Office Policies

Appointments

At Miller Health, we try to accommodate patients when scheduling appointment whenever possible. We reserve time for you. If you cannot keep your appointment time, please call, and leave a message the day 24 hours before the appointment. If a patient forgets, skips, or makes other plans and does not notify the office the day before, there is a “no show” charge. We appreciate your consideration. Certain emergencies are considered. Please call to reschedule if needed. Appointments are scheduled for time based on how many problems you want Dr Miller to help you with, how many prescriptions and medical issues you have, and the time Dr Miller spends with you in the patient room plus planning your treatment, writing orders and referrals, and writing prescriptions. Deductibles and copays and all self-pay charges You will want to be prepared to pay your deductible amounts at your appointments until your amount has been paid by you, then your insurance will pay. All charges are due at the time of service.

Patient ages

Our office offers a full-service option for the medical concerns of all ages and all problems. At Miller Health, Dr Miller does wellness exams from infancy through geriatrics. School physicals are available. Baby and children are treated by dr miller. We do not administer vaccines at our office.

Well woman physicals.

Dr Miller does pelvic and breast exams and paps for women. If your gynecologist has retired or moved, Dr Ruth Miller is professionally qualified and experienced with doing paps and dealing with female issues. If you need gynecological surgery, dr miller can help with a referral to a gynecologist. This family medicine clinic treats a wide spectrum of illnesses and diseases, but treatment is not limited to helping sick people. Preventative medicine and promoting health is becoming a greater emphasis as we strive to help our patients be as healthy as possible.

Sick

Dr Miller treats flu, coughs, fevers, poison ivy, urinary and throat infections, and laceration repairs. We will get you to a patient room quickly, so you are not exposing other patients to infections. Sometimes patients call and cancel their appointment because they are sick. That seems counter intuitive. Going to the doctor when you are sick sounds like the best plan.

Refills

All patient refills are done at patient office appointments. Relying on a pharmacy to get refills is not efficient nor is its quality medical care. Just bring your lists and medicines to your appointment so they all run out at the same time. Dr miller can keep it recorded and you will have what you need.

Communication

Dr Ruth Miller can best treat you by sitting down and discussing your problems at an appointment. Medical advice is not given by text or email. It is more effective to call the office with an issue rather than communicate through the portal. The assistant will relay the message and call you back with the doctors advise. In the future Dr Miller will offer a special prepaid package that will extend patient options.

Supplements

Dr. Miller has offered a selection of high-quality supplements for years and embraces certain treatment options that are alternates or expansions to traditional medical practices. The doctor welcomes patients to bring all their prescription medications. If any nonprescription (over the counter) supplements are being used, please bring all of them also, so that Dr. Miller can be aware of every way a person is seeking to be healthy. It is then possible to make recommendations and integrate natural healing methods with standard prescriptions and procedures.

Individualized care

This physician is unique in her approach to helping people. She is extremely interested in each person and what their individual needs are. You may find, because of her concern for her patients, she may ask questions that other doctors haven’t been concerned about. The more Dr Miller understands about you and your life, the more she can help.

Insurance coding, appointments, diagnosis codes, and deductibles

A little history to help you understand some requirements of medical doctors for documenting and billing primarily for insurance purposes. Even without a patient having insurance, doctors have historically kept patient medical records stating 1) patient symptoms, 2) physical findings, imaging, lab data. 3) diagnoses 4) treatment plan and recommendations. You may see a code for an appointment (99202-99205 for new patients. 99212-99215 for established patients) and get upset because you think you were charged too much. Hopefully, you read your insurance eobs. Eob= explanation of benefits. Register on your insurance site and save your username and password in a findable place so you can look at your charges, how much your insurance pays and does not pay the dr, and if your charges are applied to your deductible. It is each patient’s responsibility to know the amount of your deductible. A deductible is a monetary predetermined amount that each patient must pay before your insurance will pay anything. Your doctor has nothing to do with how much your deductible is. Many policies set deductible, which is your choice, at a ridiculous high amount like $1000 to $10,000 per year. That type of insurance is major medical for hospitalization benefits. You will never be charged enough at miller health to meet a high deductible. High deductibles are hospital insurance and not for family dr appointments. Know your deductible and policies. There are so many policies. Medical offices cannot know what your policy covers. Your insurance tells you, not the medical office. Your lab charges are determined by the lab and the amount your insurance pays, or the discounted amount allowed has nothing to do with dr miller’s office. That is an issue to be solved with your insurance company. If someone tells you, ‘Your doctor coded it wrong’. There is an extremely high likelihood that is not truth at Miller Health. Dr miller knows the codes and uses them appropriately. However, insurances often change what and how frequently they will pay for a test without telling the patient or the Dr. There are a few times when a code is missing. If the lab billing dept notifies you of that, have the lab contact our office so the error can be corrected.

Cpt codes

Medical billing utilizes a protocol of about 8 most common cpt (current procedural codes) that describes a medical appointment based on the number of medical diagnoses, complexities, number of prescriptions, referral necessities and time the Dr needs to spend with the patient and time to evaluate and plan of treatment. If you ever wonder why a certain cpt code was used for your appointment, this is how it is determined. Documentation of all these issues has always been required. Historically written chart notes included a “soap” note. “s” subjective- what the patient says about how they feel and their history. “o” objective- examination, lab results, imaging results, observation of appearance and vital signs. “an” assessment- diagnosis, impressions, problems. Used to, it was permissible to include a ‘rule out’ diagnosis until adequate testing confirmed or eliminated a diagnosis. Now that is not acceptable in coding. “p” plan- what is the doctor going to do to help the patient’s problems. Prescriptions are listed, number prescribed and if any refills are given. A plan may be advisement of an eating plan, exercise instructions, self-expectations, prescriptions, patient self-monitoring, supplement suggestions, articles to educate, referrals, lab orders and interpretation, x ray mri ct ultrasound imaging Dr orders. To address all aspects of feeling the best possible, counseling/therapy referrals and book suggestions to assist in implementing better ways to cope with problems in life are valuable. Dr Miller often goes home and does the medical documenting after hours. That is the “soap”, which is still used. With electronic medical records, they may be named a little differently.

Icd codes

The list – known as the international statistical classification of disease and related health problems or icd – is released by the world health organization (who). The icd lists codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases. The regulations regarding electronic transactions and code sets promulgated under hipaa to designate icd- as the medical code set standard for diseases, injuries, or other encounters for healthcare services. These codes are required to be complete, accurate, and detailed coding to calculate appropriate reimbursement rates, determine coverage, and establish medical necessity. The international classification of disease updated or changed in 2015 to icd 10 from the icd 9 codes required in 1979. There are 68,000 codes in icd 10 and there were 13000 codes in icd 9. Originally, the U.S. required medicine billing to use the icd 9 in 1979. Prior to that, medical insurance claims were sent by the patients to their insurance company with proof of their payment and the diagnosis list. The medical insurance reimbursed the patient after they paid the doctor at the time of service. With medical insurance monopolies, ppos, hmos and primarily employer provided medical insurance, the big billing and insurance profit began in Oklahoma in the 1990s. Because medical insurance companies continue to increase premiums, what patients pay, and keep reducing what they pay doctors. We are going to need to go back to the pay as you go plan. Especially with family doctors where we don’t do expensive procedures or major surgeries. Family doctors rarely get paid what they need by medical insurance companies. General medical doctors get poor insurance reimbursement. Look at what your insurance pays. To make money as a fp or pcp, volume is required seeing 30-40 patients a day. That works ok if it is a sore throat or uti, but not when patients come with multiple problems, and sometimes massive medications and extensive medical history. With complex patients or patients that have problems that aren’t quickly solvable, it takes time, research, extended energy, and hours of documenting for insurance to be billed. Dr Ruth Miller has chosen to spend her time and expertise to assist in bringing patients to health with accurate diagnosis and effective treatment. Just one more thought to consider. The reason patients see physician assistants and nurse practitioners instead of physicians is the limited insurance reimbursement and more patients than can be helped by a doctor, due to hmo insurances, and government paid patients that are escalating in volume. Your cardiologist, orthopedist, urologist, oncologist, gastroenterologist, neurologist, rheumatologist, dermatologist doctors want to be doing procedures that make more money, so they hire what are sometimes called ‘extenders’, ‘mid-levels and providers. Because insurances didn’t want to address who ‘provides’ medical services by a physician’s assistant, advanced registered nurse practitioner, or a doctor, they lump all into “providers”. Your doctor has a degree in medicine, not providing. Pas and nps are awesome. I have employed them and worked with them for other employers and have great respect for their knowledge and skills. In Oklahoma, they require physician oversight and supervision because they have less education than doctors. They can help doctors see more patients which is often needed. Dr Ruth Miller spends a considerable amount of time for patients with complicated medical problems. She is interested in all aspects of patient health. She is actively working with patients promoting better health.

What is a D.O.?

D.O. abbreviation is for: Doctor of Osteopathy. A D.O. or Doctor of Osteopathy, is a physician who is fully licensed in all states as a fully qualified Doctor of Medicine. The training at osteopathic medical schools is equal to that of m.d. doctors, except that D.O. physicians have additional training. One special training is “osteopathic manipulative medicine” which offers these doctors another method for helping patients. Omm helps patients benefit from relief of pain and other symptoms, by a hands-on technique to manually influence the muscles and their attachment to the bones. The reference to the bone, and relieving pain without the use of medication, is actually where the Osteo-path-ic name comes from. D.O. medical schools also promote certain philosophies including: Treat the root of the problem, not just the symptoms. Teach all doctors first to be qualified to be a general doctor working in a rural area, even if none of the subspecialties are available. Teach doctors to help the patient participate in their health so that the body can help heal itself. Historically, M. Ds and D.O.s practiced at different hospitals with great segregation. When dr miller started the medical practice of medicine in 1984, she and 2 other female d.o.s were invited to be on the hillcrest medical center staff. Their research showed women wanted more women doctors and our medical class had the highest number of females to date. Prior to that. D.O.s only practiced at the osteopathic hospital in tulsa. No m.d.s were invited to be on staff. Now that the prejudice and segregation is gone. We both practice equally. D.O. physicians represent all specialties, the same as m.d. physicians. Both allopathic (M.D.) and osteopathic (D.O.) doctors work together in groups and hospitals and make mutual referrals.