Latest Office Slideshow

Updating Patient Insurance Information, Post By: Kay Ouellette, Billing Manager

Many people don’t realize how important giving the correct insurance information at the time of service is.  It can create great headaches for the Practice and the patient.  When the Office does not have the correct information and a claim is billed to the wrong insurance company it starts a chain reaction, which ultimately ends up to the patient’s responsibility.

Let’s start at the top:

-     Patient checks in at the window and does not update the sheet for any patient changes and marks same. 

-      Provider sees the patient and a claim is created. 

-      Billing looks over the claim to see whether the claim needs special attention according to the insurance company such as a needed authorization attached, medical notes, or accident date on the claim. (this really depends on each insurance company, example Medicare, Wcomp, auto, or commercial insurance all have different requirements.) The biller is assuming the claim is correct due to do patient update, so at this point the Provider has spent the time to see the patient, the biller has taken time to review the claim or charges and file the claim. 

-     The claim is sent to the insurance company. The insurance company can take anywhere from 30-45 days to process the claim and sometimes much longer, only to receive a denial for the claim stating it has rejected, because the patient does not have coverage at the time of service.

-     Now the provider has to work the denial and try to research if it denied in error or not.  Upon researching the claim the patient didn’t have this insurance at time of service and then the balance gets transferred to patient responsibility. 

-    The patient’s receives a bill and is not happy. 

Needless to say there is a lot of time, effort, and resources to bill an insurance company and if you have several patients a day that do not give the correct insurance update then there is a lot of time and money that is lost.

We at Central Florida Pain Management are very grateful for all who on conscious of their current insurance and make an effort to update it.   Thank you.

Post By:

 

Kay Ouellette, CPC

Billing Manager

Prior Authorization, Post By: Teresa McPherson, CEO

 

In today’s world of so many insurances to choose from and not really knowing which one is the right plan for your care can be confusing when it comes to choosing a plan.  Some insurances plans such as HMO’s may require a prior authorization for any services to be rendered.  I would like to take a few minutes and help our current and potential patients understand what a prior authorization is:

Pre-Authorization

Pre-authorization is a term used for obtaining prior approval from your insurance before having a procedure or service done.  We here at Central Florida Pain Management try to make sure we obtain authorization that is needed prior to services being rendered so you can receive services that are needed for your care.

Insurance Denial and Appeals

Sometimes even with a prior authorization on file a provider can still receive a denial for services that have already been rendered to the patient.  A denial means that the insurance company has decided not to pay for the procedure or other service that your doctor recommended or preformed due to many reasons such as the insurances own medical necessity guidelines which may not be met (yes, that’s correct your insurance can decide what services are acceptable over your own doctors recommendations) based on the procedure to be performed, related diagnosis code and how many times the patients may have already received this type of service already .  There are even some still pre-existing policies out there as well.  We here at Central Florida Pain Management strive to try and make sure that any services that require a pre-authorization are obtained and meet your insurances guidelines.  However even the most diligent providers office can still be denied payment for some services.  Sometimes the provider can appeal with a letter and medical documentation to convince the insurance company to change their decision and provide coverage for the service.   However in some cases if the provider is participating with the insurance plan and the appeal is denied the provider does not receive any reimbursement for the services that were provided to the patient.  It is not only important for your doctor’s office to understand your insurance plan and what it will and will not cover but it’s also just as important that the patient understands what plans/polices they are choosing to sign up with.  Only with both parties informed can the doctor and patient make the right decisions together for any future care.

Post By:  Teresa McPherson, CEO

Pain Practioners

 

 

Pain practitioners are pulled in many directions.

-First our obligation  is to care for our patients TO THE BEST OF OUR ABLITY, give them a medically sound and scientific  treatment. Unfortunately pain is closely linked to emotions. Plus a significant amount of medications for pain relief also stimulate our pleasure, gratification and addictive centers. This generates a secondary effect on the patients using opioid pain medications. Their pleasure/addictive centers get stimulated by the opioids creating a craving for more. This makes the situation difficult because patients are blurred into using more and more opioids, in the name of  still having PAIN.  It has only been recently that we have been able to clearly understand this conflict unfortunately at the expense of having created many iatrogenic (medical) addicts.

-Then, we are monitored by the DEA (drug enforcement administration) with rules and regulations that we prescribers HAVE to follow.  An important group of our available pain medications (opioids) are not only very powerful in diminishing pain but also very addictive and craved by users, so needles to say very lucrative in the black market. This creates a tense environment between prescribers and their pain patients.

-Also insurance companies are directly targeting pain practices. They are cutting re-imbursement for needed procedures, visits, tests and refusing to pay for a lot of the safer medications that we consider more effective and appropriate.

 Multiple “masters” to try and please. No winners, just losers creating a lot of tension between us (doctors) and our patients. The gap between us has gotten wider, and full of roadblocks and  conflict generating demands.

 

 

Post By: Cesar A. Euribe, M.D.

Pain Doctors Reputation, By Cesar A. Euribe, MD

PAIN DOCTORS REPUTATION 

In the practice of Pain Management we encounter multiple roadblocks.

Our patients come from a variety of backgrounds and most suffer with difficult situations and chronic pain.

Pain providers also come from many different backgrounds and styles of practice. Over the last few years there has been an influx of so called pain management specialists who joined the field with NO formal training, experience or understanding of the core of the pain management discipline.  Unfortunately some of the self proclaimed specialists were only equiped with their pens, prescription pads and a DEA license.

Pain practitioners are pulled in many directions.  I will talk more about this soon.


Cesar A. Euribe, MD

Alternative Therapies - By Cesar Euribe

I came across a patient who asked me if he postpone his traditional injections and pain management to try and see if the use of TART CHERRY JUICE would help his back and leg pain. He had heard from one of his friends who has a hip problem that his pain was gone by using that juice..

After my bruised ego stopped wining, I was able to look into that situation and was surprised by the explanations on-line.

“It’s the ANTIOXIDANTS stupid!!! In my tantrum, I forgot that there is a high content of multiple “good things” in our fruits and vegetables. Sometimes we forget that most medications come from the plants in our wonderful world. They provide us with the wonderful products we know now are essential for a balance feeling of well-being. We directly get co-enzymes, vitamins, antioxidants, prostaglandins steroids, hormones or their most important precursors.

Our grandmother’s were so right when they demanded we eat all our fruits, veggies, cod oil, spices etc etc. Those have been the basis of true homeostasis. Other OTC medicines like chondroitin, calcium pyruvate, magnesium etc are also in fruits and veggies.

My education has been in the traditional western medicine, I have been educated in some of the finest medical centers of the world such as MGH, BCH, Judge Baker, UPCH hospital and a few others. Finest traditional scientific medicine but it now feels at the expense of other disciplines now known as Alternative, Holistic, Eastern, Homeopathic, therapies.

In the last 10 years and because of high demand from the patients we are paying more attention to such alternative therapies.

I will elaborate more on Alternatives in future blogs.

Post By:
Cesar A. Euribe, M.D.

Truth about Addiction - By Cesar A. Euribe, M.D.

 

 

 

       

 

              The Truth about Addiction

 

The disease of addiction is a sad and difficult malady to treat. Ever since it was recognized we learned that the disease of addiction crosses all races, socioeconomic, cultural, educational and gender lines.

 Its diagnoses requires several conditions to be met:

1. - Genetic predisposition

2. - Dysfunctional upbringing

3. - Obsessive use in spite of negative consequences

4. - Mind altering pleasure generating serotonin and dopamine surges produced by drugs, food, sex , activities like gambling, exercise etc.

5. - A loop that goes from high to low and craving that requires more and more use.

 

Pain management is confronted all the time with doubts about is it pain or is it addiction. We are lucky we have Dr. Roger Spencer board certified in Addiction medicine. Also boarded in Anesthesiology and pain management.

 

We can help many patients with our expertise.

Cesar A. Euribe, M.D.

Medical Marijuana - Post By: Cesar A. Euribe, MD

“Medical?” Marijuana

 

I was all excited with the possibility of marijuana becoming legal for medical use here in Florida.

As a physician I would have hoped that the first thought that came to my mind was of joy for how many patients I was going to be able to help their medical conditions like …???___ By prescribing marijuana.  It was not, it was more of wonder as to what was my knowledge or education on the pharmacology and clinical indications for THC.

 I have a lot of anecdotal experience and being a baby boomer know many that during the Vietnam era, Peace and Love and Woodstock were, and some still are, great fans of the product.  My generation never claimed, even with “wide spread” experience that marijuana was medicinal. Then I wonder why was medical therapy and approval of drugs, being defined by “popular vote”.

Practicing pain medicine has been an eye opener for me. I have witnessed many unscrupulous physicians and a great number of patients that either claimed or have actually been hurt by the prescribing of mind altering (dopamine, serotonin, Mu and other mood and pleasure receptor modifiers). Marijuana IS a mood altering receptor modifying drug. Like alcohol I am concluding more and more that Marijuana should be controlled as recreational like alcohol. Lump it there with the ATF. I do not think that as a physician I should be asked to control the use of recreational drugs by VOTING them medical. I have a lot on my plate just trying to make sense of pain killers.

But truthfully my first thought was more like WOW I CAN GET RICH.

Post By: Cesar A. Euribe M.D.

Medical Terms, Post By: Cesar A. Euribe, M.D.

 

Medical Terminology

 

There are several terms that we use in medical practice that may not be very clear for everybody.  Here are some common terms that I have patients ask about frequently.  

-Palliative Care: refers to the type of interventions provided to patients in order to alleviate their symptoms. It usually does little to the disease process but it takes care of specific symptoms. This type of care applies well to patients with cancer. The disease process is managed by the oncologist but the side effects of medications, tumor invasions, radiation treatment, etc, produce many symptoms that require expert attention.

-Pain Management: is the most frequent palliative care intervention. It treats the pain that comes with many disease processes.

-Symptom management: is taking a cough suppressant to reduce coughing spells, it does not cure the cold but reduces the symptoms.

Pain management specialists treat the symptom of PAIN. We use medications, interventions and alternative therapies to achieve relief.

 So this terminology is frequently exchanged but as you can see it also has specific meanings.

 

 

Post By:  Cesar A. Euribe M.D.

Central Florida Pain Management - Complex Cancer Pain Video