Thanks for the insights. I can see a couple of differences. For one, I rely fairly heavily on the patient portal to discuss results (90% normal, or no change needed) and field limited questions. I don't get paid for this, but figure it is an extention of the initial visit. Surprises do warrant a separate visit, true, but I like that; it lets me shift mental gears to address the problem. The vast majority of our patients use the internet, so this works ok. There are some outliers.
That said, I may try it again. I do give lab slips for advance labs when I know for sure I will be needing it, or have the patient call to get a slip, e.g. for a hemoglobin A1c. I just don't think I can do as Mike suggests and review the chart a few days ahead of time. I am resistant to doing the same job twice and getting paid once.
We don't do many phone prescription refills. We are pretty meticulous about giving the amount of medication needed before the next visit. When a patient decides (s)he wants to change pharmacies and have all 12 prescriptions re-written, I usually ask for a visit to review medications. I don't feel that having an insurance company find a way to save money should cheat me out of reimbursement for honest work done.
