MHSC Ortho Clinic

See attached

Jan9: 23AM No, P[redacted] ***Office/Outpatient Visit Visit Date: Tue, Sep 23, 03:pm Provider: [redacted] *** Location: MHSC Ortho Clinic -Dr [redacted] 's Office Electronically signed by [redacted] , MD on 09/24/11:56:AMPrinted on 01/09/at 9:am.SUBJECTIVE: CC: right wrist pain HPIthe patient is a 32-year-old male who states that he wrecked a dirt bike on 10/16/He landed on his back and also injured his right handHe was seen in the emergency department in PinevilleX-rays were performed thereSince that time he has had moderate pain in the wristHe rates as a out of on the pain scaleHe says pain is sharp in qualityHe says the pain is intermittent and worse with activity, exercise, and twisting, He says that he has had swelling and bruising around the wrist, X-rays in the emergency department demonstrated a nondisplaced distal radius fracture of the right wristNo other abnormalities are notedROS: CONSTITUTIONAL: Negative EYES: Negative E/N/T: Negative CARDIOVASCULAR: Positive for pedal edemaRESPIRATORY: Negative GASTROINTESTINAL: Negative GENITOURINARY: Negative MUSCULOSKELETAL: Positive for back painINTEGUMENTARY: Negative NEUROLOGICAL: Negative PSYCHIATRIC: Negative ENDOCRINE: Negative HEMATOLOGIC/LYMPHATIC: Negative ALLERGIC/IMMUNOLOGIC: Negative Current Problems: None Recorded Current Medications: None OBJECTIVE: Vitals: Current: 9/23/3:34:PM Ht: ft, in; Wt: Ibs; BMI: 22,T: F (temporal); BP: 118/mm Hg (left arm, sitting); P: bpm (left arm (BP Cuff), sitting) Pain Index: b Exams: the patient is a well-nourished and well-developed 32-year-old male with mood and affectHe is alert and oriented xHe is in no acute distressHe has a gaitRight upper extremity: The splint was removedSkin is intactCompartments are soft and compressibleHe does have a superficial abrasion type injury to the posterior aspect of the elbow, but it is healingHe has positive swelling and ecchymosis around the wristHe has positive tenderness to palpation around the wristRange of motion of the wrist is somewhat limited secondary to painHe has no snuffbox tenderness to palpation2+ pulses are intact distallyStrength and stability not tested the wrist secondary to his distal radius fractureFingertips are warm and pink with less than second capillary refillMotor and sensation are intact in the median, ulnar, and radial nerve distributionsLeft upper extremity: Skin is intactCompartments are soft and compressibleHe has no tenderness to palpationHe has no swellingHe has range of motion, strength, stability2+ pulses are intact distallyenT 6N a nplmmad ? mw.?mnem 4e7W AeaoNtlmn Jan9: 23AM No- P6F [redacted] ***Office/Outpatient Visit Visit Date: Tue, Sep 23, 03:pm Provider: [redacted] , MD (Supervisor: [redacted] , MD) Location: MHSC Ortho Clinic -Dr, [redacted] 's Office Electronically signed by [redacted] , MD on 09/241201411:56:AMPrinted on 01/09/at 9:am.Sensation and motor function are intact distally, Back: He has no midline tenderness to palpation, He does have tenderness to palpation in the paraspinal musculature bilaterallyThere is no step-offs or other abnormalities notedLab/Test Results: outside x-rays were reviewed of the right wrist which demonstrated a nondisplaced distal radius fractureThe radiologist didn't mention of a possible lucency in the scaphoidI do not see this on x-rayIn addition, the patient has no anatomic snuffbox tenderness to palpationASSESSMENT: Other closed fracture of distal radius DDx: PLAN: the patient is a 32-year-old male with a nondisplaced distal radius fracture that does appear to be intra-articular of the right wristWe discussed his history, physical exam findings, and x-ray findingsAt this timeWe'll treat him nonoperatively in a fracture braceHe is to be nonweightbearing with the right upper extremityHe is wearing the brace at all times except for showeringWe have also given him a prescription for LortabI would like to see the patient back in approximately weeksHe is call if any further questions or concernsAt this timeHe states that he can be nonweightbearing and perform his full duties at workI will give him a work releaseOther closed fracture of distal radius Orders: Exos Wrist Brace (In-House) Other Prescriptions: Lortab (Hydrocodone/Acetaminophen) 5mg/325mg Tablet Take I to tablet(s) by mouth q to hr prn #(Forty) tablet(s) Refills: 9: 23AMMHSC Ortho Clinic -Dr [redacted] 's Office College Dr.Rock Springs, WY 82902-[redacted] ***it I Invoice No, [redacted] *Print Date: 01/09/201Invoice Date: 9126120141:30:PMInvoice No: ***Account No: [redacted] Guarantor Ace No: [redacted] Guarantor Name: [redacted] *Tax ID: [redacted] Provider Name: [redacted] , [redacted] 1)• " t ; ?lriG??fl ? .I ?.I ;ti : ? .l e l I ,I .?• n?lu•'::.i.L.k;?id;-..,.,:L'LL ??:?.J • I .: :.k•? ? :.? , f I u sOther closed fracture of distal radius09123/14-09M/99203-Office visit - new pt, level 309/23/- 09123/LExos Wrist Brace09123/- 09/23/25600-RT Treat radial fx or epiphyseal separationInsurance Company[redacted] Group Number: NonePolicy Number [redacted] - College Dr., Rock Springs, WY Phone: (307)352-Fa)c (307)352-: I i !iin ? ?ljlyl?? ?Ih-ll? LI .lOffice $168.0Office $S$ 71.0Office $o.oInvoice Amount $1,299.0Co-Payment Paid $0.0Patient Paid $0.0Patient Adj $0.0Patient Deposit $0.01Insurance Paid $439.2Insurance Adj $64.9Total Payment $504.2Invoice Balance $794.7, ' Jan9: 23AMCNIC Health SolutionsPO Box 3559Englewood, CO 80155-3559Forwarding Service RequestedMIXED AADC MD 0.692IIIIlllIIIIIIllttlltltillIIIiiIiiIIiIiuIlll llliiiJIiltllilielltliSWEETWATER MEDICAL GROUP NoP8Of you have any questions, please give usa call at (877) 229-4541.Enrollee: [redacted] Patient: rfl [redacted] [redacted] This is NOT a Bill -- Do NOT Send PaymentDates of Service Service Total Enrollee ld: [redacted] zGroup: [redacted] ***Group #: [redacted] Claim #: [redacted] Patient #: ***Date: 10/22/2014Explanation of Benefits for Services Provided By: [redacted] MD, [redacted] SPaid Payment Code Charge09/23-09/23/68.0009/23-09123/471.0009/23.09/23/PPOCo 'red ByDeductibleCodes Ian AmountW+ I W+ •W+ 52.551,Co-Pay BalanceAmount At Amount6$100% 1000/e 60% 344.6765,669,439.27Other Credits or Adjustments 0.00Total Net Payment 43927Patient Responslbilly Service Code DescriptionMAJOR MEDICALSURGERYPHYSICIAN VISITMessages I easgn/PPO Code Description: Providers can use our website to check claim statusIf you are interested n roistering to use our website, please email support(cnichs comFor all claim inquiries, please cooledL Customer Service at (877) 229-To enroll in ENT, please go to www.emdcon.cat/efi1;OR 8t' a CURIV.PUJlRp3ESTHE-- A'Cry:OFiK;flrgYD000MEIi7.g TArNSqj-r 'A A By CNlcJtteahh e M;ir :;' ,

See attached.

Jan. 1 4. 2015 9: 23AM No, 0219 P. 5[redacted]Office/Outpatient Visit Visit Date: Tue, Sep 23, 2014 03:13 pm Provider: [redacted] Location: MHSC Ortho Clinic -Dr. [redacted]'s Office Electronically signed by [redacted], MD on 09/24/2014 11:56:46 AMPrinted on 01/09/2015 at 9:45 am.SUBJECTIVE: CC: right wrist pain HPI. the patient is a 32-year-old male who states that he wrecked a dirt bike on 10/16/2014. He landed on his back and also injured his right hand. He was seen in the emergency department in Pineville. X-rays were performed there. Since that time he has had moderate pain in the wrist. He rates as a 4 out of 10 on the pain scale. He says pain is sharp in quality. He says the pain is intermittent and worse with activity, exercise, and twisting, He says that he has had swelling and bruising around the wrist, X-rays in the emergency department demonstrated a nondisplaced distal radius fracture of the right wrist. No other abnormalities are noted. ROS: CONSTITUTIONAL: Negative EYES: Negative E/N/T: Negative CARDIOVASCULAR: Positive for pedal edema. RESPIRATORY: Negative GASTROINTESTINAL: Negative GENITOURINARY: Negative MUSCULOSKELETAL: Positive for back pain. INTEGUMENTARY: Negative NEUROLOGICAL: Negative PSYCHIATRIC: Negative ENDOCRINE: Negative HEMATOLOGIC/LYMPHATIC: Negative ALLERGIC/IMMUNOLOGIC: Negative Current Problems: None Recorded Current Medications: None OBJECTIVE: Vitals: Current: 9/23/2014 3:34:28 PM Ht: 5 ft, 8 in; Wt: 150 Ibs; BMI: 22,8 T: 98.1 F (temporal); BP: 118/65 mm Hg (left arm, sitting); P: 75 bpm (left arm (BP Cuff), sitting) Pain Index: b Exams: the patient is a well-nourished and well-developed 32-year-old male with normal mood and affect. He is alert and oriented x3. He is in no acute distress. He has a normal gait. Right upper extremity: The splint was removed. Skin is intact. Compartments are soft and compressible. He does have a superficial abrasion type injury to the posterior aspect of the elbow, but it is healing. He has positive swelling and ecchymosis around the wrist. He has positive tenderness to palpation around the wrist. Range of motion of the wrist is somewhat limited secondary to pain. He has no snuffbox tenderness to palpation. 2+ pulses are intact distally. Strength and stability not tested the wrist secondary to his distal radius fracture. Fingertips are warm and pink with less than 2 second capillary refill. Motor and sensation are intact in the median, ulnar, and radial nerve distributions. Left upper extremity: Skin is intact. Compartments are soft and compressible. He has no tenderness to palpation. He has no swelling. He has normal range of motion, normal strength, normal stability. 2+ pulses are intact distally. enT 6N a nplmmad ? mw.?mnem 4e7W AeaoNtlmn  Jan. 1 4. 2015 9: 23AM No- 0219 P. 6F[redacted]Office/Outpatient Visit Visit Date: Tue, Sep 23, 2014 03:13 pm Provider: [redacted], MD (Supervisor: [redacted], MD) Location: MHSC Ortho Clinic -Dr, [redacted]'s Office Electronically signed by [redacted], MD on 09/241201411:56:46 AMPrinted on 01/09/2015 at 9:45 am.Sensation and motor function are intact distally, Back: He has no midline tenderness to palpation, He does have tenderness to palpation in the paraspinal musculature bilaterally. There is no step-offs or other abnormalities noted. Lab/Test Results: outside x-rays were reviewed of the right wrist which demonstrated a nondisplaced distal radius fracture. The radiologist didn't mention of a possible lucency in the scaphoid. I do not see this on x-ray. In addition, the patient has no anatomic snuffbox tenderness to palpation. ASSESSMENT: 813.42 Other closed fracture of distal radius DDx: PLAN: the patient is a 32-year-old male with a nondisplaced distal radius fracture that does appear to be intra-articular of the right wrist. We discussed his history, physical exam findings, and x-ray findings. At this time. We'll treat him nonoperatively in a fracture brace. He is to be nonweightbearing with the right upper extremity. He is wearing the brace at all times except for showering. We have also given him a prescription for Lortab. I would like to see the patient back in approximately 6 weeks. He is call if any further questions or concerns. At this time. He states that he can be nonweightbearing and perform his full duties at work. I will give him a work release. Other closed fracture of distal radius Orders: Exos Wrist Brace (In-House) Other Prescriptions: Lortab (Hydrocodone/Acetaminophen) 5mg/325mg Tablet Take I to 2 tablet(s) by mouth q 4 to 6 hr prn #40 (Forty) tablet(s) Refills: 0   2015 9: 23AMMHSC Ortho Clinic -Dr. [redacted]'s Office 1180 College Dr.Rock Springs, WY 82902-5863[redacted]
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[redacted]it I Invoice  No, [redacted]Print Date: 01/09/201Invoice Date: 9126120141:30:00 PMInvoice No: [redacted]Account No: [redacted]Guarantor Ace No: [redacted]Guarantor Name: [redacted]Tax ID: [redacted]Provider Name: [redacted], [redacted]1)• " t ; ?lriG??fl ? .I ?.I ;ti : ? .l e l I 1... ,I .?• n?lu•'::.i.L.k;?id;-..,.,:L'LL ??:?.J • I .: :.k•? ? :1. .? , f I u s813.42 Other closed fracture of distal radius09123/14-09M/14 99203-57 Office visit - new pt, level 309/23/14 - 09123/14 L3964 Exos Wrist Brace09123/14 - 09/23/14 25600-RT Treat radial fx or epiphyseal separationInsurance Company.[redacted]Group Number: NonePolicy Number. [redacted]- 1180 College Dr., Rock Springs, WY 8202.5383 Phone: (307)352-8545 Fa)c (307)352-8583 : I i !iin ? ?ljlyl?? ?Ih-ll? LI .lOffice $168.00 1.0 168.0Office $471.00 1. S$ 71.0Office $660.00 3 o.oInvoice Amount $1,299.0Co-Payment Paid $0.0Patient Paid $0.0Patient Adj $0.0Patient Deposit $0.01Insurance Paid $439.2Insurance Adj $64.9Total Payment $504.2Invoice Balance $794.7,   ' Jan. 1 4. 2015 9: 23AM2 CNIC Health SolutionsPO Box 3559Englewood, CO 80155-3559Forwarding Service RequestedMIXED AADC 8205262 2.5438 MD 0.692IIIIlllIIIIIIllttlltltillIIIiiIiiIIiIiuIlll llliiiJIiltllilielltliSWEETWATER MEDICAL GROUP 177 No. 0219 P. 8Of you have any questions, please give usa call at (877) 229-4541.Enrollee: [redacted]Patient: rfl [redacted]
[redacted]This is NOT a Bill -- Do NOT Send PaymentDates of Service Service Total Enrollee ld: [redacted] zGroup: [redacted]Group #: [redacted]Claim #: [redacted]Patient #: [redacted]Date: 10/22/2014Explanation of Benefits for Services Provided By:[redacted] MD, [redacted] SPaid Payment Code Charge09/23-09/23/2014 30 1 68.0009/23-09123/2014 19 471.0009/23.09/23/2014 20 660.001.299.00 PPOCo 'red ByDeductibleCodes Ian Amount0.00 W+ I 159.60 0.000.00 W+ •1 447.45 447.450.00 W+ 627.00 52.551,234.05 500.00 Co-Pay BalanceAmount At Amount6$.00 94.60 100% 94.600.00 0.00 1000/e 0.000.00 574.45 60% 344.6765,00 669,05 439.27Other Credits or Adjustments 0.00Total Net Payment 1 43927Patient Responslbilly 794.78 Service Code Description19 MAJOR MEDICAL20 SURGERY30 PHYSICIAN VISITMessages I easgn/PPO Code Description:1  Providers can use our website to check claim status. If you are interested n roistering to use our website, please email support(cnichs com. For all claim inquiries, please cooledL Customer Service at (877) 229-4541. To enroll in ENT, please go to www.emdcon.cat/efi. 1;OR 8t' a CURIV.PUJlRp3ES. THE-- A'Cry:OFiK;flrgYD000MEIi7.g TArNSqj-r 'A A By CNlcJtteahh e 5.9 M;ir :;' ,<r? ?::.''•' - I t . r?' POW has a o A t[:bfWyomftSC eot$oauls.I ?PlQ?oX ? ?M' ;Englew Cd dl 8 55? t 'S 59 r• t r:; t? ~ I6kCe bAk, ?6Ct PAY FOUR,HIUNDRED THIRTY-NIr E DOLLARS:AND 27 CECV.1• -•i TO THE Ace Vi f1+ (,6-wraee, Tf7 45 1l- [redacted]
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[redacted]   Jan. 1 4. 2015° 9: 24AMatments of fracturesCoding for closed treatments of fractures No, 0219 FP.o_91 of 5  By [redacted], RN, MA, CCS-P, CPC; [redacted], BSN, MS; Robert H. Haralson III, MD, MBA; [redacted], MD, MBA; [redacted], MA Coding for closed treatment of fractures Is controversial; this article provides suggestions on how to code for this form of treatment. Closed treatments are either with or without manipulation. An orthopaedic surgeon has the following two ways of coding closed treatment of a fracture under Current Procedural Terminology (CPT): • "Global" reporting of the services by using the 90-day, global fracture code with or without reporting the Initial evaluation and management (E&M) service that resulted in the decision for closed treatment, or "Itemized" reporting of the services by reporting each patient encounter separately. The physician. reports each service independently and does not enter Into a 90-day global period. The AAOS position is that the orthopaedist must have the option of coding these services either way to enable the treating surgeon to address the specific situation and to meet the physician's contractual obligations with payers. Charging a single, all-inclusive large global fee may seem excessive to a patient, especially if the patient doesn't understand that the charge includes 90 days of physician E&M services related to the fracture. Other times, insurance companies may pay for emergency visits (for example, a global fee with limited patient financial responsibility) but may not pay for office visits, or vice versa. Some insurers require high copayments for office visits, while others apply a coinsurance to the global fracture service. In these situations, a patient may express concern about the financial cost of one method or the other. The physician should report the method that best addresses the situation, meets the physician's contractual obligations, and complies with coding rules. The Centers for Medicare and Medicaid Services (CMS) does not have a preference for coding closed nonmanipulative fracture services. Processing a single global claim for 90 days of care may be less expensive for the government, insurance companies, and physician offices than submitting and processing multiple claims (during 90 days of fracture care) and adjudicating disputes resulting from appeals to claim denials. Because CMS does not give coding advice, it has not given specific directions for reporting closed treatment of fractures, In 2003, however, CMS issued a directive about adjudication http://www.aa0s.orginews/aaosnow/iulO8/managinL2_a n , /n/,)[ %l r, Jan, 1 4. 20151 9: 24AMtmentsoffractures No, 0219 PLP, 1 0)f5of claims stating that carriers will not allow the total compensation for fragmented (eg, Itemized) coding to exceed the total compensation for comparable global coding. Additionally, in recent years, CMS carriers (such as Rhode Island and Kentucky) have asked for a refund when investigating a patient complaint resulting from a large financial responsibility after a physician had charged for nonmanipulative fracture "surgery," Global and itemized options When using the global method, code for the procedure, which invokes a 90-day global period. All subsequent E&M services related to the fracture are covered by the global fee as well as the application of the first cast or splint. The original E&M service may be coded with a modifier (such as 57 or 25), depending on the level of the encounter. If the encounter is minimal, which it may be for evaluation of an isolated injury, do not code for the encounter. Many payors will not pay for an encounter code in this situation. When using the itemized method, report the initial services by the physician or nonphysician provider (physician assistant, nurse practitioner, or clinical nurse specialist) with the appropriate codes, as follows: • E&M for the first vlslt-9920x--25 for a new patient office visit, 992i.x-25 for an established patient office visit, or 9924x-25 for a consultation provided in the emergency department (ED) or in the physician office. The modifier 25 is necessary to show that the E&M service is a significant and separately identifiable service because it is associated with a procedure (application of a cast or splint). If the service is provided in a setting other than the office or ED, report the appropriate category and level based on the place of service and append modifier 25. • Application of an initial cast or splint (assuming that the physician or supervised staff employed by or under contract to the physician applies the cast or splint) • Supplies for casting/splinting, if applicable, depending on the place of service • Subsequent services are reported as follows: • E&M services using established patient visit codes if the services are provided in the  office (9921x), or other E&M code that Is specific to the service setting • Application of replacement cast(s) or splint(s), assuming the physician or supervised employed or contracted staff applies the cast or splint). Add modifier 25 to the appropriate E&M code if it is a "significant and separate service" provided in addition to the procedural service (such as application of the cast/splint). • Supplies, if applicable, depending on the place of service When is closed treatment of fractures reported? Closed treatment of fractures Is commonly reported in two scenarios. One is when the httn_//www.aaos.ora/news/aaosnow/iu108/mana6ne2.aso 1/9/2015  Jan. 1 4. 2 015" 9: 2 4 A N eatments of fractures No. 0219 P.-41 1 1; of5  fracture care," the ED physician may use the global code with modifier 54 (surgical care only). However, this treatment must meet the "restorative" care definition and should not be merely splinting a fracture after straightening the limb. According to CPT, the following reference supports reporting the services using an E&M code and the appropriate cast/splint application code as applicable. "if cast application or strapping is provided as an initial service (eg, casting of a sprained ankle or knee) in which no other procedure or treatment (eg, surgical repair, reduction of a fracture or joint dislocation) is performed or is expected to be performed by a physician rendering the Initial care only, use the casting, strapping and/or supply code (99070) in addition to an evaluation and management code as appropriate. " Supplies would be reported using the appropriate A (nonMedicare) or Q (Medicare and other payors requiring Q) codes. [redacted], RN, MA, CCS-P, CPC, and [redacted], BSN, MS, are consultants with [redacted], is AAOS director of medical affairs. [redacted], MD, MBA, is a member of the AAOS Coding, Coverage, and Reimbursement Committee; [redacted], MA, is senior policy analyst in the AAOS department of health policy and governance initiatives. If you have coding questions or would like to see a coding column on a specific topic, e-mail aaoscomm@aaos. ora References 1. CMS: 40.4 - Adjudication of Claims for Global Surgeries (Rev. 1, 10-01-03) 2. B3-4824, 83-4825, B3-7100-7120.7 3. Abstracted from CMS EOB regarding closed treatment of acetabular fracture (27220) which stated: "The documentation stated "no surgery required" therefore this service will be denied as billed-the physician is liable for refunding an overpayment..." 4. CPT Assistant February 1996, Vol 6 Issue 02; page 3 5. CPT Assistant Summer 1995, Vol 5, page 3 6. CPT Assistant February 1996, Vol 6 Issue 02, page3 and Summer 1995, Vol 5. Page 3 7. 008 AMA CPT Manual. 2007 American Medical Association, page 126. AAOS Now July 2008 Issue htto://www aaos ora/news%aaosnow/j 108/ anaging2?sp http://www.aaos.org/news/aaosnowliu]08/manaainLY2.asn I f' 1" A  Jan. 1 4. 2015.1 9: 25AMtments of fractures No. 0219 PAP, 1 2)f5-PRIVACY POLICY-Disclaimers & Agreement Advertising & Sponsorship Contact AAOSTechnical Requirements Careers 9400 West Higgins Road Rosemont, Illinois 60018 Phone 847.823.7186 Fax 847

MemorialHospital OF SWEETW:k7-Fp, COUNTY' P.O. Box 1359,1200 College Drive Rock Springs, Wyoming 82901 HUMAN RESOURCES DEPT. FAX# (307)352-8157 Fax Cover Sheet TO:...

REFRENCE: COMMENTS; The information contained in this facsimile transmission is privileged. It is intended only for the use of the addressee. If you receive this communication and are not the intended recipient, you are hereby notified that the copying or distribution of this communication is prohibited and may be illegal. If you received this communication in error, or fax is intended for you and is not clear, please notify us Immediately by telephone at (307)352- 1FOR SPECIFIC RELEASE OF PATIENT RECORDS "This information has been disclosed to you from records whose confidentiality is protected by Federal Law. Federal Regulation (42CFR, Part 2) prohibits you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is not sufficient for this purpose," Jan. 1 4. 20150murRevdex.comMHSC Ortho ClinicP.O. box 13599: 22AMRevdex.com8020 S County Rd 5, Ste 100 Fort Collins, CO 80528Phone: 970.224,4222 1800.564.0370 Email: [email protected]:orgNo. 0219 '. 2Fax: 970.221.1239Monday, January 05, 2015 Rock Springs, WY 82902 Dear Representative MHSC Ortho Clinic, Revdex.com® received information from your customer regarding their concerns with your business. The information was submitted on 12/6/2014 8:07:13 PM and was assigned an 10 of [redacted]. HXPAA: HIPAA Release was offered and accepted on 12/6/2014. Although Revdex.com makes no judgment on the validity of this complaint, we recognize that there are two sides to every dispute. We are simply requesting your cooperation in making a good faith effort to resolve the dispute, regardless of the settlement explanation given by the consumer. Our objective is to assist both parties in reaching a resolution outside of the legal system. Please review this information and respond within the next 10 days. If you received this complaint via email simply click on the "Respond to this Complaint" link located on the left, when you are ready to answer. If this complaint was received via postal mail, the complaint detail Is printed on the back-side of this letter. Please state your position by emailing [email protected] or by submitting your response via fax or mail to Revdex.com. All responses will be copied to the complainant. If you feel a response is not warranted, or If the complainant is not your customer, please send us written clarification to that effect.  Please understand that the consumer's complaint and your response will be publicly posted on the Revdex.com web site (Revdex.com reserves the right to not post in accordance with Revdex.com policy). Please do not Include any information that personally Identifies your customer. By submitting your response, you are representing that it is a truthful account of your experience with this consumer. The Revdex.com may edit the complaint or your response to protect privacy rights and to remove Inappropriate language. To ensure timely communication please provide your email address. This will also enable you to update your Revdex.com Business Review. 
If you should have any questions or concerns, please do not hesitate to contact me. 
Sincerely, 
Jay Pollock Dispute Resolution and Advertising Counselor [email protected] Revdex.com Complaint ID: [redacted]) Jar, 1 4. 2015 9: 22AM No. 0219CUSTOMER EXPERIENCE INFORMATION Customer Information: [redacted] 
[redacted] 
[redacted] 
[redacted] The details of this matter are as follows: Complaint Involves: Billing or Collection Issues Customer's Statement of the Problem: I received services from dr. [redacted] oMce and am being charged for services I did not receive. I had an ulna fracture, was x rayed and treated at my local clinic and referred to an orthopedic surgeon for further treatment. I made an appointment with dr. [redacted] office, had taken the x Rays from my local clinic and they were reviewed by MHSC's office. He looked at the x Rays I had taken with me and ordered a wrist brace. No further treatment was needed. I received a bill from this office ordering me to pay 794.78 for the services he had provided that day. I was charged for treatment of a radial fx bone separation costing me 794.98 dollars. The fracture was not treated. I paldl=or the office visit and the brace, and was billed for a treatment procedure. The break was not treated, operated on or set by this dlnic, I paid for the services provided and refuse to pay the remaining amount for a service that was not provided. I contacted this clinic and they refuseTo work with me or handle my dispute. 
-Complaint Background: Product/Service: Orthopedic visit Purchase Date: 9/23/2014 Problem Occurred: 9/23/2014 Account Number: [redacted] Name of Salesperson: Purchase Price: $1150.00 Disputed Amount: $794.78 Desired Settlement: I would like the 794.78 dollar amountTaken off of my bill. This is a false transaction. HIPAA: HIPAA Release was offered and accepted on 12/6/2014. BB8 Complaint ID: [redacted]) Jan.No. 0219 P. 41 4. 2015 9: 23AMDear Revdex.com,In response to Revdex.com Complaint 1D: [redacted]). This patient was seen in my office on 9/23/14 for an injury to the right wrist that was sustained during a motorbike accident. After the injury, he was seen at an outside ER or urgent care facility where x-rays were taken. The patient was found to have a distal radius fracture. In the aforementioned complaint, the patient states that he had an ulna fracture. 
This is not correct, as he was treated for a distal radius fracture. The x-rays demonstrated a distal radius racture not an ulna fracture. He was sent to my office for follow up. His history was obtained in my office. He was examined thoroughly. His outside x-rays were reviewed and these results were shared with the patient. The decision was made to treat the patient's injury non-surgically. The previous temporary splint form the urgent care facility was removed and he was placed into a molded fracture brace, given activity limitations, and given a prescription for pain medication. He was advised to follow up in our office in 6 weeks for further x-rays, making sure the fracture was healing appropriately and that there was no further displacement of the fracture. The patient never returned for follow up to our office. (See attached office note for further information on the visit.)
The patent was billed for the initial office visit where the injury was evaluated, a global fracture charge that included the initial fracture care and included a 90 day follow up period, and the brace that was fitted to him at the time of his vist. Charging the global fracture charge is a standard method for billing for fracture care. I have attached an article from The American Academy of Orthopaedic Surgery that supports this method of billing. The patient was supposed to follow up in 6 weeks and would not have received further charges related to the distal radius fracture for the rest of the 90 day period of his care. However, he chose not to follow up further in our office.
The attached invoice from our office that the patient received will show that he was billed for a new patient office visit, fracture brace, and the global fracture care charge. The attached EOB (explanation of benefits) from the patient's insurance company will show what insurance paid and for what portion of payment the patient was responsible. In the complaint, the patient states that he paid for the office visit and the brace. The patient has paid nothing towards his portion of the bill as our office invoice shows.In summary: The patient was evaluated and examined in our office. His previous x-rays were reviewed and these results were discussed with the patient. He was found to have a distal radius fracture. His temporary splint was removed and he was placed into a fitted fracture brace.We then developed a follow up plan to monitor the healing of his fracture including activity limitations/restrictions, brace usage, and a prescription for pain medication. He was to follow up with us in 6 weeks but that did not occur. He was treated appropriately for the injury as was billed properly for this care.