Forms & Policies
Forms & Patient Information
New Patients
Prior to the first visit, new patients will need to fill out the following forms. You may print the following forms, fill them out, and bring them with you to save time at the office.
Current Patients
Prior to each visit, all current patients should ensure their information is up to date via the Patient Portal.
Scheduled for either Virtual Physical or in-person Physical? Dr. Fuisz and Dr. Mills patients electronic form
Prefer writing things out? Dr. Fuisz current patients printable pdf
Other Forms
Medical Records Request (from another doctor’s office)
Medical Records Release (to another doctor’s office)
Policies
The following policies cover some basic matters that we feel are important to review. We ask that our patients be aware of these policies and keep them in mind. From time to time, we update and change policies and procedures but try to be consistent so that our patients have a clear understanding of how we operate.
Office Hours
The office is open by appointment only (Spring 2020) from 8:30 a.m. to 5:00 p.m. Phones are answered from 9:00 a.m. to 12:00 p.m. and from 1:00 p.m. to 4:00 p.m.
A doctor is on call for emergencies after hours. You can reach the doctor on call by dialing (202) 728-9630
Appointment Cancellation / No-Shows
Please be courteous. When you do not come to scheduled appointments or cancel at the last minute, the office is usually unable to accommodate another patient who may want to be seen in your time slot. Please call us at least 24 hours prior to a visit if you are unable to come. At your doctor’s discretion, the following fees may apply: failure to cancel an office visit $50; failure to cancel a physical $100. Your doctor reserves the right to dismiss you as a patient for repeated failure to keep your scheduled appointments.
Financial Responsibility
Patients are financially responsible for all charges for services received. Payment is collected at the time of the visit. If the doctor you see participates with your health plan, you are still responsible for designated co-payments at each visit and deductible when applicable. Washington Internists Group L.L.C. (WIG) will directly bill insurance carriers with whom we have contracts. If your insurance denies payment and advises you that the bill is your responsibility, payment is due immediately. You need to submit payment for any balance due within 30 days. If you do not pay bills in a timely manner, the account may be sent to a collection agency, and you may be discharged from the practice. You must agree to reimburse WIG for any expenses, including attorney and collection fees incurred in connection with the collection of sums due for services rendered. You authorize WIG to submit claims for benefits without obtaining your signature on each and every claim to be submitted. You authorize the release of authorization and release of your medical information necessary to process claims. You permit a copy of this authorization to be used in place of the original.
Keep your contact information and insurance information up to date.
It is your responsibility to provide WIG with your current insurance card at the time of your visit. If you provide incorrect or expired insurance information, you will assume full financial responsibility for all charges incurred.
Billing Inquiries
We submit medical claims to our patients’ insurance companies as a courtesy. We want to help our patients take advantage of their benefits; here are a few guidelines:
Please be aware that EOBs (Explanations Of Benefits) are often received 3 to 4 weeks before the checks are actually mailed--despite the EOB stating that the check was mailed. We do NOT accept checks from insurance companies. If they send them to us, we return the check to the company to send to the patient.
If you have questions or concerns, please email our practice manager Shaquana Roy at
practicemanager@washingtoninternistsgroup.com
Please provide as much information as possible, such as:
The date of service,
Copies of any EOBs as email attachments ,
The date you spoke to the insurance company,
The name and phone number of the person you spoke with at the insurance company,
The issue involved (invalid codes or uncovered services).
We will do our best to help resolve the issues. Our practice manager “batches” these requests and works on them weekly. You will hear back from us as soon as we know anything.