1. Financial Aspect: Can you describe the financial aspect of the company in a little more detail such as:

Transcription

1 1. Financial Aspect: Can you describe the financial aspect of the company in a little more detail such as: a) There was a statement that one fee is charged based on cost of various areas: Can you tell me how the costs are categorized? (Example: 1. Billing fees 2. staffing fees 3. Fees per procedure test) Sympta rolls all our costs into the fees charges for each code enumerated in the contract. There are no other regular itemized charges to the practice, but there can be other expenses that do not fall into these services, but those are negotiated prior to being billed. b) How is this laid out to the physician? That Sympta is a white-glove service that does not charge any start-up fees and all other fees are listed in the contract specific to the services provided. c) You state in your presentation Net proceeds to the physician": Is it after the fee from Sympta is factored in? From the practice s point of view, yes. Sympta charges fees for the services we provide regardless of the doctors reimbursements and collection from the patient. However, as Sympta does provide billing services for our procedures, we give the practice a very good estimate of the expected reimbursement for each patient and the contract lays out our charges. d) Is there a financial outline I can see to understand that is not too revealing or specific? We can provide a sample of the financial responsibility form we provide for every patient referred for allergy testing as well as a sample invoice which will illuminate everything. 2. Important Roles and Legal Responsibilities of Sympta staff, physician office staff and physician in office: a) Who exactly is staffed by Sympta in Florida for 1. Initial allergy testing. 2. Follow up allergy results visit 3. Immunotherapy Treatment visits? Sympta provides staff for all testing and treatment in the practices offices the physician needs to sign the referral for testing or treatment, provide the appropriate diagnostic code and help with scheduling b) What is the Role of the physician in terms of requirements for each visit? Must be onsite during any testing/treatment for the entire time. Needs to refer patients to get tested.

2 c) When does the physician only need to sign and approve each visit note? Like other staff in the office, we work as an adjunct to the physician and provide the service under his supervision our staff is trained in the complete allergy platform (The Practice Parameters of the College of Asthma, Allergy & Immunology) and we provide the results and expertise the doctor would need for our services, supervised by our Board Certified Allergist. d) When does the physician need to do a physical exam and treatment plan? The physician does a physical exam when he deems it necessary for his patient there is no requirement that the physician needs to do a physical for a patient being tested or treated for allergy. The treatment plan for any immunotherapy candidate will be recommended by Sympta for the physician to evaluate. e) Is Sympta s Allergist legally necessary for every treatment plan? The order for treatment must still be signed off on by the practice physician, Sympta just makes the recommendation based on our training and knowledge of allergy. Our allergy personnel in the office is who you are contracting to do these services on behalf of your practice. In the overwhelming majority of cases the technician. As our Allergist has trained our PAs/RNs and almost all diagnoses are fairly routine, Sympta s allergist allows the technicians with the PA/RN to make most therapy recommendations. In the rare cases where the diagnosis or treatment might be more difficult to ascertain, the Allergist will always be consulted to review those cases. f) Who ultimately is legally responsible/liable for the medical care given by the Sympta staff? Is it the physician or the consult allergist MD or both? The primary responsibility still falls on the practice physician as they are supervising onsite and billing for the services that they technically are prescribing. However, as a contracted service, Sympta does have liability insurance for the services we perform in the doctor s office. Both parties will be ultimately responsible. g) What is the role and requirement of the consult Allergist? As our Medical Director he supervises all of our medical procedures and protocols keeping us up to date with industry standards and insurance requirements, providing expertise in any case where needed, and offers assurance to practices that we follow the strict guideline of the governing bodies of this specialty. h) As our Allergist has trained our PAs/RNs and almost all diagnoses are fairly routine, Sympta s allergist allows the technicians with the PA/RN to make most therapy recommendations. In the rare cases where the diagnosis or treatment might be more difficult to ascertain, the Allergist will always be consulted to review those cases. i) Does he provide just a recommended assessment and treatment and the physician has the ultimate say? Yes. The practice physician has the final say on any patient, but our model includes the expertise in allergy and are best suited to know what to do, the practice should follow our recommendation regularly.

3 j) On the same note, can the physician disagree with the assessment and treatment recommendation from Sympta allergist and make his own assessment and plan? He can, but this would be an anomaly we will not perform a treatment that our medical team does not recommend, but technically the practice can do what they want. k) If so, how is this relayed to the Sympta team and implemented? We expect to make recommendations to the practice and those to be evaluated by the physician and basically followed unless there is a good reason offered by that physician. In this case we would have our Board Certified Allergist talk with the practice physician to review and determine next steps. l) On the same note, who decides when and if IgE Rast testing can or should be done? Every patient undergoing our testing protocol has blood drawn and tested for allergies. It can be Immuno-Cap or Elisa as RAST is no longer used. m) Can you clarify from the meaning of the statement SYMPTA s medical malpractice insurance covers SYMPTA s employees and may name the physician as an additional insured? At the physicians request we can name them under our coverage as additionally insured under our malpractice insurance policy. 3. Structure of Typical Visits from Sympta Staff and Physician in office: a) What is the exact role of the doctor in terms of medical care (a. history and physical exam b. assessment c. treatment) at or in between: The Doctor always has the option to be present. b) Initial visit: Once the Physician refers the patient for allergy testing, he no longer needs to be at the initial allergy visit and there is no office visit being billed, only the allergy (asthma and immunology) services provided. c) Follow up test results visit: Again, the doctor does not have to attend and we do not expect any visit to be billed (unless the doctor provides the CMS minimum services required to bill a visit). Treatment visits Same as above we bill for the admin associated with treatment at each visit, but the actual immunotherapy (medicine) is billed upon mixing. d) Periodic follow up after immunotherapy has begun and completed? Again same as above.

4 e) How long is the immunotherapy program: one year, two, five? Is there follow-up testing to see if immune? The standard mixing is for one year of treatment, but treatment can take longer. f) I want to clarify that the immunotherapy program is only for environmental allergies and venom and not food? Yes at this time avoidance is the recommended treatment for ingestible allergens. 4. Safety: a) Do you guys make sure the doctor get an epinephrine pen, Benadryl and know CPR for anaphylaxis? If the office does not have these products which are required by our protocol, Sympta will provide them. We also provide documentation on how we and the doctor need to handle any adverse reactions b) Does the staff know how to use these and do CPR? Our staff is trained on how to deal with adverse allergy reaction, but the doctor of the practice that is required to be there for every test and treatment would need to supervise if not participate if needed. 5. Scheduling and Billing: a) Does the physician office get free access to the scheduling program and the software billing program? No. We provide scheduling access by an agreed upon system and that can include access to our system, but usually does not. We provide summary billing reports, but do not grant access to our billing software. b) If so, is it view only or can they change it? We control our software, but will listen to recommendations. c) Is the charting done through an electronic system by Sympta and if so what company? Sympta uses a Practice Management Software Tool, AdvancedMD. d) If so, is this printed as a paper chart for the office? We normally provide printed reports for the practice to upload into their software. e) Is the medical software used by Sympta and Sympta Allergist able to be incorporated into the EMR of the physician office electronically/digitally? Usually not.

5 6. My Role As A Sales Representative: a) I know my clear sales role up until the contract is signed by the physician. What is my active role in the implementation process? Getting the required material from the practice which includes the BAA, FAW, New Practice Form, Contract and patient face sheets for referred allergy candidates. During the implementation phase we may require additional information from the practice that would require your assistance since you have the direct relationships. Your availability to assist when needed is imperative. b) When do I need to go to the office with Sympta staff to train, etc? If you are referring the office that we are in the process of launching-you do not need to be there for any training however, the first steps of rolling out a new practice include an implementation visit which if present will teach you a lot about the implementation process related to what is discussed regarding expectations and the steps taken to get an account up and running seamlessly. If you are referring to Sympta HQ training all of your training is done via Lynx. c) What is my role after implementation in terms of follow up to make sure the physicians are happy, compliant and continuing to add patients to the program? Sympta provides daily and monthly productivity reports that track your practices referrals, evaluations, allergy tests performed, immunotherapy mixing and administration. Relaying company updates and information is imperative to the maintenance and management of your practice to support its success. It is the sales representative s responsibility to communicate directly with the account to maintain their relationship while ensuring the practice's satisfaction with the services provided throughout their partnership with Sympta. It is the sales representatives job to remain a conduit to their practice's to assure each location maintains tests are being performed and the accurate amount of patients are being referred by the practice for allergy testing. If for any reason these requirements are not being met, it is the representative s duty to work with the Sympta team and the practice to evaluate the situation and provide a solution.