|
|
|
|
|
Search
05/03/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
RE: Harassment by Ciox Health
From: Name Withheld
Ciox is now calling our office countless number of times for the same requests, sending 60-70 pages at a time over and over, wasting paper, ink, etc. THEY DO NOT STOP! This is nothing new, but now they have started questioning my staff about 1) when were certain patients seen and 2) are they current, etc?
Name Withheld
Other messages in this thread:
07/23/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Ivar E. Roth, DPM, MPH
While Dr. Lang makes some good points, until you have practiced direct pay/concierge podiatry, you cannot understand what we go through. As a concierge podiatrist, we are all about service. I instituted a no-show fee a few years ago. While we rarely impose the fees if the patient makes any effort to contact us, there are some patients who are abusive, and so we bill them and they pay.
Some learn their lessons, some never come back, and that is okay. It is all about patient responsibility. As direct pay doctors, we take our practices seriously, and therefore we expect the same from our patients. Allowing no shows and very late shows to disrupt our practice is just not tolerated and that is the way it has to be in this modern world.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
07/22/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Joel Lang, DPM
What an absolutely terrible idea! PM News just finished a series of articles "10 Things More Important Than Money", which emphasized the importance of interpersonal relationships, personal values, and lifestyle taking precedent over accumulating wealth. In the end, the only thing that matters is the relationships you develop in your lifetime and that legacy you leave to those left behind. Let's explore the issue. Over a year's time, how many new patients will actually be "no-shows" and what would be the total monetary loss to the practice as compared to the annual gross income of the practice? Most all would agree that the percentage of loss is immeasurably small.
Compare that to the message you send, not only to the people you have not yet met, but to the current patients who will know about this policy and how they will then feel about your priorities. Every patient you alienate with this policy will not only represent that loss, but the lost referrals that patient might make in the future. If you have moved to a self-pay practice, you undoubtedly have great self-confidence, above average skills, and a stellar reputation in your community. Why jeopardize that for a few dollars?
The old adage of "patients don't care about how much you know, until they know how much you care". I prefer, "People won't always remember what you said, and they may forget what you did, but they will always remember how you made them feel." We can never know the burdens others carry and what might make them do the things they do. Enjoy your success and celebrate it with the patients you have. Do not punish, but rather forgive, the patients you will never have. You will both be happier.
Joel Lang, DPM (retired), Cheverly, MD
03/15/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Raymond F Posa, MBA
Regarding Dr. Dellinger’s question about interpreters; The answer from OCR’s FAQ’s "Are Doctors Required to Provide Interpreters for Medical Visits and Other Medical-Related Situations?" The short answer is yes. This is covered under the Title III of the Americans with Disabilities Act (ADA).
Title III of the Americans with Disabilities Act prohibits discrimination against individuals with disabilities by places of public accommodation. 42 U.S.C. Š 12181 - Š 12189. Private health care providers are considered places of public accommodation. The Department of Justice has issued regulations for the obligations of public accommodations under Title III at 28 C.F.R. Part 36. The Department's Analysis to this regulation is at 56 Fed. Reg. 35544 et seq. (July 26, 1991).
Raymond F Posa, MBA, Prescott, AZ
Editor's comment: PM News does not provide legal advice. Mr. Posa is correct and the initial response to this query has been corrected.
02/14/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Ivar E. Roth, DPM, MPH, Darryl Martins, DPM
Starting this year, we implemented charging 3% for credit cards. Now about 5% of my patients pay with a check, up from 1%. Other than that, there seems to be universal acceptance of this fee. I pondered and hesitated for quite a while trying to decide if I would charge a fee or not. Now that I am doing it I have basically given myself a nice raise of tens of thousands of dollars per year. Times have changed and so we must change with them to stay competitive. I recommend that my fellow practitioners consider charging this reasonable fee.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
Due to the increase cost of care and no fee schedule increases, we have implemented a 3.5 % credit card convenience fee. The merchant process charges the patient and there is no rental cost for the equipment. Patients are aware at the time of scheduling and it is transparent on my website. Unfortunately, running a medical practice has higher fixed and fluctuating costs. Practices have to reduce expenses and offer more products/services to offset the stagnant reimbursement we are receiving.
Darryl Martins, DPM, Ann Arbor, MI
02/13/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1
From: Farshid Nejad, DPM
We use Elavon. They have a reverse fee program. They charge the customer the credit card fee. We inform the patient of the fees and offer other payment options. We get charged a monthly flat fee for their equipment. We have saved thousands of dollars in credit card fees.
Farshid Nejad, DPM, Beverly Hills, CA
01/11/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Ivar E. Roth, DPM, MPH
Concerning Dr. Manolian's comment about the best place to do a nerve biopsy... I agree that the three location biopsy we all do in the lower leg to me is where this should be done. But if the manufacturer requires a thigh location to be in compliance, probably this is where you would have to do this biopsy. I have checked with legal counsel here in California with the APMA and their response is this is legal here.
As far as why would anyone pay for this procedure vs getting it covered by a pain doc, the answer is simple. The surgical fee is the only fee the patient would be responsible for as their insurance covers the surgical center fee and thus the equipment and the anesthesia charges. As a concierge podiatrist, patients who you have a relationship with you want YOU to do the surgery and are willing to pay for it. If the patient is okay with you doing the surgery and you are upfront with the fees and they approve, what would be wrong with that?
Having said the above, almost all podiatrists accept insurance and the fee to do this would be generous I am sure. So it is a great area for advancement of our profession. Why not do these surgeries?
Ivar E. Roth, DPM, MPH, Newport Beach, CA
01/10/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1
From: Michael Moharan, DPM, Judd Davis,
I agree with Dr. Lloyd Bardfeld. It’s disheartening to hear about the challenges faced by podiatrists in that hospital. The historical perspective you provided underscores the progress made in integrating podiatrists into the medical staff. Your suggestion to address the issue through a meeting with the hospital CEO and involving the APMA, if needed, seems like a proactive and reasonable approach to resolve the situation.
Michael Moharan, DPM, Norwood, MA
Discrimination is still rampant against podiatrists and will continue to be that way as long as we allow it, and in my opinion, as long as we have DPM behind our names instead of MD or DO. In my city, the same thing happened over ten years ago. Taking call without pay was forced upon the podiatrists at the city hospital which has a tremendous amount of uninsured, indigent, pro bono care. The hospital decided to pay all specialties for call there, EXCEPT podiatry, due to the tremendous burden, but would not let us out of our call obligation. Talk about discriminating! This led to an expensive lawsuit and ended with most podiatrists resigning privileges at the hospital. The hospital went over a year without any podiatrist and their amputation rate skyrocketed to the point they were forced to hire 2 podiatrists to take on...
Editor's note: Dr. Davis' extended-length letter can be read here.
01/10/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 2
From: Elliot Udell DPM
Dr. Roth says it all when he states that in his state, California, podiatrists are allowed to perform thigh biopsies for the sake of diagnoses. He also feels that if podiatrists take training, we should be capable of doing spinal implants to control lower extremity pain.
Dr. Roth is correct when he says that DPMs are more than capable of doing a spinal implant and thigh biopsy, with proper training. Most of us do far more intricate surgical procedures on the lower extremity. The major issue for all podiatrists is that we need not forget that our scope of practice is governed state by state, not by capability but by anatomic restrictions. We can and should do a biopsy of a suspicious lesion that presents on the foot. We legally cannot biopsy that same-sized lesion if it presents on the patient's back even though it would be essentially the same procedure.
The bottom line for all of us is that before doing any procedure which is above the lower extremity whether it be a thigh biopsy, spinal implant, or whatever, we must check with our local state authorities to ascertain whether that particular procedure is within the scope of our practices in the state where we practice.
Elliot Udell, DPM, Hicksville, NY
01/09/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1 A
From: Shashank Srivastava, DPM
Was this change made to any other sub-specialties? If you opted to have a status that does not have clinical privileges, is this really an issue for you? I would wager that the legality of this would be based on state statutes. That all said, the hospitals usually can make a requirement for active utilization of the facility in order to maintain credentials, but it generally should not have specialty specifics. Generally, call taking cannot be "forced" but utilization minimums can be required. Also, I would implore you to reach out to your state APMA component.
Shashank Srivastava, DPM, Rockville, MD
01/09/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1 B
From: Lloyd Bardfeld, DPM
I find this post extremely upsetting. There is no place for this aggressive negative activity in our profession today. I question both the legality as well as the willingness of the few podiatrists to choose to remain on staff of the facility. I was the first resident at Peninsula Hospital Center in 1970. At the time, there were no surgical privileges for podiatrists and they were part of the adjunct staff. Surgical privileges opened up and soon after, the bylaws were changed, making us officially part of the medical surgical staff.
Similarly at St. John’s Episcopal Hospital in Far Rockaway New York, where I started podiatry, things went from podiatrists not being allowed to be members of the medical board to me being president. These achievements did not come easy. It required us displaying our professionalism and not accepting being treated as secondary citizens. As we are all aware, podiatry is now more than ever not only a crucial medical profession, but an extremely lucrative addition to any hospital. We as a profession absolutely cannot accept situations like this.
I suggest a member of our profession in the area of the hospital request a meeting with the CEO of the hospital and discuss the situation and if possible settle it amicably. If that does not achieve results, the APMA must get involved, and if necessary, pursue legal action against the administration.
Lloyd Bardfeld, DPM, Far Rockaway, NY
01/09/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 2 A
From: Richard J. Manolian, DPM
Assuming you can do a thigh biopsy in California, is that the best place to do a biopsy for diagnosis of peripheral neuropathy? The answer is no. Next question is when you implant this device, completely out of the scope of your practice, will your malpractice carrier cover you? The answer is no.
Again, I ask when you post such things, why would a patient pay out-of-pocket for this in your office when an actual pain specialist or neurosurgeon will be covered by their insurance? The answer, well you get it by now. If I’m wrong, somebody please elucidate!
Richard J. Manolian, DPM, Boston, MA
01/09/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 2 B
From: Allen Jacobs, DPM
I am hopeful that the comment by Dr. Roth, in which he suggests that he would place a spinal cord neuromodulator in a patient with foot or ankle neurological pain, was submitted in humor. If a patient has a drop foot from L4-L5, would he perform a decompression surgery with fusion? What about an anterior cerebral artery aneurysm affecting only the leg and foot, or an aortic aneurysm causing blue toe syndrome or digital infarction? Is Dr. Roth prepared to treat potential complications such as spinal hemorrhage?
By the way, Dr. Roth, I suspect the placement of a spinal neuromodulator may not be comparable with your no insurance cash-only practice you profess to have mastered. You completed a non-ACGME approved podiatry residency, which you believe provided you with adequate training to place anything in a spinal cord? Please tell us you were joking.
Allen Jacobs, DPM, St. Louis, MO
01/08/2024
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Ivar E. Roth, DPM, MPH
From a California perspective, doing a thigh biopsy is okay in California for podiatrists if that is what is required to diagnose a neuropathy concern of the feet. The law reads that if you must do a test or procedure to help/diagnose foot or ankle symptoms, i.e. neuropathy of the foot, it is LEGAL for us to do this. Recently, I went to a dinner meeting for this device, and a pain specialist discussed the procedure of the spinal insertion of the device. I am 100% certain that podiatrists can take the course that Abbott labs offer, and start implanting tomorrow.
As podiatric surgeons, we have more training in surgery than a pain care specialist. I want to take the course and would do this procedure for my patients in a minute. Our profession needs to start having to think a bit more progressively. As a 3-year residency trained podiatric surgeon, I truly believe I have a superior surgical skill set over the average pain care specialist out in practice just learning to do this procedure at a certified lab course.
I have already called Abbott labs and they do offer courses on this device for practitioners who did not get residency training. I strongly encourage my fellow practitioners to take the course and start doing these procedures. It not only will help our patients but will allow better care and follow-up as we are the primary providers for many neuropathy patients.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
08/18/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Paul Kesselman, DPM
I went through this scenario several years ago when I discontinued trauma call, performing bone surgery, and limiting my surgical procedures to minor soft tissue procedures. Before you proceed with these comments: Be sure you have alternative meds to use for those cases where analgesics may be required. In my experience, this has been successful for at least the past 8 years:
Step 1: Call your state board of pharmacy to inquire if a DEA license is required to prescribe non-controlled substances. Here in NYS, the State Board of Pharmacy informed me that a DEA registration was not required. If your state board of pharmacy does not require a DEA number, continue to step 2. If your state board of pharmacy does require a DEA number...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
08/10/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Alan Sherman, DPM
PRESENT e-Learning Systems has 2 DEA MATE Online Training Course solutions for you. They offer a monthly one-day streaming 8 hour course which provides the accredited DEA MATE Training plus 8 hours of CME credit and 2 ABPM MOC Points for $149. You attend, fill out a post-event survey, and you receive your 2 certificates immediately. The next one is scheduled for Sept 23, 2023. They also just released an on-demand version of the course consisting of 8 separate 1 hour models that you can complete individually at your own pace. You receive a DEA MATE and a CME certificate for each of the 8 modules and when you have completed the set of 8, you are done. This complete on-demand course is $99.
Disclosure: I am the CEO of PRESENT e-Learning Systems.
Alan Sherman, DPM, Boca Raton, FL
07/27/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Elliot Udell, DPM
For the record, Dr. Gordon is partly correct. Benzodiazepines, Ambien, and Tramadol are considered controlled substances but gabapentin is only considered a controlled drug in a handful of states and not by the federal government. This is as of 2022 and could change.
The bottom line on whether an individual should register for a DEA number depends on whether his or her practice warrants it. I know medical doctors who do not have DEA numbers and they are well-respected members of the healthcare community. They are however in specialties where prescribing opioids or the drugs listed by Dr. Gordon is rare for them. Because their practices are very large and have many PAs and nurse practitioners working for them, they deemed the expense of paying for DEA licenses for all of their practitioners to not be worth it.
Elliot Udell, DPM, Hicksville, NY
07/26/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Sloan Gordon, DPM
Unfortunately, I don’t agree with my esteemed colleague. Many medications that we prescribe in a normal podiatric practice are actually controlled substances (scheduled drugs) without being opioids. Often, I find people grouping opioids with other controlled substances that are unrelated. Some examples:
Gabapentin (neuropathy), Ultram (pain), Ambien (post-op for sleep), and certain benzodiazepines to relax a patient undergoing an office procedure.
I think to be a legitimate provider and be able to have a complete armamentarium to take care of your patients, one should be able to have all of the appropriate licenses and credentials to do so.
Sloan Gordon, DPM, Houston, TX
07/25/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Elliot Udell, DPM
Unless you are prescribing controlled substances, you do not need to pay the government the huge sum of money it is charging to renew your DEA license. This does not just apply to podiatrists. My allergist did not renew his DEA for himself and his medical staff because they do not prescribe controlled substances. Insurance companies tend to be understanding of this and will require that you provide them with the name and address of a colleague who can prescribe opioids for you in case the patient needs them.
If you do opt to renew your DEA license, you need to take one of the courses on narcotics. Present Conferences is offering the course online at a reasonable cost and it comes with CME credits. Their course is listed in PM News.
Elliot Udell, DPM, Hicksville, NY
07/11/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: John Moglia, DPM
I received an Episource request for 66 charts. I charged $50 per chart. I told the representative I would forward the chart notes when the check for $3,300 was received. I refused to negotiate and received the check a week later. I will now charge $100 per chart, hoping Episource or Ciox will refuse payment so the chore will not take office staff away from their regular duties. Please note this chart request was not an audit.
John Moglia, DPM, Berkeley Hts, NJ
07/10/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
RE: Episource Chart Requests
From: Steve E. Abraham. DPM
I received a chart request from Episource for 10 patients. I sent in the notes for 5 patients and followed this with a bill for $50 per patient, for a total of $500. I indicated that I would send the remainder after receiving the payment of $500. I was called by Episource and asked if I would accept $20 per patient (not per chart note, please note!) I agreed and sent a new bill. I just got a check for $200 from Episource and sent in the remainder of the chart notes they requested.
I hope they will stop. I advise everyone who gets chart requests from Episource to follow my plan!
Steve E Abraham, DPM, NY, NY
05/30/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Jack Ressler, DPM
I believe I have had requests from Episource in the past. They never paid my invoice and were never given charts. Name Withheld said they approved payment, but the big question is whether they actually paid. There have been many times that these companies agree to pay invoices but never send payment. I cannot imagine how much money 66 charts will bring in from Medicare if Episource gets those charts! Even if they pay Name Withheld the $3,300, which I highly doubt, Episource will clean up!
Jack Ressler, DPM, Boca Raton, FL
05/13/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Jack Ressler, DPM
When you receive a request from Ciox, calculate the number of patient requests and multiply it by the amount of money per chart your office has set. Send them an invoice and move on. You will not likely receive payment and it had been my office policy not to send charts requested by Ciox until payment is received.
I retired a few months ago, but was never cancelled from any insurance company for not sending charts to Ciox until they send payment. This has been ongoing for several years. Your obligation should be to Medicare which is being completely ripped off by Ciox and other companies, which has been documented in previous posts.
Jack Ressler, DPM, Boca Raton, FL
05/13/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1B
From: Robert Kornfeld, DPM
You see what lurks in the fine print of your contracts? My advice is to go to a direct-pay practice with a strong niche. This insanity has to stop!
Robert Kornfeld, DPM, NY, NY
05/08/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Michael L Brody, DPM
In his recent post, Dr. Rosenblatt makes an assumption: “but I assume that most of it is delegated to describing the ‘craftiness’ of addicts' attempts to get prescribers to get them what they want.” I cannot speak for all courses but the topics in the CME Online course include: What is the patient perspective? Strategies for the reduction of opioid use in the peri-operative patient, Pharmacologic Alternatives for managing pain including CBD, Pharmacology of Opioids, Allodynia – what is it and how to address it, Proper Documentation when Prescribing Opioids, among other lectures.
The lectures and the course is about understanding how and when to prescribe opioid analgesics, and provide better quality of care and proper documentation techniques when prescribing these medications. Education of this nature should be based upon providing actionable clinical information to allow us to be better podiatrists and the program we have created is focused on that goal.
Michael L Brody, DPM, CEO CME Online
05/05/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1
From: Paul Kesselman, DPM
I have made it no secret that while there is an obligation to respond to the requests, there is no requirement to submit charts at no charge. Here are some things you need to do:
1) Get rid of the dinosaur fax machine. There are methods by which to receive faxes directly to your computer. So no ink, no paper. You can do an Internet search to find a myriad of companies which charge a minimal amount based on the number of pages. (e.g. $10 for 100 pages incoming and outgoing). Let Ciox send as much as they want. Depending on the service you choose, you may also be able to block incoming faxes based on the phone...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
|
| |
|
|
|
