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Seriously. What’s the point of having appointment times if patients feel entitled to show up “a few or 5 minutes late”?! And before the “doctors are late” replies, we are late because patients show up late. Believe it or not we are pretty damn good at time management. This isn’t the Olive Garden. Show up early especially if new or at the very least on fucking time. “But I waited all this time and your next appt isn’t for 3 weeks”! That sounds like a you problem. Use this time to buy a watch and gps. /rant

Title. After 5 years I'm now getting random rejections from the coders stating "medicaid pay for only one professional service per day". So you can't bill 99396 (annual) + 99214 (acute) despite proper documentation?! (annual + diabetics for example, easy 99214).

Can someone confirm with any proof? I have asked 5 different "admins" and nobody will respond. This is a practice changing if so...cries in so much free work

I'm outpatient internal medicine, no hospital call. we have about 20 physicians/aprns so call is rare but past few years on call has become a concierge service for a few physicians who have let their patients abuse it, or these are physicians who simple fail to keep up with refills/notes etc.

99% of the pages are not emergencies and all of them should be seen in urgent cares.

1. any legal risk to "not taking call"? ie im taking call but the only people that can page me are physicians/healthcare/pharmacy. Patients have to send a mychart message or wait for business hours or go to ER/urgent care.

2. any downside to switching from a large call group- I'm rarely on call, maybe 1-2 times a

I've been seeing a lot of requests to stat clear patients, were talking same week or 24 hours for things like retinal detachments, muscle tears, and other ortho problems- trimalleolar fracture with nonunion and severe pain was my turning point- never seen a man cry from so much pain and still be told "no opiates" by surgical schedulers.

I was always taught if the procedure is needed that urgently then no amount of pre-op is going to change the outcome, thus you need to do the surgery.

This feels like a dump on the PCP both legally and paperwork wise- most likely because it's a CRNA doing the anesthesia.

So meddit, whats your take on "stat" pre-ops *(aside from them being easy visits in

Hands down night and day with the cut and suction power with their high lift blades. Whatever Toro sells as high lift is not remotely high lift compared to these. 100% recommend especially for those with thick lawns. If you’re looking for new blades check them out.

With that being said, how sharp do y’all keep your blades if you have clean yards/99% grass ? Razor sharp or butter? In between?

I've been seeing a lot of requests for "clearance" for things like routine colonoscopy - no joke AP said must get the heart scan I ordered for screening before patient could be scheduled...MRI with sedation, cataracts, dental, all of which are MAC sedation. Yes it's easy money but it's also a waste of everyone's time. Is it just our systems culture or a new "trend"?

For those “oh yea and there’s also…” moments. I typically bill annual plus 99213 if I’m refilling or looking at a lot of meds but I don’t document much if they’re stable. With that being said, documenting those additional few points is super easy and I wonder if most of my visits could be annuals plus 99214.

What would my note have to consist of to ensure I don’t get audited for an annual+ 99214 if you assume I refill all medsand adjust one, order/review labs in addition preventive stuff orders. Meaning would I need to write an hpi equivalent to level 4 plus do the a/p as a level 4 and basically “insert” it into the appropriate spots on the annual exam “note”?

My annuals are straight fo

Not necessarily in terms of how often, but do you treat via call? do you convert to video? do you have a triage service (if so who?). Do you field your own patients or as part of a group? Ways to reduce demands and pages from patients? Legal risks?

Thanks!

Does everyone have their pay tied to unattainable metrics? Seems ridiculous to get dinged for someone not getting colonoscopy or eye doc when barely any are available. On top of that treating diabetes by guidelines basically means you have to use non generics thus, dinged again. List goes on.

I’ve only ever worked private practice in the same clinic until our buy out and we did not have this. Now things are changing and not for the better. If this is everywhere….how the hell can I game the system with these pointless metrics?( while obviously still doing right by the patient)

Any thoughts on what this is? Doesnt seem to be hurting the grass but i just noticed it. has been humid. i assume fungus, but not all fungus is bad fungus? grass is in good condition overall.

picked up the landzie to topdress and my local supply has 50 topsoil/25 fine sand/25 compost and its been prescreened and is dry. When I use the landzie I notice most of it comes out in the first few feet. Could this be because the material is too small? I had much better luck just chucking it on the lawn. Any ideas for alternatives or is the landzie meant more for store bought bags/screen the crap? Echo spreader sort of worked but the rotating fins are not longer enough. I can hopefully have an endless supply of this type of mulch so I definitely plan to do a lot more of this so any sort of proper spready would save my back! Thanks

Pharmacists and other docs, given the new guidelines are to give ICS + SABA rescue to all asthmatics how do you get these ICS+ meds covered without sending all of them? Most of the midwest is on some sort of ICS/LABA and it's near impossible to find which one is covered. HFA vs diskus vs powder vs generic vs not generic vs purple vs red top etc.

What's the best way to communicate "give them a low/medium/high dose ICS/LABA And i don't give a hoot which one you give as long as it's cheap and covered by insurance". We use epic btw.

Also, albuterol--proair vs ventolin vs generic...epic has one order....

Anyone have any institutional protocols for medications in epic? It surprises me that medications aren't defaulted to their standard dosing per lexicomp/FDA but instead are completely open. Does epic have standardized medication orders? is there any way to search for a medication by class, such as GLP or ACE, so that I can see all the meds that are potentially covered instead of having to search for each one? I can create favorites but that doesn't solve the underlying issue, especially when our triage has to refill meds using a "new order". It also reduces the "insurance won't pay for that" messages (fuck you inhalers!)

Example: If I type "angiotensin receptor blocker" or ARB into the ord

I send chronic meds for 90 days + 3 refills yet each day there's 5-10 automated requests for medications I recently sent. On top of that, most patients then say they don't have any refills on file.

Anyone have any tips on how to reduce the automated requests in epic or ways to ensure the 1 year supply is fulfilled provided the patient requests from pharmacy and they have refills on file (up to 1 year IMO).

Anyone have this combo? I can't get the dampers to open/close with two of these installed. there's air blowing on both floors and both dampers remain open. the dampers do work as I tested it using the panel. Thanks for any advice.