Webinar #6 - Highlights from the Comments

Chip & Paulie's Webinars
1

Thanks to @Jan, we have a summarized and cleaned up version of the comments and Q&A from the webinar last week, just in time for tonight! [She had this done a few days ago, I just realized I hadn’t posted it.]

There are questions, many of which are answered by other attendees. There are unanswered questions. There are comments. There is guidance. There’s something for everyone. Read through and warm up your brain for tonight. If you can answer someone’s query here, please reply! And if you learn something important for your office, let us know. Thanks again to @Jan, it’s a lot of hard work. There is gold in here!

  • Funding/Loans

    • everyone: talk to your accountant
    • for PPP look for small and local— be a big fish in a small pond- play up community champion… give them your business
    • Please tell me exactly where on the forum is the Q and A from the CPA
    • If the bank says they have all the documents but has not given me an SBA number, can I apply with a different bank?
    • Yes you can get EIDL and PPP loan
    • FYI SBA website states they are unable to accept new applications for the EIDL based on available appropriations of funding.
    • applied for pop can I now apply for EIDL/
    • EIDL is not forgivable, but you can’t find a line of credit that is anywhere close. So bottom line EIDL vs line of credit: EIDL every time.
    • if you get EIDL, can you pay it back faster without a “fee”?
      • @eshita. the EIDL doesn’t have a prepay penalty, so you’d be fine to pay early.
      • My understanding it is a true loan not forgiven
      • No Prepay at 30 years for EIDL, but if you take 15 years, there is a prepay penalty they said at a previous webinar
      • not forgivable… but our local Economic Development Council said maybe in the future… purely a rumor
      • I thought $10k of EIDL was forgiven
    • How do you handle PPP for independent contractors
    • Would our solar expense count as a utility?
    • what is considered as utilities? Does phones and internet fall under utilities?
    • Yes both phones and internet are listed as covered utilities as long as you had them in place before Feb 15
    • Phones internet is unknown yet…
    • what if your 8 weeks is actually in 3 different months april may and june???
    • I read the dates 2/15/19-6/30/19 were for seasonal businesses only and 1/1/20-2/29/20 were for businesses that opened in late 2019
    • can we use that loan for vaccine payments
    • is a distribution part of payroll??? the 75 percentage or in their 25 like rent
    • Can you account your salary in PPP if you are solo LLC?
    • How much can I pay myself? I have not paid myself for 1 month but apparently I can only pay myself $8000 a month
    • Our calculation was $8.333.333
    • If you were previously paid $100k over the 8 weeks and now you’re paid $40K over the 8 weeks your payroll drops $60k. so your total payroll (if no one else takes a cut) would need to previously be $240,000 and now is $180,000 (so your total payroll decreased 75%). Does that make sense?
    • If I make less than $100,000 per year, can I increase my pay for 2.5 months?
      • no more than 3800 q 2 weeks. Not to reach max of equivalent of $100,000 a yr.
    • you can pay yourself what you want, but can only claim that much on the loan as expense.
    • You can pay yourself however much you want but under the PPP there is a cap of $100,000 annually that will be forgiven.
    • Since the max is 100K/yr, that comes out to $8333/month, so you can pay yourself for 2 months ($16,666)
    • No, they have capped it at what 8 weeks of 100k salary is which equates to around $15,380 for the 8 weeks
    • As long as being paid $40K doesn’t cause your total payroll to drop below 75% of the portion of your PPP dollars. I.e. if your total payroll over the 8 weeks is $160,000 or more you’ll be okay
    • So if I pay myself $40,000 over those 8 weeks , all of that money should be forgiven?
    • They only allow for you to pay an annual salary of 100K for the purposes of the forgiveness calculations
    • no more that $1900 a week which equals $100,000 mx a year!
    • No - just 100,000/12*2 is the amt you can count toward the forgiveness. But you can pay yourself as much as you can afford!
    • $15,385 is the max per person over 8 weeks (pay only, not including benefits) - so no to the paying $40k in 8 weeks
    • I am a sole proprietor and don’t pay myself a monthly salary. how do I get compensated through the PPP
    • I understand that PPP loan considers it as 30 hrs a week.
    • I’m near retirement from a solo practice and don’t want to be paying a loan for 30 years. Is there a pre-payment penalty for EIDL loans? If so, might it just be better to borrow from my retirement fund?
    • You can maximize your forgiveness by bonusing your employees who make less than 100k. I do not want to give any back - we have 40 employees who make less than 100k - so $100 each would burn up $4,000. Is that legal? To bonus employees?
      • @graham - my understanding is that the feds wont penalize you for being more generous
    • House of Representatives just PASSED THE $484 Billion SMALL BUSINESS relief bill.
    • so if someone has NOT applied for a PPP OR received funds - what do you recommend they do?
    • is suplemental insurance consider a payroll expense for the PPP
    • Are the “retirement benefits” based on the first 100k of docs salary or if a doc makes 240k annually and the retirement expense on the 240k is 12,000. Do you count just the portion of the doc salary retirement that counts - 100k - or the entire retirement expense.?
    • I think you cannot pay yourself any more than the equivalent of a 100K salary – so only 8 weeks of that-
    • How do I decide on the 30 or 40 hour work week with the PPP loan?
    • I am glad AAP is fighting…but I have still not got a PPP or EIDL or anything…I have put my own savings into my rural solo practice…I feel like the government has totally let us down
    • Is EIDL forgivable?
      • EIDL is not forgivable
      • EIDL is not accepting applications anymore
      • No EIDL is a "lower"interest loan up to 30 years to pay back.
    • Applications
      • However the biggest return is having all your front desk calling community banks for PPP loan and if they can’t get it for you in 24hrs keep calling.
      • Can do EIDL andPPP?
        • FL Med Assoc said NO
    • Uses
      • Open account for each loan disbursement and pay from each. Easier bookkeeping.
      • Words of wisdom on how to best use PPP money?
    • Bank behaviors
      • Good
        • Central Bank, Lexington, KY
      • Bad
        • BOA
          • BofA requires all info be submitted using your business login. If you have a personal account with BofA and log in to see everything using your personal log in, AND if you submitted using your personal log in, they will not submit your business application for the PPP.

  • Employment

    • Can you please clarify the details for me about paying sick leave for presumed COVID in an employee or their family when using PPP money for payroll. I have heard it should be allocated differently. I only have 14 employees.
    • staff who don’t want to come back are staff you didn’t want. It’s going to be an employers’ market soon
    • eif employee is collecting unemployment, how many hours they can work, meaning reduced hours
    • I heard today that a FTE is equal to employees working 30 hours or more
    • Any suggestions on getting employees back from unemployment when with the extra $600 they are getting till July 26 get them more money than working fulltime?
    • Do employees out on 2wks emergency paid sick leave (@100%) count as one of the full time employees?
    • What about employees who voluntarily resigned? Will that adversely affect our restoration test?
    • I understand that PPP loan considers it as 30 hrs a week.
    • problem…some employees are making more with unemployment. Don’t want to come back. So to meet forgiveness criteria would need to hire NEW employees?
    • Who is Considered an Employee? How does SBA define the term “employee”? Employee means all individuals employed on a full-time, part-time, or other basis, so long as that individual works a minimum of 40 hours per month. This includes employees obtained from a temporary employee agency, leasing concern, or through a union agreement or co-employed pursuant to a professional employer organization agreement. This is from accounting firm MARCUM
    • Does anyone know if it is better for employees (hourly APP’s) to apply for unemployment as a furloughed employee or a reduced hours employee?
    • Does anybody have C- or S- corps anymore?
      • 20:17:14 From Mary Owens To All Panelists : yes
      • 20:17:17 From Lori Taylor To All Panelists : yes we are S-corps
      • 20:17:22 From Wayne Siegel To All Panelists : s-corp
      • 20:17:25 From Gail Ryan : yes c corp
      • 20:17:27 From Salma Elfaki To All Panelists : I’m an S-Corp. solo private practice
      • 20:17:30 From eshita bakshi : yes - s corp
      • 20:17:32 From Barb Periard : yup c corp
      • 20:17:36 From Steven Moore : S corp
      • 20:17:39 From Jennifer Mellick To All Panelists : Yes s-corp
      • 20:17:40 From Sushma Penmetsa To All Panelists : s corp
      • 20:17:40 From Melinda Willingham To All Panelists : Yes C corp
      • 20:17:41 From Staci Young To All Panelists : yes S corp
      • 20:17:46 From SHARON MCFAYDEN-EYO To All Panelists : yes S
      • 20:17:48 From mike Fiedler : S corp
      • 20:17:48 From Susan Rogers-Low : yes, S corp
      • 20:17:49 From Ellen Miele : S
      • 20:17:51 From Javier Alfonso To All Panelists : PLLC with S election
      • 20:17:51 From Nathalie Rubin To All Panelists : C-Corp. Southern CA
      • 20:17:57 From Samuel Mirrop : yes, S Corp
      • 20:18:07 From Michelle Prettyman To All Panelists : S
      • 20:18:12 From sandy herron : Ha! I guess the answer is yes.
      • 20:18:17 From Debra Titterington To All Panelists : c corp
      • 20:18:17 From Javier Alfonso : PLLC with S election
      • 20:18:21 From Leslie Smith To All Panelists : S corp
      • 20:18:24 From Melanie Lachman To All Panelists : s corp

  • Preventive Med Checks

    • Can do safely?
      • if you can go to wal-mart, you can come to your pediatrician, who has created a safe environment for your child to be seen, for a well child check
      • Will be paid?
      • We’re working all the care gaps

  • Advocacy

    • How do you join SOAPM? A colleague was telling me about a lengthy process - is it quick?
      • to join SOAPM contact Elisha Ferguson at eferguson@aap.org for informationl
      • you have to pay first to join SOAPM
      • I just paid $30 on aap website to register for SOAPM. Super easy. Now I get the 75+ emails a day from the message threads!
      • Once you joint the AAP administration chapter (pay $40 or so besides your AAP membership dues) you automatically sign to SOAPM.
    • Sage words from Mark Del Monte “in DC 2 good stories is a worth a pile of published studies"
    • Need for Medicare Medicaid parity
    • Vaccines
      • NYT Article
      • Governors
    • Physical Exams
      • IN H.S. athletics waiving Sports PEs
      • How can the AAP broach the issues of some states who are bypassing physicals for the next school year?
    • Value of Peds
      • “Remember that the CARES act sent payments AUTOMATICALLY to physicians seeing Medicare patients–but did NOTHING for those of us seeing Medicaid patients.”
    • Link to the letter: The AAP Steps Up
      • "The aap’s advocacy IS awesome -but I haven’t heard that Peds got anything specific in the new bill. Anyone know of anything?”
      • "It says to “distribute grants from the Public Health…” so nothing for us to apply to get???”
      • "Pat Hynes To All Panelists : The new bill does NOT have money for Peds in it—HOWEVER, speaking to Mitch McConnells policy person about 2 hours ago directly, we ARE DEFINATELY in the next round—final details unclear though. They discussed the AAP letter directly in the HHS meeting this afternoon”
      • "Remember KIDS ARE NOT AFFECTED…So Pediatricians are GOOD during COVID-19 epidemic.”
      • "jeffrey bienstock To All Panelists : https://www.cmadocs.org/newsroom/news/view/ArticleId/48849/HHS-to-release-additional-20-billion-in-payments-from-CARES-Act-Provider-Relief-Fund”
    • Post COVID
      • Also being able to practice in all states if you have license in one state can be a topic for advocacy
      • COLLEEN, SOAPM, everyone Please help us keep telehealth covered beyond COVID - especially for the complicated patients for care management and afterhours/weekend hours - would save so much $$$$
      • Practicing in the US with one state license should be advocated! No other country practices this way, not many professions have this issue
      • Much agreed! A doctor has to have 3 states licenses to practice in DMV area, thousands of dollars and time spent. patients being affected by this the most!
    • Sarah Bobus : Does anyone find their state medical societies or county medical societies to be helpful with advocating for them? I am not a physician but used to work for the IL State Medical Society so I am curious!
      • Sarah…sadly, no. I am in the metro-east near St. Louis but in IL. Here, if you are not in Chicago, there is a lot of lip service but no one advocates for us. We are on our own.
      • @sarah - in my state i find that they are more helpful advocating for adult docs but they also essentially have minimal pediatric participation so I think we are to blame for not having of much of a presence (SC)
      • In our small state of Vermont, the VT Medical Society, AAP-VT chapter, and VT Academy of Family Physicians collaborate effectively on behalf of pediatricians, family physicians, and the specialty societies. The unified voice, just as at the national level, has been effective.
      • When I worked for the IL State Med Society we found it difficult to determine what benefits we could provide docs aside from some advocacy through legislation and advocacy but there were only so many bills they could introduce each year and many only benefited PCP’s exactly

  • Billing and Payers

    • Are they paying?
      • We have been doing the Telemedicine for a few weeks, we are getting reimbursed but not always at the reimbursements rates promised and it’s with the Blue’s. Anyone else experiencing this?
      • Joanne Asuncion To All Panelists : We just got paid 43 cents for a telephone encounter!
      • All Telemed must be resub’d
      • AAP wants us doing wcc’s but now it’s up to the individual state Medicaids and private insurers to cover
      • I saw it but it was unclear to me. I thought it was we can do all WCCs but should stay <2
      • can we get medicare rates for medicaid?
      • Just starting to get telemed payments— after denials. On the 99214 people are filing, are you using a modifier and what place of service are you filing with?
      • so far, many telehealth visits being denied by ins carriers; will have to resubmit; are others having this same problem?
    • What are they paying for?
      • Can we bill level 1 for medical assistants’ call?
      • I am getting paid in GA for Telehealth sick visits, but I am hearing we won’t get paid for the well check ups
      • I think telehealth for well visits will happen for everyone just a matter of when…and what payer
    • Who’s paying?
      • We’ve been getting paid (somewhat and variable) in Maryland.
      • Great success with Telehealth in our office. Seeing things the provider would have never seen, like the child who had trouble navigating stairs. Huge success! So far, we are getting paid at full parity in Massachusetts.
      • NC now covers well child care for the 24 month+ kids - THANKS Christoph Diasio!
      • Are well child visits via Telemedicine being paid in the state of Texas.
      • Many of the payors in Nevada have informed us that we CANNOT complete well visits through telemedicine…Has anyone been successful in getting reimbursed for well visits
      • We haven’t gotten any payments yet from UHC for Telemedicine
      • Just learned that Ga is beginning to cover telewell visits. Take a look at today’s Ga AAP eblast.
      • Susie Stokes To All Panelists : In Tennessee we are suppose to get paid for well visits for our TennCare (Medicaid) patients. We are starting next week. Keep you updated
    • Public shaming for non-payers
      • Texas Medicaid refuses to pay for WCC that is not done in the office
      • UHC in FL difficult
    • POS 02 gets paid less?
    • Can bill well via Telemed?
    • At minimum be <2y if states have strict stay-at-home requirements but AAP advocates for getting WCC’s accomplished in any creative way possible that the ins co’s will pay for
    • all WCC’s no reason to restrict
    • do you have any info on well visits being covered by telemedicine ?
    • you should check with your insurance company, as each payer prefers a different method.
    • why can’t the insurance make things is consistent for us. so we know how to bill . different modifiers for different insurance plans. Some want you to charge an E&M code for the Telehealth piece, and then a well code for the exam, others are opposite.
    • Recently you gave an example of a 99214 exam via telehealth. the detail and bullets are possible if you are meticulous. Can you post an example of an exam like this so I can have it in writing? Thank you!

  • Rendering Telemed

    • Do telemed and do it NOW
    • Jeff, JUST START DOING THEM.
    • What telehealth apps/venues are working best? We are currently using Doxy,me
    • WE’RE BEING PAID RIGHT NOW. GET IN THE BOAT!!!
    • I know telemedicine well care is state by state — would you recommend starting to do the visits before confirming they will be paid for or just start doing them ?
    • Local decision for WCC. Check your state regs. Most states will be able to see all WCC next week.
    • telehealth has been amazing for us
    • are wcc visits covered by telemedicine?
    • Can AAP clarify about what WCCs we can do now?
    • Telehealth is great and go for it and set up office to get as many WCC you can get in safely.
    • i haven’t done any virtual PEs yet, but i also haven’t been advised by organization to not bill now
    • Different states allowing different ways for this to be coded. Including the type of codes surgeons use when bundling post-op follow ups later. But surgeons would NEVER perform surgery without getting paid. Get paid for the work you do.
    • Our docs are very resistant to do WCC telemed they strongly feel they cannot do a physical exam and concerned that with our population they will not come in for the physical exam and something will be missed how is everyone handling this.
    • you can obtain a lot of physical exam via telehealth
    • The “exam” can be what you see on video and have the parents help examine, right?
    • we are charging now and then will charge for a nurse visit for vaccines
    • We are doing 2 part WCCs now but not charging until Part 2
      • You better start charging now!
      • why not charge until part 2?
      • But yes I agree you have to charge on the first visit , why wait for the second ?
      • you will never get paid if you don’t charge now. they may not come back. charge for both components
    • yes🙁 telling them unless need sports clearance to return flu shot time for exam and if any follow up (allergy, acne, sleep problem, picky eater etc all will get 9921x; otherwise Dr Kressley recommended a follow up code similar to global surgery follow up (if I understood correctly)
    • WE did not complete the physical so weren’t charging. Are others charging now?
    • So the AAP is planning a Fireside Chat Webinar on Telehealth that will likely capture the experience of all this rapid implementation as well as the creative ways we COULD implement the platform. Stay tuned and be sure to join SOAPM if you’re not a member which is sponsoring the lecture.
    • Can bill 99214?
      • Yes, document time and all other details
      • 20% of ours 99214
      • Medical necessity
      • Most of mine are
    • Document your time
    • Doing screenings?
      • Yes, post on website, ask to print complete and send to us
      • Doc has a blank and asks
      • CHADIS
      • Phreesia
    • Would like to perform WCCs but believe our patients won’t come in for part 2
    • We’ve been offering anyone or everyone in house or telemed checkups with stipulations that they will need to come back for follow ups. We have been trying to get all the under2’s to come in. We ask for height, weight, and temp for all.
    • Picture WCC in phases now. A full awesome hx with time for parents to really feel ‘heard’ and ask about so many of the issues that really matter in parenting. Then the second visit for an exam and doctor interface. I’m ALL in….
    • We would need to be considered front line and urgent care providers so we can get the testing to our offices. We taught our patients for years that we are their first call if something happens. We need to be able to test and the CDC and government needs to count us in. At this time they just approve testing for urgent care
    • In Maryland, we have Inova in VA who “can’t” do telemedicine for patient who live in Maryland due to “legal” issues and sometimes CNMC in DC who “can’t do telemedicine” with Marylanders. So the primary care Ped is trying to trouble shoot the G-tube feeds for the infant with TOF and trisomy 9. It’s ludicrous how tertiary care centers are limited by internal policies. It puts both the patient and the pediatrician who has to take over at risk.We would need to be considered front line and urgent care providers so we can get the testing to our offices. We taught our patients for years that we are their first call if something happens. We need to be able to test and the CDC and government needs to count us in. At this time they just approve testing for urgent care

  • Marketing

    • Best way to market Telemed?
      • FB, phone, email, website
      • Pokemon won’t let you as of one month ago
      • Not familiar with Google visit evals. Explain?
      • "I will offer to be a sounding board for how to jumpstart a better technology platform and lift up SoMe, AdWords, FBLive if you’re interested. GSSmith@aap if there’s interest. We’ve been blogging, tweeting, interacting on FB for years.”
      • "If you have local businesses that helped you out during the pandemic or did a service for you - give them a shotout on your facebook page - all their followers will see it, giving your page more posts, also your followers will see it giving the other people more business - win win!”
      • “the posts we make that get the biggest reaction from our followers are those that have pictures and videos from our doctors. Your patients want to see and hear from you! Even a quick 30 second video filmed on your smartphone will make a huge impact”

  • Shift in practice paradigm

    • how is it $25 a patient?
      • @nancy - divide your annual revenue from last year by the number of active patients you have. It’s usually in the $25-35/month per patient
    • Creating a new value to medicine by asking parents to think about the membership model of medicine. Join the gym. Join our paradigm shift because we know medicine can do things differently. And we’re doing it differently.how is it $25 a patient?