About Don Self & Associates

Your Billing History

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Your Billing History

Until I talk to you, ask some questions and get some answers, I'm not sure I CAN help you. Normally, I like to schedule a one hour Zoom call with any new prospect. During that hour, I'm going to show you what Medicare shows YOUR billing patterns are (which is public information and I have this on every doctor in the country that was billing Medicare Part B in 2016). I will ask the manager some questions about office policies and I'll ask the doctor medical questions about the type of patients they see, mix of insurance, mix of diagnosis, etc. During the call, I may pull up the Medicare LCDs or Carrier Policies, depending on the type of services, specialty of practice, etc. At the end of the call, I'll make specific suggestions (**which follow all regulations, rules and laws) for YOUR practice. If YOU believe my advice helps you to the tune of at least $20,000 per year - you pay me $500. If not - you don't owe me - but you make that decision. We've done this for hundreds of physicians in the past, and 92% of them have seen increases over $80,000 per year. You have nothing to lose, but a lot to gain.

(** Note: To keep our attorneys from going pee pee all over themselves, we notify all that we're only making suggestions that are legal, lawful and within regulations)

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TELE-MONITORING

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Your Billing History

Effective Jan 1, 2019, Medicare started paying for telemonitoring (totally different than telemedicine) and they pay REALLY well.

In fact, the average is $118 per month and it only takes your MA about 20 minutes a month to get that. That is almost 3 times what they pay for Chronic Care Management and every hypertensive or diabetic patie

Effective Jan 1, 2019, Medicare started paying for telemonitoring (totally different than telemedicine) and they pay REALLY well.

This is why we opened TELECARE-USA in January of 2019 and started renting combination glucose-blood pressure monitors to clinics. One of the requirements for the new codes is that the physician must PROVIDE the monitor. So - by using our monitors, the physicians are still averaging NET $50 - $110 per month, per patient in net profit.

Call us today at 903 871-1172 and let's talk about this and see why so many physicians from coast to coast are helping their patients while increasing their clinic income substantially.

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$20,000 Guarantee on Our Consult

Don is a medical reimbursement consultant who cares about his clients and will do almost anything to help the client achieve better medical outcomes and increase their practice income. He will help keep his client profitable and compliant with billing and coding regulations through his medical consulting. Don has helped thousands of phy

Most primary care practices (family, internal and geriatric) will easily increase their monthly income by more than $4,000 per month - which many will see more than $7,000 per month after a one hour conference call with Don.

Most physicians are NOT billing for everything they should be. Don has the CMS data on more than 900,000 physicians in the country and if you schedule a one hour analysis with him, he'll probably point out several things you are doing and not billing, several areas where you may be flagging audits or several ways to find out exactly what Medicare wants you to do - that you're NOT doing now. Give us a phone call today & schedule it at 903 871-1172

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FIRST OF 4 ARTICLES ON THE 2021 CHANGES BY DON, DATED AUG 14

PRIMARY CARE PRACTICES WILL SEE LARGE INCREASE…. SMART ONES WILL

Yesterday, I studied the 1043 pages to be published in the Federal Register that deals with the 2021 changes on Medicare.

On August 17th, CMS will publish their proposals and recommendations in the Federal Register for the 2021 calendar year Medicare Part B system. Part B is the traditional Medicare program and not one advertised on television by a movie star or sports personality that can barely spell Medicare, much less have any idea whether the plan they are promoting is ripping the patient off or even halfway decent.

Each year, CMS publishes in July or August what they are proposing for the next year, giving medical providers and patients the chance to either approve or disapprove of their plans. Some years, the changes are not earth shattering. This year, the 1043 pages go into great detail with the changes they are making for the E&M codes (visit codes), documentation requirement changes, making telehealth coverage permanent and more. Yep – it’s pretty involved this year, as you would expect it to be with more than 443,000 words. If you would like to read the pre-release copy, you can do so on the CMS website at: https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-4

Related to this is the article on the CMS page about where President Trump proposed to expand telehealth benefits permanently beyond the COVID PHE, also released on August 3rd and it is evident that CMS included the president’s proposals.

Unfortunately, you may have already heard from some who are claiming that Medicare is making a 10% cut or reduction in physician payments, which is not exactly accurate. What many do not realize is that the Social Security Act of 1988 requires a budget neutral change with the Medicare program starting in 1992, with only a cost of living increase. That was reinforced with Health Care Reconciliation Act as well as the 2010 PPACA requires the Medicare program be reconciled each year, based on the economic index. What this means is that if Medicare is going to approve payments for new procedures or a lot money in a specific area, they must take it from another area…. This is similar to what you do when your child needs orthodontics. Until the braces are paid for, you limit how much you go to the movies or how many pizza’s you order. This makes sense from an economic standpoint if you have a fixed income and need to keep your expenses budget neutral. Unfortunately, most Americans do not do this, and instead just increase their debt, which is why the average family in the USA have a debt of about $137,000 (per the US Federal Reserve in 2019).

While the conversion factor is having a 10% reduction, we do know that CMS issued corrections on the Misvalued relative value units for 2021 (many of which are 7% to 21% increases) or what the locality indicators will be for each of the 113 Medicare payment localities. All of this determines the “allowed” or MPFS (Medicare Physician Fee Schedule) amount. While it is possible that individual codes may be reduced by some amount, this does NOT mean that every physician will take a reduction. In fact, I believe you’ll find that family physicians, internal medicine physicians, general practice physicians and Endocrinologists will see a very substantial increases – if they practice smart.

If they (and their managers) are truly smart, the primary care (family, internal, geriatric) physicians should also see an increase in clinic income of more than 40% (some may be more than 100%), but those are only the smart ones willing to learn. Unfortunately, many are not willing to change. In 35 years of working with doctors, nurse practitioners and physician assistants, I’ve found that most do NOT like change, and as a result – they miss out on an incredible amount of income.

In fact, as I’ve proven time and time and time again, many primary care doctors are missing more money by not knowing what they should be billing than they’re actually paid. Yes – you read this correctly. Most miss out on more than the amount they ARE paid.

Just a few days ago, I did an analysis with a family doctor who was paid $108,000 by Medicare a couple of years ago, and that same year, he missed more than $220,000 in Medicare Part B allowed that he should have also performed and billed. He had no idea and most doctors and nurse practitioners we talk to also do not know. So -if someone says “A primary care doctor makes more on commercial insurance than Medicare”, tell them “Don Self said you don’t have a clue”.

So, returning to the subject of reduced payment amounts due to a reduced conversion factor, it is possible and probable that Medicare will be paying less for some procedure codes than they were in 2020, but if they are paying for more services (new coverage) and allowing physicians to bill for more things they are doing now than they did in 2020, perhaps it will help lessen the reductions or even end up in practices increasing their clinic income.

We won’t know the net effect until we see the actual allowed amounts for 2021 (simply because we do not know the locality indicators and malpractice indicators for 2021 yet), but we definitely need to re-educate physicians and NPPs what they should be billing in the new year. We also need to educate the medical providers, managers, billers and coders of the differences between Medicare and commercial insurance as far too many have no idea that they can bill commercial insurance patients for things that Medicare does not pay for. Many seem to think that everyone follows Medicare’s payment rules, which is a huge mistake. A surprising number do not even know that the global fee period rules are different.

(Yes, you are allowed to copy and paste this to other groups or pages or share it if you wish. The more people that learn that CMS is not reducing all physician income next year, the better)

Don Self, CMCS, CPC, CASA

Don Self and Assoc. Inc.

Don Self and Assoc. Inc.

Don Self & Assoc., Inc., Medical Business Consulting

About Don Self & Associates

Your Billing History

$20,000 Guarantee on Our Consult

Your Billing History

TELE-MONITORING

$20,000 Guarantee on Our Consult

Your Billing History

$20,000 Guarantee on Our Consult

$20,000 Guarantee on Our Consult

$20,000 Guarantee on Our Consult

FIRST OF 4 ARTICLES ON THE 2021 CHANGES BY DON, DATED AUG 14

PRIMARY CARE PRACTICES WILL SEE LARGE INCREASE…. SMART ONES WILL

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