Visiting Physicians

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WEST BLOOMFIELD, MI
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We have a visiting Physicians business.
The cost of running the operation is pretty high as the reimbursement are not adequate it seems.
Is there an expert that can guide us through what are all the good practices are and steps to follow to get the most of what we do?
Our average is 10 to 12 pts a day. In a 8 hours days makes the profit very low.
However the pts we see are among the sickest, homebound and frequents fliers to hospitals.
We use the Visit codes 99348 to 99350 and the new Visits Codes 99342 to 99345
we mostly see pts at homes and groups homes.
I am aware of fall risk codes, non face to face, CPO, Certs and recerts, smoke counseling etc..
However i wanted to clearly understand the possible frequency of those to billed and the documentation requirement.
For example the Adv Care directive it says it needs the first 30 mins , however the documentation for it does not seem to be very extensive, hence it would not take a provider more than5 mins perhaps to go over it.
Furthermore it says that there is no limit on how often it is done. Our Pts probably need 4 of those a year at minimum but does it suffice that a Dr goes over the plan with the pt every quarter (as an example and bills
for that ACP in addition to an E/M code?) also the smoke counseling it says twice a year for 4 intervals for each, does that mean we can do it almost 8 times? and how extensive the documentation should be?
The non face to face we are trying to explore using that code, is it possible to one provider do the review of the chart and coordination of care and bill under that provider? or does the
non face to face has to be conducted only by the provider who is seeing the pts and billed under him/her?
When we hire new providers we are always surprised how little they know and how little they document, it takes us a lot time and effort to get them where their notes enhanced, i am
curious sometimes if we are just more picky over what needs to be done.
I apologize in advance for asking too many questions, but i am seeking clear guidance as Medicare is pretty vague with what hey require in terms of time and documentation.
Lastly there are the code for CPO, non face to face and CCM some of those services seem to overlap how do we know when to bill for what?

Thank you for you time and effort in helping us in advance.
 
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