Home Forums Discussions General Discussion Charging for forms.

I charge to fill out forms (handicap parking, disability). We verify information and take time to fill the forms out properly, even filling in the patient's potion for them.

A patient ( one that my staff and I bend over backwards to accommodate) told me this week that she was leaving my practice because I am a money grubbing doctor who takes advantage of others and that I make more than enough money. I tried to explain to her the cost of doing business, the time and effort placed in completing (sometime even mailing the forms at no additional charge) forms. I also explained to her that she should not comment on other' s finances ( it has been a tough few years I started the practice, just as the economy tanked).

I filled out her form. I did not charge them a co-pay ( her husband and her also had an office visit) and explained to her husband (alone) that our time has value and that we put a lot of effort and expertise in taking care of our patients. Merry Christmas.

We got no thank you.

We did get a letter and check (covering the form fee) explaining that we were unprofessional and "all about the money".

We returned the check with a letter disengaging the patient from the practice.

I am very frustrated. It just seems to be getting worse out there.

I charge for forms as well. If a patient wants to leave then we show them the door. When they go some where else and get care that is substandard they may come crawling back. I actually had a patient put a bottle of patron tequila on my car recently asking me to take him back. I said he forgot the limes. In 10 min they were here as well. If people dont understand that your time is valuable then go get other patients that do. I take emails, electronically refill medications, handle faxes electronically and all this takes valuable time and I tell patients that a few too many ill-informed people voted in for another 4 years a president that is going to ruin the healthcare industry. Currently we are turing away new patients as I cannot fit them all in. Ask them how much the local car dealer charges for shop time or the local lawyer charges for a visit and then tell them exactly what you get out of a visit. It surprises patients. One nice older patient wants to pay me the medicare cut that we are all supposed to feel in a few days. I told her that if I accepted it that she would have to visit me in Leavenworth, Kansas...she laughed...Chin up....

Good riddance to them! If more physicians had the guts to stand up for their business interests, patients would not be able to go shopping for doctors based on who doesn't charge for services.

This idea that every Tom, Dick, Harry and Eloise can assign you and your staff additional work with no compensation for your time and effort has got to end. These people will willingly pay anyone Except their PCP. Personally, I feel you spent too much time trying to placate them about it. Heck, some doctors have different fees for different forms (varies based on how much work and information goes into completing the form)

I have had parents leave for a variety of reasons, including fees for filling forms. I am egotistical enough to feel that if they leave, they do not deserve me. I am very selective about taking them back. There are other patients out there.

Physicians eat so many changes without reimbursement that others would not even consider. What if lawyers were not reimbursed for phone calls?

I will complete forms IFF they are part of an exam. Otherwise, they pay.

It's not [only] ego if it is true. Statistically speaking, there are far more patients than Doctors. In a non-manipulated market, Doctors *should have* more pricing power than mechanics, plumbers, even [gasp] lawyers.

They would have the phones ripped out of their private offices - their staff place almost all of their calls anyhow.

All good responses to Frank's post. I think we all have felt his pain... we know in our hearts that it is reasonable to charge a fair amount for completing forms (and it would be reasonable to charge for phone calls, too), and ultimately that we are better off when a patient like this leaves the practice.
Somehow it is still like a punch to the gut when you bend over backwards to do all that you can, and the response is so selfish. It makes one wonder exactly how many people out there feel like we are all a bunch of rich, overpaid opportunists. Even when we know we are not, and when we know the person is acting like a spoiled child, it still takes a little wind out of your sails...

As physicians, we can only expect to be paid for face-to-face time. This situation evolved over a long time, and seems to be engraved in stone.
I used to believe that it might change with the "electronic revolution" -- but it isn't.

My solution is that I never answer the phone, I don't speak to patients on the phone (all telephone communication goes through my nurse), I don't fill out forms unless they come in, and I almost never fill out a prior authorization form (unless it is my idea to use a medication I believe the patient needs and know the insurance won't cover.)

Anyone who needs a form filled out, or prescriptions need to be re-written because they are changing pharmacies, or wants me to explain their lab reports in detail or needs a home health referral -- they are all required to come in for a visit.

Some complain, most don't.

I'm trying to simplify my life, and it seems to be working.

Tom I agree, running a practice is frought with distractions to the task at hand and requiring patients to come in to properly fill out forms actually makes that task easier for me to do properly aside from getting paid for my efforts.

That's what we tell them, and it's true.

How do you know how to fill out form unless you see the people and ask them what is going on.
And with prior auth for meds, you have to ask them what they have tried and why it didn't work -- can't make that up, and even if the info is in the chart (which it often isn't -- especially if the med was originally prescribed (or sampled) by a specialist, and now you are stuck with continuing it.
That all takes a lot of time that no one will pay for outside of a face-to-face visit.

Among the worst is the requirement for "face-to-face" for home health and hospice -- people are often too sick to come in for face to face visit.

[quote=Tom]Among the worst is the requirement for "face-to-face" for home health and hospice -- people are often too sick to come in for face to face visit.[\quote]

I would like to chime in. I agree with everyone, but I think a few tweaks are in order. First, with the quote above, when I first heard about it for certain things, I wasn't happy. We only have to do it with DME. So, a nebulizer needs Face to face encounter on such and such a date. Of course, albuterol needs the diagnosis. So, when I prescribe asthma meds for the first time, I have to remember to write Dx: Asthma and for the nebulizer I have to write Face to face encounter on such and such. But, it can be eight years ago (not sure how long) as long as you did see them then. I put F2F today as my DAW and, wow, did I get pharmacy calls. I guess they don't know the texting acronys. So, after I got over my PA (not prior auth) but passive-aggressiveness, I wrote out the whole thing. What kills me is the Concerta Dx: ADHD and albuterol Dx: Asthma. Please Maine or the government, what else are they going to be used for: Albuterol for eczema and Concert Dx: Diversion?

I think part of the issue with forms is how much effort we put into the form. Do you have a set fee for each one? Or is it time? I, too, have patients come in for difficult forms which require a lot of work and correct answers, but when a patient comes in with a form allowing them to do sports, and they had a physical last week and all I have to do is sign it, that is a bit difficult to charge for. What is irritating is when a patient is seen for an exam, the computer is locked and then they want a short letter or form filled out that my staff could have done at the front.

With 65% MaineCare, I couldn't charge 25 cents (literally) as they are not allowed to pay anything. Same way with charging for no shows.

Part of the problem is whether or not a patron (patient) has an expectation of the charge. I feel that is 95% of it. Now, when I go to a convenience store and purchase three things, the cashier almost always asks me, "Would you like a bag?" I always say no to stay green, but I have never once been charged. Now, while the store would have every right to then say, "That will be 15 cents for the bag and my time of putting the products in the bag," people would flip out and tell them essentially the same thing, "Well I am going to the store down the stree."

I always charge for records when somene leaves the practice because they were unhappy for any reason. I do have a weird practice in that if they are brave enough to tell me that I suck as a doctor, it's free. But, no, I usually get a records release. Now, if a patient of mine needs records or I send a consultant records, I don't charge, and I am spending the same amount. I send a brief certified letter to them that their 11 page record will cost them $13.50 as the law allows. I usally get one of four responses:

1. I never hear from them and they never get their records.
2. They simply send a check, and we send the records same day.
3. We don't hear from them until we get a call from the other practice stating they are there for their six month and they need the records especially the immunization record (we send the immunization record).
4. Or they call wondering why they have to pay for the records and why 11 sheets of paper costs $13.50. They never remember that it isn't just for sending the records but for the time to enter all the demographics in to begin with.

I generally tell them because I can. Some will threaten me with a lawyer, which has happened three times, and I have always won given there is a law right on the books.

But, the point is they will almost always say, "But, my last two doctors where I shopped didn't charge me." That's the point. If it were commonplace for every doctor to charge for the faxing of records, they wouldn't bat an eye.

And, that is sort of the issue with forms. If it were commonplace, I doubt patients would balk at being asked. But, they walk in expecting the form to be signed and then get told it is $10.00, and they get a little upset. Please understand. I agree completely with everyone. But, I don't think it is that they don't want to pay (it is with some), it is just the shock of the first time.

My last analogy: For years, you just pulled up to a gas station and got free air. I will admit you likely do now as well. But, many places charge around a dollar to get your tires from 28 lbs per square inch back up to 32. Now that we are used to it, it doesn't bother us.

Wow, a long post. I am sure it will get picked apart.

So true. These CMS bureaucrats must have hearts of stone. We are being required to force a "house-bound" patient struggle into the office for a "face-to-face" encounter, so they can be certified as "house-bound".

As George Washington said, "Government is not reason; it is ... a dangerous servant and a fearful master."

Bert, yes I do agree that it is that they do not expect to be charged for forms. I just feel that all PCPs should charge for most forms. At least if your income is dependent on their insurance reimbursements.

When you can set your own prices, you can then factor in any forms charge into your general charge. Or just eat the cost. But when you are forced to accept 50% of your charge, then cheated out of more via "bundling" and other shenanigans, well you have to make sure that any work you do is compensated.

There is a value to having a physician review and sign off on a form. Your signature is worth something. I feel you need to be paid that especially today. And if all the physicians begin to do it, then everyone will expect it. Like air at the gas station.

Couldn't agree with you more. Who would have thought that one day people would find it commonplace to pay $2.00 for a bottle of water.

Right Bert--
But all of that is solved by just making people come in for an office call -- then you get the right info, F2F if you need it, and the patient can watch you struggle with the form and possibly have some idea of the administrative load we are under.

Of course, if I just did a physical and the parent drops off a sports physical form I will sign it for free -- but that's not what I'm talking about.

See Tom, my opinion on your example there is that in that case you should charge a forms fee (yes, you obviously disagree. That's ok, We all have our own opinions about these details).

But, if you perform a special service called Sports Physical (not just their annual preventive exam) then you set the fee for the service such that it includes any fee you wish to charge for the service, including filling out the form.

That parent may be upset. "You don't even have to do anything," they may say. But maybe you do. Because being generally healthy may not be the same as being healthy such that they can run full-court basketball for a team several times a week (games + practice). And you are signing off of something that says you think they are healthy enough to do that. I'd say there is an extra value to you signing off on this. That's why they want a doctor's signature on it...to shift the liability if forbid the kid collapses on the court.

So many people seem to want to claim that certain work the PCP does isn't worth anything. Or not much. It's ridiculous. I had someone on the phone recently that was asking about the pricing for a Yellow Fever vaccination. I told the price of the vaccination and of the office visit fee. She replied that while she would pay for the vaccine, she didn't want to pay the doctor anything her services. I had another guy who said that he didn't need a pre-travel health consultation (where the Dr. reviews your vaccination record and advises you what you should do to avoid illness while traveling especially to a developing nation). He says he doesn't need that..he can get that from the internet. Ok. Then he proceeds to attempt to hand me his vaccination record, and ask a ton of questions. That he doesn't need since he can get the answers from the internet. yeah right. I informed him that those things are part of a the consult with the Dr., and we would really like to schedule him for one. Oh, but that means he has to pay the Dr to provide advice, and that isn't worth anything.

Maybe I'm just getting jaded, cynical and crotchety.

Some patients are morons. Or vultures. Or both.

We charge $25 flat charge for any document, including sick notes, those absurd family leave forms with inane/non-pertinent questions, etc. The front desk delivers the bad news, not me. They can take it or leave it. I refuse to discuss it with them.

We are a medical office, not their typing pool.

I fill out many a form for free. Usually handicap placards, etc. Longer forms such as FMLA, etc require an office visit which, in my opinion, increases the likelihood that it will get filled out to the patient's satisfaction and decreases the likelihood I will have to do it again. My office fee exceeds the $25 fee you charge to fill out a form so it makes economic sense and I have yet to have a pt complain about having to come in to have a form filled out. You can bill a 99213 etc using time as the determining factor if there is a diagnosis you can use or you can bill a V68.9 which is an "encounter for unspecified administrative purpose". Many times it has offered the opportunity to discuss other elements of their health care with them which is providing a better service and my improve the reimbursement. It doesn't seem to me that the $25 charge puts anything meaningful in your pocket and is creating more friction with some of your patients than necessary. Get them in the office and charge them $100. Then everyone is happy.

So please give me advice on a related issue.
We treat a lot of patients for hepatitis C. The course of treatment is challenging, both for the patient and for the provider. It is also very rewarding when it is successful (which is now usually the case). The meds are also incredibly expensive, so we expect some diligence on the part of the insurance company to be sure that the patient is an appropriate candidate and will be getting the appropriate follow-up care. We have been doing this for some time, and we know that there are a number of administrative hoops (some reasonable and some rather arbitrary) that we must jump through. We are prepared to do so.
On the other hand, in some cases the requirements are so onerous, variable, and arbitrary, that to me they seem clearly designed to prevent the insurance company from providing the required benefits.
Friday was a day off, but I was in the office when a hepatitis C patient knocked at the door. Several people in the practice had already spent hours trying to get the medication for him. I told him to have a seat, and I proceeded to spend 93 minutes on the phone dealing with a rep and then her supervisor. We dealt with a series of administrative issues, some of which are really crazy; I won't bore you with the details. I will be enumerating those in my letter to the state insurance commissioner.
We have already had some discussions about how to recoup something for all of the administrative time spent on these issues. There is no way that the patient is responsible for this cost; this is different than charging for an FMLA form. Any reimbursement to us should come from the insurance company which creates this meaningless work.
So my specific questions: since the patient was sitting there, can I bill a 99215, saying that "over 90 minutes was spent in direct contact with the patient"? How else should this be documented? Can you tell me more about the V68.9 code Bill mentions? Anyone using it? Getting paid for it? Is there any way to bill the insurance company for our time spent on this ridiculousness if the patient is NOT in the office?

There is no way to bill the insurance company. Yes, I think you can bill for the time as long as you somehow state that greater than 50 minutes was spent doing management and counseling. I could be wrong.

John, obviously your method is working for you, but it seems just like E & M coding, the charge for filling out documents should not be fixed. I don't mean that it is the same as E & M coding. For me to do a Social Security form or write a three page letter to an insurance company is one thing but I can't imagine charging $25.00 to write on a form letter:

So and so saw me today for an illness. Please excuse him for the past two days. That takes all of one minute meaning which equates to $1500.00 per hour. I am definitely in the wrong business. There is no way our patients would pay that.

Please don't get me wrong. Not telling you how to run your practice nor what is fair. I just can't believe your patients pay that. I would say that greater than 95% of the time a letter to excuse the patient is done during an office visit or we couldn't ethically excuse them. So, it just goes along with the visit. I generally just message the receptionist, and she pulls out a form letter. It doesn't have to be good. Just so and so was in. Please excuse. I have charged the schools, and they have always paid.

V68.9 is a new one for me. Thanks Bill! This sounds like a way to do it, its just new to me. I'll have to research it.

I have yet to see a patient not come in for a visit for a form. And, it also makes the form more accurate, and I tend to learn more about the patient.

I'll have to try that V68.9. The resistance is paying extra for the form. Usually presented by walking in, dropping off or mail-bombing it. Always needed ASAP, seldom can appear for a visit (sound familiar?). As always, a battle of wills.

I think you are right. Again, it comes down to expectations. If they know in advance, they will either make less fuss about it or not do it at all. Not to brag, but as I said before, we have a 43 inch TV with these slides on them. Maybe you could have your MA write in the HPI. Here for fever and vomiting. Missed today and yesterday from school if you have patients in school.

Then in the plan, simply have a macro or shortcut key or template or just type: Patient improved, not contagious. Please excuse for days above. Hell, I put not contagious even if they have Influenza A (which they got from the flu shot), RSV, Ebola virus and Chicken pox).

I really hate when someone shows up with Ebola virus. Have to suit up, spray the whole office, all those CDC people hanging around. Really messes up the schedule.

Hey man:

I also charge for forms. We let them know that we do the basics for free (give work/school notes etc) but if you have a form you want filled out we charge. IF they don't like it, they can go down the street to another physician who will do the same thing I did.

I don't tolerate people in my practice who think I am in it for the money. Honestly, for the money I would have done finance and made a shitload..but i have $300K in debt and i started my practice 3.5 years ago and i pay myself less then $4000 a month on a regular basis...if they don't like it they can kiss my [censored]...

I had a patient call and they didn't want to pya the $500 they owed over multiple visits because it was early in the year and they hadn't met the deductible...i treated the same kid 5 other times later that year and of course all covered cause insurance figured they paid their deductible. he says he is having tough times...so we let him know we would claim financial issues for the patients family but he would have to trn in tax forms to the BCBS (which is what bcbs told us)...and he was like well i made more then enough that they won't allow it! we told him he would pay us or claim financial issues or go to collections.

we don't tolerate the bullshit that some patients give us..and there is no love lost when they try to pull one over on me...

you shouldn't feel bad!!!

I love you Ketan. Give 'em hell. Have a nice New Year.

Ketan is correct.

I just finished my morning review for my ACOI recert.

I'll be doing that everyday to prep and I don't get paid for that time.

Our time is valuable.

I started this thread and I want you to know that I don't feel bad about disengaging the patient (nor does my landlord, mortgage company car loan holder, med school loan holders). After the fiasco I watched last week in congress and last night with the "vote", I realized that I work hard for my patients and they will have to pay for my services. That's the deal we made when they came in the door. Deductible, co-pay, 20% co-insurance.

Don't tell me that you just got back from an Alaskan cruise and how great it was, but you can't pay. I used to eat a lot of the patient responsibilities until my CPA "Gibbsed" (NCIS) me.

Every time I have offered and started "monthly" programs for payment, I have gotten screwed. "You make enough off of insurance" will no longer be tolerated.

For monthly installments on large balances, you need to require they set up a credit card auto-payment plan, or I think you can set up something called ACH that deducts directly from their bank account. Assuming they have money in the account (or haven't exceeded their card credit limit) you can space the payments out over a few months. We do this with credit cards using Updox or Zirmed.

Everyone in the same boat -- which will sink, if we don't get tough.

This all reminds me of an uncle who started med school in early 1930's, but had to drop out because of the Depression. He did manage to get a chiropractor's degree, and went on to make quite a lot of money -- enough to go to medical school.

Then he finally opened a "real" medical practice in a small town in Minnesota, and lived in near poverty ever after!

@Bert -- Banks charge $25 to give you a copy of your last years' bank statements, and that just spits out of their computer. How much is that per hour? Lawyers charge for phone calls by the 5min increment.

The problem is one of expectations -- we are bucking custom to charge fees for filling out forms, when the only thing we get paid for is face to face time. I agree with all those who say you need to get the patient in for a visit, so the form can be filled out correctly. If they drop it off or FAX it in, I just have the receptionist call and schedule an appointment, and the form is not filled in until they show up for an office call.

The worst for me are the FMLA forms for children of elderly people who fly in from Somewhere to see their parents, then need the FMLA form filled out for themselves when they go back to work. I might start sending bills for those after reading this discussion -- some of them might pay, but at least there is some satisfaction in charging for the service even if I can't collect.

@Tomastoria I doubt I will ever say to a lawyer, "Are you kidding? I have to pay for that phone call??

Lawyer, "Yes." Again, it's all about expections. People get pissed because I charge them for their records which is way cooler than charing $25.00 for a school form. But, they freak out. And, it's not the money. It's the passive-aggressive in me.

Bert:

I love you too man

Bert is a changed man since that bat attacked him.

I wonder, was it a *radioactive* bat?

Bat .....err....Bert-man?

A bat attacked Jon Bert-man? What a coincidence.

So Bert, do you need a note for a work excuse? Bat bite, huh? okay 5 bucks. I am with you all on the charging for forms. What do you all use for the nursing home fax's? Is that V68 code applicable here?

Does Bert now possess the proportional speed, strength and flight characteristics of a ... bat? How about built-in sonar?

Wait, with built-in sonar, he can do his own sonagrams without buying expensive equipment!!!

I'll be looking for a sonagram going on sale any time now.

I am fairly certain that if you search "bat and bert" in the advanced search field, you will find the threads from months ago about the bat incident.

I am not quite sure where this bat hijacking came from. Actually, it was from John, but at least John knows how to use wit and satire.