DialysisEthics2_Forum
Other => Historical Posts => Topic started by: admin on September 28, 2009, 08:00:56 PM
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Disgusted
Joined: 26 Jan 2003
Posts: 45
Posted: Thu Oct 23, 2003 6:34 am Post subject: Neph visit
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I am not even going to make sense of that CMS language and try to read between the lines. I KNOW THAT THIS DOCTOR HAS NOT BEEN TO THIS CLINIC SINCE HE SOLD IT AND DRIVES RIGHT BY THE CLINIC KNOWING HE SHOULD BE INSIDE DOING ROUNDS. The amount charged is $400.00 CMS approved $268.49 then my secondary insurance will pick up whatever his billing department can get out of them. Then a office visit (provided that I am well enough to drive is amount charged $70.00 CMS approved $52.71 same song and dance for the secondary insurance provider. Office visit consist of 5-10 min and a refill or two.
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Home Hemo
Joined: 23 Jun 2003
Posts: 22
Posted: Thu Oct 23, 2003 9:03 am Post subject: New Policy from CMS?
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After reading all the posts on this subject, it seems to me that Bill is right. There is no provision for home patients. The doctors are going to want the same amount of money they are getting now - so I see no alternative - either go back to the center so the doctor can see you once a week, or see the doctor in the office once a week. You all know the doctor is not going to see home patients in the office once a week, nor are home patients going to want to see them in the office once a week. From what I read, it looks like the only choice will be to go back to center dialysis. I'm not sure what those home patients who are far away from centers will do. As I said, I've already sent messages to my Congressional members, but I don't believe there are enough home patients to make any difference at all to them. I believe we all have to fight for the right to be on home hemo, even those to whom it is not available at the present time. If these new procedures go into effect, what are the odds there will be any new home programs, let alone those that are in operation at this time? It seems like since I have been on dialysis, I spend most of my time sending messages to my Congressional members, so far, all to no avail. It is enough of a "hassle" to just be on dialysis, without having to fight all the new rules. Hopefully, there will be enough of an outcry over this, that Sculley won't dare to put it into effect. It would really be a shame to do away with home programs, especially now when all the studies being done show home hemo patients have much better outcomes than center patients. We can only hope and pray that these new rules do not go into effect.
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Disgusted
Joined: 26 Jan 2003
Posts: 45
Posted: Thu Oct 23, 2003 9:36 am Post subject: Neph visit's
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Yes, my state representatives are aware also that clinic patients need to be seen in the clinic by their nephrologist. Whomever drafted this p.o.s. legislation obvisously forgot about home patients and needs to add a provision for them.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Thu Oct 23, 2003 9:42 am Post subject: to disgusted
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I do not think they can bill for an office visit if you are a dialysis patient. Thought it was covered by the composite rate.
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Disgusted
Joined: 26 Jan 2003
Posts: 45
Posted: Thu Oct 23, 2003 9:59 am Post subject: Office visits
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He seems to be I have the EOB in front of me. I don't know how he does it. Network is aware of everything but not doing anything.
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Bill Peckham
Joined: 06 Jan 2003
Posts: 65
Posted: Thu Oct 23, 2003 11:16 am Post subject: CMS rule change
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The info from the Federal Register could be alot clearer. CPT stands for Current Proceedural Terminology and is the billing code a provider uses to bill Medicare. The first part of the Federal Register quote is really saying that the old codes 90918 will be replaced with new 'G' codes. The second part of the Federal Register quote lists the three code options the docs could choose from - four or more visits in a month, down to one face to face visit a month.<
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>This rule change seems to equate quantity with quality, I think that is a mistake.
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As it stands now
Joined: 23 Oct 2003
Posts: 1
Posted: Thu Oct 23, 2003 12:17 pm Post subject: payment
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Nephrologists payment are seperate from the composite rate. They get paid automatically. They dont have to see you at all. I think that this is great that they are having to see a patient. This is what doctors are paid form<
>They have ruined it for themselves. many good doctors have been taking care of their patients, many have not. But the fact remains that the silence and not seeing patients has cost lives.<
>As it stands now doctors will be responsible for their patients and will be held accountable. I think that is a good thing.<
>However I am not sure how that will effect home hemo.
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I was bullied
Joined: 23 Oct 2003
Posts: 1
Posted: Thu Oct 23, 2003 2:43 pm Post subject: doctors' rounds are a joke!
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I currently have a doctor who makes rounds once a week. Good, right? NO WRONG! I can tell you it doesn't mean a single thing unless your doctor is truly doing his job, knows his stuff and spends time resolving the patients' tx issues. I wish I didn't have to see my doctor's face, because he's a total arrogant jerk who does not truly care for his patients. It's all a game to him to see how fast he can get in and out. And if one asks a question and he doen't know the answer he goes ballistic on you. God forbid anyone should find out he doesn't know what he's talking about much of the time.<
>I wonder when the last time was my doctor hit the books or kept up with current literature. He can't even answer basic quesitons.<
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>I can tell you all this doesn't mean a thing unless CMS qualifies it by a system of doctor accountability whereby patients have full freedom to report doctors who are arrogant and not providing solid professional care. <
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>The free ride has to stop. It's pathetic! This is a sloppy, cheating system that kills. Our law writers are game players. We teach our children to be honest..why so they can grow up and be killed off buy cheating lawmakers? <
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>We must go to the root of the problem..skunk lawmakers and laws with no backbone or integrity! This is not a game..people have died and continue to die. Healthcare is corrupt. We need new blood spelled H.O.N.E.S.T.!
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Oct 24, 2003 3:18 am Post subject: Changes
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I think things are changing because of the large amount of pts. who never see or hear from their nephs.. These nephs. neither make rounds in the unit, nor do they see the pts. in their office. If they do come by it's for a minute only to say "hi, how are you doing today?" and then turn and walk to the next pt. before the first has time to reply! Two words: easy money! <
> I go to the neph.s office, but there are many pts. who aren't able to do that and so the only contact they have with their neph. is through staff. Staff has a meeting in our unit once a month about the pt.s. The neph. is there and staff tells the neph. what is going on, the problem is that the pt. doesn't get to voice problems and concerns from their viewpoint because the pt. isn't in on the meeting. Lin.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Fri Oct 24, 2003 5:00 am Post subject: New policy
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I can see it now....Doctor sitting next to Dialysis Dave marking patients off as you come in ca - Ching (saw patinet 3098 ca - ching (saw patient 257 and saying see you next week as the patients pass by.<
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observant
Joined: 24 Oct 2003
Posts: 1
Posted: Fri Oct 24, 2003 5:32 am Post subject: Good one leadsag
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I wish they made a Dialysis Dave that would sing Dixie when it sees my doctor coming to warn us the loser is coming in.<
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>Another thing my doctor does is takes his good ole time calling me back when I have to call him at his office. I'm geting sicker and sicker and Mr. Busy can't be bothered. And then he doesn't even call back in person --he has his secretary call back to avoid having to answer any real questions. This ought to be strictly not allowed! I don't care to talk to my doctor or ask questions "through" his secretary. That takes even more time puting my health at risk as the secretary misunderstands and the communciation gets fowled up. A doctor shouldn't be allowed to hide behind his secretary's skirt!!! How is it even lawful for them to do this???
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Oct 24, 2003 9:48 am Post subject: Secretary
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Yes, I'm with you on that one! <
>Speaking of "Dave", when I was leaving tx. area yesterday the magic marker in my hand slipped and he now has a very evil looking mustache; juvenile yes, but it was so much fun. I put a hit out on him but there were no takers; guess if you want the job done have to do it yourself! Better yet I'm thinking Dave should go to Washington! Picture me standing in front of all those oh so important people holding up Dave saying "this is what is masquerading as patient education". Oh, but it's all ok because we are going to get a prize if we learn our lessons well!! Hey, maybe it'll be another trip to Washington lol Lin.