If we have a patient that's more maintenance, more just, I will say supportive care, Medicare will not cover that. Medicare will consider that a maintenance visit.
Dr. Stu:
Okay, so there’s still a little bit of confusion for me and I just want to say the way you present all of this is very clear and concise and quite frankly I think it calms all of our nerves a little bit because of what you're presenting, but also how you're presenting it. I want to thank you for that. When it comes to a Medicare patient showing up in your office, I'm just envisioning somebody coming in and maybe they did have pain on the first date of service, but they come in and maybe they come in three times a week for a couple of weeks. In the second visit, they say, “Man, I felt better for a day, I don't have any pain today whatsoever,” but they were already scheduled. You cannot bill for that or collect from Medicare at that point? How do we separate again maybe the pain from the function because you can't always predict when you're scheduling a patient, whether they're going to be in pain or not because there still can be dysfunction, which is what I was saying if there's a need for an adjustment. Well, here's what I would say to that, Medicare patients are generally older patients and you probably never going to get to a zero on the majority of them. However, let's just take what you're saying, the patient comes in and says, “I feel zero pain.” I would question that and let’s palpate. Is there tenderness? That's going to be a pain. Is there going to be pain with range of motion? The statement that I have zero pain, I would question and say, “Do you mean zero that it feels perfect and there's nothing wrong because if that's true then of course the care has worked.” We've done what we're supposed to do based on the Medicare protocol, but if we look further at the dysfunction because maybe a patient's pain is reduced, but do they still have dysfunction in the sense is there pain on palpation, is there a reduction of range of motion, is there some type of asymmetry? That certainly could be something that we could be looking at, but I would say we want to be careful that if we're saying zero pain, Medicare is going to give us an issue that they're going to say, “Not medically necessary.” I appreciate that follow up because again just because the patient may come in reporting excellent results does not mean that there wouldn't be finding of some discomfort or pain based on your physical measures. That would be correct. You got to figure, a patient is obviously going to improve quite a bit within even just a series of a few visits, but does that mean they've reached the goal you are expecting? In my opinion, generally not. [inaudible 00:19:12].
Dr. Sam:
Dr. Stu:
Dr. Sam:
Dr. Stu:
Dr. Sam:
Dr. Stu:
That was my exact point.
Dr. Sam:
Sure, but I would say, there's more to it than just reduction of pain.
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