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Topic: BS Fee Schedule DDS pays for CE and more!  (Read 9554 times)
Sassypaws15
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People helped 7
Gender: Female
Posts: 146


Stuck in NC!!!


« on: November 12, 2015, 05:27:00 PM »

I wanted to share with everyone who is dealing with CE EXAMS!!  I was looking at NC DDS recruitment site just because I wanted to see the requirements for various positions and I am now livid.  I am unsure how to paost a copy on the site, but I have no clue how to do so.  I get why so many doctors do these assessments now.  It really pads their wallets!!!

Here is an example:

I believe this rate is exact, but Neurologist gets reimburse $135 per exam.  When I went for mine the doctor was through, but his documentation sucked.  I asked him how many visits he does for DDS. The number varried day to day, but average was 3 a day.  So in theory this doctor would make:

$ 405 per day
$ 2025 per week
$ 8100 for 4 week
$ 97000 if the Dr worked 48 weeks per year

So easy money + bread  = BS documentation of patients needs = denials of due benefits to workers who have paid in = citizens suffer financialy and emotionally!!  WTF is our government thinking???  No shocker why SSID may run out of funds in 2016. 

Only in America
Logged

who every made the statement "Patients is a virtue" obviously never applied for Social security disability😡😡😡😡😡
Name: DeAnnna
Location: Burlington NC
Age at Application: 40
Disability: Juvinal diabties, schools, kyphosis, Spondolosis, DDD cervical spine, sever peripheral neuropathy loss of 90% sensation, muscle weakness, limited reflexes, chronic cellulitis, chronic ulcers of both feet, squired deformity of left leg, gamer toe left foot, instability of the ankle joint left foot, osteomyelitis, chronic MRSA infection, retinopathy with sever loss of peripheral vision left eye, premature cateracts, anxiety depression, insomnia, ADHD, effective mood disorder, PTSD, sever hypoglycemic episodes
Date Applied: April 20 2014
First Approval/Denial Date: Initial denial 11/1/2014
Reconsideration Approval/Denial Date: Denied June 2015
Date OTR requested: Requested 10/9/15 denied and June 2015 I thought it was denied, but it moved to a new ODAR program for faster processing.
Date OTR Approved/Sent to Hearing: congress and senator endorsement
Date Sent to VSU: NA
Date VSU Approved/Sent to Hearing: NA
Date Hearing Notice Received: Proposed exhibits received 7/9 and attorney previously sent all medical evidence and now ready to schedule
Hearing Date: NA
ALJ Approval/Denial Date: NA
Date Award Letter Received: NA
Date Back Pay Received: NA
Date Dependent Benefits Received: No dependants
Additional Info: A accident that took 5 minutes to occurs in the Harris Tetter parking lot changed my entire life forever.
Helper
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People helped 176
Gender: Female
Posts: 1654


« Reply #1 on: November 12, 2015, 05:37:40 PM »

$135 is less than he would make seeing private patients, especially if it is more than a 15 minute visit (including documentation time).

Also, typically physicians need to bill an amount at least 3x their salary each year to cover the cost of office staff, office space/utilities, equipment & supplies, malpractice insurance, health insurance, insurance on equipment & office space, etc.

So, the doctor would have to go to 4 years of college, 4 years of medical school, & complete a residency (making around $50,000/year during residency) & possibly a fellowship at low pay as well & incur over $200,000 in education costs & then perform 9 CEs per day to make $97,000 a year. 
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations

« Last Edit: November 12, 2015, 06:03:36 PM by Helper »
Helper
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People helped 176
Gender: Female
Posts: 1654


« Reply #2 on: November 12, 2015, 05:38:48 PM »

Also, you can request your own doctor perform the CE.  However, they will often refuse due to the poor reimbursement!
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
newdawn
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People helped 73
Gender: Female
Posts: 870



« Reply #3 on: November 12, 2015, 05:52:37 PM »

I wanted to share with everyone who is dealing with CE EXAMS!!  I was looking at NC DDS recruitment site just because I wanted to see the requirements for various positions and I am now livid.  I am unsure how to paost a copy on the site, but I have no clue how to do so.  I get why so many doctors do these assessments now.  It really pads their wallets!!!

Here is an example:

I believe this rate is exact, but Neurologist gets reimburse $135 per exam.  When I went for mine the doctor was through, but his documentation sucked.  I asked him how many visits he does for DDS. The number varried day to day, but average was 3 a day.  So in theory this doctor would make:

$ 405 per day
$ 2025 per week
$ 8100 for 4 week
$ 97000 if the Dr worked 48 weeks per year

So easy money + bread  = BS documentation of patients needs = denials of due benefits to workers who have paid in = citizens suffer financialy and emotionally!!  WTF is our government thinking???  No shocker why SSID may run out of funds in 2016.  

Only in America


I've heard that a lot of people's regular doctors won't perform CEs because the pay rate is so low. They not only have to spend time meeting with the claimant, but also generate a report. My psychiatrist charges $150 for a 20 minute session (which I find is extremely reasonable, especially considering she is a master at getting pharmacy benefit managers to cover prescriptions and faxes paperwork quickly and at no extra cost. In fact, I think she's only able to keep her rates so low because she doesn't have a full-time receptionist/scheduler and only takes self-pay, medicare, or BCBS). She charges even more for paperwork she does for me that she cannot complete during our little sessions. No way my psychiatrist would consider it lucrative to set aside time for a CE and generate a report for SSA for $135. I can see where some doctors who don't have a lot of patients for whatever reason might use CE exams to fill in the gaps, but I doubt they're getting seriously rich off of it.

Doctors have to pay a ton of overhead for malpractice insurance, office rental costs, someone to handle insurance billing, receptionist if they have one, etc.

(Helper posted much of what I had to say as I was typing.)
Logged
Name: Dawn
Location: IL
Age at Application: 31
Disability: Depression, anxiety
Date Applied: 11/2013
First Approval/Denial Date: 03/2014
Reconsideration Approval/Denial Date: 11/2014
Hearing Date: 11/13/2015 (Friday the 13th!)
ALJ Approval/Denial Date: 01/15/2016 Fully Favorable (rec'd 01/21)
Date Award Letter Received: 02/17/2016 (rec'd 02/20)
Date Back Pay Received: 02/13/2016 (paper check)
Additional Info: 02/09/16 mySSA account updated with approval info. 02/22 rec'd medicare card in mail. Hired lawyer after reconsideration denial. Requested an in-person hearing.
Lit Love
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People helped 204
Posts: 2674


« Reply #4 on: November 12, 2015, 06:21:38 PM »

Not only do doctors consider them low pay, but most have zero interest in having to learn SS's requirements which are constantly being updated. 


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Sassypaws15
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People helped 7
Gender: Female
Posts: 146


Stuck in NC!!!


« Reply #5 on: November 13, 2015, 12:18:31 AM »

I worked in the medical field as a RN for years.  There are a few misconceptions people have on these poor doctors.  When you are set up for a CE go to the medical board website and look at the Dr training history and other information like the year they graduated.  The last CE I had for psy graduated the same year I was born. He had no SSID training llst on his continuing education. 

Yes the doctors have bills and cost associated with their practice. They can write off equipment, mileage and other cost.  They truly don't have huge over head cost since everyone was forced to go to erecoeds in 2010.  So there is no records clerk. These practice go billing from provided software and insurance companies. They out size payroll if they are a large company if not they have a payroll clerk. The staff is typical made up of CNAs or CMAs. The pay rate ranges from $10 to 15 hour. Yes they have rent, but part of that is a tax exemption.

These doctors are cheap. The majority by low end equipment. I will give you an example when I started with the surgical center I was given a pulse ox that was taped together and a 5$ stephascope.  The same day I was assigned those items I went out and bought a Litmsn Cardio 3 strohascops and a 70$ pulse ox so I had adequate supplies.  The other issue was cutting corners such as not covering endoscopes or cleaning them with expires sanitizer.  So really disgusting.

I know from people I have spoken with the medical CE last 15 to 3o min so a 15 min visit the doctor makes $135 for the $15 minute visit so the actual value of his time was $33.75 for the 15 minutes he spent with you. If it was a 30 minute visit $67.50 was cost for 30 mi ute visit and the Has nice margins on these appointments. If the doctor doesn't have a regular practice site DDS pays for the location.

If you read your CE notes from your CE.  They are poorly documented and in and not adequate. So I don't get any of the pro CME REMARKS.  IN THE STATE OF NC most of the doctors are semi retires and this is their play money. 

One other interesting rid bit is during the mints and months you are waiting through your initial application thru recon your file sits and collects dust and in all an examiner my spend a grand total of 5 to 7 days actually reviewing your file.





Logged

who every made the statement "Patients is a virtue" obviously never applied for Social security disability😡😡😡😡😡
Name: DeAnnna
Location: Burlington NC
Age at Application: 40
Disability: Juvinal diabties, schools, kyphosis, Spondolosis, DDD cervical spine, sever peripheral neuropathy loss of 90% sensation, muscle weakness, limited reflexes, chronic cellulitis, chronic ulcers of both feet, squired deformity of left leg, gamer toe left foot, instability of the ankle joint left foot, osteomyelitis, chronic MRSA infection, retinopathy with sever loss of peripheral vision left eye, premature cateracts, anxiety depression, insomnia, ADHD, effective mood disorder, PTSD, sever hypoglycemic episodes
Date Applied: April 20 2014
First Approval/Denial Date: Initial denial 11/1/2014
Reconsideration Approval/Denial Date: Denied June 2015
Date OTR requested: Requested 10/9/15 denied and June 2015 I thought it was denied, but it moved to a new ODAR program for faster processing.
Date OTR Approved/Sent to Hearing: congress and senator endorsement
Date Sent to VSU: NA
Date VSU Approved/Sent to Hearing: NA
Date Hearing Notice Received: Proposed exhibits received 7/9 and attorney previously sent all medical evidence and now ready to schedule
Hearing Date: NA
ALJ Approval/Denial Date: NA
Date Award Letter Received: NA
Date Back Pay Received: NA
Date Dependent Benefits Received: No dependants
Additional Info: A accident that took 5 minutes to occurs in the Harris Tetter parking lot changed my entire life forever.
Lit Love
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People helped 204
Posts: 2674


« Reply #6 on: November 13, 2015, 01:15:08 AM »

The Green Book link:  https://www.ssa.gov/disability/professionals/greenbook/index.htm

Adult CE Report Guidelines:  https://www.ssa.gov/disability/professionals/greenbook/ce-adult.htm


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ChugginAlong
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People helped 19
Posts: 167


« Reply #7 on: November 13, 2015, 08:01:51 AM »

The psychologist who performed my CE was *much* younger than I and well regarded in the community. My therapist had shared office space with her in the past and spoke highly of her. Her write up was thorough and accurate.  I'm not sure it's fair to lump doctors who perform CE evals all in one category. 
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newdawn
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People helped 73
Gender: Female
Posts: 870



« Reply #8 on: November 14, 2015, 08:41:59 PM »

One other interesting rid bit is during the mints and months you are waiting through your initial application thru recon your file sits and collects dust and in all an examiner my spend a grand total of 5 to 7 days actually reviewing your file.

As someone who briefly worked in claims (albeit not SSA claims), I think it's normal for a file to basically sit in someone's queue while either waiting for doctors to send in requested info and/or to evaluate all of the info and make a determination. I wouldn't think it would take weeks for a competent DDS examiner to read through a person's file and make a determination. And sometimes the wrong determination is made for whatever reason but that's why there's QA, reconsideration, and appeals, some of which allow for additional evidence to be submitted.

I wish the wait times weren't as long as they are, but that seems like it could mainly be improved by employing more DDS examiners, ALJs, etc. or somehow streamlining the process further.
Logged
Name: Dawn
Location: IL
Age at Application: 31
Disability: Depression, anxiety
Date Applied: 11/2013
First Approval/Denial Date: 03/2014
Reconsideration Approval/Denial Date: 11/2014
Hearing Date: 11/13/2015 (Friday the 13th!)
ALJ Approval/Denial Date: 01/15/2016 Fully Favorable (rec'd 01/21)
Date Award Letter Received: 02/17/2016 (rec'd 02/20)
Date Back Pay Received: 02/13/2016 (paper check)
Additional Info: 02/09/16 mySSA account updated with approval info. 02/22 rec'd medicare card in mail. Hired lawyer after reconsideration denial. Requested an in-person hearing.
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