Friday, July 02, 2004

Bad Ads and Good Claims

A new record: 2 hrs 54 minutes.

That's how long it took from the time the patient walked through the door till the time I submitted her claim electronically. I think I'm getting the hang of it. She needed a refill of meds for HTN and BCP, otherwise felt fine. I went over her 2 page history form (it used to be 3 pages but I trimmed it down) and we talked a bit about what works best to lose weight. As she said, she knows what to do, she just needs to do it: eat less, exercise more. A detailed physical exam (but no breast or pelvic exam since she had a Pap done 6 months ago), then I wrote out her prescriptions, and an order for a mammogram. In all, her face-to-face time with me lasted 45 minutes.

The medical student working with me got to contrast how I see patients at Kaiser vs. seeing one in my own office. At Kaiser, I would've spent a lot less time on the history and done an abbreviated physical exam, probably taking 20 minutes instead. Which system is better? It depends on whose money is being spent, and if the patient is in a hurry or not. The net outcome is probably the same as far as mortality. A better patient-physician relationship: how much is that worth? If it means sowing the seeds for eventual weight loss and prevention of related illnesses through better motivation and encouragement, then it may be worth a lot. But it's not an easy thing to measure.

I would've gotten done sooner if I hadn't been interrupted in the middle of my progress note. Someone had called me earlier about placing an ad in a weekly flyer that would be handed out free to all Blockbuster Video customers. He guaranteed that I would be the only medical doctor listed, and even better, that they were running a contest where people could win gift certificates for $50 or $100. All they had to do was write down the names of all the advertisers in the flyer and send it in, guaranteeing that someone would remember my business. It didn't sound like a bad deal so far. I was interested so he arranged for someone to come by my office at 3:30 PM.

But when his associate came to my office an hour early, I got a different impression. Their company does the ads that show up on the back of the grocery market receipts, on the shopping carts and on bus benches (hmmmm...). The flyer, which lists new movies and TV shows of the week, looked like the throwaway flyers that you get when you go to the grocery store, except it was on glossy paper. The people that advertised in it didn't seem like the kind of businesses that I would be interested in going to. It would cost $18 a week or $936 a year with a minimum one year contract. Plus I had to tell him yes or no...NOW! That was a bit offsetting, plus the way he kept smiling and telling me repeatedly, "You are gonna make so much money from this!" I didn't have a good feeling from this.

So I pulled my trump card. "This sounds really interesting, but I'm going to have to check with my wife first." He called my bluff and said, "Can you call her right now?" I asked him to have a seat in the waiting room, and made a call to my wife's cellphone and then her brother, whom she is visiting this week in Connecticut (hi honey!). Fortunately, she was unreachable, having gone to the city to paint the Big Apple red with my daughters. I relayed the bad news to the salesman who shrugged it off and left, while I silently rejoiced at my narrow escape.

While there may be no such thing as bad publicity, I do believe there is such a thing as bad advertising.

The other noteworthy thing that happened today was that, after much hemming and hawing, I finally sent in my Medicare Enrollment form. I also heard from someone at the local Medicare contractor's office that I am able to retroactively bill Medicare for any patients I have seen since I opened my practice 4 1/2 months ago, even though I didn't submit my enrollment form until today. That seems kind of unbelieveable to me, so I hope it's true.

I officially joined the local Kiwanis chapter this week, but I consider this a form of Good Advertising. There are a lot of local business and community leaders involved in this, and I think in the long run, it will be better for my practice. This Sunday morning I will be resuscitating my old waitering skills and try not to spill any syrup on top of anybody's head at the Annual 4th of July Kiwanis Pancake Breakfast.

Finally I want to mention how helpful the people at Medrium have been so far in helping me sort out my billing snafus. My first 5 claims were rejected because I forgot to enter my medical license number in the appropriate (but non-obvious) location. My next 2 resubmissions were rejected for different reasons. The first because "v70" is not an billable code, but "v70.0" is (missed the point zero, which I should have known, having taken a medical billing class). The second rejection was for an arcane reason, however. It turns out Blue Shield doesn't like my medical license number unless it has two zeros preceding it and one zero trailing it. Don't ask me why. Those are the kind of picayune yet real obstacles to getting paid. I consider myself lucky for being able to send the claims electronically. Instead of waiting one month to find out I made a mistake, it took a week. At this rate, I'll probably get paid in one month. If I had used snail mail, I probably wouldn't get paid for 4 months, if I was lucky.

Plus these kinds of mistakes I figure I'll only make ONCE. After I learn the secret of filing clean claims, I'll be able to RULE THE WORLD! BWA! HA! HA! Or I may get paid in less than a Mercurian day. Either would be good.

I think one day it'll be possible for me to see a patient and submit their claim in less than an hour. How many doctor's offices can do that, I wonder? Happy 4th of July!