A. Michael Marasco DPM. FACFAS, CHCQM
Medicine and Surgery of the Foot and Ankle
Frequently Asked Questions
What is an Electronic Medical Record?
An Electronic Health Record (EHR) is a computer version of patient chart which allows doctors to document and retrieve patient information electronically. EHR require an initial input of patient data that is detailed and specific so you may be asked to provide detailed information on your health history, medications (including dosage), allergies and pharmacy. In the beginning your office visit may take longer as our staff and physician input and coordinate the additional amount of information for your EHR. Staff and physician will enter information into the computer during your office visit. It will be important for you to bring all your prescriptions into the office to help us accurately enter all pertinent information.
What is E - Prescribing?
You may find that the Doctor will now complete your prescription electronically. E- prescribing (electronic prescribing) replaces handwritten prescriptions and gives physicians access to up-to-date information on medications you are currently taking. Not all prescriptions can be ordered electronically. You will need to check with your pharmacy regarding anticipated pick up times for prescriptions written electronically.
Does your office have telemedicine appointments?
In response to COVID-19 restrictions we will be offering telemedicine and e-consultation options for both established and new patients. If you are in need of a telehealth appointment contact our office at 219-769-3381 for more information if an in-person visit is not possible. We don't want patients who have health safety issues or by federal standards considered "non essential" to put off seeing a doctor and risk potential complications. Click here for information on telemedicine appointments.
How do I schedule an appointment?
We value your time and realize the importance of your appointment with the Doctor. We have initiated an appointment scheduling system that makes every effort to minimize your waiting time. We ask that you arrive promptly for your appointment as we make every effort to stay on schedule. However emergencies do arise and we appreciate your patience in such situations. After hours emergency care can be arranged by calling the office at 219-769-3381. Follow the prompted message to contact the Doctor. There is a 24 hour paging service.
Appointments can be scheduling by calling the office appointment desk at 219-769-3381 between the hours of 9:30 am and 4:00pm weekly. The office is closed on Wednesday. Appointments are available from 9:30am - 3:30pm M-T-TH. The office is closed on Wednesday. Hospital surgeries are scheduled on Friday. When scheduling your appointment you will be asked to provide the following information
if you are a new patient to the practice
if you prefer a morning or afternoon appointment
the reason for your visit with the Doctor
insurance and billing information
The answers to these questions will allow us to schedule the most appropriate appointment and help us to effectively and efficiently care for you.
As a courtesy to our staff and other patients who are waiting for appointments, if you need to reschedule or cancel your appointment, please notify the office 24 hours in advance.
What can I expect on my first visit?
As the foot is attached to the rest of the body the physician will begin with a history of any general medical problems you have had in the past or are currently experiencing. Systemic medical problems such as diabetes, peripheral vascular disease and various types of arthritis and metabolic disorders often affect the lower extremities including the foot and ankle. In addition, structural and muscular problems such as low back pain and shin splints involve the foot. A thorough past and present medical history including prescription and non-prescription medications is essential to a proper diagnosis as well as any surgeries or injuries you may have had.
After the initial interview, a physical examination is performed. The physician may listen or feel the pulses in your foot and ankle, test your reflexes and observe any changes in skin color, temperature or texture. Your gait and foot structure may need be assessed through a biomechanical examination; a specialized examination that includes measurements of the quality and range of motion.
Diagnostic x-rays and/or diagnostic musculoskeletal ultrasound may be indicated and laboratory tests and scans may be ordered to confirm the diagnosis.
How are Physician Fees determined?
Patient's often have questions as to why the amount charged by their physician may differ from a previous visit charge or why their neighbor was charged one fee and they get charged another. Charges for Providers (physicians or suppliers of a medical service) are based on several different factors. These include the following
whether you are a new patient (initial appointment or have not been seen by the Doctor within the last 3 years ) or whether you are an established patient
the Doctor is part of a managed care plan with a contracted network fee schedule
whether you area a Medicare patient (age 65 or over, disabled or have met government guidelines to qualify)
the level of care and type of professional service rendered
There are 5 levels of care for both new and established patients as recognized by the AMA, HCFA (Health Care Financing Administration of the Federal Government) and the Current Procedural Terminology Code Guidelines for health insurance reimbursement.
Each level of care (referred to as Evaluation and Management) for each patient encounter is assigned a code and a usual and customary fee which Providers may or may not decide to follow. If a Provider belongs to a managed care plan, he must accept the contracted fee; if the Provider's fee is higher the balance will be adjusted and a network credit issued. Adjustments happen frequently because many managed care plans do not furnish a fee schedule to Providers.
The levels of care (Evaluation and Management) are based on 3 components
1. The type and extent of the medical history
2. The type and extent of physical exam
3. The level of medical decision making
What does all this mean? It means that the problem you are seeing the Doctor for may vary and he may need to evaluate and manage your condition at various levels of care depending on what you are being seen for and how you are progressing.
How is my privacy and health information protected?
You can count on absolute confidentiality about your health care, whether you contact us in person, by phone or in writing. Your health care service and medical records at our office are kept strictly confidential. No information can be released without your written permission. You may designate both who receives any information and for what period of time. Maintaining absolute confidentiality can sometimes be a little inconvenient. Our office for example, cannot release test results without the doctor's permission. And grown children cannot access their parent's medical records unless the patient first signs a release authorizing a specified son or daughter to obtain information. Likewise, parents of children 18 or older cannot be given information about their children unless the patient gives us written permission to do so - even if Mom or Dad are still carrying the patient on their insurance policy.
We hope this assurance helps you know you can count on our office for confidentiality and that you understand that we can't share another patient's medical information with another party unless we first have written permission. Your health care service and medical records are strictly confidential. To ensure your confidentiality is always protected, our staff follows very specific guidelines for releasing medical records. There is a nominal fee for the copying of medical records and diagnostic x-rays as provided by the State of Indiana.
Use and Disclosure of PHI (Protected Health Information)
We may use PHI for our management, administration, data aggregation, and legal obligations to the extent such use of PHI is permitted or required and not prohibited by law. In the event that PHI must be disclosed to a subcontractor or agent, we will ensure that the subcontractor or agent agrees to abide by the same restrictions and conditions that apply to us with respect to PHI, including the implementation of reasonable and appropriate safeguards.
We may also use PHI to report violations of law to appropriate federal and state authorities.
We use appropriate safeguards to prevent the use or disclosure of PHI. We have implemented administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that we create, receive, maintain, or transmit on behalf of a Covered Entity. Such safeguards include:
• Maintaining appropriate clearance procedures and providing supervision to assure that our workforce follows appropriate security procedures;
• Providing appropriate training for our staff to assure that our staff complies with our security policies;
• Making use of appropriate encryption when transmitting PHI over the Internet;
• Utilizing appropriate storage, backup, disposal and reuse procedures to protect PHI;
• Utilizing appropriate authentication and access controls to safeguard PHI;
• Utilizing appropriate security incident procedures and providing training to our staff sufficient to detect and analyze security incidents
• Maintaining a current contingency plan and emergency access plan in case of an emergency to assure that the PHI we hold on behalf of a Covered Entity is available when needed.
Mitigation of Harm
In the event of a use or disclosure of PHI that is in violation of the requirements of the BA (Business Associates) agreement, we will mitigate, to the extent practicable, any harmful effect resulting from the violation. Such mitigation will include:
• Reporting any use or disclosure of PHI not provided for by the BA Agreement and any security incident of which we become aware to the Covered Entity; and
• Documenting such disclosures of PHI and information related to such disclosures as would be required for Covered Entity to respond to a request for an accounting of disclosure of PHI in accordance with HIPAA.