Home Forums Discussions Feedback and Recommendations What am I doing wrong?

So I am trying to get all the clicks in, including all the yellow and red lines in the DECISION SUPPORT section for charting. I have all passing grades in MU.....Problem is...it is taking me a long time to enter all this crap and charting has become the overall problem in my life. I am about ready to hire a scribe as I cannot give a patient 7 minutes of time, do 5 min of charting and see 35 patients a day...and stay sane..let alone see my family. I asked AC on 2 occasions why we cannot highlight sections in decision support and attest to all of them at one instance...I got a big fat I dunno..twice...I am in a quandry on how this AC thing is making my patients better when the doctor is about ready to call Staples his third home buying memory, etc....I like AC and have been using it for over 7 years....but with the 14-20+ percent medicare fee reduction I cannot see how this is going to be a good 2012..Current version is 6.010 ..thanks for listening.....todd

Dear Todd,

We all need a good rant from time to time. :-)

You could stop clicking all the Decision Support boxes. They're not required for MU at this point. That would save you some time.

I've come to the conclusion after 30 years as a family doc that I can't see as many patients in a day, do a good job, and stay sane. I've gradually had to cut my patients/day. One thing that helped a great deal was to pay more attention to coding. After taking the courses at E/M University online I realized that I was seriously undercoding. Now that we're coding properly it has compensated for the reduction in patient visits. The other issue is to be sure that your office staff is on top of the billing and not letting stuff fall through the cracks. Finally it's critical to keep a close watch on expenses.

There's a tendency to think we need to work harder and harder to maintain income. I think it's more important to work smarter.

If you are doing your documentation while with the patient, and it takes extra time to do whatever is currently required, can you not code the visit based on time spent?

I hate to say it, but you chose to do the MU. Don't take it the wrong way, but it does hinder patient care.

I don't think Tech Support will know a lot about MU. It is more clinical. Jon built it into the program, but that's it.

David, I think that is where the "automatic" I spent 60 minutes with the patient of which > 50% was spent on management and counseling. I think you can charge for a certain length visit if it is documenting patient stuff, but I don't see how you can charge for checking off boxes.

When I was younger, my patients were younger and they didn't have multiple, interlocking problems. It wasn't too hard to see 35 patients a day -- and all I had to do was write a line or two in the chart.

I have aged, along with my patients, who now move more slowly, think more slowly, have multiple problems, can't quite understand what I say because it is too complex, they don't remember, and don't hear very well.

Plus, all that has to be documented in some format that will support a "coding audit" -- or face jail time.

Plus, reimbursement per unit is down, and threatens to drop sharply.

Work smarter, not harder?
I'm getting older, too -- not smarter.

Thank you everyone. I appreciate it that others are in the same boat. Funny thing is..of all the people that have answered so far...I have been in each of your cities/towns. As for the coding ...you are absolutely correct. Expenses..I cannot understand why Seneca Medical wants to charge me 900 dollars for a file cabinet when I can get the same darn one at 400 bucks delivered (on-line). I use aftermarket printing cartridges and save a bundle. I just hope that President Obama had fun golfing today as I have not played in 2 years...Also, thanks for coming back Bert, have some blue shell craps on me and Tom get some good Dungeness..David...get some Copper River salmon...(I worked and grew up in Seattle). Here in Findlay you get all that stuff forozen and cannot make chowder out of that crap....todd

Blue Shell crabs sounds great, but it isn't going to cut down on your expenses.

you might try deleting/inactivating the decision support health maintenance items you don't really need or use. Admin/health maint.- hightlight one and "inactivate". This helped me alot. Also, you can go into the ones that you do use and change the settings- maybe you don't need it to pop up each year, but every 3rd year instead- or you can make your own.

Todd, don't worry about checking decision support all the time. I do it only 4 times per day, when I'm doing annual physicals. I limit those to 4 per day and that's the only time I go to decision support.

I attested to M.U. yesterday. you don't need all that stuff checked to pass. Selectively use the ones you want and your stress will be lessened greatly. My head almost exploded one day 4 months ago when I started the MU process. After one week of that crap I was on the brink of my first panic attack since medical school.

I took a step back, learned what MU guidelines were actually required v.s. nice to have. And gave myself smaller bites to take.

Adam, with the power vested in me as admin, I hereby make you the MU moderator.

I don't want to be MU-Moderator.
Make me the the "MU-Meister"

Only if you buy me a steak at the TRH and some of that Benjamin Franklin beer.

Considering we are meeting at TRH at 8pm tonight, it's a deal.
BTW, I'm freaking starrrrrrrving. let's go soon.
So as of tonight I'm the "UnOfficial ACUB MU-Meister?"
That's the UOACUBMUM for short.

No, you are the OACUBMUM. It's official. Just need to check with CMS.

Once I attest with CMS to being the MU-Meister and achieve final approval from Dr. Obama, may I be the OACUBMUM?

Some medical reviewer came into my office today and read a note where I discussed everything on the decision support and documented same....he was trying to tell me that I overcoded a level 3 to a level 4 (on the phone before he got here)...he left with his tail between his legs....said nice things about AC....I heard later that he was at another doc's office in town and nailed him for underdocumentation....I feel better.....Happy New Year......

Todd that is awesome

Fantastic!

Bring on the audits.

AC users have no fear!

I once charged a patient for their records. They were Medicaid and, thus, were not allowed to pay for anything. (a whole other story). Medicaid called me and said, "You can charge her, but we will be at your office within the week to do an audit of your records."

Needless to say, I sent the records.