I'm adding a medispa to my existing practice. I would like to offer "wellness" visits entailing consults dealing with health, supplements, certain lab tests, etc. I'm par with most managed care companies, but would not want to offer these services under managed care, as I could easily spend an hour with a patient, and wouldn't get reimbursed properly for it. Does anyone know of a way to structure my practice so this would be an out of pocket expense, like getting botox? Would signing a waiver work?

From what I understand, you will need to look at each contract individually. Many insurance companies may not allow it. Medicare is very difficult and medicaid is very sticky. I would make sure a lawyer looks at every contract as you could get hit with medicare fraud which could cost your license and even jail time.

erika: yes you can offer these services, but w/ any beneficiaries of managed care plans you see they must sign a ABN (Advanced Beneficiary Notice) telling them that these services most likely are not covered by their insurance and require an additional out of pocket expense. Note this would most likely be for extended wellness visits, for the most part a wellness code/visit needs to be filed w/ the ins co Also, Hair removal, Botox Cosmetic and other aesthetic services are excluded from most insurance contracts and no ABN is usually necessary. A sample ABN can be found on the Medicare site(if I were more computer savvy I could attach a link). hope that helps

I am gong to have to disagree with DermaRogue on this one. Simply having a medicare patient sign an ABN does not release you from all of the restrictions from the federal government. Many people have been nailed for fraud thinking an ABN covers everything. I would make sure you talk to a lawyer well versed in dealing with medicare.

I would code it as a level five visit and state in the notes 60 minutes with greater than 50% of time counseling. That way you will receive the highest level of reimbursement. Unfortunately, if the client has insurance from a company you are contracted with, you have to accept the contracted rate if they cover the service.