Sample Intake Form

Physician Moonlighting Opportunities

CLICK HERE for White Label Information - OUR Telehealth Platform, integrated into YOUR groups website/EMR, using YOUR logo!

"I would like to welcome you to the future of clinical Orthopedic medicine, and personally thank you for exploring MoonlightOrtho as a viable option to deliver high quality Orthopedic patient care, while also collecting a handsome ancillary income!

MoonlightOrtho was originally developed as a convenience service to my high-end patients, those demanding a concierge-style service. However, when I saw the broader need within the field of Orthopedics I stepped out of my comfort zone of medicine and guided the development and build of MoonlightOrtho, the first and only stand-alone Orthopedic Telemedicine practice.

The site was built with the average geriatric patient and surgeon in mind, neither of which like ‘clicking a lot of buttons on the computer!’ Our main goal at MoonlightOrtho was to develop a user-friendly, all-inclusive Orthopedic telemedicine ‘hub,’ capable of bringing patients interested in telemedicine services together with forward thinking Orthopedic providers, via a cutting-edge and patent-pending form of ‘Asynchronous Video Telecommunication,’ all within an easy navigable, HL7 certified and HIPPA compliant website.

Telemedicine is the fastest growing component within the healthcare sector, as the brick and mortar model of medicine is slowly becoming obsolete. As patients are demanding easier access to healthcare choices, telemedicine, even subspecialty care, will become mainstream. Over 75 % of patients prioritize access to care over the need for in-person interaction with their provider.

With MoonlightOrtho, providers can offer the convenience of clinical Orthopedic care to patients in any area of any state which they are licensed. Whether you are fresh out of training, or years into a private practice and looking to wind down, MoonlightOrtho can easily be integrated into your existing practice, or utilized as a stand-alone service; thus functioning as a procedure generator for local patients, or purely as an ancillary income service.

So, when you're ready to hang up the white coat and practice Orthopedics on YOUR terms, without the administrative and insurance hassles, or governmental red tape policies, please fill out the form above and I'll reach out to you personally with additional details and a transparent, graduated reimbursement schedule, offering the lowest overhead in the industry; overhead which actually DECREASES with production…what a novel idea!

Thank you again for your interest and your open mindedness, I think you will find MoonlightOrtho a much better way to Moonlight!"

David E Eisenhauer, DO
Board Certified Orthopedic Surgery, CAQ-H
Dual Fellowship trained, Shoulder/Elbow & Hand

Private Contractor Opportunity

Please click HERE for a sample mock-up of the white label version of MoonlightOrtho. Keep in mind that most fields, and all wording and pictures, are customizable

Private Contractor Opportunity

FAQs for MoonlightOrtho Providers

We will be offering “Entity” malpractice coverage for MoonlightOrtho providers. This will be telemedicine coverage ONLY, and will cover providers in ANY state that they are licensed and wish to practice as a MoonlightOrtho provider.

Office based providers will then use their existing malpractice coverage for any patients that need on-going office-based care. For those providers who do not anticipate seeing patients in a clinic or surgical setting, the entity coverage should suffice for malpractice coverage. Additionally, this policy will include tail coverage, as long as MoonlightOrtho, LLC is in existence.

Yes! Providers can earn an extra $6,892/month, seeing less than 2 patients per day with MoonlightOrtho, when seeing only the minimum number of patients to qualify for the 15% overhead bracket. That’s $82,711 per year, based on seeing New Patients at $159/visit. Your income could be even more doing Second Opinions at $279 per visit or Concierge Visits at $299 per visit, and/or if you are doing a higher volume.

 We keep a small portion of your collections for web maintenance, advertising, and business/bookkeeping services. MoonlightOrtho offers the lowest “Overhead” in the industry, which decreases with volume based on a graduated scale, just the opposite of a traditional private practice overhead structure…what a novel concept!

MoonlightOrtho can help you or your practice in three ways:

1.) This can be a marketing tool, as we are a unique and cutting edge medical technology which can set you and your practice apart from the competition

2.) This can act as a procedure generator or surgical case generator for patients in your immediate catchment area, which you may not have otherwise seen.

3.) This can be a pure ancillary income, either personally or for your practice as a whole

Yes. In fact, we encourage that. MoonlightOrtho patients are YOUR patients.

With a New Patient visit there will be 3 interactions in total:

(1) First the patient will upload their pertinent information, including video.

(2) Next the provider will review and respond to the patient with an Assessment and Recommendation(s), along with a return video.

(3) Finally the patient may have an opportunity to answer any questions or respond to the provider’s recommendations.

Patients may have two options, first of all if the provider wants to give their personal contact information (email or phone number) they are welcome to do that for any difficult situations or patient. Second, the patient can register for a Return Visit via MoonlightOrtho, or in the provider’s office, for any in-depth followp care.

This is a tricky question and perhaps a grey area. We have placed a Disclaimer disallowing patients with the Medi insurances, as the telehealth laws have recently changed for the government payors. Our stance may change in the very near future, but for now, those patients will be directed away from MoonlightOrtho.

No. That’s the beauty of MoonlightOrtho, we have a patent-pending Asynchronous Video Telecommunication process, which allows the patient to upload a short video at their convenience, then the provider can review the video and upload a return video at their convenience.

Patients can search by provider name, or by condition and state; this option will give a dropdown list of all providers in the patient’s state.

Absolutely, just like you would any other patient. There is a prescription writing task bar within the Provider Dashboard that allows you to print off a generic Rx sheet, Lab or Imaging Orders, Physical/Occupational Therapy Orders or a Work/School note. You will then just fill out the patient’s information and upload a PDF to MoonlightOrtho, which can be emailed or faxed to the patient, or directly to the facility (pharmacy, lab, PT, etc.). A provider can do the same with their own prescription pad or any set of pre-made ordering forms that they have. (MoonlightOrtho recommends not prescribing narcotics to your telemedicine patients.) Eventually we will be tied in with a telehealth prescription company such as eRx. Please check your individual state at http://www.cchpca.org/ for any prescribing restrictions.

MoonlightOrtho leaves this up to the individual provider; if you want to do the footwork, or task it to someone in your office, then we encourage you to do so. With a proper patient Intake Form/History and Physical it should not be an issue. There is, however, a Disclaimer to patients stating that “Even if an MRI is ordered, it may not be authorized by your insurance without a physical exam”.

We anticipate that most patients utilizing MoonlightOrtho will seek out cash- pay MRI facilities, just as they found you…they just needed a provider to order the study. Our sister company FastXray.com is currently partnering with a very large network of Imaging Centers around the country that are able to offer MoonlightOrtho patients a cash-pay MRI option for under $500 and X-rays for $69. Other imaging modalities will be coming soon.

 A video teleconference obviously can never replace a physical exam, however MoonlightOrtho can fill a void in healthcare, that is, this service may be well suited for the busy patient who just wants to be “triaged” and offered some early treatment options or imaging modalities, thus either resolving their minor problem, or giving a more complete picture if/when they do need to come in to your clinic for an in-person visit. The MoonlightOrtho patient may have done some of their own research and they just need a clinician to help confirm the diagnosis. We as providers have all been doing this for years, via telephone, Skype or Facetime, treating family, friends or even friends of friends based upon our years of experience and seeing frequent patterns with common pathologies. Now you have an avenue to get paid for it!

 Once the patient has registered and uploaded their information the MoonlightOrtho provider gets a “ding” in their Dashboard, as well as an email reminder. The patient will expect a response within 24 – 36 hours. We recommend setting up a separate email acct to handle your MoonlightOrtho patients, so that they don’t “get lost in a sea of e-mails”. This is also an easy way to communicate with your patient, while keeping your primary email blinded to your patients, if/when you need to have continued communication with the patient, or send a prescription or order.

 Yes, a “Decline” function/button is located within your provider dashboard and should be used at your professional discretion. The money will be refunded to the patient and they will be told to “Please search another provider.”

 We want to give our MoonlightOrtho patients the ability to do their due diligence, as some patients might be weary of ‘Seeing an online doctor.’ When you upload your CV, please do not list any sensitive, personal or private information, so this can be more of a “Bio”. Please do, however, list your office address and contact information, so that patients may seek follow up care in person if they desire.

 Yes. This can be done a couple of different ways:

1.) We can license you the software platform and MoonlightOrtho then becomes yours to run any way you like (you may change the pricing, include post-op visits, etc.)

2.) You may have a link added to your practice website, directing patients to MoonlightOrtho, thereby giving your current and future patients an after- hours, concierge-style, online Orthopedic ‘Urgent Care’ option. The profits of MoonlightOrtho may then be shared among your group as group ancillary, or go directly to whomever does the consult.

3.) You may individually utilize MoonlightOrtho to “fill the gaps” in your schedule; for example, if you have a No-Show patient, or when you are sitting in the OR lounge during turnover; at which point MoonlightOrtho can function as another personal source of income.

 Yes. Within your provider Dashboard there is an option to temporarily “Disable” yourself as a provider within the system.

No. Medicine is considered practiced in the state which the patient resides. So, a provider must be licensed in that state. As a provider you can be anywhere that you have access to a computer however.

 Yes. As long as your license is unrestricted and up to date.

Telemedicine laws currently vary by state, please check on your individual state at http://www.cchpca.org/. In general, however, most laws apply to insurance reimbursement requirements; this is not an issue with MoonlightOrtho, as we are a cash pay, fee-for-service provider.

There is no minimum or maximum, and no charge if you go below a certain volume. However, the more patients you see, the lower your “Overhead” rate will be. The maximum “Overhead” will never go above 35%, which is still way below the national average for an Orthopedic private practice.

 No, not in the traditional sense. We do not require you to ‘click a lot of buttons’, as there is no coding or billing within MoonlightOrtho. However, your patient’s records, and any communication, including prescriptions, are safely stored in our HL 7 certified and HIPPA compliant server indefinitely, just as they would be in any other EMR. The records are available anytime to patients or providers via a secure portal. Furthermore, patients and providers can print a PDF of the patient Intake Form (essentially an H&P) for additional paper records, or to hand carry to an office visit.

Yes (possibly). We will be adding a new payment category, based on recent feedback, for a concierge Post-Operative Visit. Although in the global period, some patients may be willing to pay for the convenience of not having to come into the office for the 6 week wound check and routine visit, etc. Permission HAS to be given to patients, by their surgeon, at their initial post-op office visit, for patients to register for a Post-Operative Visit on MoonlightOrtho. It will be up to the surgeon to either charge for the post-op visit, or include it in the global period; either way this will open up more space on your clinic schedule for better paying patients. (We are checking with the attorneys for the legalities of this)

 Based on recent feedback, we will be adding this category, which will be a phone call-only consult. This will be geared toward your higher-end patients who may be interested in talking to an Orthopedist regarding various treatment modalities; including: Orthobiologics and regenerative medicine (such as stem cell injections), cutting edge or new procedures, etc. Or, the patients may just have multiple questions about an upcoming surgery or a current bone or joint diagnosis, such as Rheumatoid Arthritis. The Phone Consult can cover the gamut, and for your time we will charge patients $189 for a 25-minute phone call.

 Yes, for providers and patients alike. For US based physicians, providing medical care to patients living abroad is up to the individual provider.

An option for an internationally licensed provider who wants to utilize MoonlightOrtho for patients in his or her country, is to enter into a licensing agreement with us. We would even be able to get the site translated into any language that you needed.

Yes. See above, there are situations where this would be an option.

Our team of attorneys has done a very good job of spelling out which patients should NOT utilize the services of a MoonlightOrtho provider, by requiring patients to physically check a box AND click on “I Agree” to a Disclaimer page, a User Agreement and Patient Consent Form, and a Notice of Privacy Practices page before proceeding with registration. Hopefully patients will only self-refer if appropriate, however, we know that may not always be the case. If a patient ‘slips through the cracks’, as the provider, you may respectfully decline to see the patient, with a built-in “Decline” function, and the patient will be told to “Please search another provider”, at which point we will refund the patients money.

 Ideally no, as most of these patients will be screened out by the Disclaimer page; however, “cold trauma” may be seen at the provider’s discretion (distal radius fractures, metatarsal fractures, etc.)

Monthly, by check for now. Direct deposit is coming in the near future.

Yes, please do! Most of our providers have a full-time practice or are locums physicians. MoonlightOrtho does not want to restrict you or your practice in any way.

Via the screening questions on the provider registration, as well as a background check and screening via the malpractice application. If there are any issues before or during your time working with MoonlightOrtho, we reserve the right to “Disable” you as a provider in our system.

No (sorry). We believe it takes a couple of years out on your own before you are comfortable with making a diagnosis in a setting such as MoonlightOrtho.

Moonlight Ortho Disclaimer

MoonlightOrtho is an online, telemedicine technology platform offering concierge-style orthopedic medical services only. WE DO NOT OFFER EMERGENCY MEDICAL SERVICES. YOU SHOULD NOT UTILIZE THE SERVICES OF A MOONLIGHTORTHO PROVIDER IF YOU HAVE ANY OF THE FOLLOWING:

  1. (1)

    an open wound more than a superficial scrape, with or without exposed deep tissue or bone, or a deformity of a joint or extremity at the area of pain or concern;

  2. (2)

    a red/hot joint or extremity with or without swelling;

  3. (3)

    acute onset of numbness or tingling at the area of pain or concern;

  4. (4)

    significant pain or excessive swelling of a joint or extremity;

  5. (5)

    if you sustained a fall from a height above ground level or were involved in a motor vehicle accident or other high-speed injury;

  6. (6)

    if you sustained a penetrating type trauma, such as a stab or gunshot wound;

  7. (7)

    if you have ANY additional injuries, such as abdominal or head pain or trauma;

  8. (8)

    if you are running a fever, have chills, nausea, vomiting, diarrhea or other signs or symptoms of infection or a generalized illness;

  9. (9)

    if you have experienced night sweats or unintentional weight loss;

  10. (10)

    if you have any other significant medical issues or conditions that may complicate your orthopedic problem(s); such as a history of cancer, uncontrolled diabetes, uncontrolled rheumatologic disease or inflammatory arthritis, or any history of chronic infections;

  11. (11)

    if a reasonable person would otherwise seek in-person medical care with their Orthopedic Surgeon, Primary Care Physician, or their local Emergency Department

If you have any of the conditions described above you should go directly to an Emergency Room, Urgent Care center or your local Primary Care Physician or Orthopedic Surgeon, as appropriate. If you are not able to get to one of the facilities listed above, you should call 911 from your home or mobile phone.

  1. Additionally, at this time we are not able to see patients with Medicare or Medicaid due to governmental restrictions of fee-for-service telemedicine practices

MoonlightOrtho users are evaluated solely via telemedicine, and no in-person examination is performed. Thus, some orthopedic conditions and pathology may be difficult or impossible to sufficiently diagnose or treat. All assessments and recommendations, including but not limited to studies, such as lab and imaging, as well as any prescriptions, are ordered remotely based on each individual patient’s response to a medical questionnaire and asynchronous video telecommunication. For difficult or unusual orthopedic problems, a thorough physical exam, by a qualified orthopedic surgeon, may be needed.

Certain soft tissue pathology such as sprains, strains, tears, contusions or injury to nerves, arteries, veins, or tendons, as well as limb threatening compartment syndrome (severe swelling of an extremity that may lead to amputation of the limb) may not be easily diagnosed via a telemedicine process alone, and an in-person office or Emergency Department visit, with a healthcare provider, is recommended. Additionally, occult fractures, certain bone tumors, and other bony pathology may not be easily diagnosed via a telemedicine encounter and an in-person office visit or emergency department visit with a healthcare provider is recommended. This may be especially true for certain pediatric fractures where there may be a fracture through the physis (growth plate) which is not visible on X-ray alone.

For all imaging studies interpreted as "negative", when patients experience pain, MoonlightOrtho recommends an in-person follow up visit with your healthcare provider to rule out occult fracture or other bony or soft tissue abnormality that may have been “missed” by the imaging modality, or under read by the radiologist. For all lab studies interrupted as “normal”, when patients are symptomatic, MoonlightOrtho recommends an in-person follow up visit with your healthcare provider to rule out pathologic conditions not detected by the lab, for various reasons, not limited to lab error.

It is the responsibility of the patient to arrange for follow-up care after an imaging or lab study is preformed, as our providers may not routinely have access to the results and may not be able to call patients with normal or abnormal findings. Follow-up may be with the provider of your choice, including your MoonlightOrtho provider, your local Orthopedic Surgeon, or your Primary Care Physician.

If medications are prescribed by a MoonlightOrtho provider it is the patient’s responsibility to take the medications responsibly and as prescribed. If you have an adverse reaction to medication prescribed by MoonlightOrtho provider, Moonlight Ortho recommends that you go immediately to your local Emergency Department for an in-person evaluation and treatment with a healthcare provider. Please understand that prescribing restrictions vary by state, and in some states a prescription my not be possible via telemedicine.

This short list of potential problems that could arise, or pathologic conditions that could go undiagnosed or improperly treated, when utilizing the services of a MoonlightOrtho telemedicine provider, is meant to serve as a WARNING to patients to use our services responsibly, it is by NO MEANS an all-encompassing list.

Please do your due diligence when choosing a MoonlightOrtho provider. Most of our providers are board-certified Orthopedic Surgeons in a private or group practice within the state they are seeing MoonlightOrtho patients. However, some surgeons may be locums or military and be licensed in the state that they are seeing MoonlightOrtho patients, yet not have a physical address or clinic in that state. If in-person follow-up care is anticipated after the New Patient MoonlightOrtho visit, please research your provider’s physical location by reviewing their Curriculum Vitae. Additionally, some of the MoonlightOrtho Sports Medicine physicians may be Internal Medicine, Emergency Medicine, Primary Care or PM&R Sports Fellowship trained, and as such, can not provide surgical services. Podiatry services are offered by our MoonlightOrtho providers with a Doctorate of Podiatric Medicine (DPM).

Be aware that your MoonlightOrtho provider has the right to “Decline” any visit with any patient, solely at the MoonlightOrtho provider’s discretion. In this instance a full refund will be made to the patient and the patient may seek care with another MoonlightOrtho provider in their area, or choose to be seen by their local provider of choice in an office-based setting. Please understand that this is typically because the MoonlightOrtho provider feels that the patient may be a poor candidate for telemedicine services, and that the patient may be better suited for an in-office visit.

This is only ONE of FIVE legal documents that patients will encounter on the MoonlightOrtho website during their registration process; these are meant as protection for patients and providers alike. Along with this document, the others require a physical “checkbox” and “I Agee” click button to proceed, which equals a signature for medical/legal purposes. If you would like a copyrighted version of ALL medical/legal documents prepared by the MoonlightOrtho attorney team, please e-mail: de@moonlightortho.com or call 1-833-FASTXRAY.

Sample Intake Form

Provider Registration

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