We will evaluate your condition, and if we can treat you, we will, otherwise we are glad to refer you to the appropriate provider. Following are examples of some of the different conditions that we treat:

What are Minor Illnesses?

Allergy symptoms

Sinus congestion & infection

Respiratory Tract Infection

Cough

Sore Throat

Fever

Ear pain & infection

Flu-like symptoms

Gout

Headache

Indigestion & Heartburn

Nausea, Vomiting, Diarrhea

Urinary Tract Infection

Yeast Infection

What are Skin Problems?

Rashes

Acne

Athlete's foot

Toenail discoloration

Chicken Pox or Shingles

Cold, canker & mouth sores

Eczema (Allergic Dermatitis)

Impetigo

Abscess or other skin infection

Cyst

Ringworm

Scabies

Sunburn

Swimmer's Itch

Warts

Skin Tags

Poison Ivy & Poison Oak

Unknown lumps, bumps, skin discoloration

What are Minor Injuries?

Insect bites & stings

Minor burns

Minor cuts, blisters, wounds

Splinter removal

Sprains, strains, joint pain

Suture & staple removal

What are Procedures?

Ear Wax removal

Eye wash

Skin cryotherapy (freezing skin tags, warts, or other lesions)

Nebulizer treatment with albuterol or albuterol/ipratropium bromide

Pulmonary Function Testing

Audiometry

EKG

Wound debridement

Abscess drainage

Cyst excision

Suturing (stitches or staples)

Superficial excision for biopsy

Antibiotic injections

Steroid injections

Other medication administration

2015 Medicare Office Visit E/M Codes
Code	Description	2015 Medicare Assignment Fees - La Grange, TX (these amounts vary by location throughout the US and are subject to change)	Patient Copay
99203	New Patient 30 min	$103.86	$20.77
99204	New Patient 45 min	$158.81	$31.76
99205	New Patient 60 min	$199.83	$39.97
99213	Existing Patient 15 min	$69.67	$13.93
99214	Existing Patient 25 min	$103.61	$20.72

Medicare (and other insurors) essentially pay based on the complexity and time

spent in an exam (RVU's - Relative Value Units). Most office visits will fall under the above codes, plus additional fees for specific procedures or other modifiers. Insurance companies reimburse by contract fees which may represent a percent of Medicare fees. A clinic must be able to pay for its overhead (supplies, staff, services, which include extensive administration). Most physicians have substantial student loans to pay back for many years of education and training, comparable to the price of a new home.

If Medicare does not cover a particular service, then a physician can charge at their discretion, but Medicare will not pay, so you will be billed for the balance. This may apply to certain concierge medicine and other similar services, and is changed over time.

There are three types of Medicare providers:

Assigned Providers- Accept the fee schedule that Medicare provides and does not charge more to the patient. This may be less than the standard fees charged by the office. (We do accept Assignment).

Unassigned Providers - May charge up to 15% more than the fees Medicare allows. This will increase your copay, but Medicare pays the rest.

Providers who Opt Out - Providers who opt out of Medicare can charge cash prices at their discretion for services. They will agree not to bill Medicare for their services, and you will sign an agreement that you will not send your bill to Medicare for reimbursement, either. These providers may order prescriptions, laboratory work, imaging, and services which will, however, be honored by Medicare.

Non-Contracted Providers - Providers who are not registered with Medicare. New Medicare rules may prevent Medicare from paying for prescriptions by providers who are not Medicare Providers.

The increasing rules, fines, and overhead (cost) associated with patient care, documentation, approvals, and claim processing (which may exceed the amount of reimbursement or income) has induced many providers to Opt Out or stop taking new Medicare patients altogether. As our overhead is low, we are still able to take Medicare by Assignment.

The typical CPT codes (representing diagnoses) are known as ICD-10 codes. There are additional codes for service level, supplies, and special services which also have fees associated with them.

Our Services In case you were curious about Medical Billing:

Medicare Reimbursement & Estimated Copays

Walk-Ins and Appointments
Minor Illnesses, Skin Problems & Prescriptions, including ePrescriptions
Minor Injuries, Suturing & Wound Care
Osteopathic Manipulative Therapy
Health, Wellness & Physicals
DOT Physicals & Certification
Medical Consultations & Advice
Second Opinions & Referrals
Counseling & Mental Health
In-House CLIA-Waived Labs, including: Urinalysis, Rapid Strep, Influenza A&B, Pregnancy, Blood Glucose, iFOBT (Fecal Occult Blood Test)
Urine, Throat, Wound Cultures, Excisions for Pathology, sent to an outside laboratory.
Will write scripts for offsite labs, blood draws, EKG's, imaging, to be performed at St. Mark's Medical Center (or the facility of your choice), as well as recommended vaccinations (most which can be provided right away at your local pharmacy).

Call Us: (979) 484-7120

We believe in educating our patients and being open with disclosing our fees. When you come to see us, we will ask to scan a copy of your Driver's License and Insurance Cards, including Medicare, to keep in your electronic medical record. We will discuss fees at that time and provide you with our billing policies.

As both patient and provider, we have experienced the headaches of copays, deductibles, approvals, denials, and unexpected fees, and we hope to keep it as simple as possible so that we can provide good value medical care without undue hardship to ourselves and our families, or to you, our patient, and your families. At this time the only insurance that we are taking is Medicare, and as an Assigned Provider, we will charge the 20% copay for the estimated level of service. The prices listed below are public information, subject to change, and only applicable to Medicare.

Please note that this is a micropractice. At this time I do all the patient intake, billing, vital signs, examination, and procedures myself, so your face-time may be longer than you are accustomed to with other practices and will seldom be less than a half hour, inclusive of all the paperwork and billing. If you are new to the practice, please allow at least an hour to cover the additional questions and documentation to get your care established.