Let me open this blog with a summary of the phone call that inspired me to begin recording my experiences consulting with private pediatric practices around the country.

A long-time customer of PCC’s called me from San Antonio two weeks ago. I’ve always enjoyed my conversations with him, as it’s delightful to work with someone who clearly cares so deeply about his patients and his practice. It’s not that we see eye to eye on everything (in fact, I suspect we differ politically as much as two people can), but he calls me from time to time for help with his practice and I’m glad to help him.

In this instance, he’s decided to open the can of worms known as United. Somehow, he found out that the contract he renegotiated (with my help) three years ago was never fully implemented…apparently, while the other practices in town - and around the country - were being paid with RVU rates set for 2004 and beyond, he is still using 2001!

For those of you not the in the pediatric world, that means that thousands of immunization administration codes (90471, etc.) have been paid by United at, say, $5 when they should be $10-20, at least. For pediatricians, that’s real money.

So, he called United and what did they say? “Gee, we must have missed you when we updated everyone. Sorry about that.”

Sigh. No offer to fix it retroactively, of course. They only remove payments that way.

What I can’t understand is how they paid the 90465 and 466, for example, which had NO values until, what, 2005?

I called into the practice and, ignoring all of the other problems with the fee schedule (<100% of Medicare, San Antonio’s bogus placement in the “Rest of Texas”, etc. ), I’d put the loss for this practice at somewhere between $10,000 and $20,000 on just the 90471 and 90472 codes alone.

And that’s when I said, “I need to start writing these things down.”