that patients sometimes do not realize they are SWITCHING over to the dark side. They believe they are taking out a supplement or Medigap plan instead of completely getting rid of their original Medicare. When they show up at your office, and you ask them if they still have Medicare Part B, they believe they do. They pull out the cards to show you and one is for Part B and the other is for Part C (Advantage). Now you know that they replaced their B with C. If they don't pull out the cards, you may not know until you get denied from Part B and then you're out of luck because you may not be enrolled with their Advantage plan.

I spent alot of time today talking with someone that sells Part C to seniors. The senior is required to sign a paper acknowledging that they are not getting a supplement, but that they are enrolling in Part C. That is required, so they are signing it. The problem is that some patients are too ignorant of what Part C is as no one has either taught them or they are unable to understand it. The problem is also that some Part C salespeople may not be explaining it thoroughly, explaining it enough or even explaining it at all. Salespeople make money by enrolling people - and there will be some amount of larceny involved at times - but not all the time. If your office waits until the patient presents before explaining that you cannot see them today because you do not take their Part C Medicare, you're waiting too long and you may deserve losing the patients. Too many offices have a reactive approach to educating patients instead of a proactive approach. Those are the ones who wait until the patient has already switched before they tell them that they made a mistake or they cannot be seen. That is foolish, in my opinion. Physician offices and clinics, if smart, will take a PROACTIVE approach and educate the patients BEFORE the patient enrolls in Part C. Now - you really should become familiar with Part C as there are some advantages (especially on the Part A side), but if you do not take Part C - perhaps you should do something to minimize your OWN loss - and that is to educate your patients PROACTIVELY.

Here is something you can copy/paste into a note that tells folks when they can WITHDRAW from Part C. Most have no idea when they can withdraw, even though they are very well versed on when they can enroll.

Now’s the time to switch from a Medicare Advantage plan to Original Medicare if you’re dissatisfied.
If you’re unhappy with your private Medicare Advantage health plan, an annual “dis-enrollment” period allows you to return to the traditional fee-for-service Medicare program between Jan. 1 and Feb. 14. You can also select a drug plan to go with your new coverage. You should also know that the Medicare Premium dropped to $99.90 and the deductible for Part B dropped this year to $140.00.

A word of caution here: There are two things you can’t do during the six-week dis-enrollment period. You can’t sign up for a Medicare Advantage plan for the first time. And you can’t switch from one Advantage plan to another. If you have any questions, please ask our manager.

JAN 20, 2012 - 2 NEW SEMINARS FOR FEBRUARY

donself@donself.com (Don Self) — Mon, 23 Jan 2012 18:35:13 GMT

From the questions that I receive via email and on the Med-Mgrs listserv, we've noticed that alot of people have questions about the enrollment process with Medicare, PECOS, how to get credentialed with PPOs and other payers and how to negotiate contracts. In fact, it's absolutely AMAZING how many physicians have NO IDEA that they can negotiate contracts. They believe they are totally powerless - which is ridiculous! Physicians have alot more power and strength to deal with PPOs and insurance companies once they are educated on it. To sign whatever contract the payer presents is like paying list price at a car dealership.

We also see alot of questions on how to collect at the time of service, what patient statements should say, when you are allowed to collect, what the laws say about collecting or past due statements and who should collect. On many occasions, I have witnessed front desk or check out personnel not even asking for the co-pay or Medicare co-insurance when the patient did NOT have co-insurance, Medigap or Secondary policies.

For this reason, we scheduled TWO online seminars (webinars) in February. You can register for either or both at my store at DON'S WEB SHOP.

Thurs, January 19, 2012 - Annual Wellness Visits

donself@donself.com (Don Self) — Sat, 21 Jan 2012 04:54:03 GMT

Today's subject is the Annual Wellness Visits with Medicare patients. There is still quite a bit of confusion about them. There is confusion with the patients, with the medical staff, with the physicians and with the billing staff.

Let's start with the patients. Your patients believe that when they arrive, they will get to spend an hour or more with your physician discussing how many times they pee every night, what their grandchildren are or are not doing, the latest episode on Nick At Night of Andy Griffith or whatever. They NEED to be told on the phone when they make the appointment that they will NOT be seeing the doctor during this visit. They need to be told who they will be seeing and when they arrive, they SHOULD be told to sign a form acknowledging what the AWV is and what it isn't. The AWV does not require a co-pay, a co-insurance or a deductible, so the patients need to hear that if they demand to see the doctor with a problem during the visit, the patient WILL be required to pay a co-insurance or deductible.

The AWV is not the IPPE! While I have not started recommending clients offer the IPPE (welcome to Medicare physical) as I still do not believe it compensates the physicians enough for the time they spend (30 to 45 minutes), I do recommend everyone offer the Annual Wellness Visits (AWV) with codes G0438 and G0439. There are basically six points that the practice needs to make sure they do - plus the HRA (Health Risk Assessment) form that the patient can complete themselves. I added the HRA form to my site in the past couple of weeks, so feel free to download the questions. It's also apparent that Medicare pays for the AWV even when it is performed by the clinic nurse and does not necessitate the physician see the patient during the visit. This isn't a bad idea as it helps the doctor do a better job on the patient as the physician is more informed on the patient's conditions.

Even though the reimbursement only went up about 8 cents from last year to this year for the AWV as a result of the clinic having to get an HRA completed, it is still profitable. You can download additional help on the AWV on the FREE DOCUMENTS page on my website or read more in my book on this subject.

Thank you for reading the blog! if you like it, please let me know by leaving a comment. I wonder sometimes if people really take the time to read this.

Don

Jan 18 - Global Fee Periods

donself@donself.com (Don Self) — Thu, 19 Jan 2012 16:50:00 GMT

Today, we can talk about the Global Fee Periods published by Medicare and followed by alot of different insurance carriers. Unfortunately, there is a lot of confusion in the minds of folks regarding global fee periods as many think they are for surgeons only - which is not true. They apply to all doctors and most services. There are basically 4 different Medicare fee periods:

1 day global: These are shown on Medicare reports (and those you can download on my Free Documents page) as 000. Medicare says the day of the procedure, plus ZERO additional days are paid for as part of the procedure. This is their way of saying "one day".
10 day global. The day of procedure plus 10 days, anything done related to the surgery is bundled into it - per Medicare. It's interesting to note that cpt and private insurance only bundle "routine" follow up services, but Medicare bundles anything related. There is a big difference in those two - so pay attention.
90 day global means the day prior to the day of surgery, the day of surgery plus 90 days following the day of surgery are bundled into the surgery.
The last one are those shown by XXX. This means the global fee concept doesn't apply. Many people mistake 000 for meaning that - which is a huge mistake. Y

You can read more about this subject in my book. Don

JAN 12, 2012 - MEDICARE ABN'S

donself@donself.com (Don Self) — Fri, 13 Jan 2012 23:53:42 GMT

Hopefully you are not only using the Medicare ABN (Advanced Beneficiary Notice) the correct way in your medical practice, but that you are using the correct version. As of January 1st of this year, CMS says the only valid one is the one from March 2011. You can download the one approved by CMS on my FREE DOCUMENTS page on the left menu to make sure you are using the right one and there are also instructions you can download with it. Every once in awhile I talk to a medical office that either has no idea what an ABN is or they are not using it correctly. <br> <br> Some offices have the patients sign it before they get any lab tests and Medicare, CMS and the Office of Inspector General (OIG) feels that is a 'general' notice - so it's invalid. You must have a specific reason to believe that the service will be denied when you give it to a Medicare patient, per CMS. Some have the patients sign one during the first visit in case they ever need it. That's not valid either and will get you into trouble with Medicare and CMS. That is similar to you giving your wife an expensive gift when you first meet and tell her "that is my apology gift eventually when I screw up - which i will do". No way. You didn't make it to the 8 second count on that ride, cowboy. (watch rodeo to see what I mean). You also cannot have the patient sign the ABN after you render the service. That makes it invalid as well. <br> <br>Make sure you're using the correct version and using it when you should as the RACs will be looking for that as well. Hey - if you like these blogs, let me know. The really creative and brilliant ones I save for my monthly 8 page newsletter that goes out to thousands of subscribers each month.

Jan 11, 2011 - Holding Medicare Claims

donself@donself.com (Don Self) — Thu, 12 Jan 2012 22:21:00 GMT

From the www.donself.com website on January 11, 2012. If you want to find the current day's post, visit the new and revised www.donself.com and see the NEWs section on that same page.

Today was the 11th and today was the date that CMS said the carriers have to be using the revised 2012 Medicare Allowed amounts. Hopefully, you have held your Medicare claims for the first couple of weeks of this year so that you won't have the same problems that we had in 2010 and 2011 with delayed adjustments as that was a royal pain. If you've been on my site in the past week, you also know that the 2012 Medicare allowed amounts are downloadable on the link on the left in Excel for every locality. You also can go to my new Documents Page and download the 2012 Global fee periods, 2012 lab allowed amounts, HCPCs listings and more. Also - I have 2 new testimonials about how recommendations we made have helped GREATLY improve patient care, so please take the time to read those as that is what the true benefit of my advice is going to achieve. It's not about the money - it's about improving patient care and the money WILL follow! I hope you like the new format and I hope to give you updates on this page daily or every other day - so check back often.

Don

January 9, 2012 update - 2012 is HERE

donself@donself.com (Don Self) — Mon, 09 Jan 2012 23:41:44 GMT

Wow - where do I begin? 2011 was a phenomenal year and alot has happened since I last blogged. yes - that term "blogged" does sound weird and like it is something that should be outlawed in several states - but it is a term like "my bad" that people seem to use today - so why not?

Let's begin with current issues. Doctors were afraid of the threatened SGR reduction and as I've been saying for a year - it didn't happen as at the last minute, the 536 idiots in DC (435 idiots in the House, 100 idiots in the Senate and Mrs. Obama's husband at 1600 Pennsylvania) did a 2 month extension to give them more time to posture. Posturing is exactly what I am talking about as they can fix this - if they want to - but by prolonging it into the election year - they can use terms like obstructionist towards the other guys to blame the other party. I am most disgusted with the Democrats in this particular case as they could have put it off an entire year when they did the payroll cut extension - thereby giving the small businesses some kind of security so they would hire more employees than the 2 month extension to keep people afraid. The Medicare SGR delay was in the same bill with the payroll tax extension.

So - in February, we'll see them dance again - but there is NO WAY they will allow the reduction to go into effect. In fact, the new 2012 Medicare numbers (that are now on my website) show an increase in most areas (between 5% and 13% on the 3 diagnostics I sell the most of) and 1.4% as an average on others.

So - 2012 will be a great year, in my opinion. More and more doctors are starting to realize that what I've been telling them about doing better medical care and getting better medical outcomes on their patients increases their practice income - and more are trusting me. I'm getting better referrals and more of them - so business is exciting.

The family is fantastic and Angie and I are living alone again. In 2011, we moved her parents out of our house into their own and they are happy there. About 2 weeks ago, Nick and his family moved out and into their own place. So - for this has been the 3rd week out of the past 23 years, that Angie and I have lived alone in our home and we are very happy. I could run around my house nekid if I wanted to - but I'm afraid I might shock Cookie (our 13 year old dog) if I did, so I don't.

My involvement in the Royal Family Kid's Camp and Club has grown so I am now mentoring a 7 year old and really getting to have fun showing him how much fun being around a dad/grandpa is. We have alot of things planned this year. If you are not familiar with RFKC, check out their association. There are thousands of abused foster children who need someone to show them that Christ's love is not conditional and that they are worthwhile, loved, valuable and their future is not negative. Just spend 4 hours a month with one of those children and you will see how much of a difference you can make in their life. RFKC has camps (we have 3 of them a year here in Tyler) and it's amazing to see the change you can make in their lives with just a little bit of effort. Royal Family KIDS | Home and they have it for teens also called TEEN REACH. Yep - definitely worth looking into. You will be blessed even more than the children are.

So - everyone is healthy. All 3 of my grandchildren are within 2 miles of me (one is across the street) and all 3 of my sons and 2 daughters-in-law are within 6 miles of me. Angie's parents are a mile away and my dad is 1/2 mile away. In the past month, I've had the joy of seeing my sister, her husband and all 12 of their children (11 by birth and one is a son-in-law) and God is blessing me more than ever.

OK - let's talk about that for a minute. If you've read my blog in years past, you know that Obamacare scared alot of doctors and it caused me more than a bit of financial woes as that scare had physicians afraid to do anything positive in their business. For awhile, the majority were drawing in like turtles and even today - there are thousands that are borrowing money to keep their practice open - only because they either do not know about what I can do or they are too stubborn to listen and learn. But business suffered quite a bit. Now for a confession. Angie and I were out of church for a long time and we had gotten out of the habit of tithing. Sure - we did offerings when there was a special need and we gave to all kinds of charities to help others and still do - but I'm talking about tithing. Tithing is returning 10% to God through his church - which is showing obedience. It's not "giving". It's obeying. There is a reason that God wants us to tithe and it's not because HE needs our money. He owns everything and what does the God that created the entire universe need with my money? He needs my obedience. Last February, Angie and I talked about it and while we couldn't afford to - we decided to obey. Yes - you heard me right. We were not able to pay our bills, but we decided to write the check for 10% of the money we made the week before and dropped it in the plate. Hey - I knew about tithing from many years ago when we attended a different church - but I had lost the conviction that I needed to obey. So - we did in February and immediately - we started getting calls from medical offices that we had not heard of or those that had been putting us off for months and even years. There was no coincidence. I started getting people that I had never contacted calling me and asking me to speak or consult for them. Hey - that's what obeying God does. He uses your obedience to teach you. So - as a result - 2011 turned out to be a very good year financially - but more importantly - my walk with Jesus and God and the Holy Spirit has improved greatly. No - I'm still not the man I want to be and I may never get there - but I'm walking closer to God than ever before. That has transferred over to the relationship I have with my wife and my family. If this helps - just remember that He doesn't need our money or our time - he needs our obedience because through that obedience, He can give you more blessings than you are even looking for.

OK - more later.

Don

A frank discussion about Medical Offices, Medicare & Current Affairs

donself@donself.com (Don Self) — Wed, 21 Jul 2010 21:57:00 GMT

Ok - when I say "current affairs", this has nothing to do with Tiger Woods. It has everything to do with the current state our economy is, the problems we are facing with healthcare, the idiotic decisions by physicians, and the problems being faced by Medicare patients and those that will be faced by those that are 63 and 64 years old today.

First - let me say that we're all in good health and we had a very fun family reunion on Angie's side of the family.   Current news includes the fact that we have our house for sale (special pricing at shop.donself.com ) for anyone wanting to spend $225,000 on a beautiful home within walking distance to 4 schools with a great pool, guest house and more... Ok - a little shameless sales plug doesn't hurt.   Angie's parents (Jim and Ann) are looking to buy a place close to us (they have their home for sale in Early, Texas) and last - but not least is that we have a contract on 20 acres about 20 miles southwest of where we are now - literally on top of a mountain. Ok - the mountain is only 200 feet high but it is the close to the highest elevation in Cherokee County and if we get the property - we'll build a house facing the southwest with a panoramic view of at least 12 miles in about 3 directions - so it's the closest thing that I'll ever get to living on a mountain. The town is called Mount Selman - so it's legal for me to say it's a mountain. <grin>

Ok - business is slow and part of that is due to the absolute moronic decisions being made by Congress (I'm ready to get rid of 534 members today if I could - but I do want to keep Louie Gohmert as he is the ONLY one there that I trust - and that includes Kay Bailey and Cornyn!). It's also due to the ignorance of physicians and their staff that are hurting them by telling them to get rid of Medicare patients. Ok - Perhaps "get rid of" is not the right term to use. Many office managers, billers and even short sighted administrators of national and state medical and osteopathic physician associations are hurting the physicians with their bad advice.    I'll give you a little background first.

Prior to 1987, Medicare would follow whatever the private insurance carriers were doing, but that changed in 1987. That was when Medicare took advantage of the STUPIDITY of the AMA and instituted for the first time in this country - a limit on how much a physician could charge. The government doesn't limit what any other private business in this country can charge - but they effectively set the stage with physicians and the AMA let them do it because it didn't hurt them one bit. I am of the belief that the AMA looks out for the AMA and doesn't give a dang about the physicians or the members or the patients in this country. If it puts more money in their own pocket - halleluja and screw everyone else.    So - in 1985 the AMA asked for a "voluntary" fee freeze by all physicians and the physicians complied and then in 1987, Medicare came out with limits on how much physicians could legally charge - based on the previous 18 months history of fees charged by each physician.   Tadaaa!   So - the private carriers saw the government do it and then they started in 1989 sending out letters to their policyholders saying their doctor had "overcharged" or charged more than the Usual, customary and reasonable amount for the services they did" It did not matter that the patient had no idea that there was no such thing as a uniform UCR - as every carrier made up their own. They just heard "your doctor is screwing you" so they got upset. As a result in 1991, those same patients voted in someone who was going to "reform" healthcare and make the doctors accountable and honest. So - that unscrupulous jerk put his wife in charge of revamping healthcare and making it into socialized medicine.   Fortunately - the way he did that caused people to wake up and stop her - so she didn't accomplish anything.   So - then we had a couple of terms of Clinton that really didn't hurt our country too much - other than businesses paying more in taxes and our military that was stripped - but the healthcare arena stayed the same during his term with carriers slowly convincing physicians to sign contracts that anyone with a business degree would have torn up.   What many did not see happen in 1996 was the fact that Clinton - along with a republican led Congress passed a law that required a "sustained growth rate" of Medicare payments - which in fact - actually meant a budget neutral growth rate. Congress knew that in 2011, we would start having the baby boomers (those born after our soldiers and sailors returned home from World War II) hit Medicare and that would be a huge influx into the Medicare program.   So - they designed something to slowly reduce the amount Medicare was spending and that would begin in the future president's term. That took place in 2003, and Bush and the Congress felt the pressure - so they 'forestalled" the reduction of the 1.3% that year. Then in 2004 - they again did not want to upset the doctors and hospitals, so they did it again.   Each year - the reduction was not eliminated - but delayed - so it started accruing.   So - the first year, the Medicare allowed conversion factor was supposed to reduce by less than 2% and then next year when they delayed it - that meant that when it took effect it would be over 2% and over 3% the following year, etc... By this year - by federal law, the Medicare allowed (how much the physicians are paid) was supposed to reduce over 21%.   Congress was terrified that if they allowed this to happen that at least half of the physicians in the country would no longer see Medicare patients. But - since they couldn't get their heads out of their butts while they were pointing fingers at the BP people for spilling oil in the gulf (never let a good catastrophe go to waste when it comes to press time), they couldn't come up with a solution that made everyone look good.

So - last December - they delayed the reduction for five months - giving them five months to fix it.   Of course, they did NOTHING for the first 4 months on it at ALL! Then by May - when they started thinking about it - they had a great catastrophe to get in the way.   So - the government department over Medicare decided to help by holding all Medicare checks for the first 2 weeks in June to give Congress time to act. But - those Congressional members had to take some extra time off for this or that and then they couldn't come up with a solution in time. Once again, CMS (Centers for Medicare and Medicaid services) tried to help (help who???) by announcing they would hold Medicare checks for one more week. then, towards the last part of June - both chambers of Congress finally finished their tug of war between Pelosi and Reid trying to prove who had the most power and passed something - delaying it another 18 months.    That would take time for the Medicare payers to get their computers right so they had until July 1st to start issuing checks to the doctors.    Think about this.

No doctors got any checks in June for any Medicare services done in June. This doesn't mean a big deal to the Pediatrician doctors - as very few of their patients have Medicare.   But - what does it mean for the family doctor or internal medicine doctor or the geriatrician or the doctors visiting nursing homes?   What if you owned a business with alot of employees and alot of expensive supplies (drugs, equipment, lab tests, etc) that you had to buy and your income stopped - but you had to keep paying everyone?    Now - you get a feel for what your doctors have been going through.     Did you hear about this on CNN or FoxNews or in your paper? heck no!

Now - while we've seen all of this coming, I've been a voice in the wilderness telling physicians to see MORE Medicare patients and trying to convince them that Medicare patients are the most profitable they have.   While I've been telling them this - they've been listening to their office managers and billers and associations tell them to get rid of Medicare patients as they believe Medicare is one of the lowest paying (Medicaid is definitely by far the lowest paying).    The doctors listen to their office manager explain that Don must be wrong or smoking something he shouldn't and they'll give them an example of a Medicare payment.    They will show the doctor that the doctor is paid $52 for a level 3 established Medicare patient visit and they are paid $67 for a Blue Cross patient for the same service. The doctor looks at the $52 in one hand the $67 in the other hand and then doesn't take the time to let me explain why that is deceiving.

Since 2001, Medicare has been trying to get physicians to change how they practice to achieve better medical outcomes.   To accomplish this, they have moved massive amounts of money from the areas of office visits and procedures into evidenced based medicine, such as clinical lab testing and diagnostic testing.   Unfortunately - they did not tell the physicians about this move.   They just put alot more money into select areas and expected the physicians and their managers to figure it out - but they didn't.   Physicians kept seeing reduced payments for office visits (when compared to the national inflation rates) and reduced payments for procedures and did not realize that Medicare was MOVING money instead of reducing it. In fact, from 1996 to 2009, the federal government increased PHYSICIAN expenditures by more than $14 Billion per year. it almost DOUBLED IN THOSE 14 YEARS.   Yet during the first 10 years of this century, physicians kept feeling the pinch and had to draw money out of savings, reduce their own salaries, cut back on employees, offer less benefits to employees, reduce hours, etc... trying to survive.    My partner Keith and I have, for more than 3 years, been showing the physicians that would listen to us how they could easily increase their income by $ Hundreds of thousands per year while improving patient outcomes by following Medicare's new guidelines - but the vast majority were not listening to us.   So - those that have listened would benefit.    Sometimes they would come back and admit that they waited too long before listening, such as Dr. Mike Benavides in Dallas, Texas. Mike and his wife Cindy had been struggling for the first part of this decade like many other physicians and had to take out loans to cover payroll, lay off essential staff, reduce hours and sometimes go months without taking a personal paycheck.   After he listened to us, he increased his income by more than $150,000 per year by following Medicare's guidelines and he said "I wish I had acted on what you were telling me years ago instead of ignoring it".   Today - he's in great shape because he listened.

Last week I had a physician who I've known for about 20 years say "I had been reading what you've been saying for many years now Don, but when you said you could help me, I though you meant by $1,000 to $2,000 per month and did not realize you meant by $25,000 to $30,000 per month in increased profits. Now it's too late for me since I can never work again due to this disability but i wish I had acted back then".   That is Dean Gafford, DO in DeSoto, Texas. Dean had called me because he wanted someone to take over his practice since he can't practice anymore.   Another consultant and I put together a package for the doctor about to buy Dean's practice and in a 4 way conference call, Dean saw what we could actually do and he was surprised.

Keith and I have helped one doctor after another increase their income by $100,000 to $400,000 per year - so easily - just by following the new guidelines when they listen to us.   From Dr's Gastorf in Durant OK, to Tasha Wallace in Lehigh Acres Florida to Hector Lopez in El Paso to Jeff Lindenbaum in Pennsylvania to Dr. Lomas in Florida to David Braunreiter near Houston, Texas to so many others. I have dozens of letters from physicians showing what we did for them and every one of them point out that their patients are getting so much better care today than they did before.   Many of them reference patients who are ALIVE today thanks to what we taught the doctors - and while we could do so much more good - we run into the know-it-all office managers who are driving their physicians into bankruptcy. We run into the physicians who want to save 5 cents so they totally ignore the $10 they would get.

As an example, in May, I did a diagnostic analysis with a doctor and I showed the doctor the guidelines that Medicare and other carriers have and how often they want the doctor to do specific tests. Medicare and carriers have realized that it makes financial sense to pay $115 today to a physician to do an 8 minute test to detect peripheral arterial disease early enough so that the patient doesn't have to have an amputation of a toe or foot. When you consider that 33% of patients over 50 years old with diabetes have P.A.D. and that less than 10% of them are being diagnosed (per the National Institute of Health numbers), it makes sense to save the $7,000 they would pay for an amputation by paying $115.   So - I did with this doctor the same thing I've been doing for years with every one of the doctors I mentioned earlier and then asked the doctor "If you were doing this in your office, how many a day would you do and be conservative". He gave me very conservative numbers. Then, we looked at other diagnostics and some lab tests and he said that he needed to be doing these.   He agreed that it would be good for his patients and that these did meet the current guidelines (I showed them to him on the Medicare website).    As he gave me numbers, I would sometimes reduce them to be super ultra conservative.   When we finished, he agreed that after ALL expenses, by following the current guidelines, he would increase his net (net is after all expenses) monthly income by $17,312 per month.   He was excited about it and gave me his tax id and social so I could run it by the leasing agent and he could check with his CPA to make sure of the tax breaks and he wanted to start helping his patients. I also gave him 7 letters from other physicians similar to his practice that had done the same thing and increased their income by more than $200,000 per year and saved lives.   I called him a week later.   He didn't return my call. I called a week after that and sent an email. No return call.   A week later, his office manager said he was comparing prices and thought he could get the pulmonary function test equipment for $2,000 less and he would check back with me.   Last week he said he was waiting on his bank to see if they could get a better interest rate than the leasing company and I know for a fact that the leasing company we went to has rates almost equal to any bank in the country.   Ok - do the math. He has spent 2 months trying to save $2,000 and maybe save another $400 in the interest.   In that 2 months, using his conservative numbers he would have made another $34,624 but he hasn't because he's been busy trying to compare interest rates. He'll probably wait another month and by then it will be more than $50,000 he lost due to ignorance. yes - ignorance!   Forget the money for a minute. He pointed out that he was NOT running ABIs on his patients and I wonder how many of his patients have P.A.D. that are undiagnosed and by the time he acts - will need amputations of toes?    He was not running PFTs - yet 20% of Americans suffer from pulmonary dysfunction and COPD is the 4th leading cause of death. He is not performing heart rate variability tests and we KNOW that 30% of CHF patients are over beta blocked and 14% of Americans have orthostasis and between 11% and 14% of seniors with diabeteos suffer from silent ischemia.   I could go on and on but you get the idea. It's doctors like that which drive me mad.

One of the letters that I received from a physician in Malvern, Arkansas points how much he has changed how he practices by following the national guidelines that I showed him. He doesn't center on the fact that we've increased his net profits by $Hundreds of thousands per year over the past 2 years but he points out what his patients experienced as a result of it.    i give out these letters with the physician's phone numbers - yet so few of my prospects call them. They would rather spend their time trying to save $100 on the price of the equipment or listen to their office manager tell them I'm wrong instead of calling physicians who have proved that I'm right.

So - this is me spouting off.    I'll keep fighting to get these doctors to listen and some will and their patients will do better and the arrogant fools who do not listen will continue to pull money out of their savings trying to stay afloat and the battle will continue.

have a great day!

Journeys of Don, Angie & Cookie

MAR 5 - Not Many Reading Don's Latest News

MAR 1, 2012 - CREATIONISM

A CREATION STATEMENT EVERYONE AGREES WITH

A CREATION STATEMENT EVERYONE AGREES WITH

It doesn't matter if you believe in Creation or if you believe in the theory of Evolution. Everyone enjoys this one. Click on the powerpoint link here and enjoy it. I would love to hear what you think by emailing me. CREATION POWERPOINT TO MAKE YOU SMILE

FEB 21 - 2 SURVEYS TO HELP DON

FEB 18 - ELEVEN DAYS TO REPORT PQRI

OCCUPY GOLF!

Feb 15 - THEY WANT EVERYTHING FOR FREE

THEY WANT IT FOR FREE

THEY WANT IT FOR FREE

Feb 9, 2012 - BELL CURVE DATA NOW AVAILABLE

Have you wondered if you're over-coding or flagging audits? (I know you have!)

Feb 6, 2010 - Try Our Coding Portal Free for 29 DAYS

FEB 1, 2012 - MAJORING ON THE MINOR

JAN 30, 2012 - ARE YOU GETTING THE 1% E-RX CUT?

GOP PRIMARY ELECTION

JAN 26 - DON'T WAIT TILL IT'S TOO LATE

JAN 25, 2012 - MEDICARE ADVANTAGE VS MEDICARE TRADITIONAL

JAN 20, 2012 - 2 NEW SEMINARS FOR FEBRUARY

Thurs, January 19, 2012 - Annual Wellness Visits

Jan 18 - Global Fee Periods

JAN 12, 2012 - MEDICARE ABN'S

Jan 11, 2011 - Holding Medicare Claims

January 9, 2012 update - 2012 is HERE

A frank discussion about Medical Offices, Medicare & Current Affairs

It doesn't matter if you believe in Creation or if you believe in the theory of Evolution. Everyone enjoys this one. Click on the powerpoint link here and enjoy it. I would love to hear what you think by emailing me.

CREATION POWERPOINT TO MAKE YOU SMILE