Home Forums Discussions General Discussion Charging Pts $1 for Controlled Substance Paper??

It seems like every year our costs go up (wages, rent, malpractice (even being lawsuit free my entire working life)) and reimbursement just doesn't keep pace. We had a respite in Florida in 2013 and 2014 with Medicaid basically doubling and matching Medicare rates. However, our governor has decided Florida will not renew the Medicaid increase legislation and we are feeling it already this year.

I am about to run out of the "special" numbered RX paper we were first forced to buy in late 2011 due to the abundance of Florida pill mills. I have to order more and it pains me to see our costs on printing controlled substances. I am seriously considering charging a $0.50 to $1 supply fee for controlled substance RXs. This would just be enough to cover our cost for the paper and ink.

And if you're thinking how could a Medicaid patient pay $0.50, well, they spend more than that each day on the cigarette pack in their pocket, or their new smart phone plan, fast food which causes their DM, HTN....

Has anyone here implemented such a policy? Any issues with insurances, specifically Medicare/Medicaid?

Thanks,

Anthony

Anthony
Thankfully (or regretfully depending on perspective) NY is moving to required e-prescriptions for everything including controlled substances. Even before this soon to implemented policy, NY provided written scripts w/o asking for printing costs. (Commercially printed scripts were outlawed) I'm sure it came out of our pockets in some way, though. I feel your pain.

I understand the frustration but I think that is thee wrong approach. It looks like you are charging a fee to get controlled substances; even if it is nominal it looks wrong.
Plus I think you may find that you can not even legally charge your Medicaid patients that fee.
You can work on other strategies to minimize use of the controlled substances, only write them at the time of an office visit??

Best wishes
Greg

Marc - thanks for the empathy, we would greatly prefer a fully electronic model. As it stands, printing controlled RXs greatly interrupts our workflow. We have to manually feed the RX paper into a slot on the front of the printer, tell everyone not to print anything, and only then can we print, and then sign it. I am usually with another pt. when the MA knocks on the exam room door to have me sign the RX from the previous pt. I refuse to buy another printer just for controlled substances.

Greg - I understand your point of view. It has been my policy for over 30 years to only prescribe narcotics and benzos, well...any controlled meds, in-office. I have to see the patient, evaluate them for abuse, urine test, and only then will I continue therapy. For chronic pain meds, which I really only give to the elderly and pts I have known for a long time, I see them once monthly for their RX since we cannot give refills anymore. Before that, chronic hydrocodone use required a visit every 3 months. I can't remember the last time I wrote an Oxycodone RX and I once wrote a Morphine RX for a pt. who couldn't wait for their oncologist appt. For alprazolam for insomnia and anxiety, I'll give a 1 month RX with 2 refills. For Concerta/Adderall, I see pt's monthly. I have had too many cases of abuse or parents taking/selling meds, so I am careful with this.

Now that Tramadol and other meds require this special paper, I have seen my supply dwindle very quickly.

I want to also volunteer the following:
1. Regardless of insurance, pt's are charged a $25 fee for any paperwork, written letters, or forms to be filled out.

2. Pt's are charged for copies of lab results, x-ray readings, medical records, per the state allowed rates.

3. Most docs in my area charge a no-show fee and will not see the pt. until it is paid, this is very common and it applies to all insurances.

With the above in mind, I have not been contacted by any insurance in regards to the fees. Some patients may gripe about it, but they understand and will pay.

I look forward to reading everyone's opinion, certainly our members in Florida.

-Anthony

Hi Anthony,

I also feel your pain. We were lucky as our governor is big on small business and OKd the Medicaid increase another year. In fact, it is our best insurance. I hope you don't mind, but I am kinda on the other side on everything.

While we charge for patients who leave the practice (not for leaving town or other bonafide reasons -- mostly due to passive-aggressive behavior on my part), we do not charge for patient records if they ask within reason. Most of our pediatric patients (the parents) do not request them. Actually, almost none. We will write nearly any excuse letter -- usually takes about ten seconds using a template. Haven't thought much about longer ones, but I have written longer ones in the past.

I am not sure about Florida, but you can NOT charge Medicaid patients for ANYTHING. Even a penny. It is considered fraud here, and MaineCare will come down on your hard if they find out. They may not. For example, I used to charge everyone for records for transfers. When the patients got the letters, they would mostly pay. Some wouldn't and those didn't get a copy of their records. Since 99% of the MaineCare (Medicaid) patients didn't know their rights, they paid as well. Until that 1% called MaineCare. MaineCare was on the phone with me that very day and threatened a complete audit of six years of MaineCare charges if I collected the money. So, I didn't.

I would have a difficult time charging patients for no shows. It would be just one more example of how paying for insurance is actually worse than living off the state. Just doesn't seem fair that the MaineCare patient doesn't have to pay but the Aetna patient does. We just have a three-strike rule.

*****************

I separate this because, if there is ONE thing I can do to help you, it is the following. I would highly recommend that you at least think about it. You are losing way more money with inefficiency than by buying another printer. Our office is a bit over the top in printers. We have seven black and white laser printers, one color laser printer, two Star printers and six Dymo label printers. Some of the printers were purchased for particular reasons that would not have had to be purchased in the beginning. It sounds as if you had more regular printers or even one networked printer, you would at least not have to have everyone not print. That is time consuming right there. And, if someone did, wouldn't that ruin the entire sheet of tamper-proof paper? Are you using an 8 1/2 by 11 sheet of four scripts? That seems like it would be wasteful as well.

This would be my suggestion. It will help with your office flow tremendously. While the Star TSP800x printers have crazy-difficult drivers, once set up via your network, they are invaluable. Once set up, they are flawless. You can print one or fifty scripts at a time. It is just so helpful to (as you likely do) print the same script from AC each time. I not only print to my receptionist's Star printer, my MA has her own. When I print them, I walk up to her desk, she already has them stamped for what month they can be filled, and I sign them in seconds. It's also nice, because she has proofread it, and I do, and the patient does.

I generally see about three to four ADHD patients a day. If the patient is doing well, my MA has already printed the scripts and stamped them, and paper-clipped them to the chart. You have no idea how happy I am when I see the chart on the door with scripts on them. This means a ten-second visit. Literally, a ten-second visit. "Everything OK? Great? How is school? Super." Hand them the scripts. I don't even log onto the computer. I was behind thirty minutes, now I am only behind 15 minutes. Of course, if it says med check on the Superbill, and there are no scripts pre-printed, then I know, I have to spend the 15 minutes going over what their issues are.

I also don't blame MaineCare patients too much. Yes, I cringe a bit when they have their cigarettes, etc. But, I always tell my staff if someone handed me the keys to a Porsche 911 for free, I wouldn't hesitate to drive off in it. And, if the state is going to continue to encourage entitlement and Methadone clinics, etc., then people are going to take advantage of it. I am not saying it isn't wrong. It is. But....what can I do?

Hope this helps.

Is everyone aware of the OBAMA SEQUESTRATION cut that all of us are under

Doctors are also grapping with a 2 percent pay reduction from the sequester.

physicians could by 2019 be subjected to a set of penalties that reduce Medicare payments by 13 percent.

Time to kiss CMS goodbye

you can actually just have a cheap 100 laser printer with scheduled meds paper in it..for me it isn't a huge deal...i just don't write narcotics often at all...

i stopped taking medicaid patients because i do sports med and i lose freaking money on all my braces from medicaid and they can't buy them from me..so i just don't take the cases anymore...not worth my while...

it will be soon for docs to band together and say F$%# insurance and just take cash, provide a superbill and the patient can do the work themselves...honestly i am getting closer to that point every day...

tired of this crap

I use a cheap laser printer off Ebay, load it with blank tamper-resistant paper that really doesn't cost much.
The 8x10 sheets are scored in quarters, and if you print the prescriptions "full page" but scaled down to A6, you have a usable printed prescription on the correct paper for very little outlay.
Of course the printing is 1/4 size and very tiny -- but the pharmacists get used to it.