Many physicians in my area don't want to take Medicare, Medicaid, Tricare
Posted By: it's common on 2006-01-03
In Reply to: Question re elderly patient being dropped by long-time PCP. sm - wondering
or other insurances because the insurance companies require a huge buydown of charges and then disallow quite a bit for being "above the reasonable amount."
For example, I had double insurance of Blue Cross/Blue Shield and Tricare when I had surgery. The bills totaled $15,000. Blue Cross knocked $5,000 off the physician's $7,800 bill, paid him $600 and left Tricare and me to deal with the $1,200 balance. Tricare wouldn't pay because they disallowed the amount as unreasonable, the physician's office forced me to make payments on it, and I had to fight just so I didn't owe them another $1,200. It was ridiculous that I had double insurance coverage and wound up owing anything. Meanwhile, the doctor didn't even get paid that much, and he did my presurgery appointments, the actual surgery, two postsurgery appointments to remove hardware, plus coordinating everything between cardiology, radiology, anesthesia, laboratory, surgery, and having special equipment trucked in from out of state.
If I had not had insurance at all, I would have had to pay the entire amount. I think it's crazy that noninsureds have to pay the full amount but insurance companies can disallow or buy down the amounts due. Anyway, you hit a big rant of mine. Shortly after I lost my Blue Cross coverage, my son needed to be seen but we couldn't find a provider to even take Tricare at all. So much for my husband serving his country and being away from his family in the line of duty. The doctors get rich and refuse to treat military personnel who fight for their freedom. Talk about a total lack of appreciation.
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Cuts in medicare and medicaid are about to take place
I have mentioned this but it was always deleted as I think the monitor thought I was talking politics.
There will be a marked decline in coverage for services to medicare and medicaid patients and I believe to offset this, medical facilities are finding ways to cut costs.
The cuts will be significant. You could do a Google search for Deficit Reduction Act. Radiology will be most severely hit, especially stand alone facilities.
Will I not get paid if the hospital isn't reimbursed with Medicare/Medicaid?
I was told by a coworker that California is in so much debt that I may not get a paycheck if CA goes bankrupt because the hospital I work for will not be getting subsidized any longer....
could this be true?
Medicare is offering free installation of EMR to physicians and hospitals.
http://www.medscape.com/px/instantpollservlet/result?PollID=1502
But because of having Medicaid...sm
Those who abuse the Medicaid system look at it like who cares when I take my child, it'll be paid for. The ER docs know when Friday night comes, in comes tons of children who could have seen an walk-in doc all week long.....these are not urgent cases. The moms sit on cell phones, talk to everyone, it becomes a free for all night at the ER.
The uninsured and those with Medicaid
often use the ER for their medical care. I was in the hospital with gastroenteritis because I was having syncopal spells from dehydration. While still undergoing testing in the ER there was a woman on the other side of the curtain who had a headache. She called a friend on her cell phone and had her friend come keep her company. They talked nonstop. I have migraines and I want quiet when I have them. This woman had never even taken anything for the headache, just came to the ER. An incidental finding was thrush because she had a baby and when the baby dropped the pacifier the mother stuck it in her mouth to "clean" it.
I also type ER reports. What gets me is when the patient has abdominal pain for 2 weeks and never sought treatment, then decides to come to the ER.
Our local "indigent" ER is also in the only hospital to take pediatric patients, so if we should have to go to the ER we go to that one. We thought my son had appendicitis and took him and were told they had no acute beds and he'd have to wait, yet they took several with flu symptoms ahead of us, so he was considered acute but not only no bed, but no care. Although as I type this, I'm thinking we had no insurance at the time as DH has changed jobs and we couldn't afford Cobra. We were less than a week away from having insurance, but had none at the time of the visit, although we did pay the bill in full, so maybe that played a factor in things.
I asked about this too, you can get medicaid if you get hospitalized and spend a certain amount.
If you have out of pocket expences equalling up to 2000, then you can get Medicaid. I think it is still based on your income, but it is not as strict as it normally is. You have to still pay that first 2000 but they do help with future bills.
PA - Pittsburgh area is one locale, Philadelphia area also.
TriState area - PA, NJ, DE.
SE Medicare and SS are taken out, not fed tax.
I looked on the IRS website. You do get a SE W2 and then you can deduct business expenses to lower your fed tax, but you still are responsibile for fed tax yourself. I double checked at the IRS website.
Question about Medicare.
I hope I'm posting on the right board, but here it goes. My elderly mother was in the hospital back in January and on Friday received a bill from a nephrologist who saw her briefly once and billed Medicare $375 for his in-hospital consultation. Medicare paid them $15.68, they "wrote down" $240.40 and the supplementary paid $3.92, and now they are billing her $115. This is the first time she has ever received a bill from anyone as her insurance has always paid. I keep thinking that they have used a wrong CPT code for their billing as it is beyond me that Medicare would only pay $15.68 for an in-hospital consultation. I will have to wrangle with these people tomorrow, but wanted to know if anyone had any opinions about this and feels like I do. I don't think this is her deductible amount as she had seen many physicians before him seeing her in the hospital. I know I will also have to call Medicare to see if in fact they are the ones that got their bill in first and this is in fact her yearly deductible, but as they say, knowledge is your best tool before someone tries to pull the "wool over your eyes."
yes..they are taking out for SS and Medicare...
a friend of mine said when she wasn't making that much money she had them withold an extra 10.00 for federal so i may have to do that...
Forgot to say this was for Medicare Supplemental Insurance (NM))
nm
Your national is liable for SS and Medicare tax not you. They thinkyou are self employed. nm
:
I've actually found Medicare very easy to deal with...
wouldn't dread the call. It will probably go better with Medicare than with the nephrologist.
Yes, you're cranky. The docs may be instructed to do so to appease Medicare or other such entity.
x
If government is involved, it will be as screwed up as the Medicare medication program.
Heaven save us from all these wanna be kings that sit on top of the hill.
oh our lovely government does give illegals medicaid, foodstamps, and housing so in term we give tha
i have been through some rough times lately and had to apply for some help. there are signs, big signs, all over our offices saying "YOU DON'T HAVE TO BE LEGAL TO GET HELP". so we and our government do give them our benefits whether they are legal here or not. now that is messed up. i am helping to support them so they can take away my jobs and i can't even support my kids and yes i get benefits, wow $75 a month in food stamps which lasts not even a week in a household of 6. don't get me wrong, i am thankful for any help at the moment, but i get penalized for trying to work my tail off and still can't survive.
there was recently an article in our local newspaper where one of our local school districts tried to charge $1000 a year for each illegal student enrolled. it was bulked and the illegals got a lawyer to sue for discrimination. the school district merely stated that they had to HIRE extra teachers that could speak the foreign language just to teach these children and were trying to offset some of the expenses. ridicilous!! so again our taxpayers money is paying to educate illegals as well.
You are so right. Its up to the physicians and
also your local competition. Its all about offering the physicians something better than the competition - better rates, better TAT, and if your competitors are certified, you can bet that's part of their "sell"...But you could never predict the certified issue until you check the waters. Good luck to you! Its not that hard to pick up a local account or two. Enjoy!
Do you think ER physicians actually do as thorough
a physical exam as they dictate or do you think they fabricate a lot of the details of the physical exam?
Not all physicians are like that .....sm
I work for very generous, kind and caring orthopedic surgeons who see patients, with little to no income, and charge them nothing. They ask for no payment and nothing in return. These docs would give you the shirt off their back.
Not every physician cares only about money.
It is bad enough for the ESL physicians but
today I had an ESL PA dictating and when she dictates hypertension she says hypertensions, as in the patient has hypertensions and heart disease is diseases and lukemia is well you catch how it goes EXCEPT if you have the patient's wife, then she says the patient wife or the patient daughter. I am TICKED
Is it just me, or are physicians getting worse
with dictation. I transcribe several that use speaker phones to dictate. I think ER docs are the worst. Not only do they use the speaker phone, but that talk at a rate of about 150 miles per hour. Do they not realize (or maybe they just don't care) how difficult they are to transcribe. I really don't understand why the companies we work for allow this. 
I ask the physicians! Haven't had one yet
who didn't tell me what they were already being charged. You should be able to call the MT department at your hospital and ask around there too.
About incompetent physicians...
Yes, they are definitely out there and getting scarrier day by day. Actually, the great majority of them are quite pathetic.
local physicians
I was wondering if any one knows if local physicians would rather hire certified MT to do their work from home. I am thinking about supplementing my income with a national and wondering if this would be a good way to go. Any insight into this would be greatly appreciated !!
Prospecting physicians??
I currenlty have one account of my own and am an IC through a very small local transcription company. However, I want more of my own accounts. I have sent letters and am willing to do more. Does anyone have any idea on what it takes to "land" an account? Thanks so much for any ideas/help/suggestions!!
Physicians by State
www.healthcarehiring.com. Scroll down to the bottom and you'll find all of the states. This is a great site to search by state, and you can search by specialty even within that state. It is in alphabetical order, which is very, very helpful. I love this site myself and use it every day. 
Yep, been there,done that. Many physicians today
have gone to EMR. I talked with one not long ago who said I needed to find another line of work since EMR is replacing the MT. Even my own personal physician uses EMR.
We are either being replaced with technology (EMR or VR)or work is going offshore. Somehow for me, editing is really not something I am interested in, as I would rather transcribe.
Hopefully, others here will be able to direct you and encourage you, perhaps giving you ideas of how you can obtain clients. Much success in whatever path you choose.
We have many Muslim physicians in the US.
Would you be so quick to condemn someone who had a problem with "We took a moment to praise to Allah"? Would you be as tolerant as you claim to be in that situation?
The physicians used to have to be bribed
to come in and dictate charts, have seen for myself. I would love to know how it went from not wanting to dictate to suddenly everyone getting out their EMRs and typing away.
My take on how these physicians dictate
I question and I mean question about every day whether the person coming in as physician is really that. I have 1 that basically cannot string a sentence together, changes sentences 3, 4 or 5 times each sentence. I have physicians who pull the same stuff, going several paragraphs down and then asking you to add or delete something. I get really ticked when I hear all this and don’t hold my cool. The person in the room with me usually hears my ranting and raving. It is hard enough to get through the ESLs, mumbling, crunching, snorting, eating, sucking, sniffing, sorting papers and the list goes on without putting up with this. One change that was made at the hospital I work for was to tell dictators they could NOT use a cell phone to dictate. It worked. I only wish I were in charge so I could tell them more about how to dictate!
I've found that most physicians who
dictate at such a ridiculous pace are trying to make up for other deficiencies....you know like "male menopause" where the older guy goes out and buys an expensive sports car, etc., etc. Seems most of the speeders on my account are DOs, NOT MDs.....guess they feel inferior in some way. 
Physicians are willing to share their knowledge with (sm)
anyone who will listen. They love young bright eyed students. I expected the MT world to be just like medicine.
Why is cost the only issue? It is unprofessional to only think about money. What about pride in the profession and wanting to share knowledge? Isn't that how professions advance and grow?
I am surprised.
State Licensure for physicians
I use the State licensing agency for whatever state the physician is in. I just Google State License or Health State licenses and it brings that particular website up and then I do a search. Great Tool!
When do physicians give feedback to MTs?
x
I have heard American physicians say that. What is the
big deal? You know what they mean.
A lot of physicians refer to their patients
as heterosexual or having same sex partners, it is very relevant in some aspects, as in exposure to AIDS/HIV, etc.
physicians pinching pennies
while making over $100K a year (after insurance premiums), for a service that is tax deductable.... they really dont have a clue...
To my knowledge, you can't print the physicians'....sm
list and I doubt they are in there by specialty, too. You can print the contents of your ESP file if you save it to your desktop and then print it. Hope this helps.
There are no dictators, physicians, nurses, PAs or the like
who don’t dictate on the VR I use, wish I did not have the crap dictators as you call them but they are not left out on my end. I really, really hate it now when I do get a straight report to type I am so happy with the VR I do. I think before long most big places will go that route, little ones not so much as I think VR costs quite a bit.
A great site for referring physicians
that includes credentials and you can search by state is:
http://www.healthcarehiring.com/physician_pennsylvania.php
Down at the bottom you can change the state. I have used this site quite a bit.
Good gried!!! Plenty of physicians
mispronounce terminology, medications, etc. that they are not familiar with in their specialities. Get a life and find something worthwhile to gripe about. Did you understand what they meant? Apparently so, so just do the work.
Physicians and caring or lack thereof
recently I have experienced both sides of this aspect. In January I was hospitalized for asthma by my then family physician. I had been to him 3 times in the month before that with problems but he made no effort to adjust meds, etc. About a month later, he walks into his office and tells his staff today is your last day. I'm closing the office.
I got strep throat and went to a different doctor. She was absolutely the best. She looked at ME while she was in the room, not at the chart or her PDA in her hand (like the first doctor used to do). She talked to ME. Asked ME questions and answered any I had. asked about allergies (which I have many). The first doctor tried to give me medicine I was allergic to (and he had been told multiple times). Two weeks ago I was hospitalized through the emergency room with another asthma attack (brought on by the flu). My new doctor sat down beside me in the room. Talked to me. Got a very detailed history. Explained what tests she was going to do. Explained the results of what tests had already been done. Told me she was going to refer me to a pulmonologist to evaluate if my meds need tweaking. Even asked me which one I preferred based on how my insurance would pay. I have only seen her in the office twice and then while hospitalized and I already feel more at ease and reassured that 2 years of using the other doctor.
Also, at work this past week a patient was admitted after lunch. Because the patient had missed the noon meal, the PHYSICIAN went to the cafeteria and bought lunch for the patient and took it to him. Now THAT is a physician that cares about the welbeing of their patient!
I wish all doctors could be like these two - both of them female! Maybe it has something to do with our nurturing instincts! 
I have to agree. I would be uneasy having some ESLs as my physicians - sm
at times, too, for that same reason -- I've seen too many errors creep into the medical record because of the language barrier (though I would place equal, or greater, blame upon the MTs and/or QA who allowed it to happen through the "god help us, we can't have a blank so fill that blank with SOME kind of word, quickly!" mindset).
I once had an ESL psychiatrist who had a terribly thick accent. After doing hundreds of his reports I would still have a difficult time understanding him at times, yet when he was interviewing his patients and they didn't follow the conversation well he would often enter that into the record by saying that "the patient had a difficult time understanding this examiner and following the conversation" ... well, h--l, anyone would, doc.
I'm sorry, but the physicians are supposed to review the medical records for
accuracy, then sign off on them. THEY are the people who went to medical school, did their internship, and actually saw the patients. THEY know what they were trying, often badly, to say. THEY are the ones making the big bucks. NOT US. We go to maybe a year-long correspondence school, make crappy money, and watch our butts spread wider every day while we TYPE, yes, I said TYPE, medical records for them. Anyone who thinks it's more than that is kidding themselves. And save your speeches on patient care and work ethics. I know all about that stuff. The harsh reality is that this job does not require a college education to get into, and your income is tied to your production level. The doctors don't care enough about the medical records to speak slowly, enunciate, and double check everything before signing off. How are we supposed to read their minds? Anyone in this field who knows more than grammar and medical terminology ought to be working as an RN or MD, because you'd be better at it than half the medical providers we type for.
switchboard.com is another good site for finding physicians
x
Same situation here. When worked in-house or for physicians offices,
never as much as a single episode of no work available. Much to my dismay, I have found out that MTing from home for a nation is so unpredictable, in so far as what your paycheck is going to be every week or 2. They all say "there is plenty of work," which is probably factual. However, the nationals are primarily interested in pleasing the client with their promised swift turn-around-times. What they forget is that if it weren't for the MTs, there would be no turn-around-time whatsoever. It's really very discouraging and quite unfair. Most people try to adhere to their monthly budget, which is impossible when one never knows how much they are going to make from one week to the next. We ARE the providers, not peeons, and resent being treated as such.
Does anyone know where to find a listing of the V.A. Medical Center physicians?
Thanks for the help.
Not sure, I have deductions for federal income tax, SS tax, Medicare tax, and state income tax. ???
nm
I also have two offices w/mult physicians on tapes, but going digital this month (sm)
at my encouragement. I am training them with a consulting fee by the hour. They were resistant, very old fashioned, but after multiple problems with a few docs dictating over each other's tapes, and the cost of gas, paper, and everything else... I encouraged this. In fact one service just added another physician and I told them I could not handle their transcription anymore, but they said whatever I can do to continue, so we are going digital and longer turn-around time. It will be a time saver and more cost effective for me right away. I will still be going in to the offices probably twice a month because I feel the personal touch is really important. I also work PT for a national, by my choice, as I feel it keeps me on my toes with different types of transcription. Also the national is a guaranteed paycheck via direct deposit every 2 weeks, whereas my own customers, thought good money, well sometimes they are late. 
They are physicians, not grammarians. I transcribe it so it is grammatically correct, but my accoun
The MR reports were being filed. Referring physicians/medical care providers reports were not.
This is a hospital radiology department with in-house MTs and a clerk who is in charge of the report distribution.
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