Fam Pract Manag. 2008 May;15(5):41.

Strengthen your patient relationships

I often begin or end new patient visits with the question “How do you want me to remember you?” Usually, patients reply with some personal detail, such as “I am a World War II veteran.” Sometimes patients have to think about it and let me know at their next visit. Not only does this tactic help me remember my patients, but it also demonstrates curiosity and a personal touch that is often missing in the medical environment.

Use screen savers to convey information to patients

I create customized screen savers for our exam room computers that feature information for patients to read while they're waiting. We use Screensaver Wonder 4 (available at, which is easy for a computer novice to use and, at a cost of about $20, relatively inexpensive.

Nearly every time I enter the exam room, I see the patient reading the screen saver. Topics have included our breadth of services, vaccines and information about disease processes. Patients tell us they appreciate the information and find reading it to be a good use of their time while they're waiting. The screen savers have also decreased the number of paper signs that collect on office walls. More important, they have helped us stay on top of health maintenance tasks. I don't have to work as hard to convince patients of the value of a particular service (e.g., colonoscopy) because the screen saver educates them. Purchasing this tool is the best $20 my practice has ever spent.

Understanding private, fee-for-service Medicare plans


A patient recently presented to our office with a Medicare health plan we had not seen before. It was neither traditional Medicare nor a Medicare HMO. When we explored it further, we discovered it was a private, fee-for-service plan, but we're not sure what that means or what the implications are for our practice. Can you help alleviate our confusion?


Your patient's private, fee-for-service (PFFS) plan is a type of Medicare Advantage health benefit plan offered by a state-licensed risk-bearing entity (i.e., an insurance company) that has a yearly contract with the Centers for Medicare & Medicaid Services (CMS) to provide beneficiaries with all their Medicare benefits plus any additional benefits the company decides to provide.

One major difference between a PFFS plan and other Medicare Advantage plans (e.g., Medicare HMOs) is that, in most cases, beneficiaries who join a PFFS plan are not required to use a particular network of physicians. Beneficiaries can see any physician who is eligible to receive payment from Medicare and agrees to accept the PFFS plan's standard payments.

A physician must follow a PFFS plan's terms and conditions of participation if the physician knows prior to furnishing services to a patient that the patient is enrolled in a PFFS plan and the physician either possesses or has access to the plan's terms and conditions of participation. A PFFS plan is required to make its terms and conditions of participation “reasonably available” to physicians in the United States.

In most instances, if a Medicare beneficiary presents his or her PFFS plan enrollment card (which will typically specify a phone number or Web address where you can obtain the PFFS plan's terms and conditions of participation) in advance of the service and you proceed to provide the service, you will be considered a “deemed” physician. This means you will be subject to the plan's terms and conditions, including its fee schedule and beneficiary cost-sharing limitations.

It is important to note that you are not required to furnish health care services to enrollees of a PFFS plan. However, when you choose to and the deeming conditions have been met, you are automatically a deemed physician for that enrollee and must follow the PFFS plan's rules. Note that the physician can make the decision to be “deemed” for individual patients on a case-by-case, per-visit basis, so you can be deemed for one patient but not another, and you can be deemed for a patient at one visit but not at his or her next visit.

To be paid by a PFFS plan, you must file your claim according to the plan's terms and conditions of participation. The Medicare carrier to which you submit traditional Medicare claims will not accept claims for enrollees in a PFFS plan.

For more information on Medicare PFFS plans, visit the CMS Web site at


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


Copyright © 2008 by the American Academy of Family Physicians.
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